Office Of Health Policy
The Office of Health Policy (OHP) within the Department of Industrial Accidents was created in July of 1993 by the Commissioner pursuant to the promulgation of MGL c. 152, sections 5, 13, and 30. The statute authorizes the Office of Health Policy to approve and monitor workers' compensation utilization review programs in Massachusetts to ensure compliance with the requirements of the regulations 452 CMR 6.00 et seq.
The Office Of Health Policy Responsibilities
To gain approval to conduct workers' compensation utilization review in the Commonwealth a prospective utilization review agent may apply to the Office of Health Policy. The agent completes the Department's application for approval in which they agree to comply with all laws, rules, regulations, ordinances, orders or requirements of the Commonwealth. They then forward the application to the Office of Health Policy for review. The Department's utilization review coordinator is available to provide technical assistance to agents throughout the application approval process.
452 CMR 6.00 - Utilization Review And Quality Assessment
C.L. 270 Utilization Review and Quality Assessment Regulations 7/1/93
List of Approved Utilization Review Agents
Application For Approval Of Utilization Review And Quality Assessment Program
Application Technical Assistance Tool
Sample Letters
Procedures For Conducting Prospective, Concurrent and Retrospective Utilization Reviews - Updated 10-8-2009
Quality Assessment Program Tool For Audit Reviews
Utilization Review (UR) Agent Complaint Form (Form 133A)
Treatment Guidelines
Compensation Review System (CRS)
Informational Bulletins
Memos And Minutes
Frequently Asked Questions By UR Agents