Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 154.00 - Enforcement Of Mental Health Parity
Section 154.03 - Certification of Compliance with State and Federal Mental Health Parity Requirements

Universal Citation: 211 MA Code of Regs 211.154

Current through Register 1531, September 27, 2024

(1) Initial Certification Materials to be Submitted by no Later than October 1, 2013.

(a) Carriers must review their administrative and other practices, including those delegated to subcontracting organizations, for compliance with the relevant provisions of State Mental Health Parity Laws and Federal Mental Health Parity Law, and any interim or final regulations, guidelines, sub-regulatory guidances, or related instructions that have been issued or promulgated by the federal Center for Medicaid and Medicare Services or other federal organization in its exercise of appropriate authority over the Federal Mental Health Parity Law.

(b) Carriers must submit a certification to the Division of Insurance and the Office of the Attorney General signed by the Carrier's chief executive officer and chief medical officer that states that the Carrier has completed a comprehensive review of the administrative practices of the Carrier for the 2012 calendar year for compliance with the provisions of State Mental Health Parity Laws and the Federal Mental Health Parity Law.
1. If the Carrier determines that all administrative and other practices were in compliance with State Mental Health Parity Laws and Federal Mental Health Parity Law during calendar year 2012, the certification will affirmatively state, that all relevant administrative and other practices were in compliance with State Mental Health Parity Laws and Federal Mental Health Parity Law.

2. If the Carrier determines that any administrative or other practices were not in compliance with State Mental Health Parity Laws or Federal Mental Health Parity Law during calendar year 2012, the certification will state that not all practices were in compliance with State Mental Health Partiy Laws and Federal Mental Health Parity Law and will include a list of the practices not in compliance and the steps the Carrier has taken to bring these practices into compliance.

(c) In support of its certification, every Carrier shall submit such information as determined by the Commissioner that demonstrates the Carrier's compliance with State Mental Health Parity Laws and Federal Mental Health Parity Law, including but not limited to information regarding financial and treatment limitations, medical necessity criteria, and authorization processes.

(2) Annual Certification for Calendar Years Following 2012.

(a) Prior to July 1st in each year, Carriers must review their administrative and other practices, including those delegated to subcontracting organizations, for the prior calendar year for compliance with the relevant provisions of State Mental Health Parity Laws and Federal Mental Health Parity Law, and any interim or final regulations, guidelines, sub-regulatory guidances, or related instructions that have been issued or promulgated by the Federal Mental Health Parity Law Agencies in their exercise ofappropriate authority over Federal Mental Health Parity Law.

(b) On or before July 1st in each year, Carriers are required to submit a certification to the Division of Insurance and the Office of the Attorney General signed by the Carrier's chief executive officer and chief medical officer that states that the Carrier has completed a comprehensive review of the administrative practices of the Carrier for the prior calendar year for compliance with the necessary provisions of State Mental Health Parity Laws and Federal Mental Health Parity Law.
1. If the Carrier determines that all administrative and other practices were in compliance with State Mental Health Parity Laws and Federal Mental Health Parity Law, the certification will affirmatively state that all the relevant administrative and other practices were in compliance with State Mental Health Parity Laws and Federal Mental Health Parity Law.

2. If the Carrier determines that any administrative or other practices were not in compliance with State Mental Health Parity Laws and Federal Mental Health Parity Law, the certification will state that not all practices were in compliance with State Mental Health Partiy Laws and Federal Mental Health Parity Law and will include a list of all practices not in compliance and the steps that have been taken to bring these practices into compliance.

(c) On or before July 1st of each year, in support of annual certification, every Carrier shall submit the same information that is required under 211 CMR 154.03(1)(c).

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