Mass. Gen. Laws ch. 176G – Health Maintenance Organizations | Midpage

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Massachusetts General Laws

Chapter 176G

Mass. Gen. Laws ch. 176G

Health Maintenance Organizations

1Definitions 2Application of laws 3Organization; accounting; contracts 4Required coverage for certain conditions and groups 4AEmployees terminated due to plant closings; coverage 4BConfidentiality of information; mental or nervous condition; exceptions 4CHome care benefits 4DNonprescription enteral formulas for home use 4EOff-label drug use; cancer treatment 4FGroup health maintenance contracts; coverage for bone marrow transplants 4GOff-label use of prescription drugs for HIV/AIDS treatment 4HItems medically necessary for diagnosis and treatment of diabetes 4IAbortion, abortion-related care, prenatal care, childbirth and postpartum care benefits; minimum coverage for in-patient care; exemptions 4JScalp hair prostheses necessary due to cancer or leukemia treatment 4KNewborn hearing screening tests 4LCoverage for hospice services 4MMental health benefits; biologically-based mental disorders; rape-related mental disorders; non-biologically-based mental disorders of children and adolescents under age 19 4NCoverage for speech, hearing and language disorders; hearing aids 4OOutpatient services; hormone replacement therapy for peri and post menopausal women; contraceptive services; approved prescription contraceptive drugs or devices; exception 4PPatient care services provided pursuant to qualified clinical trials 4QCoverage for human leukocyte or histocompatibility locus antigen testing 4SCoverage for prosthetic devices and repairs 4TCoverage for eligible dependents under 26 years of age or dependents mentally or physically incapable of earning their own living due to disability 4UCoverage for medically necessary hypodermic syringes or needles 4VCoverage for diagnosis and treatment of autism spectrum disorder 4WCoverage for children under age 18 for cleft lip and cleft palate 4XCoverage for orally administered anticancer medications 4YCoverage for abuse deterrent opioid drug products 4ZPreauthorization for substance abuse treatment not to be required 4AACoverage for medically necessary acute treatment and clinical stabilization services 4CCCoverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome 4DDFilling of remaining portion of prescription for covered drug that is a narcotic substance earlier filled in lesser quantity 4EEPain management access plan; non-medication and nonsurgical treatment; review; educational materials 4FFCoverage for tobacco use cessation counseling and tobacco cessation products 4GGCoverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome 4IICoverage for prescription eye drops 4JJCoverage for mental health or substance use disorder services delivered through psychiatric collaborative care model 4KKCoverage for medically necessary mental health acute treatment, community-based acute treatment and intensive community-based acute treatment 4LLBenefits for medically necessary emergency services programs 4MMCoverage for annual mental health wellness examination 4NNCoverage for federally-defined preventive services 4OOCoverage for standard fertility preservation services 4PPCoverage for postpartum depression and major depressive disorder screenings 4QQCoverage for the provision of medically necessary pasteurized donor human milk and donor human milk-derived products 4RRCoverage for universal postpartum home visiting services 4SSCoverage for diagnostic examinations for breast cancer; digital breast tomosynthesis screening, MRIs and ultrasounds 4TTCoverage for prescribed, ordered or dispensed opioid antagonists 4UUCoverage for the provision of services by a recovery coach 4V1/2Coverage for the treatment of Down syndrome through speech therapy, occupational therapy, physical therapy and applied behavior analysis services 4VVCoverage for identified generic and brand name drug used to treat diabetes, asthma, and certain heart conditions 5Emergency services provided to members for emergency medical conditions 5ADivorced or separated spouses; coverage 6Contracts 6AGroup health maintenance contracts; contribution percentages 6BRetroactive claims denials for behavioral health services 8Public dissemination of deceptive or misleading materials 9Trade regulation practices; application of law 10Reports; audits, examinations or inspections; confidentiality and privilege 10AApplicability of chapter 176V to health maintenance organizations governed by this chapter 10BApplicability of chapter 176W to health maintenance organizations governed by this chapter 11Contracts with group insurance commission or local governments 11AAlternative dental coverage option 12Health regulations not limited 13Name restriction 14Licensure applicants; documents required; approval by commissioner 15Bond; waiver 16Contracts, rates, evidence of coverage; disapproval of commissioner 16ADisapproval of certain health maintenance contracts based on high deductibles 16BDisapproval of certain health maintenance contracts for coverage of young adults 17Rules and regulations; standardized claim form 17AOpen enrollment for nongroup medicare beneficiaries; period, notice of termination 19Discrimination against abuse victims in terms of health maintenance contract 20Insolvent health maintenance organization; administrative supervision, rehabilitation or liquidation; priority of claims 20AAdministrative supervision, rehabilitation or liquidation of health maintenance organizations; revocation or suspension of license 21Participating provider; contracts with health maintenance organizations; hold harmless clause; limitation on collection actions 22Health care providers; liability of member of health maintenance organization; limitation on collection of amounts owed 23Insolvency of health maintenance organization; replacement coverage 24Health maintenance contracts; genetic tests; discrimination based on genetic information 25Net worth of health maintenance organization 26Deposit maintained with trustee acceptable to commissioner 27Merger or acquisition of control 28Registration with commissioner 29Violations of Secs. 27 to 29; application for order enjoining violations of Secs. 27 to 29; penalties 30Statement for individuals provided with creditable coverage; reporting 31Attribution of members to a primary care provider 32Disclosure of patient-level data and contracted prices of individual health care services by carriers to providers 33Coverage for health care services delivered via telehealth by a contracted health care provider