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  • Acts
  • 1997
  • Chapter 170 AN ACT EXPANDING ACCESS TO QUALITY HEALTH CARE FOR WORKING FAMILIES, CHILDREN AND SENIOR CITIZENS IN THE COMMONWEALTH.

Whereas , The deferred operation of this act would tend to defeat its purpose, which is to assist forthwith in making health care services available to low income uninsured and underinsured residents of the commonwealth, therefore it is hereby declared to be an emergency law, necessary for the immediate preservation of the public convenience.


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. The second sentence of section 2FF of chapter 29 of the General Laws, as amended by section 1 of chapter 47 of the acts of 1997, is hereby further amended by striking out clauses (c) and (d) and inserting in place thereof the following four clauses:- (c) any income derived from the investment of amounts credited to said fund; (d) any federal reimbursement received for benefits and payments provided pursuant to section 9C of said chapter 118E; (e) any appropriations transferred to said fund pursuant to the provisions of section 24G of chapter 111; and (f) premiums paid by enrollees in the program established pursuant to the provisions of said section 24G of said chapter 111.

SECTION 2. The third sentence of said section 2FF of said chapter 29, as appearing in the 1996 Official Edition, is hereby amended by striking out, in line 21, the words "and (b)" and inserting in place thereof the following words:- (b) a program of health care assistance authorized pursuant to the provisions of section 16C of chapter 118E; (c) a program of primary and preventive health care for children from birth through age 18 authorized pursuant to the provisions of section 24G of chapter 111; and (d).

SECTION 3. Section 28 of chapter 64C of the General Laws, as so appearing, is hereby amended by striking out clauses (a) to (c), inclusive, and inserting in place thereof the following two clauses:-

(a) Forty per cent of the amount in excess of $169,800,000 received during a fiscal year shall be credited to the Local Aid Fund;

(b) The balance remaining after crediting the amounts required under clause (a) shall be credited to the General Fund.

SECTION 4. Section 24F of chapter 111 of the General Laws is hereby repealed.

SECTION 5. Section 24G of said chapter 111, as so appearing, is hereby amended by inserting after the word "eighteen", in line 3, the following words:- ; provided, however, that only said youths who are ineligible for medical benefits pursuant to chapter 118E of the General Laws shall be eligible for the services defined herein.

SECTION 6. Said section 24G of said chapter 111, as so appearing, is hereby further amended by striking out, in lines 5 to 7, inclusive, the words "health care access fund established pursuant to section twenty-four F of chapter one hundred and eleven and other appropriated funds" and inserting in place thereof the following:- Children's and Seniors' Health Care Assistance Fund established pursuant to the provisions of section 2FF of chapter 29 and other appropriated funds. The comptroller is hereby authorized and directed to transfer amounts appropriated from the General Fund or any other fiscal resource of the commonwealth designated for health care services provided to said youths from birth to age 12, inclusive, to said Children's and Seniors' Health Care Assistance Fund.

SECTION 7. The second paragraph of said section 24G of said chapter 111, as so appearing, is hereby amended by striking out clause (1) and inserting in place thereof the following clause:-

(1) prescription drugs up to $200 per year; provided, however, that enrollees shall be responsible for a copayment of $3 for each interchangeable drug prescription and $4 for each brand name drug prescription; provided, further, that the department may authorize a higher prescription benefit level for any person enrolled in said program for which said higher benefit will prevent hospitalization.

SECTION 8. Said second paragraph of said section 24G of said chapter 111, as so appearing, is hereby further amended by striking out clauses (4) and (5) and inserting in place thereof the following five clauses:-

(4) annual and medically necessary eye examinations;

(5) medically necessary outpatient mental health services not to exceed 13 visits per year; provided, however, an additional seven outpatient visits may be approved by the department when clinically necessary according to program guidelines; provided further, that no such mental health services shall be provided by the department that would substitute for mental health services required to be provided by the division of medical assistance, or local education authorities pursuant to chapter 71B;

(6) dental health services, including preventive dental care; provided, however, that no funds shall be expended for cosmetic or surgical dentistry;

(7) durable medical equipment up to $200 per year; provided, however, the department may authorize up to $500 per year to prevent unnecessary hospitalization for children with chronic medical conditions, so-called, when clinically necessary according to program guidelines; and

(8) auditory screening.

