Division of Medical Assistance

  1. Law
  2. Massachusetts General Laws
  3. Administration of the Government
  4. Public Welfare
  5. Division of Medical Assistance

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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To 5 - Repealed, 2003, 26, Sec. 308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
8a

Definitions for Secs. 13c to 13k and Secs. 64 to 70

Section
9

Eligibility

Section
9a

Masshealth; Beneficiaries; Eligibility; Payment; Information Applications

Section
9b

Repealed, 2013, 35, Sec. 25

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
9f

Duals Demonstration; Review of Request for Financial Solvency

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
10g

Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate

Section
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

Section
10i

Coverage for Administration of All Federal Food and Drug Administration Approved Drugs for Opioid or Alcohol Dependence Treatment

Section
10j

Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section
10k

Coverage for Certain Services and Contraceptive Methods

Section
10l

Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section
10m

Coverage for Tobacco Use Cessation Counseling and Products

Section
11

Cooperation With Federal Authorities

Section
12

Policies; Procedures; Rules and Regulations; Contracts

Section
12a

Pharmaceutical Drugs; Negotiation of Supplemental Rebate Agreements

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
13c

Establishment of Rates of Payment for Health Care Services

Section
13d

Duties of Ratemaking Authority; Criteria for Establishing Rates

Section
13e

Appeals of Interim or Final Rates

Section
13e1/2

Contractual Arrangements With Acute and Non-Acute Hospitals

Section
13f

Contracts Between Acute and Non-Acute Hospital Service Providers and Office of Medicaid

Section
13g

Hospital Assets Not to Be Considered as Resources for Purpose of Establishing Rates

Section
13h

Recipients of Benefits Under Chapter 117a

Section
13i

Patients With Foreign Residency

Section
13j

Health Maintenance Organizations; Contracting Rights

Section
13k

Adjustment of Facility's Rate

Section
13l

Restriction of Hospital Access to Discounted Purchase of Prescription Drugs

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 Reduce Work Hours

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
25a

Determination of Eligibility for Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual Programs; Consideration of Certain Income or Assets

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
38a

Retroactive Claims Denials for Behavioral Health Services

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 Which the Commonwealth Receives Federal Reimbursement

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

Controlled Substance Management Program for Masshealth Enrollees

Section
57

To 60 - [There Are No 118e:57 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

Section
63

Assessment per Non–medicare Reimbursed Patient Day

Section
64

Definitions for Secs. 64 Through 69

Section
65

Health Safety Net Office

Section
66

Health Safety Net Trust Fund

Section
67

Liability of Acute Hospital to Fund

Section
68

Surcharge Assessed by Acute Hospitals and Ambulatory Surgical Centers

Section
69

Reimbursements to Hospitals and Community Health Centers for Health Services Provided to Uninsured and Underinsured Individuals

Section
70

Definitions for Secs. 70 Through 75

Section
71

Pca Quality Home Care Workforce Council

Section
72

Duties of Workforce Council; Pca Recruitment, Training and Referral Resources; Lists of Pcas

Section
73

Rights of Consumers Regarding Pcas; Public Employee Status for Limited Purposes; Collective Bargaining

Section
74

Pca Quality Home Care Workforce Council; Scope of Power and Authority

Section
75

Performance Reviews

Section
76

Designation of Another Governmental Unit to Perform Functions Set Forth in Secs. 13c Through 13k and 64 Through 75

Section
77

Office of Medicaid to Attribute Members to Primary Care Providers

Section
78

Employer Healthcare Coverage Form