Massachusetts Chapter 118E — Division of Medical Assistance

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Mass. Gen. Laws ch. 118E, § 1— Duties of office
Mass. Gen. Laws ch. 118E, § 2— Established authority
Mass. Gen. Laws ch. 118E, § 2A— Director of dental services
Mass. Gen. Laws ch. 118E, § 6— Medical care advisory committee; member; staff; report from office of Medicaid
Mass. Gen. Laws ch. 118E, § 7— Powers
Mass. Gen. Laws ch. 118E, § 8— Definitions
Mass. Gen. Laws ch. 118E, § 8A— Definitions for Secs. 13C to 13K and Secs. 64 to 70
Mass. Gen. Laws ch. 118E, § 9— Eligibility
Mass. Gen. Laws ch. 118E, § 9A— MassHealth; beneficiaries; eligibility; payment; information applications
Mass. Gen. Laws ch. 118E, § 9B— Repealed, 2013, 35, Sec. 25
Mass. Gen. Laws ch. 118E, § 9C— Medical insurance reimbursement programs; definitions; eligibility; expenditures; submission of plans
Mass. Gen. Laws ch. 118E, § 9D— Senior care options initiative; senior care organizations; enrollment choices; advisory committee; report
Mass. Gen. Laws ch. 118E, § 9E— Application for authority; implementation of measures; waiver of measures due to hardship
Mass. Gen. Laws ch. 118E, § 9F— Duals demonstration; review of request for financial solvency
Mass. Gen. Laws ch. 118E, § 10— Medical care assistance program for pregnant women and infants
Mass. Gen. Laws ch. 118E, § 10A— Required coverage for abortion, abortion-related care, prenatal care, childbirth and postpartum care
Mass. Gen. Laws ch. 118E, § 10B— Required coverage for newborn hearing screening tests
Mass. Gen. Laws ch. 118E, § 10C— Required coverage for items medically necessary for the diagnosis or treatment of diabetes
Mass. Gen. Laws ch. 118E, § 10D— Required coverage for treatment of breast and cervical cancer
Mass. Gen. Laws ch. 118E, § 10E— Healthy start program; medical assistance for pregnant women and infants; eligibility; types of assistance; protection from billing and collection practices
Mass. Gen. Laws ch. 118E, § 10F— Health care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement
Mass. Gen. Laws ch. 118E, § 10G— Coverage for children under age 18 for cleft lip and cleft palate
Mass. Gen. Laws ch. 118E, § 10H— Coverage for medically necessary treatments for persons younger than 21 years old diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist
Mass. Gen. Laws ch. 118E, § 10H.5— Coverage for treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services
Mass. Gen. Laws ch. 118E, § 10I— Coverage for administration of all federal Food and Drug Administration approved drugs for opioid or alcohol dependence treatment
Mass. Gen. Laws ch. 118E, § 10J— Coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome
Mass. Gen. Laws ch. 118E, § 10K— Coverage for certain services and contraceptive methods
Mass. Gen. Laws ch. 118E, § 10L— Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity
Mass. Gen. Laws ch. 118E, § 10M— Coverage for tobacco use cessation counseling and products
Mass. Gen. Laws ch. 118E, § 10N— Urgent care facilities; referrals; primary care providers
Mass. Gen. Laws ch. 118E, § 10O— Coverage for mental health acute treatment, community-based acute treatment and intensive community-based acute treatment
Mass. Gen. Laws ch. 118E, § 10P— Coverage for mental health or substance use disorder services delivered through psychiatric collaborative care model
Mass. Gen. Laws ch. 118E, § 10Q— Coverage for annual mental health wellness examination
Mass. Gen. Laws ch. 118E, § 10R— Coverage for noninvasive prenatal screening
Mass. Gen. Laws ch. 118E, § 10S— Coverage for postpartum depression and major depressive disorder screenings conducted pursuant to section 247 of chapter 111
Mass. Gen. Laws ch. 118E, § 10T— Coverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products