SECTION 9. Said section 24G of said chapter 111, as so appearing, is hereby further amended by inserting after the word "households", in line 60, the following words:- ineligible for medical benefits pursuant to chapter 118E.

SECTION 10. Said section 24G of said chapter 111, as so appearing, is hereby further amended by striking out, in lines 74 and 75, the words "health care access fund established pursuant to section twenty-four F of chapter one hundred and eleven" and inserting in place thereof the following words:- Children's and Seniors' Health Care Assistance Fund, established by section 2FF of chapter 29.

SECTION 11. Said chapter 111 is hereby further amended by inserting after section 24G the following three sections:-

Section 24H. The department shall, subject to appropriation, establish a program of managed care within community health centers pursuant to regulations promulgated by the department; provided, however, that the department may transfer funds to the division of medical assistance to provide medical benefits pursuant to section 9A of chapter 118E equal to the cost of providing such benefits to persons eligible for said programs. Any revenues generated by said program shall be credited to the General Fund.

Section 24I. There is hereby established a universal immunization program. Said program shall be administered by the department, subject to appropriation. Any revenues generated by said program shall be credited to the General Fund.

Section 24J. There is hereby established a program of medical respite services provided by the Boston health care for the homeless program. Said program shall be administered by the department, subject to appropriation. Any revenues generated by said program shall be credited to the General Fund.

SECTION 12. Section 8 of chapter 118E of the General Laws, as appearing in the 1996 Official Edition, is hereby amended by adding the following definition:-

k. "Title XXI", Title XXI of the Social Security Act, 42 USC 1397 et seq. or any successor thereto.

SECTION 13. Subsection (2) of section 9A of said chapter 118E is hereby amended by striking out clause (b), as so appearing, and inserting in place thereof the following clause:-

(b) infants to age one and pregnant women whose financial eligibility as determined by the division does not exceed 200 per cent of the federal poverty level, and children and adolescents aged one to 18 years, inclusive, whose financial eligibility as determined by the division does not exceed 133 per cent of the federal poverty level and who would otherwise not qualify for Medicaid within the definition of traditional beneficiaries;.

SECTION 14. Said subsection (2) of said section 9A of said chapter 118E is hereby further amended by striking out clauses (c) and (d), as amended by section 88 of chapter 43 of the acts of 1997, and inserting in place thereof the following two clauses:-

(c) children and adolescents aged one to 18 years, inclusive, whose financial eligibility as determined by the division exceeds 133 per cent of the federal poverty level but is not more than 200 per cent of the federal poverty level, including such children and adolescents made eligible for medical benefits under this chapter by Title XXI of the Social Security Act.

(d) adults 19 to 64, inclusive, whose financial eligibility as determined by the division does not exceed 133 per cent of the federal poverty level and who otherwise would not qualify for Medicaid within the definition of traditional beneficiaries; provided, however, that said adults shall meet such other eligibility criteria that the division and the secretary may establish, including, but not limited to, the presence of dependent children in the household.

SECTION 15. Said section 9A of said chapter 118E, as appearing in the 1996 Official Edition, is hereby amended by striking out, in lines 111 and 112, inclusive, the words "to persons in eligibility category (b) with incomes in excess of one hundred and thirty-three percent of the federal poverty level" and inserting in place thereof the following words:- to persons who would otherwise qualify for a program of medical benefits pursuant to clause (c) of subsection 2.

SECTION 16. Said section 9A of said chapter 118E, as so appearing, is hereby further amended by striking out, in line 118, the word "employer-sponsored".

SECTION 17. Section 10 of said chapter 118E, as so appearing, is hereby amended by striking out, in lines 8 to 10, inclusive, the words "standards of eligibility established in section 1902 of the Social Security Act, as amended by section 4101 of the Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203)" and inserting in place thereof the following words:- the standards of eligibility established pursuant to section 9A, section 16C or Title XIX.

