HD 2728 Massachusetts House · 194th Legislature (2025-2026)

An Act relative to rate equity for community health centers

This bill requires Massachusetts health insurers, health plans, and other entities reimbursing community health centers to pay for Federally Qualified Health Center (FQHC) services at rates equivalent to what those centers would receive from MassHealth (the state's Medicaid program). It directly affects FQHCs serving Medicaid patients and the health plans/insurers that cover their services. The key mechanism mandates that reimbursement rates must align with federal Medicaid payment methodologies (42 U.S.C. §1396a(bb) and §1396b(m)(2)(A)(ix)) as of January 1, 2025, and requires annual reporting to ensure compliance. The bill aims to ensure FQHCs receive fair reimbursement without changing existing Medicaid payment structures.
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