Amendment #733 to H4000

Children's Medical Security Plan

Representatives Andrews of Orange, Malia of Boston, Gregoire of Marlborough, Decker of Cambridge and Farley-Bouvier of Pittsfield move to amend the bill by adding the following section:

"SECTION XX:  Section 10F of chapter 118E of the General Laws is hereby amended by striking out subsections (a) and (b), as appearing in the 2010 Official Edition, 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 regulations of the executive office of health and human services as the secretary 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, but primary care shall not include emergency or post-stabilization services provided in a hospital or other setting; and

(3) unlimited sick visits in a primary care provider's office.

(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's discretion:

(1) dental health care, including preventive dental care; but no funds shall be expended for cosmetic or surgical dentistry;

(2) prescription drugs; and

(3) behavioral health.

Prior to setting any benefit changes forth in regulation, the Office of Medicaid shall provide to the House and Senate Committees on Ways and Means a description of the cost per covered program member in the year preceding implementation of the regulation, as well as the anticipated cost per covered program member in the year following implementation of the regulation.  Said description shall clearly indicate any changes in anticipated costs resulting from changes in covered program services."