957 CMR, § 11.03 - Reporting Requirements

(1) General Reporting Requirements. Each Registered Provider Organization shall provide information, as specified in the most recent Data Submission Manual, which may include:

(a) Information regarding ownership, governance, and operational structure, including, organizational charts and narrative descriptions of the type and kind of Corporate and Contracting Affiliations; information regarding incentive structures and compensation models, including Funds Flow within the Registered Provider Organization; and information regarding the characteristics of any Clinical Affiliations and the role of Community Advisory Boards;

(b) Information regarding the number of affiliated Health Care Professional Full-time Equivalents by license type, specialty, each Health Care Professional's name, address of principal location of work, national provider identifier, or other identifying information, and whether the Health Care Professional is employed by or affiliated with the Registered Provider Organization and the nature of that relationship, including whether provisions exist in physician participation or employment agreements such as referral requirements;

(c) The name and address of each Facility and Practice Site, by license number, license type, tax identification number, national provider identifier, and capacity in each Major Service Category, or by any other relevant characteristic as defined in the Data Submission Manual;

(d) Information regarding utilization by Major Service Category;

(e) Comprehensive financial statements, including Audited Financial Statements, Consolidating Schedules and standardized filings that shall include a balance sheet, a statement of operations, and a cash flow statement;

(f) Information on stop-loss insurance and any non-fee-for-service payment arrangements;

(g) Information on clinical quality, care coordination and patient referral practices;

(h) Information regarding expenditures and funding sources for payroll, teaching, research, advertising, taxes or payments-in-lieu-of-taxes and other non-clinical functions;

(i) Information regarding charitable care and community benefit programs;

(j) For any risk-bearing provider organization, a certificate from the Division under M.G.L. c. 176U;

(k) Information regarding any discounts, rebates or any other type of refunds or remuneration in exchange for, or in any way related to, the provision of heath care services; and

(l) Such other information as the MA-RPO Program considers appropriate.

(2) Administrative Simplification. The MA-RPO Program will coordinate with the Division and other Governmental Units to obtain information directly from such entities where available.

Notes

957 CMR, § 11.03

Adopted by Mass Register Issue 1334, eff. 3/10/2017. Amended by Mass Register Issue 1537, eff. 12/20/2024.