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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 251 Rev. 02/13/2026

130 CMR 501.000: HEALTH CARE REFORM: MASSHEALTH: GENERAL POLICIES

501.001: Definition of Terms

The terms listed in 130 CMR 501.001 have the following meanings for the purposes of MassHealth, as described in 130 CMR 501.000 through 508.000. If a definition conflicts with federal law, the federal law supersedes.

Accountable Care Organization (ACO). An entity that enters into a population-based payment model contract with EOHHS as an accountable care organization, wherein the entity is held financially accountable for the cost and quality of care for an attributed or enrolled member population. ACOs include Accountable Care Partnership Plans, Primary Care ACOs, and MCO- administered ACOs.

Accountable Care Partnership Plan. A type of ACO with which the MassHealth agency contracts under its ACO program to provide, arrange for, and coordinate care and certain other medical services to members on a capitated basis and which is approved by the Massachusetts Division of Insurance as a health-maintenance organization (HMO) and which is organized primarily for the purpose of providing health care services.

Access to Health Insurance The ability to obtain employer-sponsored health insurance for an uninsured family member where an employer would contribute at least 50% of the premium cost, and the health insurance offered would meet the basic-benefit level.

American Indian or Alaska Native. A person who (1) is a member of a federally recognized tribe, band, or group as defined in Title 25 of U.S.C.; (2) is an Eskimo, Aleut, or other Alaska Native enrolled by the Secretary of the Interior, pursuant to the Alaska Native Claims Settlement Act at 43 U.S.C. 1601 et seq.; or (3) has been determined eligible to receive health care services from Indian HealthCare Providers as an Indian pursuant to 42 CFR 136.12 or Title V of the Indian HealthCare Improvement Act.

Appeal A written request, by an aggrieved applicant or member, for a fair hearing.

Appeal Representative. An Appeal Representative as defined in 130 CMR 610.004: Definitions.

Applicant A person who completes and submits an application for MassHealth.

Application A request for health benefits that is received by the MassHealth agency and includes all required information and a signature by the applicant or their authorized representative. The application may be submitted at www.MAHix.org, or the applicant may complete a paper application, complete a telephone application, or apply in person at a MassHealth Enrollment Center (MEC).