An Act to ensure access and continuity of care to specialist and hospital services for dual eligibles

This bill aims to improve healthcare access for dual eligibles in Massachusetts, who qualify for both Medicare and MassHealth. It allows these individuals to receive specialist and hospital services from any provider enrolled in Medicare or MassHealth, regardless of their specific health plan's network restrictions. If a provider is not already contracted with the patient's plan, the bill requires the plan to pay the provider using Medicare or MassHealth fee-for-service rates, unless a different agreement is reached. Additionally, the legislation mandates that when a One Care or SCO plan ends a contract with a provider, the affected members must be able to continue receiving care from that provider for twelve months under the old contract terms. This continuity provision ensures patients do not lose access to their doctors or hospitals immediately upon a contract termination, while preventing plans from using this rule to delay necessary negotiations.