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Mass. General Laws c.176O

Health insurance consumer protections

This page links to the current version of each section of G.L. c.176O.

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§ 1 Definitions 

Amended by St.2020, c.260, §§ 55-57, effective January 1, 2021

§ 2 Bureau of managed care 

Amended by St.2020, c.260, §§ 55-57, effective January 1, 2021

§ 3 Complaints against carriers; notice; hearing 
§ 4 Refusal of carriers to contract with eligible health, dental or vision care providers solely because providers have practiced good faith advocacy on behalf of patients 
§ 5 Contracts; liability 
§ 5A Acceptance and recognition of information submitted pursuant to current coding standards and guidelines required; use of standardized claim formats 
§ 5B Policies and procedures to enforce Sec. 5A 
§ 5C Failure of carrier to comply with coding standards and guidelines; notice; penalty 
§ 5D Base fee schedule for evaluation and management services for behavioral health providers; regulations 

Added by St.2022, c.177, § 63, effective November 8, 2023

§ 6 Evidence of coverage to be delivered to covered adults by health, dental and vision care providers; contents 

Amended by St.2020, c.260, §§ 55-57, effective January 1, 2021

§ 7 Information provided by carrier upon enrollment or upon request 
§ 8 Failure by carrier to file annual statement; fine 
§ 9 Utilization review programs; annual attestations 
§ 9A Agreements or contracts between carrier and health care provider prohibited if containing certain provisions 
§ 9B Alternate payment arrangements involving downside risk prohibited without risk certificate 
§ 10 Contractual financial incentive plans 
§ 11 Rights of health benefit plans to include as providers religious non-medical providers 
§ 12 Utilization review 
§ 12A Clinical review criteria used to establish a step therapy protocol; requests for exceptions to protocol; annual report to the division by carriers 

Added by by St.2022, c.254, § 2, effective January 30, 2023

§ 12B Commission on step therapy protocols 

Added by by St.2022, c.254, § 2, effective January 30, 2023

§ 13 Formal internal grievance process; expedited resolution policy 

Amended by St.2022, c.177, §§ 64-66, effective November 8, 2022

§ 14 Review panel; patient protection office 

Amended by St.2023, c.2, § 20, effective March 29, 2023

§ 15 Disenrollment of provider; continuation of treatment; specialty health care coverage 
§ 16 Clinical decisions regarding medical treatment made by treating physicians; payment for health care services ordered by treating physician or primary care provider 

Amended by St.2022, c.177, §§ 71, effective November 8, 2022

§ 17 Regulations; promulgation 
§ 18 Responsibility of carrier for behavioral health services compliance 
§ 19 Display of name and telephone number of health service manager on enrollment cards of carrier 
§ 20 Information provided to insured adults by behavioral health manager; submission of material changes; workers' compensation; preferred provider arrangements 
§ 21 Submission by carrier of annual comprehensive financial statement 
§ 22 Participation in medical assistance program as condition for participation in carrier's provider network 
§ 23 Disclosure by carrier upon request for estimated or maximum allowed amount or charge for a proposed admission, procedure or service and amount insured responsible to pay; establishment of toll-free telephone number and website 

Amended by St.2020, c.260, § 62, effective January 1, 2021

§ 24 Internal appeals processes for risk-bearing provider organizations; patient's right to third-party advocate; external review process 
§ 25 Use and acceptance of specifically designated prior authorization forms 
§ 26 Establishment of standardized processes and procedures for the determination of patient's health benefit plan eligibility at or prior to time of service 
§ 27 Development of common summary of payments form 

Amended by St.2018, c. 63, § 1, effective April 1, 2019

§ 28 Provider directories; contents; audits; print copies; customer service contact information; accommodations; accuracy; updates 

Added by St.2019, c.124, § 2, effective November 26, 2019

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