HOUSE DOCKET, NO. 2544        FILED ON: 1/19/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 948

 

The Commonwealth of Massachusetts

_________________

PRESENTED BY:

Natalie M. Blais

_________________

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 requiring prospective payment system methodology for reimbursement to community health centers.

_______________

PETITION OF:

 

Name:

District/Address:

Date Added:

Natalie M. Blais

1st Franklin

1/19/2023

Susannah M. Whipps

2nd Franklin

1/25/2023

Lindsay N. Sabadosa

1st Hampshire

1/26/2023

Meghan K. Kilcoyne

12th Worcester

1/27/2023

Peter Capano

11th Essex

1/30/2023

Joanne M. Comerford

Hampshire, Franklin and Worcester

1/30/2023

John J. Cronin

Worcester and Middlesex

1/30/2023

David Henry Argosky LeBoeuf

17th Worcester

1/31/2023

Daniel Cahill

10th Essex

2/1/2023

Vanna Howard

17th Middlesex

2/1/2023

Tackey Chan

2nd Norfolk

2/2/2023

Thomas M. Stanley

9th Middlesex

2/2/2023

Michael P. Kushmerek

3rd Worcester

2/2/2023

Rodney M. Elliott

16th Middlesex

2/3/2023

Jack Patrick Lewis

7th Middlesex

2/5/2023

James J. O'Day

14th Worcester

2/6/2023

Mary S. Keefe

15th Worcester

2/6/2023

James K. Hawkins

2nd Bristol

2/7/2023

Brian W. Murray

10th Worcester

2/17/2023

Dylan A. Fernandes

Barnstable, Dukes and Nantucket

2/17/2023

Rebecca L. Rausch

Norfolk, Worcester and Middlesex

2/23/2023

Christopher Richard Flanagan

1st Barnstable

2/24/2023

Estela A. Reyes

4th Essex

3/1/2023

Kevin G. Honan

17th Suffolk

3/14/2023

Natalie M. Higgins

4th Worcester

3/14/2023

Rady Mom

18th Middlesex

3/22/2023

Susan L. Moran

Plymouth and Barnstable

4/5/2023


HOUSE DOCKET, NO. 2544        FILED ON: 1/19/2023

HOUSE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 948

By Representative Blais of Deerfield, a petition (accompanied by bill, House, No. 948) of Natalie M. Blais and others relative to the rate of payment for certain federally qualified health center services provided to patients by  community health centers.  Financial Services.

 

The Commonwealth of Massachusetts

 

_______________

In the One Hundred and Ninety-Third General Court
(2023-2024)

_______________

 

An Act requiring prospective payment system methodology for reimbursement to community health centers.

 

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. Chapter 32A of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 32 the following new section:-

Section 33. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:

“Federally Qualified Health Center”, any entity receiving a grant under 42 USC 254B.

“Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C. 1396d(a)(2)(C)

(b) Notwithstanding any general or special law to the contrary, the Commission shall ensure that the rate of payment for any Federally Qualified Health Center services provided to a patient by a community health center, shall be reimbursed through a methodology that conforms with 42 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2023.

(c) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as described in subclause (i) of clause (4) of subsection (a) of section 6 of chapter 176O.

SECTION 2. Chapter 118E of the General laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 13d ½ the following new section:-

Section 13d ¾. (a) For purposes of this section, the term “community health center” shall mean any entity reimbursed as a community health center under this chapter.

(b) Notwithstanding any general or special law to the contrary, reimbursement for community health centers under this chapter, shall be through a methodology that conforms with 42 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as appearing in Title 42 of the United States Code as of January 1, 2023.

SECTION 3. Chapter 175 of the General law, as appearing in the 2020 Official Edition, is hereby amended by inserting after section 47TT the following new section:-

Section 47UU. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:

“Federally Qualified Health Center”, any entity receiving a grant under 42 USC 254B.

“Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C. 1396d(a)(2)(C)

(b) Notwithstanding any general or special law to the contrary, insurers organized under this chapter shall ensure that the rate of payment for any Federally Qualified Health Center services provided to a patient by a community health center, shall be reimbursed through a methodology that conforms with 42 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2023. 

