Chapter 118E - DIVISION OF MEDICAL ASSISTANCE

Section 118E:1 - Division of medical assistance; administration of program
Section 118E:2 - Commissioner of medical assistance; appointment; qualifications; salary
Section 118E:2A - Director of dental services
Section 118E:3 through 118E:5 - [Repealed]
Section 118E:6 - Medical care advisory committee; members; staff
Section 118E:7 - Powers
Section 118E:8 - Definitions
Section 118E:8A - Definitions for secs. 13C to 13K and 64 to 70
Section 118E:9 - Medicaid; eligibility
Section 118E:9A - MassHealth; beneficiaries; eligibility; payment; information applications
Section 118E:9B - [Repealed]
Section 118E:9C - Insurance reimbursement; employee subsidy program; subsidy program for self-employed persons; employer health care incentive program; amount of payments; eligibility
Section 118E:9D - Senior care options initiative; senior care organizations; enrollment choices; advisory committee; report
Section 118E:9E - Application for authority; implementation of measures; waiver of measures due to hardship
Section 118E:9F - [See also Version 2] Duals demonstration; review of request for financial solvency
Section 118E:9F - [See also Version 1] Independent community care coordinator
Section 118E:10 - Medical care and assistance for pregnant women and infants
Section 118E:10A - [Effective Until 11/21/2024] Required coverage for prenatal care, childbirth and postpartum care
Section 118E:10A - [Effective 11/21/2024] Required coverage for prenatal care, childbirth and postpartum care
Section 118E:10A 1/2 - Continuation of MassHealth standard coverage for certain pregnant or postpartum residents
Section 118E:10B - Required coverage for newborn hearing screening tests
Section 118E:10C - Required coverage for items medically necessary for the diagnosis or treatment of diabetes
Section 118E:10D - Required coverage for treatment of breast and cervical cancer
Section 118E:10E - Healthy start program; medical assistance for pregnant women and infants; eligibility; types of assistance; protection from billing and collection practices
Section 118E:10F - [Effective Until the earlier of: (i) the receipt of all necessary federal approvals, including state plan and 1115 demonstration amendments; or (ii) January 1, 2025] Health care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement
Section 118E:10F - [Effective the earlier of: (i) the receipt of all necessary federal approvals, including state plan and 1115 demonstration amendments; or (ii) January 1, 2025] Health care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement
Section 118E:10G - Coverage for treating cleft lip and cleft palate for children under age 18
Section 118E:10H - [Multiple Versions] Coverage of medically necessary treatment for persons younger than 21 diagnosed with an autism spectrum disorder
Section 118E:10H - [Multiple Versions] Coverage of medically necessary acute treatment services and clinical stabilization services
Section 118E:10I - Coverage for administration of federal FDA approved drugs for treatment of opioid or alcohol dependence
Section 118E:10J - Coverage for treatment for HIV associated with lipodystrophy syndrome
Section 118E:10K - Coverage provided by division
Section 118E:10L - Prescriptions filled in a lesser quantity pursuant to sec. 18 of chapter 94C not subject to additional payment or obligation
Section 118E:10M - Coverage for tobacco use cessation counseling and products
Section 118E:10N - Enrollees not required to obtain referral from primary care provider prior to obtaining health care services from urgent care facility
Section 118E:10O - Coverage of costs of medically necessary mental health acute treatment, etc.
