§ 1 Duties of office
§ 2 Established authority
§ 2A Director of dental services
§ 6 Medical care advisory committee; member; staff; report from office of Medicaid
§ 7 Powers
§ 8 Definitions
§ 8A Definitions for Secs. 13C to 13K and Secs. 64 to 70
§ 9 Eligibility
§ 9A MassHealth; beneficiaries; eligibility; payment; information applications
§ 9C Medical insurance reimbursement programs; definitions; eligibility; expenditures; submission of plans
§ 9D Senior care options initiative; senior care organizations; enrollment choices; advisory committee; report
§ 9E Application for authority; implementation of measures; waiver of measures due to hardship
§ 9F Duals demonstration; review of request for financial solvency
§ 10 Medical care assistance program for pregnant women and infants
§ 10A Required coverage for abortion, abortion-related care, prenatal care, childbirth and postpartum care
§ 10A1/2 MassHealth standard coverage for pregnant or postpartum residents
§ 10B Required coverage for newborn hearing screening tests
§ 10C Required coverage for items medically necessary for the diagnosis or treatment of diabetes
§ 10D Required coverage for treatment of breast and cervical cancer
§ 10E Healthy start program; medical assistance for pregnant women and infants; eligibility; types of assistance; protection from billing and collection practices
§ 10F Health care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement
§ 10G Coverage for children under age 18 for cleft lip and cleft palate
§ 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
§ 10I Coverage for administration of all federal Food and Drug Administration approved drugs for opioid or alcohol dependence treatment
§ 10J Coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome
§ 10K Coverage for certain services and contraceptive methods
§ 10L Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity
§ 10M Coverage for tobacco use cessation counseling and products
§ 10N Urgent care facilities; referrals; primary care providers
§ 10O Coverage for mental health acute treatment, community-based acute treatment and intensive community-based acute treatment
§ 10P Coverage for mental health or substance use disorder services delivered through psychiatric collaborative care model
§ 10Q Coverage for annual mental health wellness examination
§ 11 Cooperation with federal authorities
§ 12 Policies; procedures; rules and regulations; contracts
§ 12A Pharmaceutical drugs; negotiation of supplemental rebate agreements
§ 13 Rate changes; review
§ 13A Non-acute hospitals; rates and terms of payment
§ 13B Hospital rate increases; quality standards and benchmarks
§ 13C Establishment of rates of payment for health care services
§ 13D Duties of ratemaking authority; criteria for establishing rates
§ 13D1/2 Minimum payment rates to be paid to providers of behavioral health services delivered in community behavioral health centers by managed care entities; annual review and reporting
§ 13E Appeals of interim or final rates
§ 13E1/2 Contractual arrangements with acute and non-acute hospitals
§ 13F Contracts between acute and non-acute hospital service providers and office of Medicaid
§ 13G Hospital assets not to be considered as resources for purpose of establishing rates
§ 13H Recipients of benefits under chapter 117A
§ 13I Patients with foreign residency
§ 13J Health maintenance organizations; contracting rights
§ 13K Adjustment of facility’s rate
§ 13L Restriction of hospital access to discounted purchase of prescription drugs
§ 14 Nursing home negotiated rate contracts
§ 14A Reimbursement to nursing homes for admissions to acute care and chronic disease or rehabilitation hospitals
§ 15 Medicaid benefits; rules and regulations; managed care; personal expenses
§ 16 Primary and supplemental medical care and assistance program for disabled residents; assistance program for chronically ill or disabled persons forced to leave employment or substantially reduce work hours
§ 16A Medical care and assistance program for disabled children
§ 16A1/2 Costs incurred for medical programs projected to exceed available appropriations; notice
§ 16C Child health insurance program; medical benefits; costs; eligibility
§ 16D Aliens or persons residing in United States under color of law; benefits
§ 17 Reimbursements for non-generic drugs
§ 17A Emergency services provided to beneficiaries for emergency medical conditions
§ 18 Medical insurance purchases for persons eligible for assistance
§ 19 Prior approval of medical services; methods; rules and regulations; posttreatment examinations
§ 20 Application; forms; application by institution
§ 21 Inquiry by department; notification of applicant; agreement
§ 21A Medical assistance eligibility of an institutionalized spouse
§ 22 Third party payments; repayment; assignment; subrogation
§ 23 Subrogation rights; health insurance benefits; garnishment of wages
§ 23A Financial institutions; request for deposit and withdrawal records; penalty
§ 25 Exempt income and resources
§ 25A Determination of eligibility for Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual programs; consideration of certain income or assets
§ 26 Identification card
§ 27 Redetermination of eligibility
§ 28 Disposal of resources at less than fair market value; period of ineligibility
§ 29 Transfer of interest in real property; notice
§ 30 Time of payment
§ 31 Adjustment or recovery of payments
§ 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
§ 33 Long term care insurance purchasers; liability for medical assistance paid
§ 34 Liens and encumbrances
§ 35 Reimbursement for covered claims; submission of information
§ 36 Eligible providers; responsibility for overpayments
§ 37 Distribution of rules, regulations to providers; administrative sanctions
§ 38 Submission of bills by providers; appeals for erroneous denials; overpayments; civil collection actions
§ 38A Retroactive claims denials for behavioral health services
§ 39 False representations, failure to disclose; penalty
§ 40 False statements or representations by providers; penalty
§ 41 Bribery or rebates; penalty
§ 42 Excess charges; penalty
§ 43 Health care facilities; additional charges as precondition for admission or continuance; penalty
§ 44 Civil remedies; limitations
§ 45 Venue; actions relating to false claims
§ 46 Availability of other remedies
§ 46A Providers; submission of claims for payment not in compliance with policies and procedures of medical assistance program; proof of clerical or administrative error
§ 47 Persons aggrieved; written notification of denial of requested benefits or services; right to hearing; investigation; decision; rehearing; notice
§ 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
§ 48 Board of hearings
§ 49 Use and disclosure of information
§ 50 Contract for administrative functions; underwriting of program
§ 51 Utilization review of care and services; data processing and collection procedures; liability in civil actions
§ 51A Step therapy protocol clinical review criteria; prescription coverage
§ 52 Maintenance of standards for providers; development of new programs
§ 53 Covered services
§ 54 Wellness program for MassHealth enrollees
§ 56 Controlled substance management program for MassHealth enrollees
§ 57 to 60 [There are no 118E:57 to 118E:60.]
