Current through Register 1531, September 27, 2024
(1) In
addition, as part of its Qualified Patient Care Assessment Program, the health
care facility's bylaws shall authorize the establishment of the following
provisions:
(a) At least annually, every
health care provider as defined by M.G.L. c. 111, § 1, who is employed by
or has privileges at the health care facility, or provides patient care on
behalf of an HMO, shall receive written notice of the requirements and rights
in M.G.L. c. 112, § 5F.
(b)
Violation of any health care facility bylaw or regulation required as part of a
Qualified Patient Care Assessment Program may be grounds for summary suspension
of employment, practice, association for the purpose of providing patient care,
or privileges at the health care facility or on behalf of an HMO.
(c)
Patients'
Rights. Prior to or within 24 hours following admission to a
health care facility, every patient (or the person from whom informed consent
must be obtained) shall receive written notice, in plain language, of the
rights established by M.G.L. c. 111, § 70E, except that if the patient is
a member of a health maintenance organization and the health care facility is
owned by or controlled by such organization, such notice shall be provided at
the time of enrollment in such organization and also upon admittance to said
facility. Such rights shall be conspicuously posted in the health care
facility. In addition, all such patients shall be informed that they may file
complaints with a designated office, person or committee established under
243
CMR 3.07(3)(f), and of the
existence of the Board, the Department of Public Health, and their addresses
and telephone numbers.
(d) The
health care facility shall require that the appropriate personnel respond
promptly and in no event in more than 30 days to a second health care
facility's "reasonable inquiry" under
243 CMR
3.05 regarding a health care provider's
application for employment, practice, association or privileges at the second
health care facility. The health care facility shall maintain personnel records
regarding its health care providers for a minimum of ten years.
(2) Where it appears that a health
care facility has engaged in a pattern and practice of violating M.G.L. c. 111,
§ 203 or
243 CMR 3.00, or if there is
any other indication of a serious violation, the Board shall report same to the
Department of Public Health or Division of Insurance for such action as is
warranted.
(3) Before taking formal
enforcement action or referring a suspected violation to another agency for any
enforcement action, the Board shall provide at least 30 days prior written
notice to the health care facility to allow it to implement corrective
measures, unless the Board, by majority vote, determines that the public
health, safety or welfare necessitates earlier referral or enforcement
action.
(4) The following
information shall be filed annually as part of the report and according to the
schedule described in
243
CMR 3.07(3)(g) (except all
Health Maintenance Organizations shall file annual reports by January
31st of each year):
(a) A summary analysis of patient complaints
and their disposition.
(b) The
names of all full licensees who have terminated their relationship with the
health care facility.
(c) Any
amendments to the Patient Care Assessment Plan and any proposed amendments
thereto, pursuant to
243
CMR 3.03(1).
(d) The number of Major Incident Reports
filed pursuant to
243
CMR 3.08.
(e) The written instructions for the Patient
Care Assessment Plan, pursuant to
243 CMR
3.06(3).
(f) Summary information on the handling of
impaired physicians.
