Bill > H983

This bill aims to ensure equitable reimbursement for healthcare providers in Massachusetts by amending Chapter 118E of the General Laws. It introduces definitions for "Managed Care Organization" (MCO), which is an entity contracted by the Commonwealth to provide healthcare services to MassHealth enrollees on a fixed per-person payment basis (capitated), and "Network," which refers to a group of healthcare providers contracted by an MCO to serve its enrollees. The bill also defines a "Non-network provider" as a healthcare provider not contracted with an MCO. Crucially, the bill mandates that for emergency services, post-stabilization care, and other services requiring prior approval from an MCO, a non-network provider must accept payment at the same rate that Medicaid would pay for those services, while still allowing MCOs to deny payment for services they did not approve.