211 CMR 52.03 - Accreditation of Carriers

Current through Register 1466, April 1, 2022

(1) A Carrier must be accredited according to the requirements set forth in 211 CMR 52.00 in order to offer for sale, provide, or arrange for the provision of a defined set of Health Care Services to Insureds through affiliated and contracting Providers or employ Utilization Review in making decisions about whether services are Covered Benefits under a Health Benefit Plan.
(2) Accreditation granted to Carriers pursuant to 211 CMR 52.00 shall remain in effect for up to 24 months until the end of the respective biennial Accreditation period, unless revoked or suspended by the Commissioner.
(3) A Carrier shall be exempt from 211 CMR 52.00 if in the written opinion of the Attorney General, the Commissioner, and the Commissioner of Public Health, the health and safety of health care consumers would be materially jeopardized by requiring Accreditation of the Carrier.
(a) Before publishing a written exemption pursuant to 211 CMR 52.03(3), the Attorney General, the Commissioner, and the Commissioner of Public Health shall jointly hold at least one public hearing at which testimony from interested parties on the subject of the exemption shall be solicited.
(b) A Carrier granted an exemption pursuant to 211 CMR 52.03(3) shall be provisionally accredited and, during such provisional Accreditation, shall be subject to review not less than every four months and shall be subject to those requirements of M.G.L. c. 176O and 211 CMR 52.00 as deemed appropriate by the Commissioner.
(c) Before the end of each four-month period specified in 211 CMR 52.03(3)(b) the Commissioner shall review the Carrier's exemption.
1. If the Bureau determines that the Carrier has met the requirements of 211 CMR 52.00, then the Carrier shall be accredited and the exemption shall expire upon Accreditation.
2. If the Commissioner determines that the Carrier's exemption should be continued, the Commissioner shall communicate that determination in writing to the Attorney General and the Commissioner of Public Health. Continuation of the exemption shall be granted only upon a written decision by the Commissioner, the Attorney General and the Commissioner of Public Health.


211 CMR 52.03
Amended by Mass Register Issue 1345, eff. 8/11/2017.

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