Massachusetts Chapter 176O — Health Insurance Consumer Protections

38 sections hosted, reproduced from the official public-domain source.

Mass. Gen. Laws ch. 176O, § 1— Definitions
Mass. Gen. Laws ch. 176O, § 2— Bureau of managed care
Mass. Gen. Laws ch. 176O, § 3— Complaints against carriers; notice; hearing
Mass. Gen. Laws ch. 176O, § 4— Refusal of carriers to contract with eligible health, dental or vision care providers solely because providers have practiced good faith advocacy on behalf of patients
Mass. Gen. Laws ch. 176O, § 5— Contracts; liability
Mass. Gen. Laws ch. 176O, § 5A— Acceptance and recognition of information submitted pursuant to current coding standards and guidelines required; use of standardized claim formats
Mass. Gen. Laws ch. 176O, § 5B— Policies and procedures to enforce Sec. 5A
Mass. Gen. Laws ch. 176O, § 5C— Failure of carrier to comply with coding standards and guidelines; notice; penalty
Mass. Gen. Laws ch. 176O, § 5D— Establishment of base fee schedule for evaluation and management services for behavioral health providers
Mass. Gen. Laws ch. 176O, § 6— Evidence of coverage to be delivered to covered adults by health, dental and vision care providers; contents
Mass. Gen. Laws ch. 176O, § 7— Information provided by carrier upon enrollment or upon request
Mass. Gen. Laws ch. 176O, § 8— Failure by carrier to file annual statement; fine
Mass. Gen. Laws ch. 176O, § 9— Utilization review programs; annual attestations
Mass. Gen. Laws ch. 176O, § 9A— Agreements or contracts between carrier and health care provider prohibited if containing certain provisions
Mass. Gen. Laws ch. 176O, § 9B— Alternate payment arrangements involving downside risk prohibited without risk certificate
Mass. Gen. Laws ch. 176O, § 10— Contractual financial incentive plans
Mass. Gen. Laws ch. 176O, § 11— Rights of health benefit plans to include as providers religious non-medical providers
Mass. Gen. Laws ch. 176O, § 12— Utilization review
Mass. Gen. Laws ch. 176O, § 12A— Step therapy protocol: prescription drugs: annual report
Mass. Gen. Laws ch. 176O, § 12B— Commission on step therapy protocol; responsibilities; annual report
Mass. Gen. Laws ch. 176O, § 13— Formal internal grievance process; expedited resolution policy
Mass. Gen. Laws ch. 176O, § 14— Review panel; patient protection office
Mass. Gen. Laws ch. 176O, § 15— Disenrollment of provider; continuation of treatment; specialty health care coverage
Mass. Gen. Laws ch. 176O, § 16— Clinical decisions regarding medical treatment made by treating physicians; payment for health care services ordered by treating physician or primary care provider
Mass. Gen. Laws ch. 176O, § 17— Regulations; promulgation
Mass. Gen. Laws ch. 176O, § 18— Responsibility of carrier for behavioral health services compliance
Mass. Gen. Laws ch. 176O, § 19— Display of name and telephone number of health service manager on enrollment cards of carrier
Mass. Gen. Laws ch. 176O, § 20— Information provided to insured adults by behavioral health manager; submission of material changes; workers' compensation; preferred provider arrangements
Mass. Gen. Laws ch. 176O, § 21— Submission by carrier of annual comprehensive financial statement
Mass. Gen. Laws ch. 176O, § 22— Participation in medical assistance program as condition for participation in carrier's provider network
Mass. Gen. Laws ch. 176O, § 23— Disclosure by carrier upon request for network status of health care provider and estimated or maximum allowed amount or charge for a proposed admission, procedure or service and amount insured responsible to pay; establishment of toll-free telephone number and website
Mass. Gen. Laws ch. 176O, § 24— Internal appeals processes for risk-bearing provider organizations; patient's right to third-party advocate; external review process
Mass. Gen. Laws ch. 176O, § 25— Use and acceptance of specifically designated prior authorization forms
Mass. Gen. Laws ch. 176O, § 26— Establishment of standardized processes and procedures for the determination of patient's health benefit plan eligibility at or prior to time of service
Mass. Gen. Laws ch. 176O, § 27— Development and use of common summary of payments form; implementation of education plan
Mass. Gen. Laws ch. 176O, § 28— Provider directories; contents; audits; print copies; customer service contact information; accommodations; accuracy; updates
Mass. Gen. Laws ch. 176O, § 29— Health care provider credentialing
Mass. Gen. Laws ch. 176O, § 30— Report to division regarding drugs selected to be provided with no or limited cost-sharing