reglab/statecodes huggingface dataset:
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4s - Items Medically Necessary for Diagnosis and Treatment of Diabetes

Section 4S. A subscription certificate under an individual or group medical service agreement which provides hospital expense and surgical expense insurance, except certificates which provide 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, shall provide benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth coverage for the following items if such items are within a category of benefits or services for which coverage is otherwise afforded by the medical service agreement, have been prescribed by a health care professional legally authorized to prescribe such items and if the items are medically necessary for the diagnosis or treatment of insulin-dependent, insulin-using, gestational and non-insulin-dependent diabetes: blood glucose monitors; blood glucose monitoring strips for home use; voice-synthesizers for blood glucose monitors for use by the legally blind; visual magnifying aids for use by the legally blind; urine glucose strips; ketone strips; lancets; insulin; insulin syringes; prescribed oral diabetes medications that influence blood sugar levels; laboratory tests, including glycosylated hemoglobin, or HbAlc, tests; urinary protein/microalbumin and lipid profiles; insulin pumps and insulin pump supplies; insulin pens, so-called; therapeutic/molded shoes and shoe inserts for people who have severe diabetic foot disease when the need for therapeutic shoes and inserts has been certified by the treating doctor and prescribed by a podiatrist or other qualified doctor and furnished by a podiatrist, orthotist, prosthetist or pedorthist; supplies and equipment approved by the Federal Drug Administration for the purposes for which they have been prescribed and diabetes outpatient self-management training and education, including medical nutrition therapy, when provided by a certified diabetes health care provider participating with the medical service agreement or affiliated with a provider participating with the medical service agreement. As used in this section, ''certified diabetes health care provider'' shall mean a licensed health care professional with expertise in diabetes, a registered dietician or a health care provider certified by the National Certification Board of Diabetes Educators as a certified diabetes educator. Nothing in this section shall be construed to require a medical service corporation to contract with a certified diabetes health care provider who is not already under contract with such medical service corporation.
The benefits provided in this section shall meet all other terms and conditions within a subscription certificate. Medical service agreements shall not reduce or eliminate coverage due to the requirements of this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4ss - Coverage for Medically Necessary Mental Health Acute Treatment, Community-Based Acute Treatment, Intensive Community-Based Acute Treatment

Section 4SS. 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 and adolescents that is usually provided as an alternative to mental health acute treatment.
''Intensive community-based acute treatment'', intensive 24–hour clinically managed mental health diversionary or step-down services for children and adolescents that is usually provided as an alternative to mental health acute treatment.
''Mental health acute treatment'', 24–hour medically supervised mental health services provided in an inpatient facility, licensed by the department of mental health, that provides psychiatric evaluation, management, treatment and discharge planning in a structured treatment milieu.
(b) A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for medically necessary mental health acute treatment, community-based acute treatment, intensive community-based acute treatment and shall not require a preauthorization before obtaining treatment; provided, however, that the facility shall notify the carrier of the admission and the initial treatment plan within 72 hours of admission.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4t - Subscription Certificate Benefits for Services Rendered by a Nurse Anesthetist or Nurse Practitioner

Section 4T. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed in the commonwealth shall provide as benefits to all individual subscribers and members within the commonwealth and to all group members having a principal place of employment within the commonwealth for services rendered by a certified registered nurse anesthetist or nurse practitioner designated as such a certified registered nurse anesthetist or nurse practitioner by the board of registration in nursing pursuant to the provisions of section 80B of chapter 112; provided, however, that the following conditions are met: (1) the service rendered is within the scope of the certified registered nurse anesthetist's license or nurse practitioner's authorization to practice by the board of registration in nursing; and (2) the policy or contract currently provides benefits for identical services rendered by a provider of health care licensed by the commonwealth.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4tt - Benefits for Medically Necessary Emergency Services Programs

Section 4TT. A subscription certificate under an individual or group medical service agreement that is issued or renewed shall provide benefits on a nondiscriminatory basis for medically necessary emergency services programs, as defined in section 1 of chapter 175.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4uu - Coverage for Annual Mental Health Wellness Examination

