101 CMR 20.06 - Provider Organizations

The requirement that all providers must connect to the Mass HIway applies to provider organizations. Provider organizations include, but are not limited to, acute care hospitals, community health centers, and medical ambulatory practices, which are defined as:

(1) Acute Care Hospital. A hospital licensed under M.G.L. c. 111, ยง 51, and the teaching hospital of the University of Massachusetts Medical School, which contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the department. Hospitals that meet this definition of acute care hospital can be found in the Massachusetts Licensed or Certified Health Care Facility/Agency Listing, which is maintained by the Department of Public Health and is publicly available on the Department of Public Health's website.
(2) Community Health Center.
(a) An organization that is either:
1. A "Federally Qualified Health Center" or a "Federally Qualified Health Center look-alike" as defined by the federal Department of Health and Human Services Health Resources and Services Administration (HRSA) and operating in conformance with Section 330 of United States Public Law 95-626; or
2. An organization that files cost reports as a community health center, as requested by the Health Policy Commission within the Executive Office for Administration and Finance.
(b) For the purposes of 101 CMR 20.00, the following definitions of large and small community health centers apply:
1. Large Community Health Center. A community health center where ten or more licensed providers participate in providing health care for patients.
2. Small Community Health Center. A community health center where fewer than ten licensed providers participate in providing health care for patients.
(c) In Community Health Center, licensed providers are limited to include medical doctors, doctors of osteopathy, nurse practitioners, or physician assistants.
(3) Medical Ambulatory Practice.
(a) An organization in Massachusetts that includes licensed providers who provide primary or specialty outpatient health care services to patients. In a medical ambulatory practice, licensed providers are limited to include medical doctors, doctors of osteopathy, nurse practitioners, or physician assistants. Medical Ambulatory Practice does not include Community Health Center, as defined in 101 CMR 20.06(2), and does not include ambulatory practices whose primary purpose is to provide behavioral health services. In a medical ambulatory practice, "outpatient health care services" are defined as health care services that do not require an overnight stay.
(b) For the purposes of 101 CMR 20.00, the following definitions of large and medium medical ambulatory practices apply:
1. Large Medical Ambulatory Practice. A medical ambulatory practice where more than 50 licensed providers participate in providing health care for patients.
2. Medium Medical Ambulatory Practice. A medical ambulatory practice where ten to 50 licensed providers participate in providing health care for patients.
3. Small Medical Ambulatory Practice. A medical ambulatory practice where fewer than ten licensed providers participate in providing health care for patients. Small medical ambulatory practices includes medical ambulatory practices where only one licensed provider participates in providing health care for patients.
(4) For the purposes of 101 CMR 20.00, the applicability of the provider organization definitions shall be determined by calculating the number of licensed providers that provide health care services to patients on behalf of the provider organization in the month of June prior to that organization's initial required connection date to the Mass HIway, regardless of employment status.
(5) EOHHS may issue administrative bulletins or other issuances to define and describe additional types of provider organizations.

Notes

101 CMR 20.06
Adopted by Mass Register Issue 1332, eff. 2/10/2017. Amended by Mass Register Issue 1336, eff. 2/10/2017. Amended by Mass Register Issue 1401, eff. 10/4/2019.

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