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.
Notes
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