CHAPTER 118E DIVISION OF MEDICAL ASSISTANCE - Massachusetts Statutes

State Codes and Statutes

Statutes > Massachusetts > PARTI > TITLEXVII > CHAPTER118E

Section 1 Duties of office
Section 2 Established authority
Section 2A Director of dental services
Section 3 to 5 Repealed, 2003, 26, Sec. 308
Section 6 Medical care advisory committee; member; staff; report from office of Medicaid
Section 7 Powers
Section 8 Definitions
Section 9 Eligibility
Section 9A MassHealth; beneficiaries; eligibility; payment; information applications
Section 9B Participation of commonwealth; budget neutrality certification; projected expenditure and revenue reports; beneficiary distinctions
Section 9C Medical insurance reimbursement programs; definitions; eligibility; expenditures; submission of plans
Section 9D Senior care options initiative; senior care organizations; enrollment choices; advisory committee; report
Section 9E Application for authority; implementation of measures; waiver of measures due to hardship
Section 10 Medical care assistance program for pregnant women and infants
Section 10A Required coverage for prenatal care, childbirth and postpartum care
Section 10B Required coverage for newborn hearing screening tests
Section 10C Required coverage for items medically necessary for the diagnosis or treatment of diabetes
Section 10D Required coverage for treatment of breast and cervical cancer
Section 10E Healthy start program; medical assistance for pregnant women and infants; eligibility; types of assistance; protection from billing and collection practices
Section 10F Health care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement
Section 11 Cooperation with federal authorities
Section 12 Policies; procedures; rules and regulations; contracts
Section 13 Rate changes; review
Section 13A Non-acute hospitals; rates and terms of payment
Section 13B Hospital rate increases; quality standards and benchmarks
Section 14 Nursing home negotiated rate contracts
Section 14A Reimbursement to nursing homes for admissions to acute care and chronic disease or rehabilitation hospitals
Section 15 Medicaid benefits; rules and regulations; managed care; personal expenses
Section 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 r
Section 16A Medical care and assistance program for disabled children
Section 16A1/2 Costs incurred for medical programs projected to exceed available appropriations; notice
Section 16B Repealed, 1996, 203, Sec. 16
Section 16C Child health insurance program; medical benefits; costs; eligibility
Section 16D Aliens or persons residing in United States under color of law; benefits
Section 17 Reimbursements for non-generic drugs
Section 17A Emergency services provided to beneficiaries for emergency medical conditions
Section 18 Medical insurance purchases for persons eligible for assistance
Section 19 Prior approval of medical services; methods; rules and regulations; posttreatment examinations
Section 20 Application; forms; application by institution
Section 21 Inquiry by department; notification of applicant; agreement
Section 21A Medical assistance eligibility of an institutionalized spouse
Section 22 Third party payments; repayment; assignment; subrogation
Section 23 Subrogation rights; health insurance benefits; garnishment of wages
Section 23A Financial institutions; request for deposit and withdrawal records; penalty
Section 24 Repealed, 1996, 450, Sec. 157
Section 25 Exempt income and resources
Section 26 Identification card
Section 27 Redetermination of eligibility
Section 28 Disposal of resources at less than fair market value; period of ineligibility
Section 29 Transfer of interest in real property; notice
Section 30 Time of payment
Section 31 Adjustment or recovery of payments
Section 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
Section 32A Repealed, 2005, 6, Sec. 14
Section 33 Long term care insurance purchasers; liability for medical assistance paid
Section 34 Liens and encumbrances
Section 35 Reimbursement for covered claims; submission of information
Section 36 Eligible providers; responsibility for overpayments
Section 37 Distribution of rules, regulations to providers; administrative sanctions
Section 38 Submission of bills by providers; appeals for erroneous denials; overpayments; civil collection actions
Section 39 False representations, failure to disclose; penalty
Section 40 False statements or representations by providers; penalty
Section 41 Bribery or rebates; penalty
Section 41A Repealed, 2001, 177, Sec. 27
Section 42 Excess charges; penalty
Section 43 Health care facilities; additional charges as precondition for admission or continuance; penalty
Section 44 Civil remedies; limitations
Section 45 Venue; actions relating to false claims
Section 46 Availability of other remedies
Section 46A Providers; submission of claims for payment not in compliance with policies and procedures of medical assistance program; proof of clerical or administrative error
Section 47 Persons aggrieved; right to hearing; investigation; decision; rehearing; notice
Section 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 whic
Section 48 Board of hearings
Section 49 Use and disclosure of information
Section 50 Contract for administrative functions; underwriting of program
Section 51 Utilization review of care and services; data processing and collection procedures; liability in civil actions
Section 52 Maintenance of standards for providers; development of new programs
Section 53 Covered services
Section 54 Wellness program for MassHealth enrollees
Section 55 Repealed, 2008, 451, Sec. 75
Section 56 to 60 [There is no 118E:56 to 60.]
Section 61 Availability of benefits to persons recognized as a spouse under laws of the commonwealth
Section 62 Acceptance and recognition of information submitted pursuant to coding standards and guidelines required; use of standardized claim formats

