Mass. Gen. Laws ch. 176O – Health Insurance Consumer Protections | Midpage

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Massachusetts General Laws

Chapter 176O

Mass. Gen. Laws ch. 176O

Health Insurance Consumer Protections

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