reglab/statecodes huggingface dataset:
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 27 - Redetermination of Eligibility

Section 27. If an individual has become eligible under this chapter, eligibility shall be reconsidered or redetermined:
(a) When required on the basis of information the division has obtained previously about anticipated changes in the individual's situation.
(b) Promptly within thirty days, after a report is obtained from any source which indicates that changes in the individual's circumstances may affect the amount of assistance to which he or she is entitled or may make him or her ineligible.
(c) Periodically in accordance with federal law.
(d) If any recipient shall by gift, inheritance, or other manner acquire additional assets during any twelve month interval following determination of his or her eligibility, the recipient shall, to the extent required by federal law, immediately report such acquisition to the division which shall immediately make a reevaluation of such recipient's eligibility.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 28 - Disposal of Resources at Less Than Fair Market Value; Period of Ineligibility

Section 28. In determining the eligibility of an institutionalized individual, as defined by Title XIX, the division shall impose a period of ineligibility, consistent with said Title XIX, against any such individual if said individual or his spouse disposes of resources for less than fair market value. In determining the eligibility of a non-institutionalized individual, as defined in said Title XIX, the division may impose a period of ineligibility as permitted by said Title XIX.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 29 - Transfer of Interest in Real Property; Notice

Section 29. Whenever an individual who is receiving medical assistance under this chapter transfers an interest in real or personal property, such individual shall notify the division. Such notice shall include, at a minimum, the individual's name, social security number or, if different, medical assistance identification number, the date of transfer and the dollar value, if any, paid or received by the individual receiving benefits under this chapter.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 30 - Time of Payment

Section 30. When the division determines that an applicant is eligible for Medicaid, it shall pay for eligible care and services furnished on or after the date of application. Payment shall be made to the provider, institution or insurance entity supplying medical services. The date of application for Medicaid of an individual who has applied for financial assistance under the provisions of chapter one hundred and eighteen A or section one hundred and thirty-one of chapter six, shall be deemed to be the date of application for such financial assistance, whether or not such financial assistance is granted. If consistent with Title XIX of the federal Social Security Act and the regulations established thereunder, the division shall pay for eligible care and services furnished to an eligible applicant during the three months immediately prior to the month in which the applicant filed his or her application; provided, however, that, at the time such care or services are furnished to such individual, that individual upon application would have been eligible for Medicaid pursuant to this chapter.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 33 - Long Term Care Insurance Purchasers; Liability for Medical Assistance Paid

Section 33. No claim for costs of a nursing facility or other long-term care services shall be made by the division under section 31 or 32 if the individual receiving medical assistance was permanently institutionalized, had notified the division that the individual had no intention to return home and, on the date of admission to the nursing facility or other medical institution, had long-term care insurance that, when purchased or at any time thereafter, met the requirements of 211 C.M.R. 65.00.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 34 - Liens and Encumbrances

Section 34. No lien or encumbrance of any kind except as may be permitted by the Secretary, shall be required from or imposed against the property of any individual prior to his death because of Medicaid benefits paid or to be paid on his behalf except pursuant to the judgment of a court on account of benefits incorrectly paid on behalf of a Medicaid recipient.
The division shall not be required to pay a recording fee for filing a notice of lien or encumbrance or a release or discharge of a lien or encumbrance under this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 35 - Reimbursement for Covered Claims; Submission of Information

Section 35. No claim for medical care or services provided for under this chapter shall be reimbursed if any health insurance company, non-profit hospital service corporation, medical service corporation, or other health insurer is liable for such claim under the terms of a group or individual policy providing coverage for such claim to a person eligible for assistance under this chapter. The division shall establish procedures to ensure that no such unauthorized claims are paid, including the soliciting of information regarding alternative health coverage from all applicants and recipients.
Notwithstanding the provisions of any general or special law to the contrary, chronic hospitals and skilled nursing facilities shall seek certification for Title XVIII of the Social Security Act for those services reimbursed under Title XVIII of the Social Security Act.
Notwithstanding any law to the contrary, all health insurers governed by chapters one hundred and seventy-five, one hundred and seventy-six A, one hundred and seventy-six B, one hundred and seventy-six C, one hundred and seventy-six E, one hundred and seventy-six F, and one hundred and seventy-six G, shall provide information to the division which is necessary to carry out the purposes of this section, including the names and addresses of their policyholders or subscribers.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 36 - Eligible Providers; Responsibility for Overpayments