§ 61 Availability of benefits to persons recognized as a spouse under laws of the commonwealth
§ 62 Acceptance and recognition of information submitted pursuant to coding standards and guidelines required; use of standardized claim formats
§ 63 Assessment per non–Medicare reimbursed patient day
§ 64 Definitions for Secs. 64 through 69
§ 65 Health safety net office
§ 66 Health Safety Net Trust Fund
§ 67 Liability of acute hospital to fund
§ 67A Nonpublic ambulance services; liability; uniform assessment; enforcement
§ 68 Surcharge assessed by acute hospitals and ambulatory surgical centers
§ 69 Reimbursements to hospitals and community health centers for health services provided to uninsured and underinsured individuals
§ 69A Behavioral health payor surcharge; transfer of ownership; enforcement of payment
§ 70 Definitions for Secs. 70 through 75
§ 71 PCA quality home care workforce council
§ 72 Duties of workforce council; PCA recruitment, training and referral resources; lists of PCAs
§ 73 Rights of consumers regarding PCAs; public employee status for limited purposes; collective bargaining
§ 74 PCA quality home care workforce council; scope of power and authority
§ 75 Performance reviews
§ 76 Designation of another governmental unit to perform functions set forth in Secs. 13C through 13K and 64 through 75
§ 77 Office of Medicaid to attribute members to primary care providers
§ 78 Employer healthcare coverage form
§ 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
§ 80 Sickle cell disease; executive office review; content of report
§ 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 functio
§ 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

Terms Used In Massachusetts General Laws > Chapter 118E - Division of Medical Assistance

  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Annual percentage rate: The cost of credit at a yearly rate. It is calculated in a standard way, taking the average compound interest rate over the term of the loan so borrowers can compare loans. Lenders are required by law to disclose a card account's APR. Source: FDIC
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Bankruptcy: Refers to statutes and judicial proceedings involving persons or businesses that cannot pay their debts and seek the assistance of the court in getting a fresh start. Under the protection of the bankruptcy court, debtors may discharge their debts, perhaps by paying a portion of each debt. Bankruptcy judges preside over these proceedings.
  • Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
  • Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
  • Common law: The legal system that originated in England and is now in use in the United States. It is based on judicial decisions rather than legislative action.
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Decedent: A deceased person.
  • Dependent: A person dependent for support upon another.
  • Docket: A log containing brief entries of court proceedings.
  • Donor: The person who makes a gift.
  • Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Executor: A male person named in a will to carry out the decedent
  • Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
  • Fiduciary: A trustee, executor, or administrator.
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Fraud: Intentional deception resulting in injury to another.
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Interests: includes any form of membership in a domestic or foreign nonprofit corporation. See Massachusetts General Laws ch. 156D sec. 11.01
  • Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
  • Mortgagee: The person to whom property is mortgaged and who has loaned the money.
  • National Bank: A bank that is subject to the supervision of the Comptroller of the Currency. The Office of the Comptroller of the Currency is a bureau of the U.S. Treasury Department. A national bank can be recognized because it must have "national" or "national association" in its name. Source: OCC
  • Oath: A promise to tell the truth.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Other entity: includes a domestic or foreign nonprofit corporation. See Massachusetts General Laws ch. 156D sec. 11.01
  • Oversight: Committee review of the activities of a Federal agency or program.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Personal property: All property that is not real property.
  • Probate: Proving a will
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Quorum: The number of legislators that must be present to do business.
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Remand: When an appellate court sends a case back to a lower court for further proceedings.
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • Subpoena: A command to a witness to appear and give testimony.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.
  • Trust account: A general term that covers all types of accounts in a trust department, such as estates, guardianships, and agencies. Source: OCC
  • Trustee: A person or institution holding and administering property in trust.