SENATE, No. 661

SECTION 1. Subsection (8) of section 9A of chapter 118E of the General Laws is hereby amended by adding the following sentence:- Premiums shall not be charged for medical benefits for children in households in which an adult is enrolled in the Commonwealth Care Health Insurance Program established in chapter 118H.

SECTION 2. The second sentence of subsection (4) of section 16C of said chapter 118E, is hereby amended by inserting after the word “level” the following words:- ; provided, that no premiums shall be required of households in which an adult is enrolled in Commonwealth Care Health Insurance Program established in chapter 118H.

SECTION 3. Subsection (d) of section 10F of said chapter 118E is hereby amended by adding the following sentence:- Premium contributions shall not be charged for children in households in which an adult is enrolled in the Commonwealth Care Health Insurance Program established in chapter 118H.

SECTION 4.  Section 3 of chapter 118H of the General Laws, as appearing in section 45 of chapter 58 of the Acts of 2006, is hereby amended by adding after subsection (b) the following subsection:-

(c) Insurance plans made available by the program shall include, but not be limited to: (1) inpatient services; (2) outpatient services and preventive care by participating providers; (3) prescription drugs; (4) medically necessary inpatient and outpatient mental health services and substance abuse services; (5) medically necessary dental services, including preventive and restorative procedures; (6) smoking and tobacco use cessation treatment and information benefits, including nicotine replacement therapy, other evidence-based pharmacologic aids to quitting smoking and accompanying counseling by a physician, certified tobacco use cessation counselor or other qualified clinician; and (7) all emergency ambulance calls which result in a transport and all medically-necessary, non-emergency ambulance and wheelchair van trips.

SECTION 5. Subsection (a) of section 6 of chapter 118H of the General Laws, as so appearing, is hereby amended by striking the words: “and (5) medically necessary dental services, including preventive and restorative procedures.” and inserting in place thereof the following:- ; (5) medically necessary dental services, including preventive and restorative procedures; (6) smoking and tobacco use cessation treatment and information benefits, including nicotine replacement therapy, other evidence-based pharmacologic aids to quitting smoking and accompanying counseling by a physician, certified tobacco use cessation counselor or other qualified clinician; and (7) all emergency ambulance calls which result in a transport and all medically-necessary, non-emergency ambulance and wheelchair van trips.

SECTION 6. Section 108 of chapter 58 of the Acts of 2006 is hereby repealed.

SECTION 7. Chapter 118E of the General Laws is hereby amended by inserting after section 10F the following section:-

Section 10G. The division shall provide coverage for smoking and tobacco use cessation treatment, information, and education, including relevant promotional activities, within its MassHealth–covered services.  Smoking and tobacco use cessation treatment and information benefits shall include nicotine replacement therapy, and other evidence-based pharmacologic aids to quitting smoking and accompanying counseling by a physician, dentist, certified tobacco use cessation counselor or other qualified clinician.  The executive office shall report annually on the number of enrollees who participate in smoking cessation services, number of enrollees who quit smoking, and Medicaid expenditures tied to tobacco use by Medicaid enrollees.  The comptroller shall transfer not less than $7 million from the Health Care Security Trust, established by Section 1 of Chapter 29D, to the General Fund in each fiscal year to fund this program.

SECTION 8. Chapter 118H of the General Laws, as appearing in section 45 of chapter 58 of the Acts of 2006, as amended by chapter 324 of the Acts of 2006, is hereby amended by striking out section 5 and inserting in place thereof the following section:-

Section 5. Premium assistance payments shall be made under a schedule set annually by the board, in consultation with the office of Medicaid and the health safety net office; provided that this schedule shall be published on or before September 30, starting in 2006.  Premium assistance payments shall not be subject to appropriation from the fund, established by section 2000 of chapter 29, and shall be made directly by the connector to eligible health insurance plans, under chapter 176Q.  If the board, after a public hearing, determines that amounts in the fund are insufficient to meet the projected costs of enrolling new eligible individuals, the director may impose a cap on enrollment in the program.

            SECTION 9. Notwithstanding any general or special law to the contrary, all agencies and instrumentalities of the commonwealth, including, but not limited to the commonwealth health insurance connector authority, the executive office of health and human services and its constituent agencies, the division of insurance and the executive office of administration and finance shall fully cooperate with any independent evaluations of the health reform policies enacted by chapter 58 of the acts of 2006, as amended and implemented, including by providing all available data reports and information relating to the implementation of said chapter 58, including enrollment statistics, cost and spending statistics and raw survey results.

SECTION 10.  Section 21 of chapter 118E of the General Laws is hereby amended by adding the following paragraph:–

The division shall assist applicants and recipients to obtain at no cost to said applicant or recipient any verification of citizenship required for purposes of obtaining federal reimbursement for Medicaid expenditures.  A U.S. citizen who has not provided verification of citizenship required for a MassHealth determination but who satisfies all other conditions of eligibility for medical benefits, including benefits provided through the Commonwealth Care Health Insurance Program, Uncompensated Care Trust Fund or the Health Safety Net Trust Fund shall not have a determination of eligibility for such benefits denied or delayed so long as the applicant or recipient is making a good faith effort to obtain such verification; an individual who is unable to comply due to a physical or mental incapacity shall be deemed to be making such a good faith effort and the Division shall provide such further assistance as may be necessary to obtain required verifications for such an individual.

SECTION 11. Chapter 46 of the General Laws is hereby amended by inserting after section 19C the following new section:-

Section 19D. The state registrar shall exempt from payment of a fee any person requesting a copy of a birth certificate for the purpose of establishing eligibility for benefits under chapter 118E or chapter 118H, and payments so exempted shall be considered expenses of the executive office in administering said benefits.

