FILED ON: 1/26/2012

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 2119

The Commonwealth of Massachusetts

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In the Year Two Thousand Twelve

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An Act requiring MassHealth to provide an explanation of benefits to beneficiaries.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

SECTION 1. Section 8 of chapter 118E of the General Laws, as appearing in the 2008 Official Edition, is hereby amended by striking out subparagraph b½  and inserting in place thereof the following 2 subparagraphs:-

b½.  “Explanation of benefits”, a form, statement, or document sent to an insurance enrollee explaining what medical treatment or services were provided, amounts to be billed to the insurer and the enrollee, and payments made on each claim.

b¾.  “Institution”, a licensed hospital, nursing home or public medical institution that meets the requirements of the secretary.

SECTION 2.  Said chapter 118E is hereby amended by inserting after said section 62 the following section:-

Section 63.  The division shall provide an explanation of benefits in an electronic format to any person who receives medical or dental care under this chapter.  Each explanation of benefits shall include a statement requesting that the recipient of Medicaid benefits review the explanation of benefits and notify the MassHealth fraud hotline or the attorney general’s Medicaid fraud tip line of any discrepancy in payment for services that may not have been provided.  The statement shall provide the phone numbers for the MassHealth fraud hotline and the attorney general’s Medicaid fraud tip line and state that the recipient of Medicaid benefits who has reported an adjudicated claim of fraud shall be granted a cash award.  The division shall establish by regulation the amount of award that a recipient of benefits under this chapter shall receive for an adjudicated claim.