State Codes and Statutes

Statutes > Massachusetts > PARTI > TITLEXVII > CHAPTER118E

Section 1 Duties of office
Section 2 Established authority
Section 2A Director of dental services
Section 3 to 5 Repealed, 2003, 26, Sec. 308
Section 6 Medical care advisory committee; member; staff; report from office of Medicaid
Section 7 Powers
Section 8 Definitions
Section 9 Eligibility
Section 9A MassHealth; beneficiaries; eligibility; payment; information applications
Section 9B Participation of commonwealth; budget neutrality certification; projected expenditure and revenue reports; beneficiary distinctions
Section 9C Medical insurance reimbursement programs; definitions; eligibility; expenditures; submission of plans
Section 9D Senior care options initiative; senior care organizations; enrollment choices; advisory committee; report
Section 9E Application for authority; implementation of measures; waiver of measures due to hardship
Section 10 Medical care assistance program for pregnant women and infants
Section 10A Required coverage for prenatal care, childbirth and postpartum care
Section 10B Required coverage for newborn hearing screening tests
Section 10C Required coverage for items medically necessary for the diagnosis or treatment of diabetes
Section 10D Required coverage for treatment of breast and cervical cancer
Section 10E Healthy start program; medical assistance for pregnant women and infants; eligibility; types of assistance; protection from billing and collection practices
Section 10F Health care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement
Section 11 Cooperation with federal authorities
Section 12 Policies; procedures; rules and regulations; contracts
Section 13 Rate changes; review
Section 13A Non-acute hospitals; rates and terms of payment
Section 13B Hospital rate increases; quality standards and benchmarks
Section 14 Nursing home negotiated rate contracts
Section 14A Reimbursement to nursing homes for admissions to acute care and chronic disease or rehabilitation hospitals
Section 15 Medicaid benefits; rules and regulations; managed care; personal expenses
Section 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 r
Section 16A Medical care and assistance program for disabled children
Section 16A1/2 Costs incurred for medical programs projected to exceed available appropriations; notice
Section 16B Repealed, 1996, 203, Sec. 16
Section 16C Child health insurance program; medical benefits; costs; eligibility
Section 16D Aliens or persons residing in United States under color of law; benefits
Section 17 Reimbursements for non-generic drugs
Section 17A Emergency services provided to beneficiaries for emergency medical conditions
Section 18 Medical insurance purchases for persons eligible for assistance
Section 19 Prior approval of medical services; methods; rules and regulations; posttreatment examinations
Section 20 Application; forms; application by institution
Section 21 Inquiry by department; notification of applicant; agreement
Section 21A Medical assistance eligibility of an institutionalized spouse
Section 22 Third party payments; repayment; assignment; subrogation
Section 23 Subrogation rights; health insurance benefits; garnishment of wages
Section 23A Financial institutions; request for deposit and withdrawal records; penalty
Section 24 Repealed, 1996, 450, Sec. 157
Section 25 Exempt income and resources
Section 26 Identification card
Section 27 Redetermination of eligibility
Section 28 Disposal of resources at less than fair market value; period of ineligibility
Section 29 Transfer of interest in real property; notice
Section 30 Time of payment
Section 31 Adjustment or recovery of payments
Section 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
Section 32A Repealed, 2005, 6, Sec. 14
Section 33 Long term care insurance purchasers; liability for medical assistance paid
Section 34 Liens and encumbrances
Section 35 Reimbursement for covered claims; submission of information
Section 36 Eligible providers; responsibility for overpayments
Section 37 Distribution of rules, regulations to providers; administrative sanctions
Section 38 Submission of bills by providers; appeals for erroneous denials; overpayments; civil collection actions
Section 39 False representations, failure to disclose; penalty
Section 40 False statements or representations by providers; penalty
Section 41 Bribery or rebates; penalty
Section 41A Repealed, 2001, 177, Sec. 27
Section 42 Excess charges; penalty
Section 43 Health care facilities; additional charges as precondition for admission or continuance; penalty
Section 44 Civil remedies; limitations
Section 45 Venue; actions relating to false claims
Section 46 Availability of other remedies
Section 46A Providers; submission of claims for payment not in compliance with policies and procedures of medical assistance program; proof of clerical or administrative error
Section 47 Persons aggrieved; right to hearing; investigation; decision; rehearing; notice
Section 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 whic
Section 48 Board of hearings
Section 49 Use and disclosure of information
Section 50 Contract for administrative functions; underwriting of program
Section 51 Utilization review of care and services; data processing and collection procedures; liability in civil actions
Section 52 Maintenance of standards for providers; development of new programs
Section 53 Covered services
Section 54 Wellness program for MassHealth enrollees
Section 55 Repealed, 2008, 451, Sec. 75
Section 56 to 60 [There is no 118E:56 to 60.]
Section 61 Availability of benefits to persons recognized as a spouse under laws of the commonwealth
Section 62 Acceptance and recognition of information submitted pursuant to coding standards and guidelines required; use of standardized claim formats