Section 36. Participation in the medical assistance programs established under this chapter shall be limited to providers of services who have not been convicted of larceny or fraud or any other crime in connection with such services, or the billing therefor and who:
(1) indicate their intention to the division to so participate;
(2) present evidence, satisfactory to the division, of their qualifications to provide such services;
(3) agree to accept, as payment in full, the amounts paid in accordance with the fee schedules provided for under this chapter;
(4) agree to comply with all laws, rules and regulations governing the operation of the programs;
(5) agree to be responsible for all overpayments owed to the division, including, in the case of transfer of ownership, the overpayments of any and all previous owners.
If any individual or entity has an ownership interest in more than one institutional provider, the division may offset any monetary liability of such individual or entity to the division under this section or otherwise from any amounts the division owes to any such institutional provider. Any individual or entity having an ownership interest in an institutional provider shall be liable to the division for all monetary liabilities of such provider to the division to the extent of such individual's or entity's ownership interest. For purposes of this paragraph, an ''ownership interest'' shall include both direct ownership interests and ownership interests in any entity which has an ownership interest in an institutional provider, and an ''institutional provider'' shall mean any entity which participates in any medical assistance program under this chapter as a provider of nursing facility services or acute, chronic, or rehabilitation hospital services.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 37 - Distribution of Rules, Regulations to Providers; Administrative Sanctions

Section 37. The division shall distribute to all providers a copy of the rules, regulations, standards, and laws governing the medical assistance programs established by this chapter and shall establish administrative sanctions against providers, including, but not limited to, administrative fines, and, suspension or termination from the programs, for any violations of said rules, regulations, standards or laws. The division shall notify the proper professional society and licensing agency of any such violations.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 39 - False Representations, Failure to Disclose; Penalty

Section 39. Any person or institution which knowingly makes a false representation or, contrary to a legal duty to do so, knowingly fails to disclose any material fact to the division or its agents affecting eligibility or level of benefits for the purpose of causing any person, including the person making such representations, to be supported in whole or in part by the commonwealth, or for the purpose of procuring a payment under any medical assistance program administered by the division, shall be punished by a fine of not less than two hundred nor more than five hundred dollars or by imprisonment for not more than one year.
Nothing in this section shall be construed as preventing the institution of criminal proceedings for the violation of any other law of the commonwealth.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 40 - False Statements or Representations by Providers; Penalty

Section 40. Any person who furnishes items or services for which payment may be made under this chapter, who: (1) knowingly and willfully makes or causes to be made any false statement or representation of a material fact in any application for any benefit or payment under this chapter; or (2) knowingly and willfully makes or causes to be made any false statement or representation of a material fact for use in determining rights to such benefit or payment; or (3) having knowledge of the occurrence of any event affecting his or her initial or continued right to any such benefit or payment, or the benefit of any other individual in whose behalf he or she has applied for or is receiving such benefit or payment, conceals or fails to disclose such an event with an intent fraudulently to secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized; or (4) having made application to receive any such benefit or payment for the use and benefit of another and having received it, knowingly and willfully converts such benefits or payment other than for the use and benefit of such person, shall be punished by a fine of not more than ten thousand dollars, or by imprisonment in the state prison for not more than five years or in a jail or house of correction for not more than two and one-half years, or by both such fine and imprisonment.
Any person who does not furnish items of services for which payment may be made under this chapter, who violates any of the provisions of clauses (1) to (4), inclusive, shall be punished by imprisonment in a jail or house of correction for not more than two and one-half years or by a fine of not more than five thousand dollars or by both such fine and imprisonment.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 41 - Bribery or Rebates; Penalty

Section 41. Whoever solicits or receives any remuneration, including any bribe or rebate, directly or indirectly, overtly or covertly, in cash or in kind in return for purchasing, leasing, ordering or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under this chapter, or whoever offers or pays any remuneration, including any bribe or rebate, directly or indirectly, overtly or covertly, in cash or in kind to induce such person to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under this chapter shall be punished by a fine of not more than ten thousand dollars, or by imprisonment in the state prison for not more than five years or in a jail or house of correction for not more than two and one-half years, or by both such fine and imprisonment.
This section shall not apply to a discount or other reduction in price obtained by a provider of services or other entity under this chapter if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under this chapter or to any amount paid by an employer to an employee, who has a bona fide employment relationship with such employer, for employment in the provision of covered items or services.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 42 - Excess Charges; Penalty

