Standing Referrals
Effective Apr 28, 2023Mass. Register #1494MGL c. 6D, § 16 MGL c. 176OMassachusetts Health Policy Commission
(1) A carrier that requires an insured to designate a primary care provider shall allow such a primary care provider to authorize a standing referral for specialty health care, including mental health care, provided by a health care provider participating in such carrier's network when:
- (a) the primary care provider determines that such referrals are appropriate;
- (b) the provider of specialty health care agrees to a treatment plan for the insured and provides the primary care provider with all necessary clinical and administrative information on a regular basis; and
- (c) the health care services to be provided are consistent with the terms of the carrier's evidence of coverage.
- (2) Nothing in 958 CMR 3.505 shall be construed to permit a provider of specialty health care who is the subject of a referral to authorize any further referral of an insured to any other provider without the approval of the insured's carrier.
- (3) For the purposes of 958 CMR 3.505, "specialty health care" means health care services rendered by a provider other than a primary care provider.