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Mass. General Laws c.118E

Division of Medical Assistance

This page links to an unofficial version of each section of G.L. c. 118E. Please note that sections that appear missing have been either reserved for future use or repealed.

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§ 1 Duties of office 
§ 2 Established authority 
§ 2A Director of dental services 
§ 6 Medical care advisory committee; member; staff; report from office of Medicaid 
§ 7 Powers 
§ 8 Definitions 
§ 8A Definitions for Secs. 13C to 13K and Secs. 64 to 70 
§ 9 Eligibility 
§ 9A MassHealth; beneficiaries; eligibility; payment; information applications 
§ 9C Medical insurance reimbursement programs; definitions; eligibility; expenditures; submission of plans 
§ 9D Senior care options initiative; senior care organizations; enrollment choices; advisory committee; report 

Amended by St. 2024, c. 392, § 138, effective January 9, 2025

§ 9E Application for authority; implementation of measures; waiver of measures due to hardship 
§ 9F Duals demonstration; review of request for financial solvency 
§ 10 Medical care assistance program for pregnant women and infants 
§ 10A Required coverage for prenatal care, childbirth and postpartum care 

Amended by St. 2024, c. 186, §§ 39-40, effective November 21, 2024

§ 10A 1/2 MassHealth standard coverage for pregnant or postpartum residents 

Added by St.2022, c.436, effective April 5, 2023

§ 10B Required coverage for newborn hearing screening tests 
§ 10C Required coverage for items medically necessary for the diagnosis or treatment of diabetes 
§ 10D Required coverage for treatment of breast and cervical cancer 
§ 10E Healthy start program; medical assistance for pregnant women and infants; eligibility; types of assistance; protection from billing and collection practices 
§ 10F Health care services for dependent and adopted youths; funding; types of services; eligibility; program reports; no entitlement 

Amended by St. 2024, c. 140, §§ 117-118, effective upon the earlier of: (i) the receipt of all necessary federal approvals, including state plan and 1115 demonstration amendments; or (ii) January 1, 2025.

§ 10G Coverage for children under age 18 for cleft lip and cleft palate 
§ 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 
§ 10H 1/2 Coverage for the treatment of Down syndrome 

Added by St. 2024, c. 388, § 2, effective January 1, 2026

§ 10I Coverage for administration of all federal Food and Drug Administration approved drugs for opioid or alcohol dependence treatment 
§ 10J Coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome 
§ 10K Coverage for certain services and contraceptive methods 
§ 10L Filling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity 
§ 10M Coverage for tobacco use cessation counseling and products 
§ 10N Urgent care facilities; referrals; primary care providers 
§ 10O Coverage for mental health acute treatment, community-based acute treatment and intensive community-based acute treatment 

Added by St.2022, c.177, § 42, effective November 8, 2022

§ 10P Coverage for mental health or substance use disorder services delivered through the psychiatric collaborative care model 

Added by St.2022, c.177, § 42, effective November 8, 2022

§ 10Q Coverage for annual mental health wellness examination 

Added by St.2022, c.177, § 42, effective November 8, 2022

§ 10R Coverage for noninvasive prenatal screenings 

Added by St. 2024, c. 186, § 41, effective November 21, 2024

§ 10S Coverage for postpartum depression and major depressive disorder screenings 

Added by St. 2024, c. 186, § 41, effective November 21, 2024

§ 10T Coverage for medically necessary pasteurized donor human milk and milk-derived products 

Added by St. 2024, c. 186, § 41, effective November 21, 2024

§ 10U Coverage for doula services 

Added by St. 2024, c. 186, § 41, effective November 21, 2024

§ 10V Coverage for universal postpartum home visiting services 

Added by St. 2024, c. 186, § 41, effective November 21, 2024

§ 10W Coverage for medically necessary breast screenings and examinations 

Added by St. 2024, c. 231, § 2, and shall apply to all contracts entered into, renewed or amended on or after January 1, 2026.

§ 10X Coverage and reimbursement for prescribed, ordered or dispensed opioid antagonists 

Added by St. 2024, c. 285, § 14, applicable to all contracts entered into, renewed or amended on or after July 1, 2025

§ 10Y Coverage for licensed recovery coach services 

Added by St. 2024, c. 285, § 14, applicable to all contracts entered into, renewed or amended on or after January 1, 2026

§ 10Z Coverage for brand name and generic drugs for the purpose of treating diabetes, asthma, and 2 prevalent heart conditions 

Added by St. 2024, c. 342, § 28, applicable to all contracts entered into, renewed or amended on or after July 1, 2025.