Section 42. Whoever knowingly and willfully charges for any service provided to a patient under this chapter, money or other consideration at a rate in excess of the rates established in accordance with this chapter, shall be punished by a fine of not more than ten thousand dollars, or by imprisonment in the state prison for not more than five years or in a jail or house of correction for not more than two and one-half years, or by both such fine and imprisonment.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 43 - Health Care Facilities; Additional Charges as Precondition for Admission or Continuance; Penalty

Section 43. Whoever knowingly and willfully charges, solicits, accepts or receives, in addition to any amount otherwise required to be paid under this chapter, any gift, money, donation, or other consideration as a precondition or guarantee of admitting a recipient of services under this chapter whether or not presently certified or otherwise lawfully approved for long term care, to a hospital or nursing facility or to expedite the admission of such recipient or as a requirement for such recipient's continued stay in such a facility shall be punished by a fine of not more than ten thousand dollars or by imprisonment in the state prison for not more than five years or in a jail or house of correction for not more than two and one-half years or by both such fine and imprisonment.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 44 - Civil Remedies; Limitations

Section 44. If any person violates the provisions of this chapter, the attorney general or a district attorney may bring a civil action, either in lieu of or in addition to a criminal prosecution, and recover three times the amount of damages sustained including the costs of investigation and litigation. No action shall be brought under this section more than six years after it accrues.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 46a - Providers; Submission of Claims for Payment Not in Compliance With Policies and Procedures of Medical Assistance Program; Proof of Clerical or Administrative Error

Section 46A. Any provider making a claim for payment under any medical assistance program administered by the division, which is not submitted in compliance with the billing policies and procedures of said program, shall not be considered in violation of sections 39 to 46, inclusive, for purposes of eligibility pursuant to section 36, upon submission of proof, to the satisfaction of the commissioner, that the submission of the claim was due solely to a clerical or administrative error.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 47a - Benefits Available Only to Otherwise Eligible Individuals Showing Lawful Presence in the United States or Meeting Applicable Federal Requirements Necessary to Qualify for Benefits for Which the Commonwealth Receives Federal Reimbursement

Section 47A. Benefits for individuals age 19 or older for any program established pursuant to this chapter or chapter 118H shall be available only to otherwise eligible individuals who provide satisfactory documentation that they are lawfully present in the United States, including persons permanently residing in the United States under color of law, or to individuals who establish that they meet all applicable federal requirements necessary to qualify for benefits for which the commonwealth receives federal reimbursement under Title XIX and Title XXI of the Social Security Act, including any demonstration program under section 1115 of the Social Security Act.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 50 - Contract for Administrative Functions; Underwriting of Program

Section 50. To the extent feasible the division may contract with one or more federal agencies or corporations authorized to do business in the commonwealth, including nonprofit hospital and medical service corporations, to carry out the necessary administrative functions of the medical assistance programs established under this chapter. The division may contract for the underwriting of all or any part of such medical assistance programs with such corporation.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 51 - Utilization Review of Care and Services; Data Processing and Collection Procedures; Liability in Civil Actions

Section 51. The division, in cooperation with the department of public health and in accordance with the regulations of the secretary, shall establish processes of utilization review for care or services for which medical assistance is available under this chapter.
The division shall establish data processing and collection procedures which will: (1) monitor eligibility of recipients; (2) assure that providers are neither paid twice for the same care or service nor paid in amounts in excess of fee schedules or other applicable limits; and (3) provide the statistical data necessary for effective utilization review.
A medical professional employee of the division, or person providing medical professional counsel or services to the division on a voluntary or paid basis or an employee of a division subcontractor, shall not be liable in a civil action for damages arising out of any act, omission, proceeding or undertaking in the performance, in good-faith, of duties or responsibilities relative to any utilization related activities authorized or established by this chapter or by regulations promulgated by the secretary.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 52 - Maintenance of Standards for Providers; Development of New Programs

Section 52. The division, in cooperation with the department of public health, shall establish and maintain standards and conditions of participation for providers of all medical care and services for which medical assistance is available under this chapter.
The department of public health, in cooperation with the division shall: (1) plan for and stimulate the development of new medical resources and the expansion of existing resources; (2) stimulate and assist providers of health care and services to develop new and improved methods of delivery of services and payment for services; and (3) expand and increase the services of the department of public health to extend and improve, as far as is practicable, the availability and accessibility of the care and services for which medical assistance is available under this chapter to all recipients of medical assistance, and the coordination of these services in such manner that the best interests of the recipients are served.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 53 - Covered Services