Mass. Gen. Laws ch. 118E, § 10U— Coverage of doula services
Mass. Gen. Laws ch. 118E, § 10V— Coverage for universal postpartum home visiting services
Mass. Gen. Laws ch. 118E, § 10W— Coverage for diagnostic examinations for breast cancer screening; digital breast tomosynthesis screening, MRIs and ultrasounds
Mass. Gen. Laws ch. 118E, § 10X— Coverage for prescribed, ordered or dispensed opioid antagonists
Mass. Gen. Laws ch. 118E, § 10Y— Coverage for the provision of services by a recovery coach
Mass. Gen. Laws ch. 118E, § 10Z— Coverage for identified generic and brand name drug used to treat diabetes, asthma, and certain heart conditions
Mass. Gen. Laws ch. 118E, § 11— Cooperation with federal authorities
Mass. Gen. Laws ch. 118E, § 12— Policies; procedures; rules and regulations; contracts
Mass. Gen. Laws ch. 118E, § 12A— Pharmaceutical drugs; negotiation of supplemental rebate agreements
Mass. Gen. Laws ch. 118E, § 13— Rate changes; review
Mass. Gen. Laws ch. 118E, § 13A— Non-acute hospitals; rates and terms of payment
Mass. Gen. Laws ch. 118E, § 13B— Hospital rate increases; quality standards and benchmarks
Mass. Gen. Laws ch. 118E, § 13C— Establishment of rates of payment for health care services
Mass. Gen. Laws ch. 118E, § 13D— Duties of ratemaking authority; criteria for establishing rates
Mass. Gen. Laws ch. 118E, § 13E— Appeals of interim or final rates
Mass. Gen. Laws ch. 118E, § 13F— Contracts between acute and non-acute hospital service providers and office of Medicaid
Mass. Gen. Laws ch. 118E, § 13G— Hospital assets not to be considered as resources for purpose of establishing rates
Mass. Gen. Laws ch. 118E, § 13H— Recipients of benefits under chapter 117A
Mass. Gen. Laws ch. 118E, § 13I— Patients with foreign residency
Mass. Gen. Laws ch. 118E, § 13J— Health maintenance organizations; contracting rights
Mass. Gen. Laws ch. 118E, § 13K— Adjustment of facility's rate
Mass. Gen. Laws ch. 118E, § 13L— Restriction of hospital access to discounted purchase of prescription drugs
Mass. Gen. Laws ch. 118E, § 14— Nursing home negotiated rate contracts
Mass. Gen. Laws ch. 118E, § 14A— Reimbursement to nursing homes for admissions to acute care and chronic disease or rehabilitation hospitals
Mass. Gen. Laws ch. 118E, § 15— Medicaid benefits; rules and regulations; managed care; personal expenses
Mass. Gen. Laws ch. 118E, § 16— Primary and supplemental medical care and assistance program for residents with disabilities; assistance program for chronically ill persons or persons with disabilities forced to leave employment or substantially reduce work hours
Mass. Gen. Laws ch. 118E, § 16A— Medical care and assistance program for children with disabilities
Mass. Gen. Laws ch. 118E, § 16B— Repealed, 1996, 203, Sec. 16
Mass. Gen. Laws ch. 118E, § 16C— Child health insurance program; medical benefits; eligibility
Mass. Gen. Laws ch. 118E, § 16D— Aliens or persons residing in United States under color of law; benefits
Mass. Gen. Laws ch. 118E, § 17— Reimbursements for non-generic drugs
Mass. Gen. Laws ch. 118E, § 17A— Emergency services provided to beneficiaries for emergency medical conditions
Mass. Gen. Laws ch. 118E, § 18— Medical insurance purchases for persons eligible for assistance
Mass. Gen. Laws ch. 118E, § 19— Prior approval of medical services; methods; rules and regulations; posttreatment examinations
Mass. Gen. Laws ch. 118E, § 20— Application; forms; application by institution
Mass. Gen. Laws ch. 118E, § 21— Inquiry by department; notification of applicant; agreement
Mass. Gen. Laws ch. 118E, § 21A— Medical assistance eligibility of an institutionalized spouse
Mass. Gen. Laws ch. 118E, § 22— Third party payments; repayment; assignment; subrogation
