Massachusetts General Laws
Chapter 176g - Health Maintenance Organizations
Section 31 - Attribution of Members to a Primary Care Provider

Massachusetts General Laws

Part I - Administration of the Government

Title XXII - Corporations

Chapter 176g - Health Maintenance Organizations

Section 1 - Definitions

Section 2 - Application of Laws

Section 3 - Organization; Accounting; Contracts

Section 4 - Required Coverage for Certain Conditions and Groups

Section 4a - Employees Terminated Due to Plant Closings; Coverage

Section 4b - Confidentiality of Information; Mental or Nervous Condition; Exceptions

Section 4c - Home Care Benefits

Section 4d - Nonprescription Enteral Formulas for Home Use

Section 4e - Off-Label Drug Use; Cancer Treatment

Section 4f - Group Health Maintenance Contracts; Coverage for Bone Marrow Transplants

Section 4g - Off-Label Use of Prescription Drugs for HIV/AIDS Treatment

Section 4h - Items Medically Necessary for Diagnosis and Treatment of Diabetes

Section 4i - Prenatal, Childbirth and Postpartum Care Benefits; Minimum Coverage for In-Patient Care

Section 4j - Scalp Hair Prostheses Necessary Due to Cancer or Leukemia Treatment

Section 4k - Newborn Hearing Screening Tests

Section 4l - Coverage for Hospice Services

Section 4m - Mental Health Benefits; Biologically-Based Mental Disorders; Rape-Related Mental Disorders; Non-Biologically-Based Mental Disorders of Children and Adolescents Under Age 19

Section 4n - Coverage for Speech, Hearing and Language Disorders; Hearing AIDS

Section 4o - Outpatient Services; Hormone Replacement Therapy for Peri and Post Menopausal Women; Contraceptive Services; Approved Prescription Contraceptive Drugs or Devices; Exception

Section 4p - Patient Care Services Provided Pursuant to Qualified Clinical Trials

Section 4q - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing

Section 4s - Coverage for Prosthetic Devices and Repairs

Section 4t - Coverage for Eligible Dependents Under 26 Years of Age

Section 4u - Coverage for Medically Necessary Hypodermic Syringes or Needles

Section 4v - Coverage for Diagnosis and Treatment of Autism Spectrum Disorder

Section 4w - Coverage for Children Under Age 18 for Cleft Lip and Cleft Palate

Section 4x - Coverage for Orally Administered Anticancer Medications

Section 4y - Coverage for Abuse Deterrent Opioid Drug Products

Section 4z - Preauthorization for Substance Abuse Treatment Not to Be Required

Section 4aa - Coverage for Medically Necessary Acute Treatment and Clinical Stabilization Services

Section 4bb - Coverage for Long-Term Antibiotic Therapy for Patients With Lyme Disease

Section 4cc - Coverage for Medical or Drug Treatments to Correct or Repair Disturbances of Body Composition Caused by HIV Associated Lipodystrophy Syndrome

Section 4dd - Filling of Remaining Portion of Prescription for Covered Drug That Is a Narcotic Substance Earlier Filled in Lesser Quantity

Section 4ee - Pain Management Access Plans

Section 4ff - Coverage for Tobacco Use Cessation Counseling and Tobacco Cessation Products

Section 4hh - Coverage for Long-Term Antibiotic Therapy for Lyme Disease; Experimental Drugs

Section 4ii - Coverage for Prescription Eye Drops

Section 4gg - Coverage for Treatment of Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections and Pediatric Acute-Onset Neuropsychiatric Syndrome

Section 5 - Emergency Services Provided to Members for Emergency Medical Conditions

Section 5a - Divorced or Separated Spouses; Coverage

Section 6 - Contracts

Section 6a - Group Health Maintenance Contracts; Contribution Percentages

Section 6b - Retroactive Claims Denials for Behavioral Health Services

Section 8 - Public Dissemination of Deceptive or Misleading Materials

Section 9 - Trade Regulation Practices; Application of Law

Section 10 - Reports; Audits, Examinations or Inspections; Confidentiality and Privilege

Section 10a - Applicability of Chapter 176v to Health Maintenance Organizations Governed by This Chapter

Section 10b - Applicability of Chapter 176w to Health Maintenance Organizations Governed by This Chapter

Section 11 - Contracts With Group Insurance Commission or Local Governments

Section 11a - Alternative Dental Coverage Option

Section 12 - Health Regulations Not Limited

Section 13 - Name Restriction

Section 14 - Licensure Applicants; Documents Required; Approval by Commissioner

Section 15 - Bond; Waiver

Section 16 - Contracts, Rates, Evidence of Coverage; Disapproval of Commissioner

Section 16a - Disapproval of Certain Health Maintenance Contracts Based on High Deductibles

Section 16b - Disapproval of Certain Health Maintenance Contracts for Coverage of Young Adults

Section 17 - Rules and Regulations; Standardized Claim Form

Section 17a - Open Enrollment for Nongroup Medicare Beneficiaries; Period, Notice of Termination

Section 19 - Discrimination Against Abuse Victims in Terms of Health Maintenance Contract

Section 20 - Insolvent Health Maintenance Organization; Administrative Supervision, Rehabilitation or Liquidation; Priority of Claims

Section 20a - Administrative Supervision, Rehabilitation or Liquidation of Health Maintenance Organizations; Revocation or Suspension of License

Section 21 - Participating Provider; Contracts With Health Maintenance Organizations; Hold Harmless Clause; Limitation on Collection Actions

Section 22 - Health Care Providers; Liability of Member of Health Maintenance Organization; Limitation on Collection of Amounts Owed

Section 23 - Insolvency of Health Maintenance Organization; Replacement Coverage

Section 24 - Health Maintenance Contracts; Genetic Tests; Discrimination Based on Genetic Information

Section 25 - Net Worth of Health Maintenance Organization

Section 26 - Deposit Maintained With Trustee Acceptable to Commissioner

Section 27 - Merger or Acquisition of Control

Section 28 - Registration With Commissioner

Section 29 - Violations of Secs. 27 to 29; Application for Order Enjoining Violations of Secs. 27 to 29; Penalties

Section 30 - Statement for Individuals Provided With Creditable Coverage; Reporting

Section 31 - Attribution of Members to a Primary Care Provider

Section 32 - Disclosure of Patient-Level Data and Contracted Prices of Individual Health Care Services by Carriers to Providers

Section 33 - Coverage for Health Care Services Delivered via Telehealth by a Contracted Health Care Provider