Section 53. The division shall include within its covered services for adults all federally optional services that were included in its state plan or demonstration program in effect on January 1, 2002. Covered services for adults in the MassHealth Essential program shall include dental services to the same extent as such services were covered for adults in the MassHealth Basic program as of January 1, 2002. To the extent permitted by the demonstration program approved under 42 U.S.C. 1315(a), covered services in the MassHealth Basic and MassHealth Essential programs shall include hospice services to the extent such services are covered in the MassHealth Standard program.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 54 - Wellness Program for Masshealth Enrollees

Section 54. The executive office of health and human services shall implement, in cooperation with the department of public health, a wellness program for MassHealth enrollees to encourage activities that lead to desired health outcomes, including smoking cessation, diabetes screening for early detection, teen pregnancy prevention, cancer screening for early detection and stroke education for enrolled individuals. The executive office may reduce MassHealth premiums or copayments, or offer other incentives to encourage enrollees to comply with wellness goals. The executive office shall publish a report annually on: (1) the number of enrollees who meet at least 1 wellness goal; (2) any reduction of copayments or premiums; and (3) any other incentives provided because enrollees met wellness goals. The report shall be submitted to the general court, by filing it with the joint committee on health care financing and the house and senate committees on ways and means.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 56 - Controlled Substance Management Program for Masshealth Enrollees

Section 56. The division shall establish a controlled substance management program for MassHealth enrollees who use excessive quantities of prescribed drugs. Those enrollees shall be restricted to obtaining prescription drugs only from the provider that the division designates as the enrollee's primary pharmacy. The division shall promulgate regulations relative to the program, including criteria for participation, service restriction, responsibilities of the primary pharmacy, change in the primary pharmacy and participation status, utilization review and enforcement.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 61 - Availability of Benefits to Persons Recognized as a Spouse Under Laws of the Commonwealth

Section 61. Notwithstanding the unavailability of federal financial participation, no person who is recognized as a spouse under the laws of the commonwealth shall be denied benefits that are otherwise available under this chapter due to the provisions of 1 U.S.C. § 7 or any other federal non-recognition of spouses of the same sex.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 62 - Acceptance and Recognition of Information Submitted Pursuant to Coding Standards and Guidelines Required; Use of Standardized Claim Formats

Section 62. (a) Subject to subsection (c), for the purposes of processing claims for health care services submitted by a health care provider and to provide uniformity and consistency in the reporting of patient diagnostic information, patient care service and procedure information as it relates to the submission and processing of health care claims, the executive office of health and human services and its subcontractors shall, without local customization, accept and recognize patient diagnostic information and patient care service and procedure information submitted pursuant to, and consistent with, the current Health Insurance Portability and Accountability Act compliant code sets as adopted by the Centers for Medicare and Medicaid Services; the International Classification of Diseases; the American Medical Association's Current Procedural Terminology codes, reporting guidelines and conventions; and the Centers for Medicare and Medicaid Services Healthcare Common Procedure Coding System. The executive office and its subcontractors shall adopt the aforementioned coding standards and guidelines, and all changes thereto, in their entirety, which shall be effective on the same date as the national implementation date established by the entity implementing the coding standards.
(b) Subject to subsection (c), the executive office and its subcontractors shall, without local customization, use the standardized claim formats for processing health care claims as adopted by the National Uniform Claim Committee and the National Uniform Billing Committee and implemented pursuant to the federal Health Insurance Portability and Accountability Act. The executive office and its subcontractors shall, without local customization, adopt and routinely process all changes to such formats which shall be effective on the same date as the implementation date established by the entity implementing the formats.
(c) Except for the requirements for consistency and uniformity in coding patient diagnostic information and patient care service and procedure information, this section shall not modify or supersede the executive office's or its subcontractor's payment policy or utilization review policy. Nothing in this section shall preclude the executive office or a subcontractor thereof from adjudicating a claim pursuant to its billing guidelines, payment policies or provider contracts.
(d) The executive office and its subcontractors shall accept and recognize all claims submitted by health care providers pursuant to this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 70 - Definitions for Secs. 70 Through 75