§ 11 Cooperation with federal authorities 
§ 12 Policies; procedures; rules and regulations; contracts 
§ 12A Pharmaceutical drugs; negotiation of supplemental rebate agreements 
§ 13 Rate changes; review 
§ 13A Non-acute hospitals; rates and terms of payment 
§ 13B Hospital rate increases; quality standards and benchmarks 
§ 13C Establishment of rates of payment for health care services 
§ 13D Duties of ratemaking authority; criteria for establishing rates 
§ 13D 1/2 Minimum payment rates to be paid to providers of behavioral health services delivered in community behavioral health centers by managed care entities; annual review and reporting 

Added by St.2022, c.177, § 43, effective November 8, 2022

§ 13E Appeals of interim or final rates 
§ 13E 1/2 Contractual arrangements with acute and non-acute hospitals 
§ 13F Contracts between acute and non-acute hospital service providers and office of Medicaid 
§ 13G Hospital assets not to be considered as resources for purpose of establishing rates 
§ 13H Recipients of benefits under chapter 117A 
§ 13I Patients with foreign residency 
§ 13J Health maintenance organizations; contracting rights 
§ 13K Adjustment of facility's rate 
§ 13L Restriction of hospital access to discounted purchase of prescription drugs 
§ 14 Nursing home negotiated rate contracts 
§ 14A Reimbursement to nursing homes for admissions to acute care and chronic disease or rehabilitation hospitals 
§ 15 Medicaid benefits; rules and regulations; managed care; personal expenses 
§ 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 
§ 16A Medical care and assistance program for disabled children 
§ 16A 1/2 Costs incurred for medical programs projected to exceed available appropriations; notice 
§ 16C Child health insurance program; medical benefits; costs; eligibility 

Amended by St. 2024, c. 140, § 119, effective upon the earlier of: (i) the receipt of all necessary federal approvals, including state plan and 1115 demonstration amendments; or (ii) January 1, 2025.

§ 16D Aliens or persons residing in United States under color of law; benefits 
§ 17 Reimbursements for non-generic drugs 
§ 17A Emergency services provided to beneficiaries for emergency medical conditions 
§ 18 Medical insurance purchases for persons eligible for assistance 
§ 19 Prior approval of medical services; methods; rules and regulations; posttreatment examinations 
§ 20 Application; forms; application by institution 
§ 21 Inquiry by department; notification of applicant; agreement 
§ 21A Medical assistance eligibility of an institutionalized spouse 
§ 22 Third party payments; repayment; assignment; subrogation 
§ 23 Subrogation rights; health insurance benefits; garnishment of wages 

Amended by St.2023, c.77, §§ 22-26, effective December 4, 2023

§ 23A Financial institutions; request for deposit and withdrawal records; penalty 
§ 25 Exempt income and resources 

Amended by St.2023, c.77, § 27, effective December 4, 2023

§ 25A Determination of eligibility for Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary and Qualified Individual programs; consideration of certain income or assets 

Amended by St.2023, c.28, §§ 46-47, effective July 1, 2023

§ 26 Identification card 
§ 27 Redetermination of eligibility 
§ 28 Disposal of resources at less than fair market value; period of ineligibility 

Amended by St. 2024, c. 197, § 19, effective December 5, 2024

§ 29 Transfer of interest in real property; notice 
§ 30 Time of payment 
§ 31 Adjustment or recovery of payments 

Amended by St. 2024, c. 197, §§ 20-21, effective December 5, 2024

§ 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 
§ 33 Long term care insurance purchasers; liability for medical assistance paid 
§ 34 Liens and encumbrances 
§ 35 Reimbursement for covered claims; submission of information 
§ 36 Eligible providers; responsibility for overpayments 
§ 37 Distribution of rules, regulations to providers; administrative sanctions 
§ 38 Submission of bills by providers; appeals for erroneous denials; overpayments; civil collection actions 
§ 38A Retroactive claims denials for behavioral health services 
§ 39 False representations, failure to disclose; penalty 
§ 40 False statements or representations by providers; penalty 
§ 41 Bribery or rebates; penalty 
§ 42 Excess charges; penalty 
§ 43 Health care facilities; additional charges as precondition for admission or continuance; penalty 
§ 44 Civil remedies; limitations 
§ 45 Venue; actions relating to false claims 
§ 46 Availability of other remedies 
§ 46A Providers; submission of claims for payment not in compliance with policies and procedures of medical assistance program; proof of clerical or administrative error 
§ 47 Persons aggrieved; right to hearing; investigation; decision; rehearing; notice 