SECTION 18. Section 16B of said chapter 118E is hereby amended by striking out, in lines 12 and 83, as so appearing, in each instance, the word "maintenance".

SECTION 19. Said section 16B of said chapter 118E, as so appearing, is hereby amended by inserting after the word "herein", in line 29, the following words:- ; provided, however, that for the purposes of determining eligibility under this section, countable annual income shall not include the cost of Medicare Part B premiums unless the cost of said premiums is paid by the division.

SECTION 20. Said section 16B of said chapter 118E is hereby further amended by striking out the definition of "Pharmacy assistance", as so appearing, and inserting in place thereof the following definition:-

"Pharmacy assistance", an amount not exceeding $750 per fiscal year for each eligible person to assist in the purchase of covered benefits.

SECTION 21. Said section 16B of said chapter 118E is hereby amended by striking out the fifth paragraph, as amended by section 3 of chapter 1 of the acts of 1997, and inserting in place thereof the following two paragraphs:-

Application to said program shall be made during an open enrollment period as determined by the division. Coverage shall be effective as of the date an application for enrollment is approved by the division. The division shall close the open enrollment period if the commissioner determines that pharmacy assistance benefits in any fiscal year are projected to exceed the amounts appropriated for the program or are expected to annualize beyond the expenditure cap imposed by the section.

The division shall submit on a monthly basis to the house and senate committees on ways and means and the secretary of administration and finance a status report on program expenditures, caseloads, and average benefit levels. Said report shall detail expenditures on a date of service basis and shall include a projection of total annual expenditures under said program which shall be based, in part, on reported year to date expenditures.

SECTION 22. The ninth paragraph of said section 16B of said chapter 118E, as so appearing, is hereby amended by striking out the second sentence and inserting in place thereof the following sentence:- During the first year said program is in effect, income eligibility shall be limited to 150 per cent of the federal poverty level.

SECTION 23. Said ninth paragraph of said section 16B of said chapter 118E, as so appearing, is hereby further amended by striking out the fifth sentence and inserting in place thereof the following sentence:- In the event that pharmacy assistance payments in the first year of said program are projected to be substantially less than the amount appropriated therefor, and that said amount would not annualize in the second year to an amount that would exceed the expenditure cap imposed by this section, the division may for the second year said program is in effect, allow individuals with pharmaceutical expenses that are excessive in relation to income to spend-down to the income eligibility level then in effect.

SECTION 24. Said section 16B of said chapter 118E is hereby further amended by striking out, in line 118, as so appearing, the words "pursuant to clause (3)".

SECTION 25. Said section 16B of said chapter 118E is hereby further amended by inserting after the word "shall", in line 135, as so appearing, the following words:- close open enrollment.

SECTION 26. Said chapter 118E is hereby further amended by inserting after section 16B the following section:-

Section 16C. (1) There is hereby established the child health insurance program, which shall provide medical assistance or medical benefits to infants, children and adolescents to age 18, inclusive, whose financial eligibility as determined by the division does not exceed 200 per cent of the federal poverty level, pursuant to and in conformity with the provisions of Title XXI, the terms and conditions of the demonstration project authorized by section 9A of this chapter, or a combination thereof.

(2) Medical benefits under said program shall be available to all such infants, children and adolescents qualifying for enrollment in said program pursuant to clauses (b) and (c) of subsection (2) of said section 9A. To the extent authorized by federal law or by the terms and conditions of the demonstration project authorized pursuant to said section 9A, the division is hereby authorized to grant presumptive eligibility for up to 60 days to children and adolescents applying for enrollment in said program. The division may deny eligibility for medical benefits under said program pursuant to the provisions of subsection (3) of said section 9A.

