Title 958 CMR 3.000 - Health Insurance Consumer Protection

Section 3.001 - Scope and Purpose
Section 3.020 - Definitions
Section 3.100 - Clinical Decisions
Section 3.101 - Carrier's Medical Necessity Guidelines
Section 3.200 - Internal Inquiry Process
Section 3.300 - Right to an Internal Grievance Process
Section 3.301 - Information on Internal Grievance Process
Section 3.302 - Form and Manner of Request
Section 3.303 - Carrier and Utilization Review Organization Records of Grievances
Section 3.304 - Carrier and Utilization Review Organization Acknowledgment of Internal Grievances
Section 3.305 - Time Limits for Resolution of Non-expedited Internal Grievances
Section 3.306 - Review of Internal Grievances
Section 3.307 - Form of Written Resolution of the Internal Grievance
Section 3.308 - Reconsideration of Carrier Decisions on Internal Grievances
Section 3.309 - Expedited Internal Review of Adverse Determinations
Section 3.310 - Right to Request a Conference
Section 3.311 - Failure of Carrier to Meet Time Limits
Section 3.312 - Coverage or Treatment Pending Resolution of Internal Grievance
Section 3.313 - Confidentiality
Section 3.314 - Internal Review Conference
Section 3.400 - External Review
Section 3.401 - Expedited External Review
Section 3.402 - Fees
Section 3.403 - Consent to Release of Medical Information
Section 3.404 - Form and Manner of Request for External Review
Section 3.405 - Screening of Requests for External Review
Section 3.406 - Requests Ineligible for External Review - Notification
Section 3.407 - Assignment of External Reviews
Section 3.408 - Notification of Assignment and Request for Information
Section 3.409 - Medical Records and Information
Section 3.410 - Review Panel
Section 3.411 - Conflict of Interest
Section 3.412 - Additional Medical or Other Information
Section 3.413 - Informal Meeting
Section 3.414 - Continuation of Services
Section 3.415 - Decisions and Notice
Section 3.416 - Confidentiality - External Review
Section 3.417 - External Review Conference
Section 3.500 - Disenrollment of Primary Care Provider
Section 3.501 - Disenrollment of Providers of Care to Pregnant Women
Section 3.502 - Disenrollment of Providers of Care to the Terminally 111
Section 3.503 - Coverage for the Newly Insured
Section 3.504 - Carrier's Coverage Conditions
Section 3.505 - Standing Referrals
Section 3.506 - Specialty Care Not Requiring Prior Authorization
Section 3.507 - Coverage of Pediatric Specialty Care
Section 3.508 - Denial of Provider Application
Section 3.509 - Provider Termination Without Cause Provisions
Section 3.600 - Reporting Requirements
Section 3.700 - Required Oral Interpretation and Written Translation Services