Bill > H974

This bill extends patient protections to individuals receiving services through MassHealth, which is a Massachusetts government program providing health insurance to low-income residents. It mandates that MassHealth, referred to as the "Division," must process physician reimbursement claims within 45 days for paper submissions or 15 days for electronic ones, or provide specific reasons for non-payment within 15 days for paper or 48 hours for electronic claims, and if these timelines are not met, the Division will owe interest on unpaid amounts. The bill also requires the Division to provide clear written guidelines to medical service providers detailing what is needed for a claim to be considered complete and outlines the Division's policies for reviewing claims, preventing retroactive denial of payments for services rendered over a year prior without proper written notice of policy changes. Furthermore, it amends the definition of "carrier" to include entities providing managed care services under contract to the Division of Medical Assistance, expands the definition of "covered benefits" to include services received under MassHealth programs, and includes MassHealth recipients within the definition of "insured" for grievance purposes, ensuring they have the same rights as those with private health insurance. Finally, it clarifies that the Division of Medical Assistance itself is not subject to certain accreditation standards applied to other carriers.