HPC Regulations
The following HPC regulations are provided for informational purposes, only.
Order by revised date:
- Final Health Insurance Consumer Protection Regulation (958 CMR 3.000) (April 28, 2023)
- Final Drug Pricing Review Regulation (958 CMR 12.00) (March 6, 2020)
- Final RBPO/ACO Appeals Regulation (958 CMR 11.00) (September 7, 2018)
- Final Performance Improvement Plan Regulation (958 CMR 10.00) (April 21, 2017)
- Final Annual Assessment Regulation (958 CMR 9.00) (August 12, 2016)
- Final Health Insurance Open Enrollment Waivers Regulation (958 CMR 4.00) (December 4, 2015)
- Final ICU Nurse Staffing Regulation (958 CMR 8.00) (July 3, 2015)
- Final Notices of Material Change and Cost and Market Impact Reviews Regulation (958 CMR 7.00) (January 2, 2015)
- Final Registration of Provider Organization Regulation (958 CMR 6.00) (July 18, 2014)
- Final CHART Investment Program Regulation (958 CMR 5.00) (October 11, 2013)
- Final One-Time Assessment Regulation (958 CMR 2.00) (March 29, 2013)
HPC Guidance
- Notices of Material Change and Cost and Market Impact Reviews
- Final 958 CMR 7.00 Technical Bulletin
- Guidance on Notices Regarding Out-of-State Organizations - April 25, 2018
- Notice of Material Change Form
- MCN Frequently Asked Questions - Issued July 14, 2015
- MCN Frequently Asked Questions - Issued December 2, 2015
- MCN Frequently Asked Questions - Issued July 27, 2016
- MCN Frequently Asked Questions Regarding Management Services, Transfers of Non-Clinical Assets, and Indirect Control - Issued January 10, 2024
- MCN Frequently Asked Questions Regarding Net Patient Service Revenue Thresholds - Issued January 10, 2024
- Mandatory Overtime for Nurses
- Guidelines on Mandatory Overtime for Nurses in a Hospital Setting - Issued June 19, 2013
- Nurse Staffing
- Bulletin HPC-2015-04 - ICU Nurse Staffing Quality Measures
- Learn more about the HPC's role in nurse staffing.
- Performance Improvement Plans
- Policy 2017-01 Process for Performance Improvement Plans
- General Instructions (958 CMR 10.02)
- Performance Improvement Plan - Proposal Form (958 CMR 10.02)
- Performance Improvement Plan - Entity Contact Information (958 CMR 10.02)
- Performance Improvement Plan - Request for Waiver (958 CMR 10.02)
- Performance Improvement Plan - Affidavit (958 CMR 10.02)
- Performance Improvement Plan - Request for Extension (958 CMR 10.02)
- ACO Certification
- Oversight and Monitoring
- Bulletin HPC-2023-01 – Independent Community Hospitals
- Bulletin: HPC-2022-01 – Independent Community Hospitals
- Bulletin: HPC-2021-01 – Independent Community Hospitals
- Bulletin: HPC-2020-01 – Independent Community Hospitals
- Bulletin: HPC-2019-01 - Independent Community Hospitals
- Bulletin: HPC-2018-01 - Independent Community Hospitals
- Registration of Provider Organizations:
Office of Patient Protection Guidance
- Memo on Submission of Information related to Medical Necessity Criteria (October 12, 2023)
- Memo on Continuation of Coverage during External Reviews (October 28, 2022)
- Interim Guidance on Chapter 177 of the Acts of 2022 (October 25, 2022)
- Memo on External Reviews under the No Surprises Act (July 27, 2022)
- Memo on Emergency Medical Conditions (January 31, 2019)
- Memo on Lyme Disease Treatment (January 24, 2019)
- Bulletin on OPP Carrier Responsibilities (March 28, 2018)
- Bulletin on RBPO Appeals (November 3, 2017)
- Continued Reporting of RBPO Appeals (May 05, 2017)
- Requests for Expedited External Review (March 24, 2017)
- Implementation Dates of RBPO Appeals (July 28, 2016)
- Information Sessions of RBPO/ACO Appeals (July 14, 2016 and July 20, 2016)
- RBPO Appeal's Sample Notice (May 6, 2016)
- Bulletin on RBPO Appeals (May 06, 2016)
- Bulletin on Medical Billing during Appeals (August 31, 2015)
- Memo on Gender Dysphoria (July 02, 2015)
- Memo on Medical Necessity Criteria (April 27, 2015)
- Bulletin: 2014-10 - Medical Necessity (November 04, 2014)
- Guidance on MA ACA Compliance (December 11, 2013)
- Memo on Experimental/Investigational Services (August 14, 2013)
- Memo on Infertility Treatment (June 24, 2013)
- Memo on Transfer of OPP from DPH to HPC (April 20, 2013)
- Memo on September 2011 Emergency Amendments to 105 CMR 128.000 (September 15, 2011)
- Memo on Chapter 176R (February 20, 2009)
- Memo to External Review Agencies regarding Experimental/Investigative Services (April 1, 2008)
- Guidance to External Reviewers regarding Experimental/Investigational Services (February 29, 2008)
- Expectations of External Review Agencies (December 11, 2002)
Note
The regulations listed on this page are not official versions of the Code of Massachusetts Regulations. In the case of any discrepancy between versions within HPC web content and the official Code of Massachusetts Regulations published by the Secretary of State, the Secretary of State's version takes precedence. Official versions of regulations are available through the Massachusetts State Bookstore.