State Codes and Statutes

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State Codes and Statutes

Statutes > Massachusetts > PARTI > TITLEXVII > CHAPTER118E

Section 1 Duties of office
Section 2 Established authority
Section 2A Director of dental services
Section 3 to 5 Repealed, 2003, 26, Sec. 308
Section 6 Medical care advisory committee; member; staff; report from office of Medicaid
Section 7 Powers
Section 8 Definitions
Section 9 Eligibility
Section 9A MassHealth; beneficiaries; eligibility; payment; information applications
Section 9B Participation of commonwealth; budget neutrality certification; projected expenditure and revenue reports; beneficiary distinctions
Section 9C Medical insurance reimbursement programs; definitions; eligibility; expenditures; submission of plans
Section 9D Senior care options initiative; senior care organizations; enrollment choices; advisory committee; report
Section 9E Application for authority; implementation of measures; waiver of measures due to hardship
Section 10 Medical care assistance program for pregnant women and infants
Section 10A Required coverage for prenatal care, childbirth and postpartum care
Section 10B Required coverage for newborn hearing screening tests
Section 10C Required coverage for items medically necessary for the diagnosis or treatment of diabetes
Section 10D Required coverage for treatment of breast and cervical cancer
Section 10E Healthy start program; medical assistance for pregnant women and infants; eligibility; types of assistance; protection from billing and collection practices
Section 10F Health care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement
Section 11 Cooperation with federal authorities
Section 12 Policies; procedures; rules and regulations; contracts
Section 13 Rate changes; review
Section 13A Non-acute hospitals; rates and terms of payment
Section 13B Hospital rate increases; quality standards and benchmarks
Section 14 Nursing home negotiated rate contracts
Section 14A Reimbursement to nursing homes for admissions to acute care and chronic disease or rehabilitation hospitals
Section 15 Medicaid benefits; rules and regulations; managed care; personal expenses
Section 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 r
Section 16A Medical care and assistance program for disabled children
Section 16A1/2 Costs incurred for medical programs projected to exceed available appropriations; notice
Section 16B Repealed, 1996, 203, Sec. 16
Section 16C Child health insurance program; medical benefits; costs; eligibility
Section 16D Aliens or persons residing in United States under color of law; benefits
Section 17 Reimbursements for non-generic drugs
Section 17A Emergency services provided to beneficiaries for emergency medical conditions
Section 18 Medical insurance purchases for persons eligible for assistance
Section 19 Prior approval of medical services; methods; rules and regulations; posttreatment examinations
Section 20 Application; forms; application by institution
Section 21 Inquiry by department; notification of applicant; agreement
Section 21A Medical assistance eligibility of an institutionalized spouse
Section 22 Third party payments; repayment; assignment; subrogation
Section 23 Subrogation rights; health insurance benefits; garnishment of wages
Section 23A Financial institutions; request for deposit and withdrawal records; penalty
Section 24 Repealed, 1996, 450, Sec. 157
Section 25 Exempt income and resources
Section 26 Identification card
Section 27 Redetermination of eligibility
Section 28 Disposal of resources at less than fair market value; period of ineligibility
Section 29 Transfer of interest in real property; notice
Section 30 Time of payment
Section 31 Adjustment or recovery of payments
Section 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
Section 32A Repealed, 2005, 6, Sec. 14
Section 33 Long term care insurance purchasers; liability for medical assistance paid
Section 34 Liens and encumbrances
Section 35 Reimbursement for covered claims; submission of information
Section 36 Eligible providers; responsibility for overpayments
Section 37 Distribution of rules, regulations to providers; administrative sanctions
Section 38 Submission of bills by providers; appeals for erroneous denials; overpayments; civil collection actions
Section 39 False representations, failure to disclose; penalty
Section 40 False statements or representations by providers; penalty
Section 41 Bribery or rebates; penalty
Section 41A Repealed, 2001, 177, Sec. 27
Section 42 Excess charges; penalty
Section 43 Health care facilities; additional charges as precondition for admission or continuance; penalty
Section 44 Civil remedies; limitations
Section 45 Venue; actions relating to false claims
Section 46 Availability of other remedies
Section 46A Providers; submission of claims for payment not in compliance with policies and procedures of medical assistance program; proof of clerical or administrative error
Section 47 Persons aggrieved; right to hearing; investigation; decision; rehearing; notice
Section 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 whic
Section 48 Board of hearings
Section 49 Use and disclosure of information
Section 50 Contract for administrative functions; underwriting of program
Section 51 Utilization review of care and services; data processing and collection procedures; liability in civil actions
Section 52 Maintenance of standards for providers; development of new programs
Section 53 Covered services
Section 54 Wellness program for MassHealth enrollees
Section 55 Repealed, 2008, 451, Sec. 75
Section 56 to 60 [There is no 118E:56 to 60.]
Section 61 Availability of benefits to persons recognized as a spouse under laws of the commonwealth
Section 62 Acceptance and recognition of information submitted pursuant to coding standards and guidelines required; use of standardized claim formats