(3) The amount, duration and scope of medical benefits provided under said program for eligible beneficiaries whose financial eligibility, as determined by the division exceeds 133 per cent of the federal poverty level but does not exceed 200 per cent of the federal poverty level, shall be established by the division; provided however, that medical benefits provided under said program shall be both consistent with the benefit levels required under the provisions of said Title XXI and comparable to the benefit levels offered under private insurance plans, shall include early and periodic screening, diagnostic and preventive services and shall include other medical services to the extent that such services are covered medical benefits under said plan.

(4) The costs of said program may be offset by copayments and deductibles to the extent permitted by Title XXI. Premiums shall not be imposed upon eligible beneficiaries by the division unless, (i) the governor submits legislation to the general court which specifies the amount of such premiums to be charged to a beneficiary and such legislation is enacted by the general court and (ii) such premiums are necessary to achieve the purpose of budget neutrality required by section 9B.

(5) Eligibility for and the medical benefits provided under said program shall not give rise nor be construed as giving rise to enforceable legal rights for any party or an enforceable entitlement to such eligibility or medical benefits other than to the extent that such rights or entitlements exist pursuant to the regulations of the division, the terms and conditions of the demonstration project established in said section 9A or this section. The provisions of this section shall not establish any rights or entitlements that exceed the rights or entitlements established by Title XIX in the absence of this program, or impose any obligations upon the commonwealth's administration or financing because of implementation of said program would exceed obligations established by Title XIX.

SECTION 27. Section 18 of chapter 118G of the General Laws, as amended by section 14 of chapter 47 of the acts of 1997, is hereby further amended by adding the following subsection:-

(o) Within the Uncompensated Care Trust Fund, there shall be established a medical assistance intergovernmental transfer account, administered by the commissioner of the division of medical assistance, consisting of any transfers to the commonwealth from publicly-operated entities providing Title XIX or Title XXI reimbursable services, and federal reimbursements related to medical assistance payments, so called, to publicly-operated entities. All amounts credited to this account shall be held in trust and shall be available for expenditure by the commissioner of the division of medical assistance to be used solely for medical assistance payments to entities designated and authorized by the general court, or which have contractually agreed to make intergovernmental transfers to said account; provided, however, that the amount of all such expenditures from said account shall be subject to annual approval by the general court. The maximum payments and transfers from said account shall not exceed those permissible for federal reimbursement under Title XIX or Title XXI of the Social Security Act or any successor federal statute. The comptroller may make payments in anticipation of receipts and shall establish procedures for reconciling overpayments or underpayments from said account to publicly-operated entities; provided, that said procedures shall include, but not be limited to, appropriate mechanisms for refunding intergovernmental transfers and federal reimbursements upon recoupment of any such overpayments. The division of medical assistance shall notify the division of health care finance and policy regarding revenue and expenditure activity within said account and submit to the secretary of administration and finance and the house and senate committees on ways and means a schedule of said payments ten days prior to any expenditures, and no funds shall be expended without an enforceable agreement with or legal obligation imposed upon the recipient public entity to make an intergovernmental transfer in an appropriate amount to said account.

SECTION 28. Subsection (e) of section 40 of chapter 121B of the General Laws, as appearing in the 1996 Official Edition, is hereby amended by inserting after the second sentence the following sentence:- For purposes of calculating the rent of elderly tenants in state-aided public housing, local housing authorities shall treat pharmacy costs reimbursed pursuant to section 16B of chapter 118E as deductible medical expenses.

SECTION 29. Item 4000-0842 of section 2 of chapter 43 of the acts of l997, inserted by section 73 of chapter 88 of the acts of l997, is hereby amended by striking out the figure "$206,256,201".

SECTION 30. Item 4000-0880 of said section 2 of said chapter 43 is hereby amended by striking out the words "clause (b) of subsection 2 of section 9A" and inserting in place thereof the words:- section 16C.

SECTION 31. Said item 4000-0880 of said section 2 of said chapter 43 is hereby further amended by striking out the words "provided further, that said division shall apply for an amendment to the MassHealth demonstration project waiver as required by section 26 of chapter 203 of the acts of 1996 no later than October 1, 1997;".

SECTION 32. Section 183 of said chapter 43 is hereby repealed.