Section 70. As used in sections 70 to 75 inclusive, the following words shall, unless the context requires otherwise, have the following meanings:—
''Consumer,'' a person to whom a personal care attendant provides personal care services.
''PCA quality home care workforce council'', ''workforce council'' or ''the council'', the Personal Care Attendant quality home care workforce council established in section 71.
''Personal care attendant'', a person, including a personal aide, who has been selected by a consumer or the consumer's surrogate to provide personal care services to persons with disabilities or seniors under the MassHealth personal care attendant program or any successor program or under any program operated by an entity under contract in whole or in part with MassHealth.
''Surrogate'', a consumer's legal guardian or person identified in a written agreement with the consumer as responsible for hiring, directing and firing on behalf of the consumer.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 71 - Pca Quality Home Care Workforce Council

Section 71. (a) There shall be a PCA quality home care workforce council which shall be within the executive office of health and human services but shall not be subject to the control of the executive office, to ensure the quality of long-term, in-home, personal care by recruiting, training and stabilizing the work force of personal care attendants.
(b) The PCA quality home care workforce council shall consist of 9 members appointed under this section. A majority of the members of the council shall be consumers as defined in this chapter. In making appointments to the council, the governor shall appoint the secretary of the executive office of health and human services or a designee, who shall serve as chair, the secretary of labor and workforce development or a designee and 1 member from a slate of 3 consumers recommended by the governor's special advisory commission on disability policy. The auditor shall appoint 1 member from a slate of 3 consumers recommended by the developmental disabilities council, 1 member from a slate of 3 consumers recommended by the Massachusetts office on disability, and 1 member from a slate of 3 consumers recommended by the statewide independent living council. The attorney general shall appoint 1 member from a slate of 3 consumers or consumer surrogates recommended by the Massachusetts home care association, 1 member from a slate of 3 consumers or consumer surrogates recommended by the Massachusetts council on aging and 1 member chosen by the attorney general. The secretary of health and human services or a designee and the secretary of labor and workforce development or a designee shall be permanent members during their term in office. Appointees to the council shall serve 3–year terms. If a vacancy occurs, the executive officer who made the original appointment shall appoint a new council member to serve the remainder of the unexpired term or, in the event that the vacancy occurs as the result of the completion of a term, to serve a full term, and such appointment shall become immediately effective upon the member taking the appropriate oath. If the departing council member was appointed under a recommendation made under this paragraph, the executive officer shall make the new appointment from a slate of 3 recommendations put forth by the entity that originally recommended the departing council member. Members of the council may serve for successive terms of office. A majority of the council shall constitute a quorum for the transaction of any business. Members of the council shall not receive compensation for their council service but members shall be reimbursed for their actual expenses necessarily incurred in the performance of their duties.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 72 - Duties of Workforce Council; Pca Recruitment, Training and Referral Resources; Lists of Pcas

Section 72. (a) The workforce council shall carry out the following duties:
(1) Undertake recruiting efforts to identify and recruit prospective personal care attendants;
(2) Provide training opportunities, either directly or through contract, for personal care attendants and consumers;
(3) Provide assistance to consumers and consumer surrogates in finding personal care attendants by establishing a referral directory of personal care attendants; provided that before placing a personal care attendant on the referral directory, the workforce council shall determine that the personal care attendant has met the requirements established by the executive office in its applicable regulations and has not stated in writing a desire to be excluded from the directory;
(4) Provide routine, emergency and respite referrals of personal care attendants to consumers and consumer surrogates who are authorized to receive long-term, in-home personal care services through a personal care attendant;
(5) Give preference in the recruiting, training, referral and employment of personal care attendants to recipients of public assistance or other low-income persons who would qualify for public assistance in the absence of such employment; and
(6) Cooperate with state and local agencies on health and aging and other federal, state and local agencies to provide the services described and set forth in this section. If the PCA quality home care workforce council identifies concerns regarding the services being provided by a personal care attendant, the workforce council shall notify the relevant office.
(b) In determining how best to carry out its duties, the PCA quality home care workforce council shall identify existing personal care attendant recruitment, training and referral resources made available to consumers or the consumer's surrogate by other state and local public, private and nonprofit agencies. The council may coordinate with the agencies to provide a local presence for the council and to provide consumers or the consumer's surrogate greater access to personal care attendant recruitment, training and referral resources in a cost-effective manner. Using requests for proposals or similar processes, the council may contract with the agencies to provide recruitment, training and referral. The council shall provide an opportunity for consumer participation in coordination efforts.
(c) The commonwealth shall provide to the council a list of all personal care attendants who have been paid through the MassHealth personal care attendant program and shall update the list not less frequently than every 6 months to ensure that the council has a complete and accurate list at all times.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 74 - Pca Quality Home Care Workforce Council; Scope of Power and Authority