Section 118E:10P - Coverage for mental health or substance use disorder services that are delivered through psychiatric collaborative care model
Section 118E:10Q - Coverage for an annual mental health wellness examination performed by licensed mental health professional or primary care provider
Section 118E:10R - [Effective 11/21/2024] Coverage for noninvasive prenatal screening
Section 118E:10S - [Effective 11/21/2024] Coverage for postpartum depression screenings
Section 118E:10T - [Effective 11/21/2024] Coverage for donor human milk
Section 118E:10U - [Effective 11/21/2024] Coverage for doula services
Section 118E:10V - [Effective 11/21/2024] Coverage for universal postpartum home visiting services
Section 118E:10W - [Effective 2/11/2025] Coverage for diagnostic examinations for breast cancer, digital breast tomosynthesis screening and medically necessary and appropriate screening with breast magnetic resonance imaging or screening breast ultrasound
Section 118E:11 - Federal funding
Section 118E:12 - Policies; procedures; rules and regulations; contracts
Section 118E:12A - Negotiation of supplemental rebate agreements with manufacturers
Section 118E:13 - Rate changes; approval; review
Section 118E:13A - Non-acute hospitals; rates and terms of payment
Section 118E:13B - Hospital rate increases; quality standards
Section 118E:13C - Establishment of rates of payment for health care services and social service programs
Section 118E:13D - Duties of ratemaking authority; determination of rates to be paid by governmental units to health care services providers
Section 118E:13D 1/2 - Review of minimum payment rates to providers
Section 118E:13E - Grievances; appeals of interim or final rates
Section 118E:13E 1/2 - Contractual arrangements with acute and non-acute hospitals
Section 118E:13F - Rates of payment to acute and non-acute hospitals to be established by contract
Section 118E:13G - Hospital assets not to be considered in setting rates
Section 118E:13H - Denial of access to care prohibited
Section 118E:13I - Costs and charges for patients with foreign residency
Section 118E:13J - Health maintenance organization's right to negotiate with hospital
Section 118E:13K - Adjustment of rates
Section 118E:13L - Restriction or limitation of eligible hospital's access to discounted purchase of prescription drugs
Section 118E:14 - Nursing home negotiated rate contracts
Section 118E:14A - Hospital care for nursing home residents; reimbursement for absence from nursing home
Section 118E:15 - Medicaid benefits; rules and regulations; managed care; personal expenses
Section 118E:16 - Disabled persons ineligible for Social Security Medical benefits; persons unemployed due to illness or disability
Section 118E:16A - Medical care and assistance for disabled children
Section 118E:16A 1/2 - Costs incurred for" medical programs projected to exceed available appropriations; notice
Section 118E:16B - [Repealed]
Section 118E:16C - [Effective Until the earlier of: (i) the receipt of all necessary federal approvals, including state plan and 1115 demonstration amendments; or (ii) January 1, 2025] Child health insurance program; medical benefits; costs; eligibility
Section 118E:16C - [Effective the earlier of: (i) the receipt of all necessary federal approvals, including state plan and 1115 demonstration amendments; or (ii) January 1, 2025] Child health insurance program; medical benefits; costs; eligibility
Section 118E:16D - Aliens or persons residing in United States under color of law; benefits
Section 118E:17 - Multiple source drugs; reimbursement
Section 118E:17A - Emergency services provided to beneficiaries for emergency medical conditions
Section 118E:18 - Purchase of medical insurance for persons eligible for assistance
Section 118E:19 - Approval of services
Section 118E:20 - Application or reapplication; forms
Section 118E:21 - Eligibility determination; time; notice to applicant
Section 118E:21A - Eligibility of institutionalized spouse; notice
Section 118E:22 - Third party payments; repayment; assignment; subrogation
Section 118E:23 - Subrogation rights; health insurance benefits; notice of benefits received; garnishment of wages
Section 118E:23A - Disclosure of financial information; penalty
Section 118E:25 - Eligibility for benefits; exemptions; recipient cost sharing
Section 118E:25A - Determination of eligibility for Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual programs
Section 118E:26 - Identification cards
Section 118E:27 - Reconsideration or redetermination of eligibility
Section 118E:28 - [Effective Until 12/5/2024] Assignment or transfer of property at less than fair market value
Section 118E:28 - [Effective 12/5/2024] Assignment or transfer of property at less than fair market value; transfer of assets to trust
Section 118E:29 - Notice of property transfers
Section 118E:30 - Date of application; benefits paid for three months prior to application date
Section 118E:31 - [Effective Until 12/5/2024] Recovery of benefits from decedent's estate; contribution from relatives; sale of property
Section 118E:31 - [Effective 12/5/2024] Recovery of benefits from decedent's estate; contribution from relatives; sale of property
Section 118E:32 - Provision of death certificate and probate petition to division; liability of estate beneficiaries; claims against estate
Section 118E:32A - [Repealed]
