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958. Mass. Code Regs. 3.600. - Reporting Requirements

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“Reporting Requirements”
Carriers must provide the information set forth in this section to the Office of Patient Protection each year.  This information includes a list of sources of independently published information assessing the beneficiaries’ satisfaction and evaluating the quality of health care services offered by the carrier. It also includes the percentage of physicians and nurse practitioners that voluntarily and involuntarily terminated participation contracts with the carrier during the previous calendar year for which such data has been compiled and the three most common reasons for disenrollment.  Other information that must be reported is the percentage of premium revenue expended by the carrier for health care services provided, a report detailing the total number of filed grievances and external appeals. Carriers shall provide to the Office of Patient Protection, a copy of the health plan data and information set compiled for the National Committee on Quality Assurance or other information collected by the carrier and deemed to be similar or equivalent thereto. At the carrier's option, proprietary financial data may be excluded from their submission. The confidentiality of any information about a carrier or utilization organization that in the opinion of the Office of Patient Protection in consultation with the Division of Insurance is proprietary in nature shall be protected. The Office of Patient Protection shall establish a site on the Internet and make managed care information collected by the Office of Patient Protection readily accessible to consumers. The following information shall be provided to the Office of Patient Protection and  to the insured upon enrollment for coverage: evidence of coverage, a list of health care providers in the carrier's network, a statement that physician profiling information, a summary description of the process by which clinical guidelines and utilization review criteria are developed, and the voluntary and involuntary disenrollment rate available.

Current as of June 2015