New Free Care Pool Regulations

August 5, 2005

The Division of Healthcare Finance and Policy has released proposed regulations due to take effect on October 1, 2005. A public hearing has been scheduled for September 8, 2005 at UMass Boston. Included in the regulation are the following changes:

1. Individuals terminated from MassHealth for failure to pay
2. premiums/deductibles, and individuals eligible for premium assistance who do not apply, will not be eligible for Low Income coverage. The retroactive period reduced from 180 to 60 days.
3. Claims for services must be submitted within 90 days of the date of service.
4. Elimination of covered services (except for dental) for MassHealth members.
5. Limit services for EAEDC, CMSP, MassHealth Limited, Healthy Start and Center Care members.
6. Requires co-pays from $3 to $5.
7. Limits hospital outpatient to prescription drugs to those on the MassHealth approved drug list.
8. Limits payments for ER Bad Debt to the first 24 hours unless the patient is determined Low Income eligible.
9. Allows providers to bill low income patients for services rendered prior to their eligibility period
10. Limits scope of home and auto lien prohibitions.

As quoted in the State House News service, "These changes, if implemented, will be a significant obstacle for many poor people in obtaining coverage," said John McDonough, executive director of Health Care For All. "It will discourage very poor people from seeking necessary and appropriate care."

HFI is reviewing the regulations and will have additional information in the near future.

At Healthcare Financial Inc., 100% of our focus is on improving bottom line profitability by converting self-pay patients to government payors. Our proprietary system specializes in converting difficult to enroll low income, medically complex, psychiatric and disabled self-pay patients into MassHealth, disability and other public health insurance programs.

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