General Laws of Massachusetts - Chapter 118E Division of Medical Assistance - Section 13 Rate changes; review

Section 13. The commissioner shall review, and approve or disapprove, any change in Title XIX rates or Title XIX rate methodology proposed by the executive office of health and human services, which shall be called the “executive office” only for the purposes of this section or by a governmental unit designated by the executive office. The commissioner shall review such proposed rate changes for consistency with agency policy and federal requirements, and within the level of funding available as authorized by the general appropriation act prior to the certification of such rates by the executive office; provided, that the commissioner shall not disapprove a rate increase solely based on the availability of funding if the federal health care financing administration provides written documentation that federal reimbursement would be denied as a result of said disapproval and said documentation is submitted to the house and senate committees on ways and means. The commissioner shall, when disapproving a rate increase, submit the reasons for disapproval to the executive office together with any recommendations for changes. Such disapproval and recommendations, if any, shall be submitted after the commissioner is notified that the executive office intends to propose a rate increase for any class of provider under Title XIX; but in no event later than the date of the public hearing held by the executive office regarding such rate change; provided, that no rates shall take effect without the approval of the commissioner. The executive office and the commissioner shall provide documentation on the reasons for increases in any class of approved rates that exceed the medical component of the consumer price index to the house and senate committees on ways and means. The center for health information and analysis shall supply the commissioner with all statistical information necessary to carry out his duties under this section. Notwithstanding the foregoing, the commissioner shall not review, approve, or disapprove any such rate set pursuant to chapter twenty-three of the acts of nineteen hundred and eighty-eight. If projected payments from rates necessary to conform to applicable requirements of Title XIX are estimated by the commissioner to exceed the amount of funding appropriated for such purpose in the general appropriation act in any fiscal year, the executive office and the commissioner shall jointly prepare and submit to the Governor a proposal for the minimum amount of supplemental funding necessary to satisfy the requirements of the under Title XIX state plan.

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Last modified: September 11, 2015