211 CMR 52.04 - Deemed Accreditation

Current through Register 1466, April 1, 2022

(1) A Carrier may apply for deemed Accreditation. A Carrier that applies for deemed Accreditation may be deemed to be in compliance with the standards set forth in 211 CMR 52.00 and may be so accredited by the Bureau if it meets the following requirements:
(a) It must be accredited by JCAHO, NCQA or URAC;
(b) It must meet all the requirements set forth in M.G.L. c. 176O, 211 CMR 52.00 and 958 CMR 3.000: Health Insurance Consumer Protection; and
(c) It must have received the ratings specified in 211 CMR 52.05(5)(c) and (d).
(2) For a Carrier that applies for deemed Accreditation:
(a) If the Carrier meets or exceeds the ratings identified in 211 CMR 52.05(5)(c), the Carrier shall not be further reviewed by the Bureau for compliance with the standards set forth in 211 CMR 52.07 and 52.08 for that applicable period.
(b) If the Carrier meets or exceeds the ratings identified in 211 CMR 52.05(5)(d), the Carrier shall not be further reviewed by the Bureau for compliance with the standards set forth in 211 CMR 52.09 for that applicable period.
(3) A Carrier shall not be eligible for deemed Accreditation status if the National Accreditation Organization has revoked the Carrier's accreditation status in the past 24 months or the accreditation status of an entity that currently contracts with the Carrier to provide services regulated by M.G.L. c. 176O.
(4) A Carrier that has applied for deemed Accreditation and been denied, shall be considered an applicant for Accreditation under 211 CMR 52.05(3) or (4). Denial of a request for deemed Accreditation shall not be eligible for reconsideration under 211 CMR 52.06(5).
(5) If a Carrier has received accreditation from a National Accreditation Organization, or a subcontracting organization, with whom the Carrier has a written agreement delegating certain services, or has received accreditation or certification from a National Accreditation Organization, but under standards other than those identified in 211 CMR 52.05(5), the Carrier may submit the documents indicating such accreditation or certification so that the Division may consider this in developing the scores described in 211 CMR 52.06(1).

Notes

211 CMR 52.04
Amended by Mass Register Issue 1345, eff. 8/11/2017.

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