Amendment #13 to H4643

Community Health Center Prospective Payment System

Ms. Blais of Deerfield moves to amend the amendment by inserting after section 266 the following section : -

SECTION XXXX. Chapter 175 of the General Laws, as so appearing, is hereby amended by inserting after section 47uu the following new section:-

Section 47vv. (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 U.S.C. 254B.

“Federally Qualified Health Center Services”, as such term is defined in 42 U.S.C. 1396d(a)(2)(C), and as further defined in 101 CMR 304.00.

(b) Notwithstanding any general or special law to the contrary, any entity licensed by the Division of Health Insurance and providing reimbursement to Federally Qualified Health Centers for services provided to patients shall ensure that payment for any Federally Qualified Health Center services provided to a patient, including, but not limited to, behavioral health services, telehealth services, primary care services, and dental services, as defined in 101 CMR 304.00, shall be reimbursed in an amount at least equivalent on annual basis to the annual aggregate revenue that the health center would have received if reimbursed by MassHealth pursuant to methodology that conforms with 42 U.S.C. § 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) Notwithstanding any general or special law to the contrary, any entity licensed by the Division of Health Insurance and providing reimbursement to Federally Qualified Health Centers for services provided to patients, including, but not limited to, non-profit hospital service corporations, medical service corporations, dental service corporations, health maintenance organizations, and preferred provider organizations, or any other entity not specifically enumerated hereunder licensed by the Division of Health Insurance and providing reimbursement to Federally Qualified Health Centers for services provided to patients, shall: (1) ensure that payment for any Federally Qualified Health Center services provided to a patient shall be reimbursed in an amount on an annual basis at least equivalent to the annual aggregate revenue that the health center would have received if reimbursed by MassHealth pursuant to methodology that conforms with 42 U.S.C. § 1396a(bb) and 1396b(m)(2)(A)(ix) as they appear in Title 42 of the United States Code as of January 1, 2023; and (2) submit an annual report to the Division of Health Insurance as a condition of their licensure evidencing that the total reimbursement to Federally Qualified Health Centers for services provided to patients in the prior year was equivalent to the annual aggregate revenue the health center would have received if reimbursed by MassHealth.

(d) 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 not contracted under the plan except as described in subclause (i) of clause (4) of subsection (a) of section 6 of chapter 176O.

(e) The Division of Health Insurance shall consult with MassHealth to receive technical assistance regarding the per visit payment rate for each individual Federally Qualified Health Center for a given year. MassHealth shall provide the Division of Health Insurance with a proxy rate for any Federally Qualified Health Center who has not received an individual prospective payment system rate and the Division of Health Insurance shall make available to health plans upon request the necessary prospective payment system rate information regarding their contracted Federally Qualified Health Centers such that the health plan can ensure compliance with this requirement. The Division of Health Insurance shall promulgate regulations no later than January 1, 2025 in order to implement the provisions of this Chapter.

Additional co-sponsor(s) added to Amendment #13 to H4643

Community Health Center Prospective Payment System