SECTION 33. Section 20 of chapter 47 of the acts of 1997 is hereby amended by striking out the second paragraph and inserting in place thereof the following paragraph:-

To accommodate contractual obligations of surcharge payors, the division may by regulation delay the effective date of the surcharge percentage intended by this act to be implemented on October 1, 1997 in hospital fiscal year 1998 until January 1, 1998; provided, however that no such delay shall occur unless and until the following five conditions are met: (1) funds are appropriated from the General Fund or another fund and transferred to the uncompensated care pool in an amount equivalent to four months' projected revenues that, if said effective date had not been delayed, would otherwise be collected from the surcharge percentage authorized by said section 18A; (2) the amounts so made available and transferred are designated as a temporary start-up loan to accommodate the delay in the effective date of the surcharge percentage; (3) the amounts so made available and transferred are restricted to that portion of the pool's liability payments to acute hospitals and community health centers that otherwise would have been collected from surcharge payors during the months of October to December, 1997, inclusive, and in January 1998, if surcharge liability had accrued on payments made beginning in October, 1997; (4) the division establishes the surcharge percentage for hospital fiscal year 1998 at a level sufficient to generate $100,000,000 in revenues from the surcharge percentage between January 1, 1998 and September 30, 1998; (5) the division certifies to the comptroller that the amount so loaned to the uncompensated care pool shall be fully repaid to the General Fund or such other fund, without interest, not later than June 30, 1998, or such other date the comptroller deems permissible to close the books on state fiscal year 1998. The comptroller is hereby authorized and directed to effectuate the repayment of said loan. If the division allows the effective date of said surcharge percentage to be delayed pursuant to this paragraph, the division shall authorize by regulation that the surcharge percentage billed by acute hospitals and ambulatory surgical centers to surcharge payors on said January 1 and for the remainder of said hospital fiscal year shall be calculated to provide sufficient funds to fully repay said loan on a timely basis while maintaining payments to acute hospitals and community health centers for uncompensated care. In order to assure that sufficient revenues are available to repay said loan, the division may authorize hospitals and ambulatory surgical centers to bill estimated advance surcharge payments due in January and February 1998; provided, however, that such payments are credited against surcharge liability in months after the loan is repaid. If the division allows the effective date of said surcharge percentage to be delayed pursuant to this paragraph, the division may redetermine the surcharge percentage as of May 1, 1998 and as of July 1, 1998 if the division projects that the surcharge percentage established previously will produce less than $90,000,000 or more than $110,000,000, or if the adjustment is necessary in order to fully repay the General Fund or other fund, as required by condition (5) of this section.

SECTION 34. Said chapter 47 is hereby further amended by striking out section 33 and inserting in place thereof the following section:-

Section 33. Notwithstanding the provisions of any special or general law to the contrary, no funds shall be expended by the division of medical assistance on the MassHealth insurance reimbursement program established by section 9C of chapter 118E of the General Laws unless the commissioner of medical assistance has certified to the committee on health care and the house and senate committees on ways and means that the division has requested federal approval under the terms of the MassHealth demonstration project to implement clause (c) of subsection (2) of section 9A of said chapter 118E with respect to providing medical benefits to children and adolescents through age 18, inclusive, whose financial eligibility does not exceed 200 per cent of the federal poverty level or has requested federal approval pursuant to Title XXI of the Social Security Act to provide medical benefits to children and adolescents through age 18 whose financial eligibility does not exceed 200 per cent of the federal poverty level.

SECTION 35. Said chapter 47 is hereby further amended by striking out section 34 and inserting in place thereof the following section:-

Section 34. The division of medical assistance shall not implement any plan pursuant to section 9C of chapter ll8E of the General Laws, inserted by section l0 of this act, before an appropriation is made available for the initial start-up and operation of said plan.

SECTION 36. Section 92 of chapter 88 of the acts of 1997 is hereby amended by striking out the second sentence and inserting in place thereof the following sentence:- Said transfer is hereby deemed a temporary start-up loan to the uncompensated care pool; provided, however, that the loan authorized herein shall be repaid to the General Fund on or before June 30, l998, or such other date the comptroller deems permissible to close the books on state fiscal year 1998.

