Current through Register 1531, September 27, 2024
(1)
Material
Changes. Each Organization with a Preferred Provider Health Plan
or Workers' Compensation Preferred Provider Arrangement shall file with the
Commissioner any material changes or additions to the material previously
submitted on or before their effective date, including amendments to an
Evidence of Coverage and significant changes to the lists of Preferred
Providers.
(2)
Annual
Reports. The Division of Insurance will collect annual report
information for each Organization with a Preferred Provider Health Plan or a
Workers' Compensation Preferred Provider Arrangement on April
30th of each year covering the prior fiscal year.
The annual report shall include at least the following information in a format
specified by the Commissioner:
(a) A summary
of the number of Covered Persons;
(b) A summary of the utilization experience
of Covered Persons; and
(c) A list
of preferred providers.
(3)
Additional
Reports. The Commissioner may require an Organization to submit
additional reports other than those specifically required by M.G.L. c.
176I.
(4)
Penalties.
(a) If,
after due hearing, a person or Organization is found to have violated any
provision of M.G.L. c. 176I or 211 CMR 51.00, or any rule or order thereunder,
the Commissioner may require the person or Organization to cease and desist
from such violations and the Commissioner may require the person or
Organization to forfeit an amount not to exceed $10,000 for any single
violation.
(b) If the Commissioner
issues a Finding of Neglect on the part of an Organization offering a Preferred
Provider Health Plan or Workers' Compensation Preferred Provider Arrangement,
the Commissioner shall notify the Organization in writing that the Organization
has failed to make and file the materials required by M.G.L. c. 176O or 211 CMR
52.00: Managed Care Consumer Protections and Accreditation of
Carriers in the form and within the time required. The notice shall
identify all deficiencies and the manner in which the neglect must be remedied.
Following the written notice, the Commissioner shall fine the Organization
$5000 for each day the neglect continues.
(c) Following notice and hearing, the
Commissioner shall suspend the Organization's authority to offer a Preferred
Provider Health Plan or use a Workers' Compensation Preferred Provider
Arrangement until all required reports or materials are received in a form
satisfactory to the Commissioner and the Commissioner has determined that the
Finding of Neglect can be removed.