(c) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as described in subclause (i) of clause (4) of subsection (a) of section 6 of chapter 176O.

(d) The division of insurance shall issue regulations governing issuance of payments to community health centers to conform with this section. 

SECTION 4. Chapter 176A of the General laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after Section 38 the following new section:-

Section 39. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise:

“Federally Qualified Health Center”, any entity receiving a grant under 42 USC 254B.

“Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C. 1396d(a)(2)(C)

(b) Notwithstanding any general or special law to the contrary, any corporation organized under this chapter shall ensure that the rate of payment for any Federally Qualified Health Center services provided to a patient by a community health center, shall be reimbursed through a methodology that conforms with 42 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2023. 

(c) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as described in subclause (i) of clause (4) of subsection (a) of section 6 of chapter 176O.

SECTION 5. Section 1 of Chapter 176B of the General laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Dependent” the following new definitions:-

“Federally Qualified Health Center,” any entity receiving a grant under 42 USC 254B.

“Federally Qualified Health Center Services,” shall have the same definition as such term is defined in 42 U.S.C. 1396d(a)(2)(C).

SECTION 6. Chapter 176B of the General laws, as so appearing is hereby further amended by inserting after Section 25 the following new section:-

Section 26: (a) Notwithstanding any general or special law to the contrary, any medical service plan organized under this Chapter shall ensure that the rate of payment for any Federally Qualified Health Center services provided to a patient by a community health center, shall be reimbursed through a methodology that conforms with 42 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2023. 

(b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as described in subclause (i) of clause (4) of subsection (a) of section 6 of chapter 176O.

SECTION 7. Section 1 of chapter 176E of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Dental Service Corporation” the following new definitions:-

“Federally Qualified Health Center,” any entity receiving a grant under 42 USC 254B.

“Federally Qualified Health Center Services,” shall have the same definition as such term is defined in 42 U.S.C. 1396d(a)(2)(C).

SECTION 8. Said chapter 176E is further amended by inserting after section 15A the following new section:-

Section 15B. (a) Notwithstanding any general or special law to the contrary, any Dental Service Corporation organized under this Chapter shall ensure that the rate of payment for any Federally Qualified Health Center services provided to a patient by a community health center, shall be reimbursed through a methodology that conforms with 42 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2023. 

(b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as described in subclause (i) of clause (4) of subsection (a) of section 6 of chapter 176O.

SECTION 9. Section 1 of chapter 176G of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Evidence of Coverage” the following new definitions:-

“Federally Qualified Health Center,” any entity receiving a grant under 42 USC 254B.

“Federally Qualified Health Center Services,” shall have the same definition as such term is defined in 42 U.S.C. 1396d(a)(2)(C).

SECTION 10. Said chapter 176G is further amended by inserting after section 33 the following new section:-

Section 34. (a) Notwithstanding any general or special law to the contrary, any Health Maintenance Organization organized under the laws of the Commonwealth shall ensure that the rate of payment for any Federally Qualified Health Center services provided to a patient by a community health center, shall be reimbursed through a methodology that conforms with 42 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2023. 

(b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as described in subclause (i) of clause (4) of subsection (a) of section 6 of chapter 176O.

SECTION 11. Section 1 of chapter 176I of the General Laws, as appearing in the 2020 Official Edition, is hereby amended by inserting after the definition of “Emergency Care” the following new definitions:-

“Federally Qualified Health Center,” any entity receiving a grant under 42 USC 254B.

“Federally Qualified Health Center Services,” shall have the same definition as such term is defined in 42 U.S.C. 1396d(a)(2)(C).

SECTION 12. Said chapter 176I, as so appearing, is further amended by inserting after section 13 the following new section:-

Section 14: (a) Notwithstanding any general or special law to the contrary, any preferred provider contract shall ensure that the rate of payment for any Federally Qualified Health Center services provided to a patient by a community health center, shall be reimbursed through a methodology that conforms with 42 USC § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2023. 

(b) A policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within or without the commonwealth shall not be required to reimburse a health care provider for a health care service that is not a covered benefit under the plan or reimburse a health care provider not contracted under the plan except as described in subclause (i) of clause (4) of subsection (a) of section 6 of chapter 176O.