Amended by St.2022, c.177, § 43A, effective November 8, 2022

§ 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 
§ 48 Board of hearings 
§ 49 Use and disclosure of information 
§ 50 Contract for administrative functions; underwriting of program 
§ 51 Utilization review of care and services; data processing and collection procedures; liability in civil actions 
§ 51A Step therapy protocol clinical review criteria; prescription coverage 

Added by by St.2022, c.254, § 1, effective October 1, 2023

§ 52 Maintenance of standards for providers; development of new programs 
§ 53 Covered services 
§ 54 Wellness program for MassHealth enrollees 
§ 56 Controlled substance management program for MassHealth enrollees 
§ 61 Availability of benefits to persons recognized as a spouse under laws of the commonwealth 
§ 62 Acceptance and recognition of information submitted pursuant to coding standards and guidelines required; use of standardized claim formats 
§ 63 Assessment per non-Medicare reimbursed patient day 

Amended by St.2021, c.24, §§ 48-49, effective July 1, 2021

§ 64 Definitions for Secs. 64 through 69 

Amended by St. 2024, c. 342, §§ 29-30, effective April 8, 2025

§ 65 Health safety net office 

Amended by St.2022, c.126, § 58, effective July 1, 2022

§ 66 Health Safety Net Trust Fund 

Amended by St. 2024, c. 140, §§ 126-128

§ 67 Liability of acute hospital to fund 

Amended by St. 2024, c. 140, § 129

§ 67A Nonpublic ambulance services; liability; uniform assessment; enforcement 
§ 68 Surcharge assessed by acute hospitals and ambulatory surgical centers 

Amended by St. 2024, c. 140, § 130

§ 69 Reimbursements to hospitals and community health centers for health services provided to uninsured and underinsured individuals 

Amended by St.2022, c.126, § 64, effective October 1, 2022

§ 70 Definitions for Secs. 70 through 75 

Amended by St.2023, c.77, § 28, effective December 4, 2023

§ 71 PCA quality home care workforce council 

Amended by St.2023, c.77, §§ 29-30, effective December 4, 2023

§ 72 Duties of workforce council; PCA recruitment, training and referral resources; lists of PCAs 
§ 73 Rights of consumers regarding PCAs; public employee status for limited purposes; collective bargaining 
§ 74 PCA quality home care workforce council; scope of power and authority 
§ 75 Performance reviews 
§ 76 Designation of another governmental unit to perform functions set forth in Secs. 13C through 13K and 64 through 75 
§ 77 Office of Medicaid to attribute members to primary care providers 
§ 78 Employer healthcare coverage form 
§ 79 Coverage for health care services delivered via telehealth by a contracted health care provider; right in in-person services; copayment or coinsurance; rate of payment; standards of care 
§ 80 Two separate laws codified under this section 

Added by St.2022, c.126, § 67 / St.2022, c.177, § 44

§ 81 Mental health and substance use disorder benefits; benefits for children and adolescents under the age of 19 for the diagnosis and treatment of mental, behavioral, emotional or substance use disorders substantially interfering with or limiting ... 

Added by St.2022, c.177, § 44, effective November 8, 2022

§ 82 Requirement that division meets parity requirements described under federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and related guidance or regulations 

Added by St.2022, c.177, § 44, effective November 8, 2022

§ 83 Two separate laws: Standing orders issued by registered practitioners for use by licensed pharmacists to dispense OTC oral contraceptives to MassHealth members or HSN patients / Determination of Medicaid rates for skilled nursing facilities 

Added by St. 2024, c. 140, § 132 and St. 2024, c. 197, § 22

§ 84 Two separate laws: Standing orders issued by registered physicians to be used by licensed pharmacists to dispense prenatal vitamins to MassHealth members or HSN patients / Rate add-on programs for bariatric patient care and at-risk residents 

Added by St. 2024, c. 140, § 132 and St. 2024, c. 197, § 22

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