Code of Massachusetts Regulations
211 CMR - DIVISION OF INSURANCE
Title 211 CMR 52.00 - Managed Care Consumer Protections And Accreditation Of Carriers
Section 52.18 - Noncompliance with 211 CMR 52.00
Current through Register 1531, September 27, 2024
(1) Reporting. If the Commissioner issues a Finding of Neglect on the part of a Carrier, the Commissioner shall notify the Carrier in writing that the Carrier has failed to make and file the materials required by M.G.L. c. 176O or 211 CMR 52.00 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 Carrier $5000 for each Day during which the neglect continues.
Following notice and hearing, the Commissioner shall suspend the Carrier's authority to do new business 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.
(2) Noncompliance with 211 CMR 52.00.
(3) Action by a National Accreditation Organization. If a National Accreditation Organization takes any action to revoke the Accreditation or otherwise limit or negatively affect the Accreditation status of a Carrier, or any entity with which a Carrier contracts for services subject to M.G.L. c. 176O, the Carrier must notify the Bureau within two Days and shall specify the action taken and the reasons given by the National Accreditation Organization for such action.
(4) Revocation by a National Accreditation Organization. If the National Accreditation Organization revokes Accreditation, the Bureau shall initiate proceedings pursuant to M.G.L. c. 30A to revoke or suspend the Carrier's Accreditation.
(5) Informal Resolutions. Nothing in 211 CMR 52.17 shall be construed to prohibit the Bureau and a Carrier from resolving compliance issues through informal means.