Code of Massachusetts Regulations
958 CMR - HEALTH POLICY COMMISSION
Title 958 CMR 3.000 - Health Insurance Consumer Protection
- Section 3.001 - Scope and Purpose
- Section 3.020 - Definitions
- Section 3.100 - Clinical Decisions
- Section 3.101 - Carrier's Medical Necessity Guidelines
- Section 3.200 - Internal Inquiry Process
- Section 3.300 - Right to an Internal Grievance Process
- Section 3.301 - Information on Internal Grievance Process
- Section 3.302 - Form and Manner of Request
- Section 3.303 - Carrier and Utilization Review Organization Records of Grievances
- Section 3.304 - Carrier and Utilization Review Organization Acknowledgment of Internal Grievances
- Section 3.305 - Time Limits for Resolution of Non-expedited Internal Grievances
- Section 3.306 - Review of Internal Grievances
- Section 3.307 - Form of Written Resolution of the Internal Grievance
- Section 3.308 - Reconsideration of Carrier Decisions on Internal Grievances
- Section 3.309 - Expedited Internal Review of Adverse Determinations
- Section 3.310 - Right to Request a Conference
- Section 3.311 - Failure of Carrier to Meet Time Limits
- Section 3.312 - Coverage or Treatment Pending Resolution of Internal Grievance
- Section 3.313 - Confidentiality
- Section 3.314 - Internal Review Conference
- Section 3.400 - External Review
- Section 3.401 - Expedited External Review
- Section 3.402 - Fees
- Section 3.403 - Consent to Release of Medical Information
- Section 3.404 - Form and Manner of Request for External Review
- Section 3.405 - Screening of Requests for External Review
- Section 3.406 - Requests Ineligible for External Review - Notification
- Section 3.407 - Assignment of External Reviews
- Section 3.408 - Notification of Assignment and Request for Information
- Section 3.409 - Medical Records and Information
- Section 3.410 - Review Panel
- Section 3.411 - Conflict of Interest
- Section 3.412 - Additional Medical or Other Information
- Section 3.413 - Informal Meeting
- Section 3.414 - Continuation of Services
- Section 3.415 - Decisions and Notice
- Section 3.416 - Confidentiality - External Review
- Section 3.417 - External Review Conference
- Section 3.500 - Disenrollment of Primary Care Provider
- Section 3.501 - Disenrollment of Providers of Care to Pregnant Women
- Section 3.502 - Disenrollment of Providers of Care to the Terminally 111
- Section 3.503 - Coverage for the Newly Insured
- Section 3.504 - Carrier's Coverage Conditions
- Section 3.505 - Standing Referrals
- Section 3.506 - Specialty Care Not Requiring Prior Authorization
- Section 3.507 - Coverage of Pediatric Specialty Care
- Section 3.508 - Denial of Provider Application
- Section 3.509 - Provider Termination Without Cause Provisions
- Section 3.600 - Reporting Requirements
- Section 3.700 - Required Oral Interpretation and Written Translation Services
Current through Register 1537, December 20, 2024
REGULATORY AUTHORITY
958 CMR 3.000: M.G.L. c. 6D, § 16 and c. 1760.
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.
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