Section 118E:33 - Long-term care insurance; claims by division under Sec. 118E:31 or 118E:32
Section 118E:34 - Liens or encumbrances; recording fee
Section 118E:35 - Unauthorized claims; certification of services reimbursed under Title XVIII of the Social Security Act
Section 118E:36 - Eligible providers; responsibility for overpayments
Section 118E:37 - Distribution of rules and regulations to providers; administrative sanctions
Section 118E:38 - Submission of bills; verification; appeal procedures; notice and determination of overpayment; salaried hospital employees
Section 118E:38A - Retroactive claims denial for behavioral health services
Section 118E:39 - False representations; penalties
Section 118E:40 - False statements or representations; providers; penalties; violations by non-providers
Section 118E:41 - Bribes or rebates in exchange for purchase of goods or services; discounts properly disclosed
Section 118E:42 - Excessive charges; penalties
Section 118E:43 - Consideration as precondition or guarantee of admission to hospital or nursing facility; penalties
Section 118E:44 - Civil damages; statute of limitations
Section 118E:45 - Filing in Suffolk County
Section 118E:46 - Available remedies
Section 118E:46A - Violations by vendors; ineligibility to participate
Section 118E:47 - Applicant grievances; time for appeal; hearing; rehearing
Section 118E:47A - Qualifications for benefits
Section 118E:48 - Board of hearings
Section 118E:49 - Disclosure of applicant information
Section 118E:50 - Administrative functions; contracts with federal agencies
Section 118E:51 - Utilization review; data processing and collection procedures
Section 118E:51A - Step therapy; clinical review criteria
Section 118E:52 - Standards and conditions of participation; providers; coordination of services
Section 118E:53 - Covered services
Section 118E:54 - Wellness program for Masshealth enrollees
Section 118E:55 - [Repealed]
Section 118E:56 - Controlled substance management program
Section 118E:57 through 118E:60 - [Sections did not take effect. See note.]
Section 118E:61 - Recognition of spouses of the same sex
Section 118E:62 - Acceptance and recognition of patient information; standardized claim formats
Section 118E:63 - Assessments to be paid per non-Medicare reimbursed patient days
Section 118E:64 - [Effective Until the later of (i) one full calendar month following the calendar month in which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2024] Definitions for secs. 64 to 69
Section 118E:64 - [Effective the later of (i) one full calendar month following the calendar month in which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2024] Definitions for secs. 64 to 69
Section 118E:65 - Health safety net office
Section 118E:66 - Health Safety Net Trust Fund
Section 118E:67 - [Effective Until 10/1/2027] Acute hospital's liability to fund
Section 118E:67 - [Effective 10/1/2027] Acute hospital's liability to fund
Section 118E:67A - Nonpublic ambulance services; liability; uniform assessment; enforcement
Section 118E:68 - [Effective Until the later of (i) one full calendar month following the calendar month in which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) January 1, 2025] Acute hospitals' and ambulatory surgical centers' assessment of surcharge
Section 118E:68 - [Effective the later of (i) one full calendar month following the calendar month in which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) January 1, 2025] Acute hospitals' and ambulatory surgical centers' assessment of surcharge
Section 118E:69 - Reimbursements from fund to hospitals and community health centers for health services provided to uninsured and underinsured individuals
Section 118E:69A - [Repealed]
Section 118E:70 - Definitions for secs. 70 to 75
Section 118E:71 - PCA quality home care workforce council
Section 118E:72 - Duties of workforce council; PCA recruitment, training and referral resources; list of PCAs
Section 118E:73 - Consumers' rights regarding PCAs; public employee status for limited purposes; collective bargaining
Section 118E:74 - PCA quality home care workforce council; contractual rights; scope of power and authority
Section 118E:75 - Council's performance review
Section 118E:76 - Designation of other governmental units to perform functions set forth in Secs. 118E:13C to 118E:13K and 118E:64 to 118E:75
Section 118E:77 - Members' primary care provider
Section 118E:78 - Employer healthcare coverage form
Section 118E:79 - Coverage for health care services delivered via telehealth
Section 118E:80 - [Multiple versions] Review of available covered medications, treatments, and adequacy of services; report
Section 118E:80 - [Multiple versions] Parity; no separate non-quantitative treatment limations allowed
Section 118E:81 - Provision of mental health and substance use disorder benefits for diagnosis and medically-necessary treatment
Section 118E:82 - Parity requirements
Section 118E:83 - [Multiple versions] Authority to dispense OTC oral contraceptives
Section 118E:83 - [Effective 10/1/2025] [Multiple versions] Medicaid rates for skilled nursing facilities
Section 118E:84 - [Multiple versions] Authority to dispense prenatal vitamins
Section 118E:84 - [Multiple versions] Skilled nursing facility rate add-on program for bariatric patient care 1-on-1 staffing of at-risk residents requiring 24-hour monitoring and supervision