An Act ensuring access and continuity of care to specialist and hospital services for dually eligible individuals

This bill (SD 1815) ensures that people in Massachusetts eligible for both Medicare and MassHealth (dually eligible individuals) can access specialist and hospital care from any provider enrolled in Medicare or MassHealth, regardless of their health plan’s network restrictions. It requires health plans (like One Care or SCO plans) to reimburse providers at Medicare or MassHealth fee-for-service rates if no existing contract exists, unless the plan and provider agree otherwise. Additionally, if a health plan terminates a contract with a provider, it must allow affected members to continue receiving care from that provider for 12 months under the original terms, including reimbursement rates, to prevent sudden disruptions in care. The law directly affects dually eligible patients and their providers, focusing on maintaining access without requiring new contract negotiations during transitions.