Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MassHealth Eligibility Letter 189 October 15, 2009 TO: MassHealth Staff FROM: Terence G. Dougherty, Interim Medicaid Director RE: Rescission of Regulations about the MassHealth Applications for Blind Individuals MassHealth has assumed responsibility for processing MassHealth applications for blind individuals in Massachusetts. The revisions to the regulations remove the provision that blind individuals submit applications for MassHealth to the Massachusetts Commission for the Blind. These emergency regulations are effective December 1, 2008. MANUAL UPKEEP Insert Remove Trans. By 501.000 501.000 E.L. 51 501.007 501.007 E.L. 95 501.009 (1 of 2) 501.009 E.L. 109 501.009 (2 of 2) -- -- 515.000 515.000 E.L. 63 515.005 515.005 E.L. 95 515.007 -- -- 515.008 515.008 E.L. 123 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 189 Rev. 12/01/08 MASSHEALTH GENERAL POLICIES Chapter 501 Page 501.000 TABLE OF CONTENTS Section 501.001: Definition of Terms 501.002: Introduction to MassHealth 501.003: MassHealth Coverage Types 501.004: Administration of MassHealth 501.005: Individuals and Families Eligible for or Receiving Medical Assistance on June 30, 1997 501.006: Children Receiving Benefits under the Children’s Medical Security Plan on August 3, 1998 501.007: Receiving Public Assistance from Another State (130 CMR 501.008 Reserved) 501.009: Rights of Applicants and Members 501.010: Responsibilities of Applicants and Members 501.011: Referrals to Investigative Units 501.012: Recovery of Overpayment of Medical Benefits 501.013: Estate Recovery 501.014: Voter Registration 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 189 Rev. 12/01/08 MASSHEALTH GENERAL POLICIES Chapter 501 Page 501.007 (1) the family group’s gross income exceeds 200 percent of the FPL; (2) the family fails to cooperate with the MassHealth eligibility review; or (3) the child no longer meets MassHealth requirements. 501.007: Receiving Public Assistance from Another State Persons who are receiving public assistance from another state are not eligible for MassHealth. (130 CMR 501.008 Reserved) 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 189 Rev. 12/01/08 MASSHEALTH GENERAL POLICIES Chapter 501 Page 501.009 (1 of 2) 501.009: Rights of Applicants and Members The policies of the MassHealth Program are administered in accordance with federal and state law. Applicants and members must be informed of their rights and responsibilities with respect to the MassHealth Program. (A) Right to Nondiscrimination and Equal Treatment. The MassHealth agency does not discriminate on the basis of race, color, sex, sexual orientation, religion, national origin, disability, or age in admission or access to, or treatment or employment in, its programs or activities. Grievance procedures for resolution of discrimination complaints are administered and applied by the MassHealth agency's Affirmative Action Office. (B) Right to Confidentiality. The confidentiality of information obtained by the MassHealth agency during the MassHealth eligibility process is protected in accordance with federal and state regulations. The use and disclosure of information concerning applicants, members, and legally liable third parties is restricted to purposes directly connected with the administration of MassHealth as governed by state and federal law. (C) Right to Timely Provision of Benefits. Eligible applicants and members have the right to the timely provision of benefits as defined in 130 CMR 502.000. (D) Right to Information. Persons who inquire about MassHealth, either orally or through a written request, have the right to receive information about medical benefits, coverage type requirements, and their rights and responsibilities as applicants and members of MassHealth. (E) Right to Apply. Any person, individually or through an eligibility representative, has the right, and must be afforded the opportunity without delay, to apply for MassHealth. (F) Right to be Assisted by Others. (1) The applicant or member has the right to be accompanied and represented by an eligibility representative during the eligibility process, and by an appeal representative during the appeal process. The MassHealth agency must provide copies of all eligibility notices to an applicant’s or member’s eligibility representative, and must provide copies of all documents related to the fair hearing process to an applicant’s or member’s appeal representative. (2) An application for MassHealth may be filed by an eligibility representative on behalf of a deceased person. (3) An appeal on behalf of a deceased person may be filed by an appeal representative, as defined in 130 CMR 501.001. 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 189 Rev. 12/01/08 MASSHEALTH GENERAL POLICIES Chapter 501 Page 501.009 (2 of 2) (G) Right to Inspect the MassHealth Case File. The applicant or member has the right to inspect information in his or her MassHealth case file and contest the accuracy of the information. (H) Right to Appeal. The applicant or member has the right to appeal and request a fair hearing as the result of any adverse action or inaction taken by the MassHealth agency. The request will not be granted if the sole issue is a federal or state law requiring an automatic change adversely affecting members. (I) Right to Interpreter Services. The MassHealth agency will inform applicants and members of the availability of interpreter services. Unless the applicant or member chooses to provide his or her own interpreter services, the MassHealth agency will provide either telephonic or other interpreter services whenever (1) the applicant or member who is seeking assistance from the MassHealth agency has limited English proficiency or sensory impairment and requests interpreter services; or (2) the MassHealth agency determines such services are necessary. (J) Right to a Certificate of Creditable Coverage Upon Termination of MassHealth. The MassHealth agency will provide a Certificate of Creditable Coverage to members whose coverage under MassHealth Standard or CommonHealth, or a MassHealth health plan under Family Assistance, Basic, or Essential has ended. The MassHealth agency will issue a Certificate to members within one week of their MassHealth termination, or within one week of the request for a Certificate, as long as the request is made within 24 months of their MassHealth termination. The Certificate may allow members to waive or reduce the length of preexisting-condition waiting periods when they enroll in a new health plan offered by other insurance. If a member’s MassHealth termination also terminates the coverage of his or her dependents, the dependents will be included on the Certificate. 