In 1998, former Governor Paul Cellucci signed Executive Order No. 405 to establish managed care protections for consumers. A section of this executive order created an Office of the Managed Care Ombudsman. Two years later, the Office of Patient Protection (OPP) was established through Chapter 141 of the Acts of 2000, a law that created new protections for health insurance consumers. During January 2001, the Office of the Managed Care Ombudsman merged with OPP.
In 2012, Massachusetts adopted its landmark health care cost-containment law, Chapter 224 of the Acts of 2012, An Act Improving the Quality of Health Care and Reducing Costs through Increased Transparency, Efficiency, and Innovation. Chapter 224 created the Health Policy Commission, and set the ambitious goal of bringing health care spending growth in line with growth in the state’s overall economy. Section 16 of Chapter 224 transferred the Office of Patient Protection from the Department of Public Health to the Health Policy Commission. This transition took effect on April 20, 2013, when the Office of Patient Protection moved to the Health Policy Commission.
The Office of Patient Protection is charged with developing regulations and implementing certain provisions of M.G.L. Chapter 176O governing insurance 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. OPP is also charged with administering and granting insurance enrollment waivers to eligible individuals who seek to purchase non-group insurance when enrollment is closed. Additionally, the Office of Patient Protection assists consumers with questions or concerns relating to health insurance, including grievance and appeal rights and enrollment waiver questions.
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