Current through Register 1518, March 29, 2024
The requirement that all providers must connect to the Mass
HIway applies to provider organizations. Provider organizations include, but
are not limited to, acute care hospitals, community health centers, and medical
ambulatory practices, which are defined as:
(1)
Acute Care
Hospital. A hospital licensed under M.G.L. c. 111, § 51, and
the teaching hospital of the University of Massachusetts Medical School, which
contains a majority of medical-surgical, pediatric, obstetric, and maternity
beds, as defined by the department. Hospitals that meet this definition of
acute care hospital can be found in the Massachusetts Licensed or Certified
Health Care Facility/Agency Listing, which is maintained by the Department of
Public Health and is publicly available on the Department of Public Health's
website.
(2)
Community
Health Center.
(a) An
organization that is either:
1. A "Federally
Qualified Health Center" or a "Federally Qualified Health Center look-alike" as
defined by the federal Department of Health and Human Services Health Resources
and Services Administration (HRSA) and operating in conformance with Section
330 of United States Public Law 95-626; or
2. An organization that files cost reports as
a community health center, as requested by the Health Policy Commission within
the Executive Office for Administration and Finance.
(b) For the purposes of
101
CMR 20.00, the following definitions of large and
small community health centers apply:
1.
Large Community Health Center. A community health
center where ten or more licensed providers participate in providing health
care for patients.
2.
Small Community Health Center. A community health
center where fewer than ten licensed providers participate in providing health
care for patients.
(c)
In Community Health Center, licensed providers are
limited to include medical doctors, doctors of osteopathy, nurse practitioners,
or physician assistants.
(3)
Medical Ambulatory
Practice.
(a) An organization in
Massachusetts that includes licensed providers who provide primary or specialty
outpatient health care services to patients. In a medical ambulatory practice,
licensed providers are limited to include medical doctors, doctors of
osteopathy, nurse practitioners, or physician assistants. Medical
Ambulatory Practice does not include Community Health Center, as
defined in 101 CMR 20.06(2), and does not include ambulatory practices whose
primary purpose is to provide behavioral health services. In a medical
ambulatory practice, "outpatient health care services" are defined as health
care services that do not require an overnight stay.
(b) For the purposes of
101
CMR 20.00, the following definitions of large and
medium medical ambulatory practices apply:
1.
Large Medical Ambulatory Practice. A medical
ambulatory practice where more than 50 licensed providers participate in
providing health care for patients.
2.
Medium Medical Ambulatory
Practice. A medical ambulatory practice where ten to 50 licensed
providers participate in providing health care for patients.
3.
Small Medical Ambulatory
Practice. A medical ambulatory practice where fewer than ten
licensed providers participate in providing health care for patients. Small
medical ambulatory practices includes medical ambulatory practices where only
one licensed provider participates in providing health care for
patients.
(4)
For the purposes of
101
CMR 20.00, the applicability of the provider
organization definitions shall be determined by calculating the number of
licensed providers that provide health care services to patients on behalf of
the provider organization in the month of June prior to that organization's
initial required connection date to the Mass HIway, regardless of employment
status.
(5) EOHHS may issue
administrative bulletins or other issuances to define and describe additional
types of provider organizations.
