Amendment 66

Amendment ID: S3116-66-R1

Redraft Amendment 66

Rate Floor Technical

Messrs. Cyr and Payano move that the proposed new draft be amended by striking section 17 and inserting in place thereof the following section:-

“SECTION 17. Chapter 15A of the General Laws is hereby amended by inserting after section 18 the following section:-

Section 18A. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally qualified health center”, a community health center as defined in 101 CMR 614.00.

“Federally qualified health center services”, medical and behavioral health services described in 42 U.S.C. 1396d(l)(2)(A) and further defined in 101 CMR 304.00 that have a prospective payment system rate established by MassHealth.(b) Notwithstanding any general or special law to the contrary, any student health insurance program or plan authorized pursuant to section 18 shall ensure that the rate of payment for any federally qualified health center services covered by the student health insurance program or plan and provided to a patient by a federally qualified health center shall be an amount equal to or greater than the applicable rate that the federally qualified health center would have received if reimbursed for such services by MassHealth and pursuant to the methodology that conforms with 42 U.S.C. 1396a(bb) and 1396b(m)(2)(A)(ix) pursuant to rates as of July 1 of the preceding rate year.

(c) The division of insurance shall consult with MassHealth for technical assistance regarding the per visit payment rate for each federally qualified health center for a given year”; and

in section 18, by striking out proposed section 36 of chapter 32A of the General Laws and inserting in place thereof the following section:-

“Section 36. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally qualified health center”, a community health center as defined in 101 CMR 614.00.

“Federally qualified health center services”, medical and behavioral health services described in 42 U.S.C. 1396d(l)(2)(A) and further defined in 101 CMR 304.00 that have a prospective payment system rate established by MassHealth.(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 covered by the commission and provided to a patient by a federally qualified health center shall be an amount equal to or greater than the applicable rate that the federally qualified health center would have received if reimbursed for such services by MassHealth and pursuant to the methodology that conforms with 42 U.S.C. 1396a(bb) and 1396b(m)(2)(A)(ix) pursuant to rates as of July 1 of the preceding rate year.

(c) The division of insurance shall consult with MassHealth for technical assistance regarding the per visit payment rate for each federally qualified health center for a given year.”; and

in section 20, by striking out proposed section 47EEE of chapter 175 of the General Laws and inserting in place thereof the following:-

“Section 47EEE. (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”, a community health center as defined in 101 CMR 614.00.

(b) Any carrier offering a policy, contract, agreement, plan or certificate of insurance issued, delivered or renewed within the commonwealth shall ensure that the rate of payment for any federally qualified health center services covered by such carrier and provided to a patient by a federally qualified health center shall be an amount equal to or greater than the applicable rate that the federally qualified health center would have received if reimbursed for such services by MassHealth and pursuant to the methodology that conforms with 42 U.S.C. 1396a(bb) and 1396b(m)(2)(A)(ix) pursuant to rates as of July 1 of the preceding rate year.

(c) The division of insurance shall consult with MassHealth for technical assistance regarding the per visit payment rate for each federally qualified health center for a given year.”; and

in section 21, by striking out proposed section 8FFF of chapter 176A of the General Laws and inserting in place thereof the following section:-

“Section 8FFF. (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”, a community health center as defined in 101 CMR 614.00.

“Federally qualified health center services”, medical and behavioral health services described in 42 U.S.C. 1396d(l)(2)(A) and further defined in 101 CMR 304.00 that have a prospective payment system rate established by MassHealth.(b) Any contract between a subscriber and a nonprofit hospital service corporation pursuant to an individual or group hospital service plan that is delivered, issued or renewed within the commonwealth shall ensure that the rate of payment for any federally qualified health center services covered by the contract between a subscriber and a nonprofit hospital service and provided to a patient by a federally qualified health center shall be an amount equal to or greater than the applicable rate that the federally qualified health center would have received if reimbursed for such services by MassHealth and pursuant to the methodology that conforms with 42 U.S.C. 1396a(bb) and 1396b(m)(2)(A)(ix) pursuant to rates as of July 1 of the preceding rate year.

(c) The division of insurance shall consult with MassHealth for technical assistance regarding the per visit payment rate for each federally qualified health center for a given year.”; and

in section 22, by striking out proposed section 4FFF of chapter 176B of the General Laws and inserting in place thereof the following section:-

“Section 4FFF. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally qualified health center”, community health center as defined in 101 CMR 614.00.

(b) A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall ensure that the rate of payment for any federally qualified health center services covered by such subscription certificate and provided to a patient by a federally qualified health center shall be an amount equal to or greater than the applicable rate that the federally qualified health center would have received if reimbursed for such services by MassHealth and pursuant to the methodology that conforms with 42 U.S.C. § 1396a(bb) and 1396b(m)(2)(A)(ix) pursuant to rates as of July 1 of the preceding rate year.

(c) The division of insurance shall consult with MassHealth for technical assistance regarding the per visit payment rate for each federally qualified health center for a given year.”; and

by striking out section 23 and inserting in place thereof the following section:-

“SECTION 23. Chapter 176E of the General Laws is hereby amended by inserting after section 15A the following section:-

Section 15B. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally qualified health center”, a community health center as defined in 101 CMR 614.00.

“Federally qualified health center services”, dental services described in 42 U.S.C. 1396d(l)(2)(A) and further defined in 101 CMR 304.00 that have a prospective payment system rate established by MassHealth.

(b) A dental service corporation organized under this chapter shall ensure that the rate of payment for any federally qualified health center services covered by such dental service corporation and provided to a patient by a federally qualified health center shall be an amount equal to or greater than the applicable rate that the federally qualified health center would have received if reimbursed for such services by MassHealth and pursuant to the methodology that conforms with 42 U.S.C. 1396a(bb) and 1396b(m)(2)(A)(ix) pursuant to rates as of July 1 of the preceding rate year.

(c) The division of insurance shall consult with MassHealth for technical assistance regarding the per visit payment rate for each federally qualified health center for a given year.”; and

in section 24, by striking out proposed section 4XX of chapter 176G of the General Laws and inserting in place thereof the following section:-

“SECTION 4XX. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Federally qualified health center”, a community health center as defined in 101 CMR 614.00.

(b) A health maintenance organization organized pursuant to this chapter shall ensure that the rate of payment for any federally qualified health center services covered by such health maintenance organization and provided to a patient by a federally qualified health center shall be an amount equal to or greater than the applicable rate that the federally qualified health center would have received if reimbursed for such services by MassHealth and pursuant to the methodology that conforms with 42 U.S.C. 1396a(bb) and 1396b(m)(2)(A)(ix) pursuant to rates as of July 1 of the preceding rate year.

(c) The division of insurance shall consult with MassHealth for technical assistance regarding the per visit payment rate for each federally qualified health center for a given year.”.