Bill > H1223

This bill aims to ensure access and continuity of care to specialist and hospital services for dual-eligible individuals, which refers to those who are eligible for both Medicare (the federal health insurance program for older adults and people with disabilities) and Medicaid (the state-based health insurance program for low-income individuals). The key provisions are: 1. Allowing dual-eligible individuals to receive healthcare services from any specialist or hospital provider in the Commonwealth that participates in and is enrolled in Medicare or MassHealth (the Massachusetts Medicaid program), regardless of their health plan or provider network limitations. 2. Requiring MassHealth to ensure continued access to primary, specialist, and hospital care for dual-eligible individuals by requiring One Care or Senior Care Options (SCO) plans to allow impacted members to continue receiving services from their primary care, specialist, or inpatient/outpatient hospital providers under the terms of the pre-existing contract for 12 months following the expiration of any continuity of care requirements. 3. Prohibiting plans and providers from using this provision to avoid using good faith efforts to negotiate contractual arrangements.

Health and Social Services

https://malegislature.gov/Bills/193/H1223