Bill > H4226

This bill aims to improve healthcare access for dually eligible individuals (people who qualify for both Medicare and Medicaid) in Massachusetts by ensuring they can receive care from specialists and hospitals regardless of their health plan's network restrictions. Specifically, the bill allows these individuals to receive services from any Medicare or MassHealth-participating provider, even if the provider is not in their health plan's network. When no existing contract exists between a health plan and a provider, the provider will be reimbursed at the standard Medicare or MassHealth fee-for-service rate. Additionally, the bill mandates that if a health plan (referred to as One Care or Senior Care Organization, or SCO) terminates a contract with a healthcare provider, the impacted members can continue receiving care from their current primary care, specialist, or hospital provider for twelve months under the previous contract's terms. This provision is designed to protect vulnerable patients from sudden disruptions in their healthcare services and requires both plans and providers to negotiate in good faith when establishing new contractual arrangements.

Health and Social Services

https://malegislature.gov/Bills/194/H4226