Section 74. (a) The PCA quality home care workforce council may make and execute contracts and all other instruments necessary or convenient for the performance of its duties or exercise of its powers, including contracts with public and private agencies, organizations, corporations and individuals to pay them for services rendered or furnished.
(b) The council may offer and provide recruitment, training and referral services to personal care attendants and consumers of long-term, in-home personal care services other than statutorily defined personal care attendants and consumers, for a fee to be determined by the council.
(c) The council may issue rules or regulations, as necessary, for the purpose and policies of sections 70 to 75, inclusive.
(d) Subject to appropriation, the chairperson of the council with the council's approval may establish offices, employ and discharge employees, agents and contractors as necessary and prescribe employees' duties and powers and fix the employees' compensation, incur expenses, and create such liabilities as are reasonable and proper for the administration of sections 70 to 75, inclusive.
(e) The council may solicit and accept for use any grant of money, services or property from the federal government, the state or any political subdivision or agency thereof, including federal matching funds under Title XIX of the federal Social Security Act, and do all things necessary to cooperate with the federal government, the state, or any political subdivision or agency thereof, in making an application for any grant.
(f) The council may coordinate its activities and cooperate with similar agencies in other states.
(g) The council may establish technical advisory committees to assist the council.
(h) The council may keep records and engage in research and the gathering of relevant statistics.
(i) The council may acquire, hold or dispose of real or personal property, or any interest therein, and construct, lease or otherwise provide facilities for the activities conducted under sections 70 to 75, inclusive, but the workforce council may not exercise any power of eminent domain.
(j) The council may delegate to the appropriate persons the power to execute contracts and other instruments on its behalf and delegate any of its powers and duties, if consistent with sections 70 to 75, inclusive.
(k) The council may perform other acts necessary or convenient to execute the powers expressly granted to it.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 75 - Performance Reviews

Section 75. (a) The council shall conduct a performance review every 2 years, submit a report of the review to the legislature and the governor and make the report available to the public upon submission to the governor and the legislature.
(b) The performance review and report shall include an evaluation of the health, welfare and satisfaction with services provided of the consumers receiving long-term in-home personal care services from personal care attendants under sections 70 to 75, inclusive, including the degree to which all required services have been delivered, the degree to which consumers receiving services from personal care attendants have ultimately required additional or more intensive services, such as home health care, or have been placed in other residential settings or nursing homes, the promptness of response to consumer complaints and any other issue considered to be relevant.
(c) The performance review report shall provide an explanation of the full cost of personal care services, including the administrative costs of the council, unemployment compensation, Social Security and Medicare payroll taxes paid and any oversight costs.
(d) The performance review report shall make recommendations to the legislature and the governor for any amendments to sections 70 to 75, inclusive to further ensure the well-being of consumers, and the most efficient means of delivering required services.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 76 - Designation of Another Governmental Unit to Perform Functions Set Forth in Secs. 13c Through 13k and 64 Through 75

Section 76. The secretary of the executive office may designate another governmental unit or units to perform any or all functions set forth in sections 13C to 13K, inclusive, and sections 64 to 75, inclusive. Such designee specifically may include the center for health information and analysis established under chapter 12C of the General Laws. The secretary may effectuate such designation through a memorandum of understanding, nonfinancial interdepartmental service agreement or similar instrument, and such designee shall be a party to any such instrument and perform the activities described therein.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 77 - Office of Medicaid to Attribute Members to Primary Care Providers

Section 77. To the maximum extent possible, the office of Medicaid shall attribute every member to a primary care provider. Members may change their primary care provider, provided that the member gives notice to the office of Medicaid.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 78 - Employer Healthcare Coverage Form

