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Guidance for ACOs/RBPOs

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 958 CMR 11.00.

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.

The HPC Accountable Care Organization (ACO) Certification Program 
Open PDF file, 222.15 KB,  Final RBPO/ACO Appeals Regulation (958 CMR 11.00) (September 7, 2018) (English, PDF 222.15 KB)
Open PDF file, 355.83 KB,  RBPO/ACO External Review Request Form (English, PDF 355.83 KB)
Open PDF file, 167.19 KB,  RBPO/ACO External Review Request Form (Spanish) (English, PDF 167.19 KB)
Open DOCX file, 141.73 KB,  RBPO/ACO External Review Request Form (Spanish) (English, DOCX 141.73 KB)
Open PDF file, 131.58 KB,  Updated RBPO/ACO Appeals Sample Notice (English, PDF 131.58 KB)
Open PDF file, 154.25 KB,  RBPO/ACO Appeals Sample Written Resolution Letter (English, PDF 154.25 KB)
Open PDF file, 179.52 KB,  RBPO/ACO Appeals FAQ (English, PDF 179.52 KB)

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