MA S856

Dually eligible individuals (enrolled in both Medicare and MassHealth) would be permitted to receive care from any specialist or hospital in Massachusetts that participates in Medicare or MassHealth, regardless of health plan network restrictions

Out-of-network providers without existing contracts would be reimbursed at Medicare or MassHealth fee-for-service rates by One Care or SCO plans

When a One Care or SCO plan terminates a contract with a provider, affected members must be allowed to continue receiving services from their primary care physician, specialist, or hospital for 12 months beyond any existing continuity of care period

During the 12-month continuation period, plans must maintain all pre-termination contract terms including reimbursement rates, unless both parties mutually agree to changes

Plans and providers are prohibited from using these provisions to avoid good faith contract negotiations