Section 123: Medicaid Managed Care Organizations Exclusive Right in Commonwealth Care

Notwithstanding any general or special law to the contrary, from July 1, 2006 to June 30, 2009, inclusive, the executive director of the commonwealth health insurance connector shall collaborate with the secretary of health and human services and the commissioner of insurance to ensure that only Medicaid managed care organizations that have contracted with the commonwealth as of July 1, 2006 to deliver managed care services shall receive premium assistance payments from the commonwealth care health insurance program, under chapter 118H of the General Laws, for the purposes of enrolling low-income individuals, but any organization referenced in section 28 of chapter 47 of the acts of 1997 may offer health benefit plans through the commonwealth care health insurance program, through the connector. Such organizations shall be considered carriers and the contracts offered by such organizations shall be considered health benefit plans. If the total enrollment among all Medicaid managed care organizations does not total 40,000 enrollees as of June 30, 2007, or 12 months after enrollment in that program is implemented, whichever is later, and 80,000 enrollees as of June 30, 2008, or 24 months after enrollment in that program is implemented, whichever is later, as defined in section 1 of chapter 118H of the General Laws, the director may allow non-Medicaid managed care organizations to apply to the commonwealth health insurance connector in order to receive premium assistance for the purposes of maximizing health insurance coverage in the commonwealth. The director shall collaborate with the secretary of health and human services and the group insurance commission to implement a methodology for the purposes of adjusting for variations in clinical risk among populations served by each of the commonwealth health insurance connector contractors. Adjustments to final payments to each of the contractors for a contract year shall be made in accordance with the risk adjustment methodology.

Summary: 
Provides exclusive rights for three years to Medicaid managed care organizations that have contracted with the Commonwealth to provide managed care to MassHealth members to offer subsidized plans through the Commonwealth Care Health Insurance Program.