Mass. Gen. Laws ch. 118E, § 23— Subrogation rights; health insurance benefits; garnishment of wages
Mass. Gen. Laws ch. 118E, § 23A— Financial institutions; request for deposit and withdrawal records; penalty
Mass. Gen. Laws ch. 118E, § 24— Repealed, 1996, 450, Sec. 157
Mass. Gen. Laws ch. 118E, § 25— Exempt income and resources
Mass. Gen. Laws ch. 118E, § 25A— Determination of eligibility for Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual programs; consideration of certain income or assets
Mass. Gen. Laws ch. 118E, § 26— Identification card
Mass. Gen. Laws ch. 118E, § 27— Redetermination of eligibility
Mass. Gen. Laws ch. 118E, § 28— Disposal of resources at less than fair market value; period of ineligibility; transfers for sole benefit of individual age 65 or older
Mass. Gen. Laws ch. 118E, § 29— Transfer of interest in real property; notice
Mass. Gen. Laws ch. 118E, § 30— Time of payment
Mass. Gen. Laws ch. 118E, § 31— Adjustment or recovery of payments
Mass. Gen. Laws ch. 118E, § 32— Provision of death certificate and probate petition to division; liability of estate beneficiaries; claims against estate; sale or transfer of property subject to lien or claim
Mass. Gen. Laws ch. 118E, § 32A— Repealed, 2005, 6, Sec. 14
Mass. Gen. Laws ch. 118E, § 33— Long term care insurance purchasers; liability for medical assistance paid
Mass. Gen. Laws ch. 118E, § 34— Liens and encumbrances
Mass. Gen. Laws ch. 118E, § 35— Reimbursement for covered claims; submission of information
Mass. Gen. Laws ch. 118E, § 36— Eligible providers; responsibility for overpayments
Mass. Gen. Laws ch. 118E, § 37— Distribution of rules, regulations to providers; administrative sanctions
Mass. Gen. Laws ch. 118E, § 38— Submission of bills by providers; appeals for erroneous denials; overpayments; civil collection actions
Mass. Gen. Laws ch. 118E, § 38A— Retroactive claims denials for behavioral health services
Mass. Gen. Laws ch. 118E, § 39— False representations, failure to disclose; penalty
Mass. Gen. Laws ch. 118E, § 40— False statements or representations by providers; penalty
Mass. Gen. Laws ch. 118E, § 41— Bribery or rebates; penalty
Mass. Gen. Laws ch. 118E, § 41A— Repealed, 2001, 177, Sec. 27
Mass. Gen. Laws ch. 118E, § 42— Excess charges; penalty
Mass. Gen. Laws ch. 118E, § 43— Health care facilities; additional charges as precondition for admission or continuance; penalty
Mass. Gen. Laws ch. 118E, § 44— Civil remedies; limitations
Mass. Gen. Laws ch. 118E, § 45— Venue; actions relating to false claims
Mass. Gen. Laws ch. 118E, § 46— Availability of other remedies
Mass. Gen. Laws ch. 118E, § 46A— Providers; submission of claims for payment not in compliance with policies and procedures of medical assistance program; proof of clerical or administrative error
Mass. Gen. Laws ch. 118E, § 47— Persons aggrieved; written notification of denial of requested benefits or services; right to hearing; investigation; decision; rehearing; notice
Mass. Gen. Laws ch. 118E, § 47A— Benefits available only to otherwise eligible individuals showing lawful presence in the United States or meeting applicable federal requirements necessary to qualify for benefits for which the commonwealth receives federal reimbursement
Mass. Gen. Laws ch. 118E, § 48— Board of hearings
Mass. Gen. Laws ch. 118E, § 49— Use and disclosure of information
Mass. Gen. Laws ch. 118E, § 50— Contract for administrative functions; underwriting of program
Mass. Gen. Laws ch. 118E, § 51— Utilization review of care and services; data processing and collection procedures; liability in civil actions
Mass. Gen. Laws ch. 118E, § 51A— Step therapy protocol clinical review criteria; prescription coverage
Mass. Gen. Laws ch. 118E, § 52— Maintenance of standards for providers; development of new programs
