Section 6. A health maintenance organization may enter into contractual arrangements with any other person or company for the provision, to the health maintenance organization, of health services, insurance, reinsurance and administrative, marketing, underwriting or other services on a nondiscriminatory basis. A health maintenance organization shall not refuse to contract with or compensate for covered services an otherwise eligible provider solely because such provider has in good faith communicated with one or more of his current, former or prospective patients regarding the provisions, terms or requirements of the organization's products as they relate to the needs of such provider's patients.
No contract between a participating provider of health care services and a health maintenance organization shall be issued or delivered in the commonwealth unless it contains a provision requiring that within 45 days after the receipt by the organization of completed forms for reimbursement to the provider of health care services, the health maintenance organization shall (i) make payments for such services provided, (ii) notify the provider in writing of the reason or reasons for nonpayment, or (iii) notify the provider in writing of what additional information or documentation is necessary to complete said forms for such reimbursement. If the health maintenance organization fails to comply with this paragraph for any claims related to the provision of health care services, said health maintenance organization shall pay, in addition to any reimbursement for health care services provided, interest on such benefits, which shall accrue beginning 45 days after the health maintenance organization's receipt of request for reimbursement at the rate of 1.5 per cent per month, not to exceed 18 per cent per year. The provisions of this paragraph relating to interest payments shall not apply to a claim that the health maintenance organization is investigating because of suspected fraud. No contract between a participating home health agency or a participating licensed hospice agency and a health maintenance organization shall be issued or delivered in the commonwealth that requires the participating home health agency or participating licensed hospice agency to be accredited by the Joint Commission on Accreditation of Healthcare Organizations or other national accrediting body if it is certified for participation in the Medicare program, Title XVIII of the federal Social Security Act, 42 U.S.C. Sections 1395 et seq.
Structure Massachusetts General Laws
Part I - Administration of the Government
Chapter 176g - Health Maintenance Organizations
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 4n - Coverage for Speech, Hearing and Language Disorders; Hearing AIDS
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 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 5 - Emergency Services Provided to Members for Emergency Medical Conditions
Section 5a - Divorced or Separated Spouses; Coverage
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 11 - Contracts With Group Insurance Commission or Local Governments
Section 11a - Alternative Dental Coverage Option
Section 12 - Health Regulations Not Limited
Section 14 - Licensure Applicants; Documents Required; Approval by Commissioner
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 23 - Insolvency of Health Maintenance Organization; Replacement Coverage
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 30 - Statement for Individuals Provided With Creditable Coverage; Reporting
Section 31 - Attribution of Members to a Primary Care Provider