Section 118E:9F - [See also Version 2] Duals demonstration; review of request for financial solvency(a) The secretary of health and human services may establish, subject to appropriation, all required federal approvals and agreements and the availability of federal financial participation a demonstration to integrate care for dual eligible individuals program, hereinafter referred to as the duals demonstration, for residents, aged 21 to 64 at the time of enrollment, who are dually eligible for benefits under MassHealth Standard or CommonHealth and Medicare under Title XVIII of the Social Security Act and do not have any additional comprehensive health coverage. Under the duals demonstration, the executive office, jointly with the Centers for Medicare and Medicaid Services, shall contract with dual eligible integrated care organizations, hereinafter referred to as ICOs, to provide integrated, comprehensive Medicaid and Medicare services, including medical, behavioral health and long-term support services for a prospective blended payment from the executive office and the Centers for Medicare and Medicaid Services.(b) Notwithstanding any general or special law to the contrary, the secretary of health and human services may review a request for financial solvency certification by a care delivery organization based in the commonwealth applying to serve as a Medicare plan caring for residents who are dually eligible for Medicare and Medicaid. Upon determination that appropriate financial standards, which may be the standards already in place for organizations with contracts pursuant to this section, have been met, the secretary shall so certify to the centers for Medicare and Medicaid services. Said secretary may require the requesting organization to pay a reasonable certification fee.(c) No contract to provide ICO services under this section shall constitute the business of insurance and no such plan shall be subject to chapters 175 to 176O, inclusive. Nothing in this subsection shall affect the legal status or obligations under said chapters 175 to 176O, inclusive, of any entity otherwise constituting or conducting the business of insurance for any other purpose.Mass. Gen. Laws ch. 118E, § 9F
Added by Acts 2012, c. 118,§ 25, eff. 6/19/2012.This section is set out more than once due to postponed, multiple, or conflicting amendments.