Massachusetts Statutes

Section 2. Except as hereinafter provided in this chapter, the provisions of chapters one hundred and seventy-five, one hundred and seventy-six A, one hundred and seventy-six B, one hundred and seventy-six C, one hundred and seventy-six E, and one hundred and seventy-six F, shall…

Section 20. Any administrative supervision, rehabilitation or liquidation of a health maintenance organization shall be deemed to be the administrative supervision, rehabilitation or liquidation of an insurance company and shall be instituted on the grounds contained in and condu…

Section 20A. If the commissioner is satisfied, upon examination or other evidence submitted to him, that (1) any health maintenance organization is insolvent or is in an unsound financial condition, (2) its business policies or methods are unsound or improper, (3) its condition o…

Section 21. (a) For purposes of this section, ''participating provider'' shall mean any physician, hospital or other person who, under an express or implied contract with the health maintenance organization or with its contractor or subcontractor, has agreed to provide health car…

Section 22. (a) For purposes of this section, ''health care provider'' shall mean any physician, hospital or other person furnishing health services who has provided such services to members under an express or implied contract or with an expectation of receiving payment, other t…

Section 23. (a) For purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:- ''Carrier'', a health maintenance organization authorized under this chapter, an insurance company authorized to provide accident …

Section 24. For the purposes of this section the following words shall have the following meanings:— ''Genetic information'', any written recorded individually identifiable result of a genetic test as defined by this section or explanation of such a result. ''Genetic test'', a te…

Section 25. (a) The commissioner shall require upon issuance of an initial license under this chapter that a health maintenance organization shall have an initial adjusted net worth of $1,500,000. (b) Except as provided by subsection (c) or (d), the commissioner shall require tha…

Section 26. (a) Except as provided in subsections (b) and (d), each health maintenance organization shall maintain a deposit with a trustee acceptable to the commissioner through which a custodial or controlled account is utilized of cash, securities or any combination of these o…

Section 27. (a) No person other than the health maintenance organization shall make a tender offer for or a request or invitation for tenders of, or enter into any agreement to exchange securities, or seek to acquire, or acquire, in the open market or otherwise, any voting securi…

Section 28. (a) Every health maintenance organization which may do business in the commonwealth and which is a member of a health maintenance organization holding company system, shall register with the commissioner. Notwithstanding the foregoing, a foreign health maintenance org…

Section 29. (a)(1) Whenever it appears to the commissioner that any health maintenance organization or any director, officer, employee or agent thereof has committed or is about to commit a violation of sections 27 to 29, inclusive, or any rule, regulation or order issued by the …

Section 3. A carrier or any two or more such companies, corporations, or their subsidiaries or affiliates may: (1) organize and operate a health maintenance organization as a line of business, division, department, subsidiary or affiliate under the provisions of this chapter prov…

Section 30. Pursuant to section 8B of chapter 62C, carriers shall provide written statements to residents of the commonwealth for whom creditable coverage is provided and shall provide a separate report verifying those statements to the commissioner of revenue.

Section 31. To the maximum extent possible, every health maintenance organization shall attribute every member to a primary care provider. Members may change their primary care provider, provided that the member gives notice to the carrier.

Section 32. To the extent permissible under applicable state and federal privacy laws, every health maintenance organization shall disclose patient-level data to providers in their network solely for the purpose of carrying out treatment, coordinating care among providers and man…

Section 33. (a) For the purposes of this section, the following words shall, unless the context clearly requires otherwise, have the following meanings: ''Behavioral health services'', care and services for the evaluation, diagnosis, treatment or management of patients with menta…

Section 4. A health maintenance contract shall provide coverage for: (a) pregnant women, infants and children as set forth in section 47C of chapter 175; (b) cardiac rehabilitation as set forth in section 47D of chapter 175; (c) prenatal care, childbirth and postpartum care as se…

Section 4A. Any health maintenance contract shall provide coverage for employees terminated due to a plant closing or covered partial closing as required by the second paragraph of section one hundred and ten D of chapter one hundred and seventy-five and the second paragraph of s…

Section 4AA. For the purposes of this section the following terms shall have the following meanings, unless the context clearly requires otherwise:— ''Acute treatment services'', 24–hour medically supervised addiction treatment for adults or adolescents provided in a medically ma…

Section 4B. No health maintenance organization shall require as a condition to receiving benefits pursuant to this chapter consent to the disclosure of information regarding services for mental disorders under different terms and conditions than consent is required for the disclo…

Section 4C. Any group health maintenance contract shall provide coverage for home care services as set forth in clause (k) of section one hundred and ten of chapter one hundred and seventy-five.

