Code of Massachusetts Regulations
805 CMR - GROUP INSURANCE COMMISSION
Title 805 CMR 5.00 - MISCELLANEOUS
Section 5.04 - Providers and Benefits

(1) A participating Nurse Practitioner operating within the scope of his or her license, including all regulations requiring collaboration with a physician under M.G.L. c. 112, § 80B, shall be considered qualified as primary care providers for the Commissions' Insureds. Health Plans that fail to comply with the law's provisions will be deemed a prima facie violation of the Consumer Choice of Nurse Practitioner Services Act and a breach of its contract with the Commission, subject to a fine or other such remedies as the Commission determines to be reasonable.

(2) A participating Physician Assistant operating within the scope of his or her license, including all regulations requiring collaboration with a physician under M.G.L. c. 112, § 9E, shall be considered qualified as primary care providers for the Commissions' Insureds. Any Commission health plan that fails to comply with the provisions of M.G.L. c. 176S will be deemed to have violated the Consumer Choice of Physician Assistant Act and to have breached its contract with the Commission, subject to a fine or other such remedies as the Commission determines to be reasonable.

(3) Health plans that require Insureds to designate a primary care provider shall provide clear and concise information to Insureds that they may select a participating Nurse Practitioner or Physician Assistant as a primary care provider or may change their medical provider to a participating Nurse Practitioner or Physician Assistant. Insureds' Evidence of Coverage shall also contain a clear, concise and complete statement that the carrier will provide benefit coverage to subscribers on a Nondiscriminatory Basis for covered services when delivered or arranged for by a participating Nurse Practitioner or Physician Assistant.

(4) Notwithstanding any general or special law to the contrary, the Commission's health plans shall include and make available to Insureds the same type of information about participating Nurse Practitioners or Physician Assistants as they provide about their participating physicians, and shall display the participating Nurse Practitioner and Physician Assistant information in the same manner and format as they do for their participating physicians.