§ 1 Definitions
§ 2 Bureau of managed care
§ 3 Complaints against carriers; notice; hearing
§ 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
§ 5 Contracts; liability
§ 5A Acceptance and recognition of information submitted pursuant to current coding standards and guidelines required; use of standardized claim formats
§ 5B Policies and procedures to enforce Sec. 5A
§ 5C Failure of carrier to comply with coding standards and guidelines; notice; penalty
§ 5D Establishment of base fee schedule for evaluation and management services for behavioral health providers
§ 6 Evidence of coverage to be delivered to covered adults by health, dental and vision care providers; contents
§ 7 Information provided by carrier upon enrollment or upon request
§ 8 Failure by carrier to file annual statement; fine
§ 9 Utilization review programs; annual attestations
§ 9A Agreements or contracts between carrier and health care provider prohibited if containing certain provisions
§ 9B Alternate payment arrangements involving downside risk prohibited without risk certificate
§ 10 Contractual financial incentive plans
§ 11 Rights of health benefit plans to include as providers religious non-medical providers
§ 12 Utilization review
§ 12A Step therapy protocol: prescription drugs: annual report
§ 12B Commission on step therapy protocol; responsibilities; annual report
§ 13 Formal internal grievance process; expedited resolution policy
§ 14 Review panel; patient protection office
§ 15 Disenrollment of provider; continuation of treatment; specialty health care coverage
§ 16 Clinical decisions regarding medical treatment made by treating physicians; payment for health care services ordered by treating physician or primary care provider
§ 17 Regulations; promulgation
§ 18 Responsibility of carrier for behavioral health services compliance
§ 19 Display of name and telephone number of health service manager on enrollment cards of carrier
§ 20 Information provided to insured adults by behavioral health manager; submission of material changes; workers’ compensation; preferred provider arrangements
§ 21 Submission by carrier of annual comprehensive financial statement
§ 22 Participation in medical assistance program as condition for participation in carrier’s provider network
§ 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-free telephone numb
§ 24 Internal appeals processes for risk-bearing provider organizations; patient’s right to third-party advocate; external review process
§ 25 Use and acceptance of specifically designated prior authorization forms
§ 26 Establishment of standardized processes and procedures for the determination of patient’s health benefit plan eligibility at or prior to time of service
§ 27 Development and use of common summary of payments form; implementation of education plan
§ 28 Provider directories; contents; audits; print copies; customer service contact information; accommodations; accuracy; updates
§ 29 Health care provider credentialing
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Terms Used In Massachusetts General Laws > Chapter 176O - Health Insurance Consumer Protections

  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fraud: Intentional deception resulting in injury to another.
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Joint committee: Committees including membership from both houses of teh legislature. Joint committees are usually established with narrow jurisdictions and normally lack authority to report legislation.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
  • Statute: A law passed by a legislature.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.