Bill > S742

This bill aims to ensure access and continuity of care to specialist and hospital services for dually eligible individuals, which refers to people who are eligible for both Medicare and Medicaid. The key provisions of the bill are: 1. Allowing dually eligible individuals to receive care from any specialist or hospital provider in Massachusetts that participates in Medicare or MassHealth (the state's Medicaid program), regardless of their health plan's network limitations, and requiring the individual's health plan to reimburse the provider at the Medicare or MassHealth fee-for-service rate if there is no existing contract between the plan and the provider. 2. Requiring MassHealth to mandate that any One Care or Senior Care Options (SCO) plan that terminates a contract with a provider must allow impacted members to continue receiving services from that provider for 12 months after the expiration of any continuity of care requirements, during which the plan must maintain the previous contractual terms and conditions unless mutually agreed upon. The goal of this bill is to ensure dually eligible individuals, who are often among the most vulnerable populations, have continued access to necessary primary, specialist, and hospital care.

Health and Social Services

https://malegislature.gov/Bills/193/S742