Code of Massachusetts Regulations
801 CMR - EXECUTIVE OFFICE FOR ADMINISTRATION AND FINANCE
Title 801 CMR 52.00 - Municipal Health Insurance
Section 52.01 - General Provisions

Universal Citation: 801 MA Code of Regs 801.52

Current through Register 1531, September 27, 2024

(1) Purpose.

(a)801 CMR 52.00 carries out the process by which political subdivisions elect to change health insurance benefits under M.G.L. c. 32B, §§ 21 through 23.

(b) The process set forth in 801 CMR 52.00 shall be followed each time a political subdivision elects to change health insurance benefits under the process authorized by M.G.L. c. 32B, §§ 21 through 23 (the implementation process), except that acceptance under M.G.L. c. 32B, § 21(a) need only occur once.

(2) Definitions. Unless otherwise provided, terms shall have the meanings assigned to them in M.G.L. c. 32B. The following terms shall have the following meanings:

Collective Bargaining Unit. An employee organization as defined in M.G.L. c. 150E, § 1 that is acting as the exclusive bargaining representation of the bargaining unit. Notice to a collective bargaining unit under 801 CMR 52.02 shall be made to the principal officer of each bargaining unit.

Impartial Member. The member of the review panel selected from a list of three potential members provided by the Secretary of Administration and Finance under the process set forth in 801 CMR 52.05(1).

Implementation Notice. The notice required under M.G.L. c. 32B, § 21(b) of the intent to enter into negotiations to implement proposed changes to health insurance benefits.

Insurance Advisory Committee. An advisory committee established by a public authority as specified in M.G.L. c. 32B, § 3.

Limited Provider Network. A reduced or selective provider network which is smaller than a carrier's general provider network and from which the carrier may choose to exclude from participation other providers who participate in the carrier's regional provider network or general provider network for the purpose of reducing premium costs but which offers the same benefits to those provided by the carrier's general provider network.

Maximum Possible Savings. The method used to determine whether a proposal to transfer subscribers to the Commission would achieve at least 5% greater savings than the maximum possible savings that would be attained by plan design changes authorized under M.G.L. c. 32B, § 22. Maximum Possible Savings means the savings that would be realized for the first 12 months if a political subdivision were to provide health insurance coverage to its subscribers by implementing changes to health insurance benefits that equal the dollar amounts of the most-subscribed plan's design features for the same or most similar benefits offered by the commission for a non-Medicare plan under M.G.L. c. 32A, § 4 and for a Medicare-extension plan under M.G.L. c. 32A, §§ 10C and 14. Where the political subdivision currently does not offer a tiered provider network, the maximum possible savings shall be calculated by comparing the savings that would result if the dollar amounts of the co-pays, deductibles and other cost-sharing plan design features in the political subdivision's plan equaled the dollar amounts of the co-pays, deductibles and other cost-sharing plan design features under tier 2 of the commission's most-subscribed plan. Where the political subdivision currently offers a tiered provider network that is tiered differently from the tiering in the commission's most-subscribed plan, the maximum possible savings shall be calculated by assuming the co-pays, deductibles and cost-sharing plan design features in each tier of the political subdivision's plan are equal to those in the same tier of the commission's most-subscribed plan, beginning with a comparison of the highest tier. If the political subdivision's plan has fewer tiers than the commission's plan, the political subdivision's highest tier shall be compared to the commission's tier 3, and the second highest tier to the commission's tier 2.

Mitigation Proposal. A proposal to mitigate, moderate or cap the impact of these changes for subscribers, including retirees, low income subscribers and subscribers with high out-of-pocket health care costs, who would otherwise be disproportionately affected.

Public Employee Committee. The committee established under M.G.L. c. 32B, § 19 or 21. If a public employee committee has not been established under M.G.L. c. 32B, § 19, a public employee committee shall be established exclusively to negotiate changes under M.G.L. c. 32B, §§ 21 through 23, and shall be established in the same form and with the same percent votes as prescribed in M.G.L. c. 32B, § 19(a), fifth paragraph. A public employee committee established under M.G.L. c. 32B, § 21 exclusively to negotiate changes under M.G.L. c. 32B, §§ 21 through 23 shall be considered dissolved upon completion of the process described in M.G.L. c. 32B, §§ 21 through 23.

Review Panel. The municipal health insurance review panel comprised of three members, one of whom shall be appointed by the public employee committee, one of whom shall be appointed by the public authority and one of whom shall be selected under the process set forth in 801 CMR 52.05(1).

RSCME. The Retired State, County and Municipal Employees Association, located at 11 Beacon Street, Suite 321, Boston, MA 02108.

Secretary. The Secretary of Administration and Finance.

Tiered Provider Network. A provider network in which a carrier assigns providers to different benefit tiers based on the carrier's assessment of a provider's cost efficiency and quality, and in which insureds pay the cost-sharing (copayment, coinsurance or deductible) associated with a provider's assigned benefit tiers.

(3) Notices.

(a) The advance notice of intent to vote sent by an appropriate pubic authority under 801 CMR 52.02(1) shall be sent:
1. by certified mail, delivery confirmation and return receipt requested; or

2. delivered by hand with a certification of delivery signed by the deliverer, and a copy shall be sent to the Secretary. If the notice is sent by certified mail, either post office evidence of attempted delivery or return receipts shall be prima facie evidence of the time of receipt. The appropriate public authority may include in this notice a statement of its intent to provide further notices by email, along with a requirement that each recipient of the notice provide an email address for future notices. If any recipient of this notice does not provide an email address, the appropriate public authority shall provide notice to that recipient by:
a. certified mail, delivery confirmation and return receipt requested; or

b. delivery by hand with a certification of delivery signed by the deliverer.

(b) Additional notices may be sent by any of the following three methods:
1. by certified mail, delivery confirmation and return receipt requested;

2. delivery by hand with a certification of delivery signed by the deliverer; or

3. by email address if a requirement for email addresses was included in notice sent under 801 CMR 52.01(3)(a). Any notices sent byemail will be presumed received unless the email is returned as undeliverable within 24 hours of sending. Notices sent to subscribers under 801 CMR 52.07 may be sent by regular mail and are not subject to the requirements of 801 CMR 52.01(3)(b).

(c) A copy of all notices shall be sent to the Secretary electronically at: MunicipalHealth@dor.state.ma.us.

(d) Notices sent by the Secretary may be sent by regular mail or by any of the methods specified in 801 CMR 52.01(3)(b).

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