Mass. Gen. Laws ch. 176A – Non–Profit Hospital Service Corporations | Midpage

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Massachusetts General Laws

Chapter 176A

Mass. Gen. Laws ch. 176A

Non–Profit Hospital Service Corporations

1Corporations governed by chapter; services received in nonparticipating hospital; substitution of benefits in nursing homes 1ARight to become subscriber; open enrollment periods 1BMedicare supplemental group coverage; medical assistance recipients 1CRetroactive premium rate increase 1DContracts of reinsurance 2Incorporators; directors; certificate of organization; commissioner's examination report 3Certificate of compliance; examination by commissioner 3ADiscrimination against abuse victims in terms of hospital service plans 3BMedical service plans; genetic tests; discrimination based on genetic information 4Accounting system; accountant, claim manager, underwriter and actuary 5Joint administration with certain corporations 6Approval of nongroup contracts 7Information gathering authority of commissioner; confidentiality and privilege 8Conditions to issuance or delivery of contract 8AMental illness expenses; inclusion in contracts as benefits; biologically-based mental disorders; rape-related mental disorders; non-biologically-based mental disorders for children and adolescents under age 19 8BDependent coverage for newborn infants or adoptive children; inclusion in contracts 8CRefusal to contract with blind or deaf persons; prohibition 8DLimited extension of benefits 8EDiethylstilbestrol exposure; discrimination 8FDivorced or separated spouses; continuation of eligibility for benefits 8GCardiac rehabilitation expense benefits 8HAbortion, abortion-related care, prenatal, childbirth and postpartum care benefits; minimum coverage for in-patient care 8IHome care benefits 8JMinimum requirements for cytologic screening and mammographic examination expense benefits 8KInfertility diagnosis and treatment benefits 8LNonprescription enteral formulas for home use 8MStandardized claim form 8NOff-label drug use; cancer 8OHospital service plan benefits for bone marrow transplants 8PItems medically necessary for diagnosis and treatment of diabetes 8QHIV/AIDS treatment; off-label prescription drug coverage 8RCoverage of hospice services for terminally ill patients 8SNurse anesthetist and nurse practitioner services 8TScalp hair prostheses necessary due to cancer or leukemia treatment 8UEmergency services provided to insureds for emergency medical conditions 8VCoverage for human leukocyte or histocompatibility locus antigen testing 8WOutpatient services; hormone replacement therapy for peri and post menopausal women; contraceptive services; approved prescription contraceptive drugs and devices; exception 8XCoverage for patient care services under qualified clinical trials 8YDiagnosis and treatment of speech, hearing and language disorders 8A3/4Retroactive claims denials for behavioral health services 8AACoverage of prosthetic devices and repairs 8BBCoverage for eligible dependents under 26 years of age or dependents mentally or physically incapable of earning their own living due to disability 8CCCoverage for medically necessary hypodermic syringes or needles 8DDCoverage for diagnosis and treatment of autism spectrum disorder 8EECoverage for children under age 18 for cleft lip and cleft palate 8FFCoverage for orally administered anticancer medications 8GGCoverage for abuse deterrent opioid drug products 8HHPreauthorization for substance abuse treatment not to be required 8IICoverage for medically necessary acute treatment or clinical stabilization services 8KKCoverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome 8LLFilling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity 8MMPain management access plan; non-medication and nonsurgical treatment; review; educational materials 8NNCoverage for tobacco use cessation counseling and tobacco cessation products 8OOCoverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome 8QQCoverage for prescription eye drops 8RRCoverage for mental health or substance use disorder services delivered through psychiatric collaborative care model 8SSCoverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment 8TTBenefits for medically necessary emergency services programs 8UUCoverage for annual mental health wellness examination 8VVCoverage for federally-defined preventive services 8WWCoverage for standard fertility preservation services 8XXCoverage for postpartum depression and major depressive disorder screenings 8YYCoverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products 8ZZCoverage for universal postpartum home visiting services 8AAACoverage for diagnostic examinations for breast cancer; digital breast tomosynthesis screening, MRIs and ultrasounds 8BBBCoverage for prescribed, ordered or dispensed opioid antagonists 8CCCCoverage for the provision of services by a recovery coach 8DD1/2Coverage for treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services 8DDDCoverage for identified generic and brand name drug used to treat diabetes, asthma, and certain heart conditions 10Group hospital service plan; approval or disapproval of contracts and rates; filing 10APreferred provider arrangements 11Officers; duties 12Publication of assets and liabilities 13Hospitalization and medical service for officers and employees of corporation 14Misrepresentation of terms of subscriber's contract 14BDisclosure of information; mental or nervous conditions; exceptions 15Costs of solicitation of subscribers and administration 16Acquisition of real estate; leases; tax exemption; limit; approval of investments, sales, loans and places of deposit 17Submission of disputes and controversies 18Annual statement of condition; verification, filing, form, violations; applicability of chapters 176V and 176W 18AFinancial statements; inclusion of electronic data processing equipment as asset 19Tax exemption 20Filing of amendment of by-laws 21Submission of advertising matter to commissioner 22Filing of riders, endorsements and applications with commissioner 23Grounds for enjoining transaction of business; rehabilitation proceedings; duties of receiver; distribution of assets 24Special contingent reserve fund 25Licensing of agents 26Salaries, compensation or emoluments paid by corporation 27Payroll deductions for governmental employees 28Violations; penalties 29Application 30Savings clause 31Contracts for administrative or other services; loans and investments 32Payment of sums owed to subscriber's estate 33Insolvency of health maintenance organization; replacement coverage 34Report of individuals provided with creditable coverage 36Attribution of members to a primary care provider 37Disclosure of patient-level data and contracted prices of individual health care services by carriers to providers 38Coverage for health care services delivered via telehealth by a contracted health care provider 81/2Sale of group non-profit hospital service contracts