Section 78. (a) The division shall create an employer healthcare coverage form. Every employer with 6 or more employees, doing business in the commonwealth, shall annually complete and submit the form under oath. The form shall indicate whether the employer has offered to pay or arrange for the purchase of health care insurance and information about such health care insurance such as the premium cost, benefits offered, cost sharing details, eligibility criteria and other information deemed necessary by the division; provided, that the information collected through the form shall not be used to deny or terminate MassHealth eligibility for non-disabled persons who would otherwise qualify for a program of medical benefits pursuant to this chapter who have access to employer sponsored health insurance.
The division may make arrangements with other agencies of the commonwealth, including the department of unemployment assistance and the department of revenue, to assist with the administration of this section. Employers shall provide supplemental information that is deemed necessary by the division or its designee upon request by the division. An employer receiving information that identifies, or could be used to identify, a MassHealth member or recipient of subsidized health insurance shall not use or disclose such information except as authorized by the division.
(b) Notwithstanding any general or special law to the contrary, information reported under subsection (a) that identifies individual employees by name or health insurance status or is protected health information shall not be a public record under clause Twenty-sixth of section 7 of chapter 4 or chapter 66. An employer who knowingly falsifies or fails to file any information required by this section, or its implementing regulation, shall be subject to a penalty of not less than $1,000 or more than $5,000 for each violation.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118e - Division of Medical Assistance › Section 82 - Requirement That Division Meets Parity Requirements Described Under Federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and Related Guidance or Regulations

Section 82. Notwithstanding any general or special law to the contrary, the office of Medicaid shall seek a waiver and promulgate regulations in order to require the division and its health insurers, health plans, health maintenance organizations, behavioral health management firms and third-party administrators under contract with the division, a Medicaid managed care organization or primary care clinician plan to meet the parity requirements described under the federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, as amended, and any federal guidance or regulations relevant to the act, including 42 CFR 438 Subpart K, 42 CFR 440.395 and 42 CFR 457.496, for all enrollees. For persons under the age of 21, MassHealth and its agents may comply with this section by meeting the obligations related to Early and Periodic Screening, Diagnostic and Treatment benefits under 42 CFR 457.496(b) or 440.395(c).
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118i - Health Information Technology › Section 1 - Definitions

Section 1. As used in this chapter, the following words shall, unless the context clearly requires otherwise, have the following meanings:
''Commission'', the health policy commission established in section 2 of chapter 6D.
''Council'', the health information technology council established under section 2.
''Electronic health record,'' an electronic record of patient health information generated by llor more encounters in any care delivery setting.
''Executive office'', the executive office of health and human services.
''Health information exchange,'' an electronic platform enabling the transmission of healthcare-related data among providers, payers, personal health records controlled by a patient and government agencies according to national standards, the reliable and secure transfer of data among diverse systems and access to and retrieval of data.
''Longitudinal medical record'', a patient's lifetime electronic health record whether located, maintained or stored on a provider server, at a central storage repository, or distributed in multiple locations but accessible with patient consent.
''Massachusetts eHealth institute'' or ''institute'', the Massachusetts e–Health institute established under section 6D of chapter 40J.
''Office of the National Coordinator'' or ''ONC'', the Office of the National Coordinator for Health Information Technology within the United States Department of Health and Human Services.
''Statewide health information exchange'', a health information exchange established, operated or funded by a governmental entity or entities in the commonwealth.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118i - Health Information Technology › Section 3 - Procurements and Contracts for Development of Statewide Health Information Exchange Technology

Section 3. (a) The executive office shall conduct procurements and enter into contracts for the purchase and development of all hardware and software in connection with the creation and implementation of the statewide health information exchange. The executive office may, in consultation with the council and the commission, oversee the technical aspects of the development, dissemination and implementation of the statewide health information exchange including any modules, applications, interfaces or other technology infrastructure necessary to connect provider electronic health records systems to the statewide health information exchange.
(b) The executive office shall:
(i) in consultation with the council, develop a health information exchange strategic and operating plan;
(ii) implement, operate and maintain the statewide health information exchange; and
(iii) develop and implement statewide health information exchange infrastructure, including, without limitation, provider directories, certificate storage, transmission gateways, auditing systems and any components necessary to connect the statewide health information exchange to provider electronic health records systems.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XVII - Public Welfare › Chapter 118i - Health Information Technology › Section 4 - Consultation With Organizations of Regional Payers and Providers; Policies Consistent With Federal Standards

Section 4. In carrying out of this chapter, the council shall consult with various organizations of regional payers and providers in developing the health information exchange plan and annual updates and in designing, developing, disseminating and implementing the health information exchange.
In carrying out this chapter, the executive office shall, to the maximum extent practicable, adopt policies that are consistent with those relating to similar subject matters adopted by the Office of the National Coordinator for Health Information Technology of the United States Department of Health and Human Services; provided, however, that nothing herein shall be construed to limit the executive office's ability to advance interoperability and other health information technology beyond the standards adopted by the ONC, including without limitation any applicable meaningful use standards.