Notice of Hearing

Docket No. G2011-03

Proposed New Regulation 211 CMR 148.00 - Registration and Reporting Requirements for Third-Party Administrators

Pursuant to Massachusetts General Laws Chapter 30A and the authority granted to the Commissioner of Insurance by SECTION 40 of Chapter 288 of the Acts of 2010 ("SECTION 40") and M.G.L. c. 176O, § 21(c), a hearing will be held at the offices of the Division of Insurance, 1000 Washington Street, Boston, MA 02118-6200 on March 16, 2011 at 10:00 a.m. The purpose of this hearing is to afford all interested persons an opportunity to provide oral and/or written comment regarding the proposed adoption of new regulation 211 CMR 148.00, Registration and Reporting Requirements for Third-Party Administrators. The proposed regulation will govern the registration and reporting requirements applicable to third-party administrators, including pharmacy benefit managers and other entities with claims data, eligibility data, provider files and other information relating to health care provided to residents of the Commonwealth and health care provided by health care providers in the Commonwealth.

Pursuant to SECTION 68 of Chapter 240 of the Acts of 2010, a small business impact statement is required to be included in this Notice of Hearing. The Division of Insurance ("Division") estimates that 211 CMR 148.00 Proposed (Clean) pdf format of 211_148_Clean.pdf
will impact small business in the Commonwealth that meet the definition of third-party administrator ("TPA") in the regulation; however, because the Division neither regulates these entities, nor has an accurate count of the number of TPAs in Massachusetts at this time, the Division is unable to provide a more definitive estimate. The Division estimates that the projected reporting, record keeping and administrative costs required for compliance with 211 CMR 148.00 will have an effect on a substantial number of small businesses as the regulation will require TPAs to register and file annual reports with the Division for the first time. The proposed regulation is drafted in a performance standards format because SECTION 40 and M.G.L. c. 176O, § 21(c) permit the Division to adopt standards and procedures requiring the registration of persons or entities not otherwise licensed or registered by the Commissioner of Insurance, such as third-party administrators. The Division is not aware of any conflicts between 211 CMR 148.00 and existing Division regulations or existing regulations of another agency or department of the Commonwealth. The Division is not aware of whether 211 CMR 148.00 is likely to deter or encourage the formation of new businesses in the Commonwealth. The Division invites and encourages comments from small businesses in the Commonwealth concerning the final promulgation of 211 CMR 148.00, particularly as to the following: (1) whether 211 CMR 148.00 could establish less stringent compliance or reporting requirements for small businesses; (2) whether 211 CMR 148.00 could establish less stringent schedules or deadlines for compliance or reporting requirements for small businesses; (3) whether 211 CMR 148.00 could consolidate or simplify compliance or reporting requirements for small businesses; (4) whether 211 CMR 148.00 is likely to deter or encourage the formation of new businesses in the Commonwealth; and (5) what alternative regulatory methods, if any, may be used to minimize the adverse impact of 211 CMR 148.00 on small businesses.

The proceedings concerning the proposed promulgation of regulation 211 CMR 148.00 shall be designated as Docket No. G2011-03. Any person who wishes to provide oral comment concerning this regulation must file a Notice of Intent to Comment with the Docket Clerk no later than March 14, 2011. Persons wishing to submit written comments may do so until the record of the hearing is closed. All submissions must be sent to the Docket Clerk, Hearings and Appeals, Division of Insurance, 1000 Washington Street, Suite 810, Boston, MA 02118-6200, or by electronic mail to Doidocket.Mailbox@state.ma.us and must refer to Docket No. G2011-03 in the subject line. Persons who do not file a Notice of Intent to Comment will be heard after those who notify the Division in advance of the hearing.

A copy of the proposed regulation is available from the Division and also is posted on its website at: www.mass.gov/doi.









Dated: February 15, 2011

________________________________

Joseph G. Murphy

Commissioner of Insurance