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Care Coordination/Care Management in Massachusetts

Massachusetts law provides patients the opportunity to be involved in the management of their own care.  Primarily, the law sets forth patients’ rights in all health care facilities.  These rights include the right to free choice in selecting a care facility, physician, or service mode, except if there is an emergency.1  Additionally, patients have the right to refuse treatment or be further informed of a medical intervention.2  Patients must also give informed consent prior to medical treatment.3  Informed consent is specifically required for HIV testing by the law.4

The state requires its insurance companies to provide consumers with detailed information about participating providers, such as method of compensation as well as quality measures.5  Additionally, the Division of Health Care Finance and Policy is required to develop and issue a report that allows individuals to evaluate and compare different insurance plans in an effort to encourage consumers to take an active role in the management of their own care.6

 

Footnotes

  • 1. M.G.L.A. 111 §70E
  • 2. M.G.L.A. 111 §70E
  • 3. M.G.L.A. 111 §70E
  • 4. M.G.L.A. 111 §70F
  • 5. M.G.L.A. 176O §7
  • 6. M.G.L.A. 118G §24

 

Care Coordination/Care Management in Massachusetts

Subtopic Statute/Regulation Description
Informed consent requirements (If the information is going beyond the patient and provider 104. Mass. Code Regs. 27.10. - Treatment “Treatment”   Informed consent means the knowing consent, voluntarily given by the patient, or his or her legally authorized...
Mass. Gen. Laws. Ann. ch. 111, § 70F - HTLV-III Test; confidentiality; informed consent HTLV-III Test; confidentiality; informed consent No health care facility or physician is allowed to test an individual for HTLV-III antibody without...
Mass. Gen. Laws. Ann. ch. 111, §70G - Genetic information and reports protected as private information; prior written consent for genetic testing “Genetic information and reports protected as private information; prior written consent for genetic testing”   This section...
Other 104. Mass. Code Regs. 27.10. - Treatment “Treatment”   Informed consent means the knowing consent, voluntarily given by the patient, or his or her legally authorized...
104. Mass. Code Regs. 27.13. - Human Rights “Human Rights”   Each facility must post a copy of the rights set forth by this section, in the admitting room of the facility, and...
114.6. Mass. Code Regs. 10.06. - Patient Rights and Responsibilities “Patient Rights and Responsibilities”   Hospitals and Community Health Centers must advise patients of their rights to: apply for...
114.6. Mass. Code Regs. 10.08. - Notification “Notification”   Hospitals and Community Health Centers must meet certain criteria regarding notification of the availability of...
Mass. Gen. Laws. Ann. ch. 111, §72AA - The distribution by long-term care facilities of an informational document containing laws and regulations “Informational document containing laws and regulations; distribution by long-term care facilities”   Long-term care facilities are...
Treatment planning when using interdisciplinary team (including assessments, plan of care, discharge/transfer planning 104. Mass. Code Regs. 27.10. - Treatment “Treatment”   Informed consent means the knowing consent, voluntarily given by the patient, or his or her legally authorized...
Discharge instructions/Required follow-up. 105. Mass. Code Regs. 130.344. - Patient Signature Requirement “Patient Signature Requirement”   Patient’s or patient’s health representative’s signature on the discharge plan...
105. Mass. Code Regs. 130.347. - Discharge Planning Records “Discharge Planning Records”   The discharge planning service shall maintain written records which contain sufficient information to...
105. Mass. Code Regs. 150.003. - Admissions, Transfers and Discharges “Admissions, Transfers and Discharges”   The law establishes the procedures for admissions, transfers and discharges of patients....
Information sharing across providers (including communication with other providers, across state lines, patient transfer) 105. Mass. Code Regs. 150.011. - Social Services “Social Services”   The law establishes that sufficient social services must be provided to meet all the social and emotional needs...
Mass. Gen. Laws. Ann. ch. 176O, § 7 - Information Provided by Carrier Upon Enrollment or Upon Request A health insurance carrier must provide the following information to an insured person either upon enrollment or to a prospective consumer upon...
Patient authorization requirements (to provide health information to another individual) 105. Mass. Code Regs. 345.300. - Duties of a Certified Clinic “Duties of a Certified Clinic”   A certified clinic must report to the Department, on forms, every patient with a sexually...
Care Coordination/Care Management Mass. Gen. Laws. Ann. ch. 111, § 228 - Advance disclosure of allowed amount or charge for admission, procedure or service Advance disclosure of allowed amount or charge for admission, procedure or service  A health care provider must disclose the allowed amount and...
Mass. Gen. Laws. Ann. ch. 111, § 70E - Patients' and residents' rights All of the rights below apply to all patients in all facilities.  This section applies to all health care facilities, which include, hospitals,...
New coordinated systems of care (ACOs, Patient Centered Medical Homes/Health homes) (Cross reference with Quality Measurement) Mass. Gen. Laws. Ann. ch. 111C, §11 - Statewide coordinated trauma care system; regulations and guidelines “Statewide coordinated trauma care system; regulations and guidelines; trauma registry reporting and analysis system; designation as trauma...
Mass. Gen. Laws. Ann. ch. 111C, §2 - Statewide EMS system; expectations; purpose “Statewide EMS system; expectations; purpose”   The law establishes the procedures and expectations of a statewide EMS system. The...
Licensure laws requiring or recommending care coordination or care management activities (Cross reference with private insurance/Medicaid/Medicare data requirements) Mass. Gen. Laws. Ann. ch. 176O, § 7 - Information Provided by Carrier Upon Enrollment or Upon Request A health insurance carrier must provide the following information to an insured person either upon enrollment or to a prospective consumer upon...