Bill
SD 917
SD 917 requires MassHealth to set minimum provider reimbursement rates, network adequacy standards, and quality metrics to improve access and care quality for over 2 million enrollees.
SD 917, titled "An Act ensuring equitable access and care quality for MassHealth recipients", is a proposed bill introduced in the Massachusetts legislature on November 29, 2025. The bill aims to address issues of inequitable access and quality of care for individuals enrolled in the state's Medicaid program, known as MassHealth.
The bill would enact the following key changes:
Minimum Provider Reimbursement Rates: The bill would establish minimum reimbursement rates for healthcare providers who serve MassHealth patients. This is intended to incentivize more providers to accept MassHealth coverage and improve access to care for enrollees.
Network Adequacy Standards: The bill would require MassHealth managed care plans to meet specific network adequacy standards, ensuring an adequate number and geographic distribution of providers for enrollees to access care in a timely manner.
Quality Metrics and Reporting: MassHealth managed care plans would be required to track and report on a set of quality metrics related to access, utilization, health outcomes, and patient satisfaction. This data would be publicly reported to improve transparency.
Care Coordination Funding: The bill would provide additional funding to MassHealth plans and providers for care coordination and management services, with the goal of improving health outcomes and reducing unnecessary utilization.
If enacted, SD 917 would primarily impact the following groups:
MassHealth Enrollees: The bill aims to improve access to healthcare providers and the quality of care received by the over 2 million Massachusetts residents enrolled in MassHealth.
Healthcare Providers: The minimum reimbursement rates and network adequacy standards may incentivize more providers, especially primary care physicians and specialists, to participate in the MassHealth program.
MassHealth Managed Care Plans: These plans would be subject to new requirements around network adequacy, quality measurement, and care coordination funding, which could affect their operations and contracts with providers.
Massachusetts Taxpayers: The additional funding for care coordination and potential increase in provider participation in MassHealth may result in increased state Medicaid expenditures, which could impact the state budget.
In summary, SD 917 is a legislative proposal that seeks to address longstanding issues of access and quality of care for MassHealth enrollees by establishing minimum provider reimbursement rates, network adequacy standards, quality reporting requirements, and care coordination funding. If passed, the bill has the potential to significantly improve healthcare for the state's Medicaid population.
Compiled from official sources — confirm details with the bill’s official record.
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