Code of Massachusetts Regulations
958 CMR - HEALTH POLICY COMMISSION
Title 958 CMR 6.00 - Registration Of Provider Organizations
Section 6.06 - Non-compliance

Universal Citation: 958 MA Code of Regs 958.6

Current through Register 1518, March 29, 2024

(1) If the Commission determines that a Provider or Provider Organization that has not registered with the Commission pursuant to 958 CMR 6.00 might meet the eligibility criteria set forth in 958 CMR 6.04(1), the Commission may send written notice to the Provider or Provider Organization. Within 30 calendar days of the date of the notice, a Provider or Provider Organization that receives such a notice from the Commission shall:

(a) Submit an application for Registration in compliance with 958 CMR 6.05; or

(b) Submit adequate supporting documentation to demonstrate that the Provider or Provider Organization does not meet the eligibility criteria set forth in 958 CMR 6.04(1). The documentation must demonstrate to the satisfaction of the Commission that the Provider or Provider Organization does not meet the criteria established in 958 CMR 6.04(1).

(2) If a Provider Organization required to register pursuant to 958 CMR 6.00 fails to submit a completed application for Registration to the Commission as required, fails to submit any additional information requested by the Commission pursuant to 958 CMR 6.05(6), (9), (10) or (11), or otherwise fails to comply with the requirements of 958 CMR 6.00, the Commission may provide written notice to the Provider Organization of non-compliance. A Provider Organization that receives a notice of non-compliance from the Commission may, within 21 calendar days of the date of the notice:

(a) Submit the required documentation in compliance with 958 CMR 6.00; or

(b) Submit documentation that demonstrates that the Provider Organization has fully complied with the requirements of 958 CMR 6.00 or explains why the Provider Organization is not required to comply with 958 CMR 6.00. Any such additional documentation shall be certified by two duly authorized representatives of the Provider Organization, one of whom shall be the Chief Executive Officer, Chief Operating Officer, Chief Financial Officer, or equivalent.

The Commission shall review any such documentation and shall determine whether the Provider Organization has met all of the requirements of 958 CMR 6.00, and if so, shall provide a written notice of completed Registration to the applicant.

(3) If the Commission determines that a Provider Organization that meets the criteria set forth in 958 CMR 6.04(1) has failed to submit a completed application for Registration as required, the Provider Organization may not negotiate, represent, or otherwise act on behalf of any Provider or Provider Organization for the purposes of establishing contracts for the payment of Health Care Services with any Carrier or Third-party Administrator. The Commission may provide notice of a Provider's or Provider Organization's non-compliance with 958 CMR 6.00 to Carriers, Third-party Administrators and the Division.

(4) If a Provider Organization has submitted documentation to the Commission pursuant to 958 CMR 6.06(2), the Provider Organization shall not be deemed non-compliant, if applicable, until after the Commission has made a determination pursuant to 958 CMR 6.06(2).

(5) With respect to those Provider Organizations that are required to register pursuant to 958 CMR 6.00, and that are also subject to the requirements of M.G.L. c. 176T or any regulations promulgated thereunder, the Commission may provide notice to the Division of a Provider Organization's non-compliance with 958 CMR 6.00.

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