Amendment #671 to H3800

Urgent Care Access for MassHealth Enrollees

Representatives Gordon of Bedford and Roy of Franklin moves to amend the bill by inserting after section 28 the following new section:-

"SECTION 28A. Chapter 118E is hereby amended by inserting after section 10L, inserted by section 71 of chapter 208 of the acts of 2018, the following new section:-

Section 10M. The division and its contracted health insurers, health plans, health maintenance organizations, behavioral health management firms and third party administrators under contract to a Medicaid managed care organization or primary care clinician plan shall not require an enrollee to obtain a referral from a primary care physician prior to obtaining health care services from an urgent care facility; provided, that any urgent care facility providing health care services to an enrollee shall notify the primary care physician of the enrollee that the enrollee received urgent care services or, when a primary care physician cannot be determined, provide the enrollee with names of primary care physicians contracted with MassHealth and practicing in the municipality of residence of the enrollee or an adjacent municipality."