SECTION 12. The third sentence of section 2 of chapter 118H of the General Laws, as appearing in section 45 of chapter 58 of the Acts of 2006, is hereby amended by striking out the words, “as determined by the board of the connector” and inserting in place thereof the following words:– as determined by the board of the connector, subject to section 7.

SECTION 13. Chapter 118H of the General Laws, as so appearing, is hereby further amended by adding the following section:-

Section 7. (a) Enrollee premium contributions for the commonwealth care health insurance program shall be subject to the following schedule:

            (1) an eligible individual with financial eligibility that exceeds 100 percent of the federal poverty level and does not exceed 150 percent of the federal poverty level shall not pay enrollee premium contributions.

            (2) an eligible individual with financial eligibility that exceeds 150 percent of the federal poverty level and does not exceed 200 percent of the federal poverty level shall pay an enrollee premium contribution that does not exceed 1 percent of the household’s income.

            (3) an eligible individual with financial eligibility that exceeds 200 percent of the federal poverty level and does not exceed 250 percent of the federal poverty level shall pay an enrollee premium contribution that does not exceed 1.5 percent of the household’s income.

            (4) an eligible individual with financial eligibility that exceeds 250 percent of the federal poverty level and does not exceed 300 percent of the federal poverty level shall pay an enrollee premium contribution that does not exceed 2 percent of the households’ income.

            (b) Nothwithstanding subsection (a),

            (1) the connector board may set a single enrollee premium contributions for a range of incomes of not more than 50 percentage points, provided that the enrollee premium contribution does not exceed the level specified in subsection (a) for an individual at the middle point of the range of incomes; and

            (2) if a member of a household is enrolled in the commonwealth care health insurance program, the enrollee premium contribution for additional persons in the household shall not exceed 75% of the enrollee premium contribution otherwise applicable to the additional person.

            (c) total commonwealth care health insurance program enrollee costs for covered medical services, including, but not limited to, enrollee premium contributions and maximum copayments, shall not exceed a schedule set by the board of the connector, provided that the schedule for individuals who have a gross income that is greater than 100 percent of the federal poverty level to individuals with gross income that does not exceed 300 percent of the federal poverty level shall range from 0 percent to 4 percent of the individual’s income along a graduated scale that increases in increments of the federal poverty level; and provided further, that the total of premium contributions and maximum copayments shall not exceed the level determined affordable pursuant to subsection (q) of section (3) of chapter 176Q.

SECTION 14. Subsection (a) of section 2 of chapter 111M of the General Laws, as appearing in section 12 of chapter 58 of the Acts of 2006, is hereby amended by inserting after the words “established by chapter 176Q” the following:- , in accordance with the requirements of subsection (f).

SECTION 15. Subsection (b) of said section 2 of said chapter 111M of the General Laws, as so appearing, is further amended by striking out clauses subsections (ii) and (iii) of section (b) and inserting in place thereof the following clauses:- (ii) claims an exemption under section 3, (iii) had a certificate issued under section 3 of chapter 176Q, or (iv) had gross income as shown on the individual’s state tax return such that the percentage of said income required to purchase the lowest cost insurance on the market for which an individual would be eligible for creditable coverage, taking into consideration the deductibles, as shown in the schedule created pursuant to subsection (p) of section 3 of chapter 176Q, exceeds the percentage of income which an individual could be expected to contribute towards the purchase of insurance in the report published pursuant to subsection (q) of section 3 of chapter 176Q.

SECTION 16. Said section 2 of chapter 111M of the General Laws, as so appearing, is hereby further amended by inserting after subsection (c) the following subsections:-

(d) For the purposes of subsection (b) only, creditable coverage that begins on January 1, 2008 shall constitute coverage as of the last day of the taxable year of 2007.

(e) All health plans providing creditable coverage shall require all employers with whom they contract for group coverage to have open enrollment periods for coverage effective on July 1, 2007 and on January 1, 2008.

(f) The affordability schedule set by the board of the connector pursuant to subsection (a) shall be subject to the following requirements:

(1) for individuals with gross income up to 100 percent of poverty the affordability schedule for premium contributions shall be 0, and for individuals who have a gross income that is greater than 100 percent of the federal poverty level but does not exceed 400 percent of the federal poverty level, the affordability schedule for all expected enrollee expenditures shall range from 0% to 5% of the individual’s income along a graduated scale that increases in 50 percentage point increments of the federal poverty level;

(2) in determining whether creditable coverage is affordable, the board of the connector shall consider expected enrollee expenditures as the 90^th percentile of out of pocket costs and premiums for those enrolled in creditable coverage;

(3) For the purposes of this section, “out-of-pocket costs” shall mean the total amount paid by an enrollee to satisfy the applicable annual deductible, co–payments and co-insurance, not including monthly premiums.

SECTION 17. The definition of “Contributing employer” in subsection (a) of section 188 of chapter 149 of the General Laws, as appearing in section 47 of chapter 58 of the Acts of 2006, as amended by chapter 324 of the Acts of 2006, is hereby amended by inserting after the words “the division of health care finance and policy” the following words:- subject to the requirements of this section.

SECTION 18. Said subsection (a) of said section 188 of said chapter 149, as so appearing, is hereby further amended by inserting after the definition of “Employee” the following definition:-

“Fair and Reasonable”, an employer will be deemed to make a fair and reasonable employee contribution if more than: (1) 50 percent of the employer’s employees enroll in the employer’s group health plan; or (2) the employer offers to contribute 50 percent or more of the premium cost of a group health plan offered to employees. Group health plans for purposes of this section shall satisfy the standard for minimum creditable coverage pursuant to chapter 111M.  Calculations of the percentage of enrolled employees shall include the pro-rata allocation of part time and seasonal employees.