Code of Massachusetts Regulations
957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS
Title 957 CMR 2.00 - Payer Data Reporting
Section 2.03 - General Reporting Requirements
Universal Citation: 957 MA Code of Regs 957.2
Current through Register 1531, September 27, 2024
(1) Annual Reports.
(a) Each Payer shall file annually its TME by Physician Group, Physician Local Practice Group, and Member zip code; its Relative Prices for Hospitals, Physicians, and Other Providers; its APMs by Registered Provider Organization, Hospital, Physician Group, Physician Local Practice Group, Other Provider, and Member zip code, its Prescription Drug Rebate data, and its Primary Care and Behavioral Health Expenses by Physician Group in accordance with the requirements of 957 CMR 2.04, 2.05, 2.06, 2.07 and 2.08.
(b) A Private Health Care Payer is subject to the reporting requirements in 957 CMR 2.00 if:
1. The Payer is a Surcharge Payer and the Payer's surcharge payments made pursuant to M.G.L. c. 118E, § 68 placed the Payer at the company level within the top ten Surcharge Payers for the period October 1, 2009 through September 30, 2010 as determined by the Health Safety Net Office and posted on the Center's website; or
2. The Payer contracts with the office of Medicaid, the Massachusetts Health Connector, or the Group Insurance Commission to pay for or arrange for the purchase of Health Care Services on behalf of individuals enrolled in health coverage programs under Titles XVIII, XIX, or XXI, under the ConnectorCare Health Insurance program, Medicaid managed care organizations, or under the Group Insurance Commission.
3. If a Private Health Care Payer subject to the reporting requirements of 957 CMR 2.00 makes separate surcharge payments pursuant to M.G.L. c. 118E, § 68 for individual plans or clients the Payer shall file the required data for all of its plans or clients.
(c) Public Health Care Payers may provide data to the Center pursuant to an interagency service agreement.
(2) Data Submission Requirements.
(a) Payers shall submit data and information to the Center in accordance with the procedures provided in 957 CMR 2.00, a Data Specification Manual, or an Administrative Bulletin. The Center will notify a Payer whether the submission has been accepted or rejected. Payers must correct and resubmit rejected data until notified that the submission has been accepted.
(b) Each Payer's chief executive officer or chief financial officer shall certify under the penalties of perjury that all reports and records filed with the Center are true, correct and accurate.
(c) The Center may request that a Payer submit additional documentation of reported TME, Relative Prices, APMs, Prescription Drug Rebates, and Primary Care and Behavioral Health Expenses. Payers must submit documentation requested by the Center within 15 business days from the date of the request, unless the Center specifies a different date. The Center may, for cause, extend the filing date of the requested information, in response to a written request for an extension of time.
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