SECTION 37. Notwithstanding the provisions of any general or special law to the contrary, the division of health care finance and policy, in collaboration with the division of insurance and division of medical assistance, is hereby authorized and directed to study the impact of changes in the Medicare Program contained in the Balanced Budget Act of 1997 as it affects Massachusetts health care providers and Medicare beneficiaries. The division shall file its report with the joint committee on health care and the house and senate committees on ways and means no later than May 1, 1998 on the following issues: (1) the impact on hospitals of reduced Medicare payments; (2) the impact on home health agencies and nursing homes of prospective payment systems; (3) the impact on beneficiaries of expanded coverage options; (4) the estimated impact on the Medicaid program of cost-shifting as a result of said changes.

SECTION 38. Notwithstanding the provisions of any of general or special law to the contrary, implementation of the program of health care assistance provided to children and adolescents with family incomes between 134 per cent and 200 per cent of the federal poverty level pursuant to the provisions of section 16C of chapter 118E of the General Laws shall be contingent upon a finding of budget neutrality by the commissioner of the division of medical assistance. Thirty days prior to implementing said program of health care assistance, the commissioner shall file with the secretary of administration and finance and the house and senate committees on ways and means a report certifying that revenues credited and other amounts transferred to the Children's and Seniors' Health Care Assistance Fund shall be sufficient by themselves to meet projected expenditures for expansion beneficiaries as defined in subsection 2 of section 9A of chapter 118E of the General Laws for the fiscal years 1998 through 2002 without requiring additional amounts to be appropriated or transferred from the General Fund or any other fiscal resource of the commonwealth. Said report shall be developed pursuant to the provisions of section 9B of chapter 118E of the General Laws.

SECTION 39. On or before April 1, 1998, the division of health care finance and policy shall file with the clerks of the house and senate the findings and conclusions of an independent study reviewing the available information on the efficacy of various approaches to increasing access to health insurance for the working uninsured below 200 per cent of the federal poverty level. The division shall convene an advisory board to consult on the preparation of said study. Said advisory body shall include, but not be limited to, Massachusetts Medical Society, Massachusetts Hospital Association, Health Care For All, Massachusetts Law Reform Institute, Massachusetts Association of Health Maintenance Organizations, Blue Cross and Blue Shield of Massachusetts and organizations representing chambers of commerce throughout the commonwealth. Said study shall compare and evaluate various alternative approaches for improving such access, including the program established by section 9C of chapter 118E of the General Laws, the MinnnesotaCare program, and such other proposals as may be considered. Said evaluation shall estimate the cost and benefits of each approach, and estimate the participation rate among the currently insured and uninsured and impact of such a program on the rate of employer-provider health insurance.

SECTION 40. Notwithstanding the provisions of any of general or special law to the contrary, the division of medical assistance is hereby authorized and directed to file with the house and senate committees on ways and means and the secretary of administration and finance a detailed operating plan for implementation of the insurance reimbursement program established pursuant to section 9C of chapter 118E of the General Laws. Said operating plan shall include, but shall not be limited to, a description of the following: (i) responsibilities and functional duties of agencies charged with administering said program; (ii) processes for determining eligibility of employers and employees participating in said program; (iii) the frequency of and mechanisms for making subsidy payments to or on behalf of employers and employees; (iv) the timing and method for accessing funds in the uncompensated care pool for the payment of such subsidies; (v) methods for allocating expenditures from and crediting revenues to appropriate state funding sources; and (vi) methods for distinguishing individuals participating in said program from individuals participating in buy-in programs, so-called, authorized by section 9A or section 16C of chapter 118E of the General Laws. Said operating plan shall be filed with the executive office of administration and finance and the house and senate committees on ways and means no later than February 1, 1998. No expenditures on benefits payable under said program shall be made until an appropriation has been made therefor and said secretary certifies viability of said implementation plan to said committees.

