HOUSE DOCKET, NO. 2594        FILED ON: 1/19/2017

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 2216

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Elizabeth A. Malia

_________________

To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act improving the children's medical security program and simplifying the administrative process.

_______________

PETITION OF:

 

Name:

District/Address:

Date Added:

Elizabeth A. Malia

11th Suffolk

1/19/2017

Jason M. Lewis

Fifth Middlesex

 

Kate Hogan

3rd Middlesex

 

Denise C. Garlick

13th Norfolk

 

Jennifer E. Benson

37th Middlesex

 

Kay Khan

11th Middlesex

 

Kevin G. Honan

17th Suffolk

 

David Paul Linsky

5th Middlesex

 

Paul McMurtry

11th Norfolk

 

Barbara A. L'Italien

Second Essex and Middlesex

 

James B. Eldridge

Middlesex and Worcester

 

Ruth B. Balser

12th Middlesex

 

Diana DiZoglio

14th Essex

 

Jack Lewis

7th Middlesex

 

José F. Tosado

9th Hampden

 

Steven Ultrino

33rd Middlesex

 

Carmine L. Gentile

13th Middlesex

 

Marjorie C. Decker

25th Middlesex

 

Jonathan Hecht

29th Middlesex

 

Christine P. Barber

34th Middlesex

 

Mike Connolly

26th Middlesex

 

Danielle W. Gregoire

4th Middlesex

 

Paul R. Heroux

2nd Bristol

 

Mathew Muratore

1st Plymouth

 

Carolyn C. Dykema

8th Middlesex

 

Chris Walsh

6th Middlesex

 

Stephan Hay

3rd Worcester

 

Peter V. Kocot

1st Hampshire

 

Natalie Higgins

4th Worcester

 


HOUSE DOCKET, NO. 2594        FILED ON: 1/19/2017

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 2216

By Ms. Malia of Boston, a petition (accompanied by bill, House, No. 2216) of Elizabeth A. Malia and others for legislation to provide for primary and preventative health care services for certain children.  Health Care Financing.

 

[SIMILAR MATTER FILED IN PREVIOUS SESSION
SEE HOUSE, NO. 1009 OF 2015-2016.]

 

The Commonwealth of Massachusetts

 

_______________

In the One Hundred and Ninetieth General Court
(2017-2018)

_______________

 

An Act improving the children's medical security program and simplifying the administrative process.

 

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 10F of chapter 118E of the General Laws, as appearing in the 2014 Official Edition, is hereby amended by striking out subsections (a) and (b) and inserting in place thereof the following 2 subsections:-

(a) There shall be a program to provide primary and preventive health care services for uninsured dependent and adopted youths from birth through age 18, in this section called the program; but only those youths who are ineligible for medical benefits pursuant to this chapter shall be eligible for the services defined in this section. The secretary of health and human services shall administer the program, subject to appropriation. The covered services available from the program shall be set forth in the regulations of the executive office of health and human services as the secretary of health and human services determines is appropriate, but at a minimum shall include the following:

1)preventive pediatric health care visits and well-child visits, including immunizations and screening tests;

2)primary care health care services customarily furnished by or through a general practitioner, family physician, internal medicine physician, obstetrician, gynecologist, pediatrician, independent nurse practitioner or physician assistant to the extent the furnishing of those services is legally authorized in the commonwealth; provided, that primary care shall not include emergency or post-stabilization services provided in a hospital or other setting; and

3)unlimited sick visits provided by a primary care provider.

(b) Additional services under the program shall include the following, but coverage for specific services within each category and the benefit limitations shall be at the secretary of health and human service's discretion:

1)dental health care, including preventive dental care; provided, however, that no funds shall be expended for cosmetic or surgical dentistry;

2)durable medical equipment;

3)urgent care visits in the outpatient department of a participating hospital when an enrollee’s primary care practitioner is not available to provide such services and emergency care in the outpatient department or emergency department of a participating hospital, including related laboratory and diagnostic radiology services for urgent or emergency care; provided, that rates of reimbursement for urgent and emergency care shall be negotiated by participating hospitals with the division or its designated vendor;

4)annual and medically necessary eye examinations;

5)auditory screenings;

6)outpatient surgery and anesthesia for tympanostomy tube placement and inguinal hernias;

7)prescription drugs; and

8)behavioral health.

SECTION 2. Subsection (g) of said section 10F of said chapter 118E, as so appearing, is hereby amended by striking out the second sentence and inserting in place thereof the following 2 sentences:- At least 30 days prior to modifying any program benefits or eligibility standards that are intended to ensure that program costs are limited to the funds appropriated therefore, the division shall provide the aforementioned committees and the secretary of administration and finance with notice of the modification and, for any program benefit modifications, a description of the cost per covered program member in the fiscal year preceding implementation of the modification, as well as the anticipated cost per covered program member in the fiscal year following implementation of the modification. The description shall clearly indicate any changes in anticipated costs resulting from changes in covered program services.

SECTION 3. The division of medical assistance may promulgate regulations to implement section 1 pursuant to subsection (f) of section 10F of chapter 118E of the General Laws.

SECTION 4. Section 1 shall take effect on July 1, 2017.