Section 4CC. Any individual or group health maintenance contract shall provide coverage for medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy syndrome including, but not limited to, reconstructive surgery, such…

Section 4D. A group health maintenance contract shall provide coverage for nonprescription enteral formulas for home use for which a physician has issued a written order and which are medically necessary for the treatment of malabsorption caused by Crohn's disease, ulcerative col…

Section 4DD. An individual or group health maintenance contract that is issued or renewed shall provide, for any covered drug that is a narcotic substance contained in schedule II pursuant to chapter 94C and subject to cost sharing, that if a person receives a prescription filled…

Section 4E. A group health maintenance contract shall provide coverage for off-label uses of prescription drugs used in the treatment of cancer as set forth in sections forty-seven K and forty-seven L of chapter one hundred and seventy-five; provided, however, that neither the at…

Section 4EE. (a) Any individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall develop a plan to provide adequate coverage and access to a broad spectrum of pain management services, including, but not limited to, non-medic…

Section 4F. Any group health maintenance contract shall provide coverage for a bone marrow transplant or transplants for persons who have been diagnosed with breast cancer that has progressed to metastatic disease; provided, however, that said person shall meet the criteria estab…

Section 4FF. (a) An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide coverage for: (i) tobacco use cessation counseling; and (ii) all generic United States Food and Drug Administration–approved tobacco cess…

Section 4G. Any individual or group health insurance maintenance contract which provides coverage for prescription drugs shall provide coverage for off-label uses of prescription drugs used in the treatment of HIV/AIDS as set forth in sections forty-seven O and forty-seven P of c…

Section 4GG. Any individual or group health maintenance contract shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute-onset neuropsychiatric syndrome including, but not limited to, the…

Section 4H. Any individual or group health maintenance contract, except contracts providing supplemental coverage to Medicare or other governmental programs, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, sh…

Section 4I. Any health maintenance contract shall provide coverage for abortion, as defined in section 12K of chapter 112, abortion-related care, prenatal care, childbirth and postpartum care in accordance with section four of chapter one hundred and seventy-six G. In addition to…

Section 4II. An individual or group health maintenance contract that provides coverage for prescription eye drops shall provide coverage for refills of prescription eye drops in accordance with the Medicare Part D guidelines on early refills of topical ophthalmic products when: (…

Section 4J. (a) For the purposes of this section, the following words shall have the following meanings: ''Prosthesis'', an artificial appliance used to replace a lost natural structure; provided, however, that prosthesis shall include, but not be limited to, artificial arms, leg…

Section 4JJ. (a) For the purposes of this section, ''psychiatric collaborative care model'' shall mean the evidence-based, integrated behavioral health service delivery method in which a primary care team consisting of a primary care provider and a care manager provides structure…

Section 4K. A health maintenance contract shall provide coverage for a newborn hearing screening test to be performed before the newborn infant is discharged from the hospital or birthing center to the care of the parent or guardian, pursuant to regulations of the department of p…

Section 4KK. (a) For the purposes of this section, the following terms shall have the following meanings unless the context clearly requires otherwise: ''Community-based acute treatment'', 24–hour clinically managed mental health diversionary or step-down services for children an…

Section 4L. Any group health maintenance contract shall provide coverage for hospice services as defined in section 57D of chapter 111 during the life of the patient, to terminally ill patients with a life expectancy of six months or less; provided, however, that such services ar…

Section 4LL. An individual or group health maintenance contract that is issued or renewed within or without the commonwealth shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175.

Section 4M. (a) A health maintenance contract issued or renewed within or without the commonwealth shall provide mental health benefits on a nondiscriminatory basis to residents of the commonwealth and to all members or enrollees having a principal place of employment in the comm…

Section 4MM. (a) For the purpose of this section, the following words shall have the following meanings unless the context clearly requires otherwise: ''Licensed mental health professional,'' a licensed physician who specializes in the practice of psychiatry, a licensed psycholog…

Section 4N. Any individual or group health maintenance contract that provides hospital expense and surgical expense insurance, delivered, issued or renewed by agreement between the insurer and the policyholder, within or without the commonwealth, shall provide benefits for reside…

Section 4NN. (a) For the purposes of this section, ''federally-defined preventive services'' shall mean: (i) evidence-based items or services that currently have a rating of ''A'' or ''B'' in the recommendations of the United States Preventive Services Task Force; (ii) immunizati…

Section 4O. (a) Any individual or group health maintenance contract that is issued, renewed or delivered within or without the commonwealth and that provides benefits for outpatient services shall provide to residents of the commonwealth and to persons having a principal place of…

Section 4OO. (a) For the purposes of this section, the following words shall have the following meaning unless the context clearly requires otherwise: ''Directly or indirectly cause impairment of fertility'', to cause circumstances where a disease or the necessary treatment for a…