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Health-Law-Announcements's Blog

The latest health law updates for advocates and social service providers in Massachusetts.

Happy New Year to Health Advocates Everywhere,

We will be sending out an update on Open Enrollment, the MassHealth Renewal-Reapplication process and other developments soon.

Many provisions of Chapter 258, a 2014 law addressing access to substance use recovery services are taking effect in 2015.

1. An updated provider bulletin from MassHealth clarifies that pursuant to the new law, effective Oct 2015, neither MassHealth nor its managed care plans can require prior authorization for acute treatment e.g. admission to a detox facility or for clinical stabilization services . The treating clinician's judgment on medical necessity rules at least for acute care and  the 1st 14 days of clinical stabilization.

Today is the first day of open enrollment for people who are already enrolled through the Connector and want to change plans in 2016 and for people who want to obtain new coverage through the Connector for 2016.  Open enrollment is for people who don't already have coverage through MassHealth, Medicare or an employer and want to purchase a nongroup plan either through the Connector or directly from a health insurance company.

1. Attached and posted in the health section of is an updated version of MLRI's paper summarizing the immigrant eligibility rules in MassHealth and the Connector. The rules have not changed since January 2014. The revisions are attempting yet again to make incomprehensible rules comprehensible. Still bewildered? Please let Vicky know for future revisions.

Attached are the updated Federal Poverty Standards for the Connector Programs (Connector Care and Qualified Health Plans) for the Open Enrollment period beginning November 1st .

The actual effective date for eligibility purposes is January 1st, but enrollment for January starts in November.

1. Substance use disorder services 

Last year a state law improving substance use disorder services was enacted (c. 258 St. 2014). A provision requiring MassHealth & MassHealth managed care plans to cover detox and up to 14 day crisis stabilization services without prior authorization took effect on Oct 1, 2015.

1. MassHealth Renewals

Extension to Oct 16 for people with disabilities.

On August 1, 2015, the Office of Medicaid notified over 30,000 households containing at least one member with a disability that they had to submit a reapplication by Sept 15, 2015 in order to remain eligible for MassHealth.

This reapplication deadline applies to over 60,000 individuals.

We learned today that the number of reapplications filed to date is on the low side. Termination notices will not go out on 9-15; there will be at least a short grace period. But terminations will happen. Over 200,000 people were terminated in July.

1. MassHealth Renewals.

MassHealth is about half-way through the process of renewing eligibility for 1.2 million beneficiaries before the end of 2015.

Renewals for People with Disabilities Underway-Workaround needed for some adults

MassHealth just released preliminary results on the first 500,000 MassHealth beneficiaries to have their eligibility renewed in the new computer eligibility system. It's attached.

The positive spin is that 80% of people who were required to reapply, responded in some way, and that of those who completed an application 83% were still eligible for MassHealth.

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