Massachusetts General Laws
Chapter 176o - Health Insurance Consumer Protections
Section 17 - Regulations; Promulgation

Massachusetts General Laws

Part I - Administration of the Government

Title XXII - Corporations

Chapter 176o - Health Insurance Consumer Protections

Section 1 - Definitions

Section 2 - Bureau of Managed Care

Section 3 - Complaints Against Carriers; Notice; Hearing

Section 4 - Refusal of Carriers to Contract With Eligible Health, Dental or Vision Care Providers Solely Because Providers Have Practiced Good Faith Advocacy on Behalf of Patients

Section 5 - Contracts; Liability

Section 5a - Acceptance and Recognition of Information Submitted Pursuant to Current Coding Standards and Guidelines Required; Use of Standardized Claim Formats

Section 5b - Policies and Procedures to Enforce Sec. 5a

Section 5c - Failure of Carrier to Comply With Coding Standards and Guidelines; Notice; Penalty

Section 6 - Evidence of Coverage to Be Delivered to Covered Adults by Health, Dental and Vision Care Providers; Contents

Section 7 - Information Provided by Carrier Upon Enrollment or Upon Request

Section 8 - Failure by Carrier to File Annual Statement; Fine

Section 9 - Utilization Review Programs; Annual Attestations

Section 9a - Agreements or Contracts Between Carrier and Health Care Provider Prohibited if Containing Certain Provisions

Section 9b - Alternate Payment Arrangements Involving Downside Risk Prohibited Without Risk Certificate

Section 10 - Contractual Financial Incentive Plans

Section 11 - Rights of Health Benefit Plans to Include as Providers Religious Non-Medical Providers

Section 12 - Utilization Review

Section 13 - Formal Internal Grievance Process; Expedited Resolution Policy

Section 14 - Review Panel; Patient Protection Office

Section 15 - Disenrollment of Provider; Continuation of Treatment; Specialty Health Care Coverage

Section 16 - Clinical Decisions Regarding Medical Treatment Made by Treating Physicians; Payment for Health Care Services Ordered by Treating Physician or Primary Care Provider

Section 17 - Regulations; Promulgation

Section 18 - Responsibility of Carrier for Behavioral Health Services Compliance

Section 19 - Display of Name and Telephone Number of Health Service Manager on Enrollment Cards of Carrier

Section 20 - Information Provided to Insured Adults by Behavioral Health Manager; Submission of Material Changes; Workers' Compensation; Preferred Provider Arrangements

Section 21 - Submission by Carrier of Annual Comprehensive Financial Statement

Section 22 - Participation in Medical Assistance Program as Condition for Participation in Carrier's Provider Network

Section 23 - Disclosure 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-F...

Section 24 - Internal Appeals Processes for Risk-Bearing Provider Organizations; Patient's Right to Third-Party Advocate; External Review Process

Section 25 - Use and Acceptance of Specifically Designated Prior Authorization Forms

Section 26 - Establishment of Standardized Processes and Procedures for the Determination of Patient's Health Benefit Plan Eligibility at or Prior to Time of Service

Section 27 - Development and Use of Common Summary of Payments Form; Implementation of Education Plan

Section 28 - Provider Directories; Contents; Audits; Print Copies; Customer Service Contact Information; Accommodations; Accuracy; Updates

Section 29 - Health Care Provider Credentialing