Mass. Gen. Laws ch. 118E, § 53— Covered services
Mass. Gen. Laws ch. 118E, § 54— Wellness program for MassHealth enrollees
Mass. Gen. Laws ch. 118E, § 55— Repealed, 2008, 451, Sec. 75
Mass. Gen. Laws ch. 118E, § 56— Controlled substance management program for MassHealth enrollees
Mass. Gen. Laws ch. 118E, § 61— Availability of benefits to persons recognized as a spouse under laws of the commonwealth
Mass. Gen. Laws ch. 118E, § 62— Acceptance and recognition of information submitted pursuant to coding standards and guidelines required; use of standardized claim formats
Mass. Gen. Laws ch. 118E, § 63— Assessment per non–Medicare reimbursed patient day
Mass. Gen. Laws ch. 118E, § 64— Definitions for Secs. 64 through 69
Mass. Gen. Laws ch. 118E, § 65— Health safety net office
Mass. Gen. Laws ch. 118E, § 66— Health Safety Net Trust Fund
Mass. Gen. Laws ch. 118E, § 67— Liability of acute hospital to fund
Mass. Gen. Laws ch. 118E, § 67A— Nonpublic ambulance services; liability; uniform assessment; enforcement
Mass. Gen. Laws ch. 118E, § 68— Managed care organization services assessment; calculation of liability; payment to health safety net trust fund
Mass. Gen. Laws ch. 118E, § 69— Reimbursements to hospitals and community health centers for health services provided to uninsured and underinsured individuals
Mass. Gen. Laws ch. 118E, § 69A— Repealed, 2024, 140, Sec. 131
Mass. Gen. Laws ch. 118E, § 70— Definitions for Secs. 70 through 75
Mass. Gen. Laws ch. 118E, § 71— PCA quality home care workforce council
Mass. Gen. Laws ch. 118E, § 72— Duties of workforce council; PCA recruitment, training and referral resources; lists of PCAs
Mass. Gen. Laws ch. 118E, § 73— Rights of consumers regarding PCAs; public employee status for limited purposes; collective bargaining
Mass. Gen. Laws ch. 118E, § 74— PCA quality home care workforce council; scope of power and authority
Mass. Gen. Laws ch. 118E, § 75— Performance reviews
Mass. Gen. Laws ch. 118E, § 76— Designation of another governmental unit to perform functions set forth in Secs. 13C through 13K and 64 through 75
Mass. Gen. Laws ch. 118E, § 77— Office of Medicaid to attribute members to primary care providers
Mass. Gen. Laws ch. 118E, § 78— Employer healthcare coverage form
Mass. Gen. Laws ch. 118E, § 79— Coverage for health care services delivered via telehealth by a contracted health care provider; right in in-person services; copayment or coinsurance; rate of payment; standards of care
Mass. Gen. Laws ch. 118E, § 80— Sickle cell disease; executive office review; content of report
Mass. Gen. Laws ch. 118E, § 81— Mental health and substance use disorder benefits; benefits for children and adolescents under the age of 19 for the diagnosis and treatment of mental, behavioral, emotional or substance use disorders substantially interfering with or limiting the functioning and social interactions of such child or adolescent; consent to disclosure of information
Mass. Gen. Laws ch. 118E, § 82— Requirement that division meets parity requirements described under federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and related guidance or regulations
Mass. Gen. Laws ch. 118E, § 83— Dispensing of OTC oral contraceptive to MassHealth member or HSN patient by licensed pharmacist
Mass. Gen. Laws ch. 118E, § 84— Dispensing of a prenatal vitamin to MassHealth member or HSN patient by licensed pharmacist
Mass. Gen. Laws ch. 118E, § 85— Establishment of Medicaid rates for licensed skilled nursing facilities
Mass. Gen. Laws ch. 118E, § 86— Skilled nursing facility rate add–on programs; bariatric care; 1–on–1 staffing of at-risk residents
Mass. Gen. Laws ch. 118E, § 87— Payment to state agencies for claims related to Medicaid