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 189 Rev. 12/01/08 MASSHEALTH GENERAL POLICIES Chapter 515 Page 515.000 TABLE OF CONTENTS Section 515.001: Definition of Terms 515.002: Introduction to MassHealth 515.003: MassHealth Coverage Types 515.004: Administration of MassHealth 515.005: Receiving Public Assistance from Another State (130 CMR 515.006 Reserved) 515.007: Rights of Applicants and Members 515.008: Responsibilities of Applicants and Members 515.009: Referrals to Investigative Units 515.010: Recovery of Overpayment of Medical Benefits 515.011: Estate Recovery 515.012: Real Estate Liens 515.013: Voter Registration 515.014: Long-Term-Care Insurance Minimum Coverage Requirements for MassHealth Exemptions 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 189 Rev. 12/01/08 MASSHEALTH GENERAL POLICIES Chapter 515 Page 515.005 515.005: Receiving Public Assistance from Another State. Persons who are receiving public assistance from another state are not eligible for MassHealth. (130 CMR 515.006 Reserved) 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 189 Rev. 12/01/08 MASSHEALTH GENERAL POLICIES Chapter 515 Page 515.007 515.007: Rights of Applicants and Members The policies of MassHealth are administered in accordance with federal and state law. Applicants and members must be informed of their rights and responsibilities with respect to MassHealth. (A) Right to Nondiscrimination and Equal Treatment. The MassHealth agency does not discriminate on the basis of race, color, sex, sexual orientation, religion, national origin, disability, or age in admission or access to, or treatment or employment in, its programs or activities. Grievance procedures for resolution of discrimination complaints are administered and applied by the MassHealth agency’s Affirmative Action Office. (B) Right to Confidentiality. The confidentiality of information obtained by the MassHealth agency during the MassHealth eligibility process is protected in accordance with federal and state regulations. The use and disclosure of information concerning applicants, members, and legally liable third parties is restricted to purposes directly connected to the administration of MassHealth as governed by state and federal law. (C) Right to Timely Provision of Benefits. Eligible applicants and members have the right to the timely provision of benefits, as defined in 130 CMR 516.000. (D) Right to Information. Persons who inquire about MassHealth, either orally or through a written request, have the right to receive information about medical benefits, coverage type requirements, and their rights and responsibilities as applicants and members of MassHealth. (E) Right to Apply. Any person, individually or through an eligibility representative, has the right, and must be afforded the opportunity without delay, to apply for MassHealth. (F) Right to be Assisted by Others. (1) The applicant or member has the right to be accompanied and represented by an eligibility representative during the eligibility process, and by an appeal representative during the appeal process. The MassHealth agency must provide copies of all eligibility notices to an applicant’s or member’s eligibility representative, and must provide copies of all documents related to the fair hearing process to an applicant’s or member’s appeal representative. (2) An application for MassHealth may be filed by an eligibility representative on behalf of a deceased person. (3) An appeal on behalf of a deceased person may be filed by an appeal representative, as defined in 130 CMR 515.001. (G) Right to Inspect the MassHealth Case File. The applicant or member has the right to inspect information in his or her MassHealth case file and contest the accuracy of the information. 130 CMR: DIVISION OF MEDICAL ASSISTANCE Trans. by E.L. 189 Rev. 12/01/08 MASSHEALTH GENERAL POLICIES Chapter 515 Page 515.008 (H) Right to Appeal. The applicant or member has the right to appeal and request a fair hearing as the result of any adverse action or inaction taken by MassHealth. The request will not be granted if the sole issue is a federal or state law requiring an automatic change adversely affecting members. (I) Right to Interpreter Services. MassHealth will inform applicants and members of the availability of interpreter services. Unless the applicant or member chooses to provide his or her own interpreter services, MassHealth will provide either telephonic or other interpreter services whenever (1) the applicant or member who is seeking assistance from MassHealth has limited English proficiency or sensory impairment and requests interpreter services; or (2) MassHealth determines such services are necessary. (J) Right to a Certificate of Creditable Coverage Upon Termination of MassHealth. MassHealth provides a Certificate of Creditable Coverage to members whose coverage under MassHealth Standard, CommonHealth, Essential, or Basic has ended. MassHealth issues a Certificate to members within one week of their MassHealth termination, or within one week of the request for a Certificate, as long as the request is made within 24 months of their MassHealth termination. The Certificate may allow members to waive or reduce the length of preexisting- condition waiting periods when they enroll in a new health plan offered by private insurance. If a member’s MassHealth termination also terminates the coverage of his or her dependents, the dependents are included on the Certificate. 515.008: Responsibilities of Applicants and Members (A) Responsibility to Cooperate. The applicant or member must cooperate with MassHealth in providing information necessary to establish and maintain eligibility, and must comply with all the rules and regulations of MassHealth, including recovery. (B) Responsibility to Report Changes. The applicant or member must report to MassHealth, within 10 days or as soon as possible, changes that may affect eligibility. Such changes include, but are not limited to, income, assets, inheritances, gifts, transfers of and proceeds from the sale of real or personal property, distributions from or transfers into trusts, address, the availability of health insurance, immigration status, and third-party liability. (C) Cooperation with Quality Control. The Quality Control Division periodically conducts an independent review of eligibility factors in a sampling of case files. When a case file is selected for review, the member must cooperate with the representative of Quality Control. Cooperation includes, but is not limited to, a personal interview and the furnishing of requested information. If the member does not cooperate, MassHealth benefits may be terminated.