Bill > H68

This bill aims to protect access to disability services for certain adults enrolled in the integrated care organization (ICO) pilot program, which is a program designed to coordinate care for individuals eligible for both Medicare and Medicaid. Key provisions include ensuring that enrollment in the ICO program is voluntary, with no penalties for choosing a traditional fee-for-service system, and that enrollees can disenroll at any time with notice. The bill also specifies that ICO benefits must at least match Medicare Parts A and B coverage, be no less restrictive than MassHealth standard coverage for Medicaid services, and include home and community-based services and mental health or substance abuse treatment. It mandates that ICOs meet minimum medical loss ratios, meaning a certain percentage of premiums must be spent on patient care, and requires them to provide additional benefits if they fall below this ratio. Furthermore, the bill mandates the establishment of ICO consumer advisory councils, requires the division to educate consumers about their enrollment choices and prohibit inducements for enrollment, and mandates the creation of an "ICO report card" for consumers to compare organizations. The bill also requires the division to measure ICO performance using quality assurance measures, ensure enrollees have a choice of at least two ICOs where available, and that ICOs comply with federal privacy standards. Finally, it requires semi-annual reports to legislative committees detailing ICO participation, expenditures, and program functioning, including enrollment and disenrollment data.