SECTION 41. Notwithstanding the provisions of any general or special law to the contrary, the division of medical assistance and the department of public health are hereby authorized and directed to develop a single application form for the purpose of determining eligibility for the child health programs established pursuant sections 9, 9A, and 16C of chapter 118E of the General Laws and section 24G of chapter 111 of the General Laws. Said single application form shall be used by said division, said department and vendors providing enrollment services no later than February 1, 1998.

SECTION 42. Notwithstanding the provisions of any of general or special law to the contrary, there is hereby established a special commission for the purpose of making an investigation and study of oral health status, effective community prevention programs, and access to dental care services for residents of the commonwealth. Said commission shall consist of the commissioner of public health or his designee, who shall serve as chairman, the commissioner of medical assistance or his designee, two members of the house of representatives to be named by the speaker, two members of the senate to be named by the president of the senate, and 16 members to be appointed by the governor, two of whom shall be representatives of the Massachusetts Dental Society, one of whom shall be a representative of the Massachusetts Dental Hygienist Association, one of whom shall be a representative of the Massachusetts Dental Assistants Association, one of whom shall be a representative of Health Care for All, one of whom shall be a representative of a community health center that provides dental health services, one of whom shall be a representative of the Boston Department of Public Health, one of whom shall be a representative of a company that provides dental insurance benefits, one of whom shall be a dean or faculty member of a school of dentistry, one of whom shall be a representative of the Massachusetts Public Health Association, one of whom shall be a representative of the Massachusetts Academy of Pediatric Dentistry, one of whom shall be a representative of a hospital that provides dental services to children, one of whom shall be a representative of the AIDS Action Committee, one of whom shall be a member of the Massachusetts Association of Orthodontists, one of whom shall be a member of the Massachusetts Association of Oral Surgeons and one of who shall be a dental practitioner with a substantial percentage of nursing home and geriatric patients.

Said commission shall investigate the current status of oral health and care for high risk populations and low income and other residents of the commonwealth and barriers to access for such residents. Said commission shall in particular review options for increasing the provision of dental services to children receiving medical assistance in light of the report by the federal Department of Health and Human Services Inspector General which found that only 34 per cent of eligible children in Massachusetts receive preventive dental services. Said commission shall also examine oral health status and dental care access issues affecting cultural and linguistic minorities and other high risk populations, improving dental care provider enrollment in programs of medical assistance, public dental health prevention and promotion programs, and such other matters as the commission shall determine.

Said commission report the results of its investigation and study, together with its recommendations, if any, by filing the same with the house and senate committees on ways and means, the committee on health care, the clerk of the house of representatives, and the clerk of the senate on or before January 1, 1999.

SECTION 43. The division of medical assistance shall conduct a study and report to the general court on or before March 1, 1998 on its initiatives to ensure that the special medical and clinical needs of disabled or chronically ill children are met as such children are enrolled in the Medicaid managed care program under the demonstration waiver program. As part of such report, said division shall define this population, taking into consideration the federal definition in 19 USC 1932 (a) (2) (a), as created in the Balanced Budget Act of 1997. Such definition includes children who (i) meet the eligibility requirements of supplemental security income on account of disability under the provisions of title XVI of the Social Security Act; (ii) are eligible for early intervention and special needs programs under the Massachusetts Title V Maternal and Child Health Block Grant; or (iii) are eligible under the Kalleigh Mulligan program under the provisions of section 1902 (e) (3) of the Social Security Act. Said division shall also report on its efforts to develop standards for care, coordination of services and appropriate capitation rates and risks adjustment for children with special health care needs in addition to outlining its plans for monitoring services and collecting data on the utilization of services and diagnoses of such population of children.

SECTION 44. Notwithstanding the provisions of section 1 of this act or any provision of general or special law to the contrary, all provisions of section 24F of chapter 111 of the General Laws shall remain in effect until June 30, 1998.

SECTION 45. The provisions of sections 27, 29 and 35 shall take effect as of July 1, 1997.

SECTION 46. The provisions of sections 3, 4, 5, 6, 9, 10, and 11 shall take effect as of July 1, 1998.

Approved November 26, 1997.