Code of Massachusetts Regulations
958 CMR - HEALTH POLICY COMMISSION
Title 958 CMR 11.00 - Internal Appeals Process and External Review Process for Risk-bearing Provider Organizations and Accountable Care Organizations
- Section 11.01 - Scope and Purpose
- Section 11.02 - Definitions
- Section 11.03 - Right to an Internal Appeal
- Section 11.04 - Information on Internal Appeals
- Section 11.05 - Form and Manner of Request for Internals Appeals
- Section 11.06 - Risk-bearing Provider Organization and Accountable Care Organization Records of Appeals
- Section 11.07 - Time Limits for Resolution of Internal Appeals
- Section 11.08 - Internal Reviewers
- Section 11.09 - Form of Written Resolution of the Internal Appeal
- Section 11.10 - External Review
- Section 11.11 - Expedited External Review
- Section 11.12 - Fees
- Section 11.13 - Consent to Release of Medical Information
- Section 11.14 - Form and Manner of Request for External Review
- Section 11.15 - Screening of Requests for External Review
- Section 11.16 - Requests Ineligible for External Review - Notification
- Section 11.17 - Assignment of External Reviews
- Section 11.18 - Notification of Assignment and Request for Information
- Section 11.19 - Medical Records and Other Information
- Section 11.20 - Conflict of Interest
- Section 11.21 - Decisions and Notice
- Section 11.22 - Confidentiality
- Section 11.23 - Reporting Requirements
- Section 11.24 - Severability
Current through Register 1518, March 29, 2024
REGULATORY AUTHORITY
958 CMR 11.00: M.G.L. c. 176O, § 24; M.G.L. c. 6D, §§ 15 and 16.
Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.