Section 4UU. (a) For the purpose of this section, the following words shall have the following meanings:
''Licensed mental health professional,'' a licensed physician who specializes in the practice of psychiatry, a licensed psychologist, a licensed independent clinical social worker, a licensed certified social worker, a licensed mental health counselor, a licensed supervised mental health counselor, a licensed psychiatric nurse mental health clinical specialist, a licensed psychiatric mental health nurse practitioner, a licensed physician assistant who practices in the area of psychiatry, a licensed alcohol and drug counselor I, as defined in section 1 of chapter 111J, or a licensed marriage and family therapist within the lawful scope of practice for such therapist.
''Mental health wellness examination,'' a screening or assessment that seeks to identify any behavioral or mental health needs and appropriate resources for treatment. The examination may include: (i) observation, a behavioral health screening, education and consultation on healthy lifestyle changes, referrals to ongoing treatment, mental health services and other necessary supports, and discussion of potential options for medication; and (ii) age-appropriate screenings or observations to understand a covered person's mental health history, personal history and mental or cognitive state and, when appropriate, relevant adult input through screenings, interviews, and questions.
''Primary care provider'', a health care professional qualified to provide general medical care for common health care problems, who: (i) supervises, coordinates, prescribes or otherwise provides or proposes health care services; (ii) initiates referrals for specialist care; and (iii) maintains continuity of care within the scope of practice.
(b) A subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide coverage for an annual mental health wellness examination that is performed by a licensed mental health professional or primary care provider, which may be provided by the primary care provider as part of an annual preventive visit. The examination shall be covered with no patient cost-sharing, provided, however, that cost-sharing shall be required if the applicable plan is governed by the Federal Internal Revenue Code and would lose its tax-exempt status as a result of the prohibition on cost-sharing for this service.
(c) The division of insurance, in consultation with the office of Medicaid, and the department of mental health, shall develop guidelines to implement this section.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4v - Coverage for Human Leukocyte or Histocompatibility Locus Antigen Testing

Section 4V. Any subscription certificate under an individual or group medical service agreement, except certificates providing supplemental coverage to Medicare or to other government programs, delivered, issued or renewed by agreement within or without the commonwealth shall provide, as a benefit for all individual subscribers or members within the commonwealth and all group members having a principal place of employment within the commonwealth, coverage for the cost of human leukocyte antigen testing or histocompatibility locus antigen testing that is necessary to establish bone marrow transplant donor suitability. The coverage shall cover the costs of testing for A, B or DR antigens, or any combination thereof, consistent with rules, regulations and criteria established by the department of public health pursuant to section 218 of chapter 111.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4vv - Coverage for Federally-Defined Preventive Services

[ Text of section added by 2023, 28, Sec. 59 effective July 1, 2023. See 2023, 28, Sec. 115.]
Section 4VV. (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) immunizations with routine use in children, adolescents and adults that currently have a recommendation from the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention with respect to the individual involved; (iii) with respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the comprehensive guidelines supported by the federal Health Resources and Services Administration; and (iv) with respect to women, such additional preventive care and screenings not described in clause (i) as provided for in comprehensive guidelines supported by the federal Health Resources and Services Administration; provided, however, that "federally-defined preventive services'' shall also include all other preventive services not subject to cost-sharing, as required by established federal regulatory and sub-regulatory guidance issued on or before July 1, 2023.
(b) Any subscription certificate under an individual or group medical service agreement that is delivered, issued or renewed within the commonwealth shall provide coverage for federally-defined preventive services.
(c) Coverage provided pursuant to this section shall not be subject to any cost-sharing, including, but not limited to, co-payments, co-insurance or any deductible, as required by established federal regulatory and sub-regulatory guidance issued on or before July 1, 2023.
(d) Nothing in this section shall prohibit: (i) coverage for items and services in addition to those recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or the federal Health Resources and Services Administration; or (ii) denying coverage for items and services that are not recommended by the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention or the federal Health Resources and Services Administration.
(e) If a recommendation described in subsection (a) is changed during a plan year, a carrier shall not be required to make changes to the health plan during the plan year.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4x - Coverage for Patient Care Services Provided Under Qualified Clinical Trials

