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Code of Massachusetts Regulations (CMR)
Title 958
Chapter 11.00
958 C.M.R. 11.00
Internal appeals process and external review process for risk-bearing provider organizations and accountable care organizations
MGL c. 6D, § 15 MGL c. 6D, § 16 MGL c. 176O, § 24
Massachusetts Health Policy Commission
11.01
Scope and Purpose
11.02
Definitions
11.03
Right to an Internal Appeal
11.04
Information on Internal Appeals
11.05
Form and Manner of Request for Internals Appeals
11.06
Risk-bearing Provider Organization and Accountable Care Organization Records of Appeals
11.07
Time Limits for Resolution of Internal Appeals
11.08
Internal Reviewers
11.09
Form of Written Resolution of the Internal Appeal
11.10
External Review
11.11
Expedited External Review
11.12
Fees
11.13
Consent to Release of Medical Information
11.14
Form and Manner of Request for External Review
11.15
Screening of Requests for External Review
11.16
Requests Ineligible for External Review – Notification
11.17
Assignment of External Reviews
11.18
Notification of Assignment and Request for Information
11.19
Medical Records and Other Information
11.20
Conflict of Interest
11.21
Decisions and Notice
11.22
Confidentiality
11.23
Reporting Requirements
11.24
Severability