SENATE DOCKET, NO. 1545 FILED ON: 1/19/2023
SENATE . . . . . . . . . . . . . . No. 620
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The Commonwealth of Massachusetts
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PRESENTED BY:
Julian Cyr
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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.
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PETITION OF:
Name: | District/Address: |
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Julian Cyr | Cape and Islands |
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John J. Cronin | Worcester and Middlesex | 2/7/2023 |
Joanne M. Comerford | Hampshire, Franklin and Worcester | 2/7/2023 |
Jack Patrick Lewis | 7th Middlesex | 2/7/2023 |
Michael O. Moore | Second Worcester | 2/7/2023 |
Thomas M. Stanley | 9th Middlesex | 2/7/2023 |
James K. Hawkins | 2nd Bristol | 2/8/2023 |
Vanna Howard | 17th Middlesex | 2/22/2023 |
Pavel M. Payano | First Essex | 2/22/2023 |
Michael J. Barrett | Third Middlesex | 2/22/2023 |
Rebecca L. Rausch | Norfolk, Worcester and Middlesex | 2/28/2023 |
Susan L. Moran | Plymouth and Barnstable | 4/14/2023 |
Brendan P. Crighton | Third Essex | 4/26/2023 |
SENATE DOCKET, NO. 1545 FILED ON: 1/19/2023
SENATE . . . . . . . . . . . . . . No. 620
By Mr. Cyr, a petition (accompanied by bill, Senate, No. 620) of Julian Cyr, John J. Cronin, Joanne M. Comerford, Jack Patrick Lewis and other members of the General Court for legislation to require prospective payment system methodology for reimbursement to community health centers. Financial Services. |
The Commonwealth of Massachusetts
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In the One Hundred and Ninety-Third General Court
(2023-2024)
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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.