Welcome to the Office of Patient Protection within the Health Policy Commission . The Office of Patient Protection was created pursuant to Chapter 141 of the Acts of 2000 signed into law by former Governor Cellucci on July 21, 2000. In January 2001, the Office of the Managed Care Ombudsman, created by an Executive Order, became part of the Office of Patient Protection.
Effective April 20, 2013, the Office of Patient Protection will move to the Health Policy Commission.
The Office of Patient Protection is charged with developing regulations and implementing new statutory provisions of M.G.L. Chapter 176O governing managed care carriers' internal grievance procedures, detailing certain guarantees of continuity of care and specialty care referral and coverage, and establishing a process for obtaining an independent external review where coverage is denied based upon a medical necessity determination. The legislation and regulations, 958 CMR 3.00 , may be accessed at the Health Policy Commission's Office of Patient Protection's web page.
Effective January 1, 2001, Massachusetts consumers and other individuals who receive health coverage from a Massachusetts carrier, insurer or HMO are entitled to new protections covering internal grievances, medical necessity guidelines, continuity of care and external appeals. An insured individual who receives an adverse determination of an internal grievance has the right to an external review of a covered benefit within four months, and may obtain the necessary forms by calling the Health Policy Commission of Patient Protection at 1-800-436-7757or by accessing the Commission's website for copies of the form .
If you are a carrier, insurer, HMO or consumer and have questions concerning the legislation, regulations, or your rights as a managed care consumer, please contact the Office of Patient Protection (OPP) at 1-800-436-7757. You may also contact OPP through email.