Section 8. As used in this chapter the following terms and phrases shall, unless the context clearly requires otherwise, have the following meanings:
a. ''Commissioner'', the commissioner of medical assistance or the secretary of elder affairs, as appropriate.
a.5. ''Department'', the department of elder affairs.
a.75. ''Division'', the division of medical assistance within the executive office of health and human services; but for the purposes of sections 9 to 52, inclusive, a reference to the word ''division'' shall mean the department of elder affairs, whenever appropriate.
b. ''Executive office'', the executive office of health and human services.
b1/4. ''Fiduciary'', a personal representative or trustee to whom power or property has been formally entrusted for the benefit of another, including, but not limited to, an executor, administrator, successor personal representative, special administrator or a person performing substantially the same function.
b.5. ''Institution'', a licensed hospital, nursing home or public medical institution that meets the requirements of the secretary.
c. ''Medicaid'', the jointly funded state and federal medical assistance program established pursuant to Title XIX under section nine of this chapter.
d. ''Medical assistance'', payment by the department, or its agent, or any predecessor or successor agency, of all or part of the cost of the medical care and services provided to recipients of any program established under this chapter, but not including benefits provided under section nine A.
d.5. ''Medical benefits'', benefits provided under section nine A.
e. ''Person'', any individual who resides in the commonwealth, or any individual residing outside the commonwealth who is deemed to be a resident of the commonwealth under Title XIX, Title XXI or other state or federal programs established or administered pursuant to this chapter.
e.5. ''Primary care provider'', a health care professional qualified to provide general medical care for common health care problems who: (i) supervises, coordinates, prescribes or otherwise provides or proposes health care services; (ii) initiates referrals for specialist care; and (iii) maintains continuity of care within the scope of practice.
f. ''Provider'', any institution, agency, individual, or other legal entity qualified under the laws of the commonwealth to perform the medical care or services for which medical assistance and medical benefits are available under this chapter.
g. ''Public medical institution'', any medical institution supported in whole or in part by public funds, either federal, state or municipal staffed by professional, medical and nursing personnel and providing medical care, in accordance with standards established through licensing or approval by the department of public health.
h. ''Reside'', to occupy an established place of abode with no present intention of definite and early removal, but not necessarily with the intention of remaining permanently, but in no event shall the word ''reside'' be construed more restrictively or less restrictively than as defined by the Secretary under Title XIX, Title XXI or other state or federal programs established or administered pursuant to this chapter.
i. ''Secretary'', the Secretary of the United States Department of Health and Human Services, except as that term is used in section two of this chapter.
j. ''Title XIX'', Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq. or any successor thereto.
k. ''Title XXI'', Title XXI of the Social Security Act, 42 USC 1397 et seq. or any successor thereto.
Structure Massachusetts General Laws
Part I - Administration of the Government
Chapter 118e - Division of Medical Assistance
Section 2 - Established Authority
Section 2a - Director of Dental Services
Section 6 - Medical Care Advisory Committee; Member; Staff; Report From Office of Medicaid
Section 8a - Definitions for Secs. 13c to 13k and Secs. 64 to 70
Section 9a - Masshealth; Beneficiaries; Eligibility; Payment; Information Applications
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 10d - Required Coverage for Treatment of Breast and Cervical Cancer
Section 10g - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate
Section 10k - Coverage for Certain Services and Contraceptive Methods
Section 10m - Coverage for Tobacco Use Cessation Counseling and Products
Section 10n - Urgent Care Facilities; Referrals; Primary Care Providers
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 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 15 - Medicaid Benefits; Rules and Regulations; Managed Care; Personal Expenses
Section 16a - Medical Care and Assistance Program for Disabled Children
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 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 25 - Exempt Income and Resources
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 31 - Adjustment or Recovery of Payments
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 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 42 - Excess Charges; Penalty
Section 44 - Civil Remedies; Limitations
Section 45 - Venue; Actions Relating to False Claims
Section 46 - Availability of Other Remedies
Section 47 - Persons Aggrieved; Right to Hearing; Investigation; Decision; Rehearing; Notice
Section 48 - Board of Hearings
Section 49 - Use and Disclosure of Information
Section 50 - Contract for Administrative Functions; Underwriting of Program
Section 52 - Maintenance of Standards for Providers; Development of New Programs
Section 54 - Wellness Program for Masshealth Enrollees
Section 56 - Controlled Substance Management Program for Masshealth Enrollees
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 67a - Nonpublic Ambulance Services; Liability; Uniform Assessment; Enforcement
Section 68 - Surcharge Assessed by Acute Hospitals and Ambulatory Surgical Centers
Section 70 - Definitions for Secs. 70 Through 75
Section 71 - Pca Quality Home Care Workforce Council
Section 74 - Pca Quality Home Care Workforce Council; Scope of Power and Authority
Section 75 - Performance Reviews
Section 77 - Office of Medicaid to Attribute Members to Primary Care Providers