Section 24. To the extent permissible under applicable state and federal privacy laws, every medical service corporation shall disclose patient-level data to providers in their network solely for the purpose of carrying out treatment, coordinating care among providers and managing the care of their own patient panel; provided, that an individual provider shall only receive patient-level data related to patients treated by said provider. Patient-level data shall include, but not be limited to, health care service utilization, medical expenses, and demographics.
The division of insurance shall develop procedures and a standard format for disclosing such patient-level information. The division may require every medical service corporation to disclose such information through the all-payer claims database established under section 12 of chapter 12C if the division and the center for health information and analysis determine that the all-payer claims database is an efficient means to provide such information.
Medical service corporations shall make available to any provider with whom they have entered into an alternative payment contract, the contracted prices of individual health care services within such payer's network for the purpose of referrals.
Structure Massachusetts General Laws
Part I - Administration of the Government
Chapter 176b - Medical Service Corporations
Section 2 - Incorporators; Formation; Articles of Organization; Certification
Section 3 - By-Laws; Joint Service Contracts; Preferred Provider Arrangements
Section 3a - Contracts of Reinsurance
Section 3b - Group Medical Service Agreements; Contribution Percentages
Section 4d - Refusal to Contract With Blind or Deaf Persons; Prohibition
Section 4e - Diethylstilbestrol Exposure; Discrimination
Section 4f - Cardiac Rehabilitation Expense Benefits
Section 4g - Certified Nurse Midwife Services Benefits
Section 4h - Prenatal, Childbirth and Postpartum Care Benefits; Minimum Coverage for In-Patient Care
Section 4i - Cytologic Screening and Mammographic Examination Benefits
Section 4j - Infertility Diagnosis and Treatment Benefits
Section 4k - Nonprescription Enteral Formulas for Home Use
Section 4l - Chiropractic Services Benefits
Section 4m - Standardized Claim Form
Section 4n - Off-Label Drug Use; Cancer
Section 4o - Medical Service Agreement Coverage for Bone Marrow Transplants
Section 4p - Off-Label Use of Prescription Drugs for HIV/AIDS Treatment
Section 4q - Coverage for Licensed Hospice Services
Section 4r - Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment
Section 4s - Items Medically Necessary for Diagnosis and Treatment of Diabetes
Section 4u - Emergency Services Provided to Insureds for Emergency Medical Conditions
Section 4v - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing
Section 4x - Coverage for Patient Care Services Provided Under Qualified Clinical Trials
Section 4y - Coverage for Speech, Hearing and Language Disorders
Section 4aa - Coverage for Prosthetic Devices and Repairs
Section 4bb - Coverage for Eligible Dependents Under 26 Years of Age
Section 4cc - Coverage for Medically Necessary Hypodermic Syringes or Needles
Section 4dd - Coverage for Diagnosis and Treatment of Autism Spectrum Disorder
Section 4ee - Coverage for Children 21 Years of Age or Younger for Hearing AIDS and Related Services
Section 4ff - Coverage for Orally Administered Anticancer Medications
Section 4gg - Coverage for Abuse Deterrent Opioid Drug Products
Section 4hh - Preauthorization for Substance Abuse Treatment Not to Be Required
Section 4ii - Coverage for Medically Necessary Acute Treatment or Clinical Stabilization Services
Section 4jj - Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease
Section 4mm - Pain Management Access Plans
Section 4nn - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products
Section 4pp - Coverage for Long-Term Antibiotic Therapy for Lyme Disease; Experimental Drugs
Section 4qq - Coverage for Prescription Eye Drops
Section 5 - Subscribers; Qualifications, Misrepresentation; Open Enrollment Periods
Section 5a - Discrimination Against Abuse Victims in Terms of Medical Service Plans
Section 5b - Medical Service Plans; Genetic Tests; Discrimination Based on Genetic Information
Section 6 - Subscription Certificate; Issuance; Content
Section 6a - Limited Extension of Benefits
Section 6b - Divorced or Separated Spouses; Continuation of Eligibility for Benefits
Section 7 - Contracts Between Corporation and Care Providers
Section 7a - Medicare Supplemental Group Coverage; Eligibility Due to Age or Disability
Section 7b - Medicare Supplemental Group Coverage; Medical Assistance Recipients
Section 7c - Retroactive Premium Rate Increase
Section 7d - Retroactive Claims Denial for Behavioral Health Services
Section 8 - Annual Statement; Verification, Form, Violations
Section 8a - Financial Statements; Inclusion of Electronic Data Processing Equipment as Asset
Section 8b - Applicability of Chapter 176v to Medical Service Corporations Governed by This Chapter
Section 8c - Applicability of Chapter 176w to Medical Service Corporations Governed by This Chapter
Section 11 - Salaries, Compensation or Emoluments
Section 12 - Submission of Disputes or Controversies to Board; Privacy of Patient Information
Section 13 - Grounds for Enjoining Transaction of Business; Receivers
Section 14 - Liability of Corporation; Exemption From Insurance Laws; Tax Exemption
Section 16 - Operators of Medical Service Plan
Section 16a - Payroll Deductions of Governmental Employees
Section 18 - Contracts for Administrative or Other Services; Loans and Investments
Section 19 - Payment of Sums Owed Subscriber's Estate
Section 20 - Disclosure of Information; Mental or Nervous Condition
Section 21 - Insolvency of Health Maintenance Organization; Replacement Coverage
Section 22 - Statement Provided to Individuals Provided With Creditable Coverage; Report
Section 23 - Attribution of Members to a Primary Care Provider