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Appeals Process for Patients of RBPOs and ACOs

This page is intended to provide additional guidance to risk-bearing provider organizations (RBPO) and accountable care organizations (ACO) establishing an appeals process pursuant to Health Policy Commission (HPC) Interim Guidance.

Chapter 224 of the Acts of 2012 requires RBPOs and ACOs to develop an appeals process. The appeals process may be used to address patient concerns regarding referral restrictions, the type or intensity of the recommended services, and timely access to care within the RBPO or ACO.

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