Section 4X. Any subscription certificate under an individual or group medical service agreement delivered, issued or renewed within the commonwealth shall provide for the coverage of patient care services furnished pursuant to qualified clinical trials as defined in, and subject to the requirements and limitations of, section 110L of chapter 175.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 4y - Coverage for Speech, Hearing and Language Disorders

Section 4Y. Any subscription certificate under an individual or group medical service agreement which 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 residents of the commonwealth and to all group members having a principal place of employment within the commonwealth for the expenses incurred in the medically necessary diagnosis and treatment of speech, hearing and language disorders by individuals licensed as speech–language pathologists or audiologists under chapter 112, if such services are rendered within the lawful scope of practice for such speech–language pathologists or audiologists regardless of whether the services are provided in a hospital, clinic or private office; provided, however, that such coverage shall not extend to the diagnosis or treatment of speech, hearing and language disorders in a school–based setting. The benefits provided by this section shall be subject to the same terms and conditions established for any other medical condition covered by such individual or group medical service agreement.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 5 - Subscribers; Qualifications, Misrepresentation; Open Enrollment Periods

Section 5. Any person residing in the commonwealth shall have the right to become a subscriber of a medical service corporation if his qualifications meet those specified in the by-laws of such corporation, provided that such a corporation may, in its discretion, refuse to issue a subscription certificate to, or upon due notice cancel the subscription certificate of, any person who has made any fraudulent claim or representation to the corporation or to a participating physician, participating chiropractor or to any other participating provider of health services licensed under the laws of the commonwealth, or has been guilty of uncooperative or unethical dealings with the corporation, or has failed to pay dues and assessments seasonably and promptly or for any other cause which may be approved by the commissioner. Such corporation shall provide for annual open enrollment periods of not less than two months' duration. Proper notification shall be given to prospective subscribers in a form subject to approval by the commissioner.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 5a - Discrimination Against Abuse Victims in Terms of Medical Service Plans

Section 5A. No corporation subject to this chapter, and no officer or agent thereof, shall cancel, refuse to issue or renew, or in any way make or permit any distinction or discrimination in the amount or payment of premiums or rates charged, in the length of coverage, or in any other of the terms and conditions of a medical service plan based on information that an individual has been a victim of abuse, as defined by section one of chapter two hundred and nine A. No corporation subject to this chapter, and no officer or agent thereof, shall seek information that such person has been a victim of abuse as defined by said section one of said chapter two hundred and nine A. The practices prohibited under this section shall include not only those overtly discriminatory but also practices and devices which are fair in form but discriminatory in practice. Nothing in this section shall be construed as creating a special class of insureds who have been victims of abuse as defined by said section one of said chapter two hundred and nine A. Any violation of this section shall constitute an unfair method of competition or an unfair or deceptive act or practice in violation of chapters ninety-three A and one hundred and seventy-six D.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 5b - Medical Service Plans; Genetic Tests; Discrimination Based on Genetic Information

Section 5B. For the purposes of this section the following words shall have the following meanings:—
''Genetic information'', a written recorded individually identifiable result of a genetic test as defined by this section or explanation of such a result.
''Genetic test'', a test of human DNA, RNA, mitochondrial DNA, chromosomes or proteins for the purposes of identifying the genes, or genetic abnormalities, or the presence or absence of inherited or acquired characteristics in genetic material.
No corporation subject to this chapter and no officer or agent thereof, shall cancel, refuse to issue or renew, or in any way make or permit any distinction or discrimination in the amount of payment of premiums as rates charged, in the length of coverage, or in any other of the terms and conditions of a medical service plan based on genetic information as defined in this section. No corporation subject to the provisions of this chapter and no officer or agent thereof, shall require genetic tests or private genetic information, as defined in this section, as a condition of the issuance or renewal of a medical service plan. Any violation of this section shall constitute an unfair method of competition or unfair or deceptive act or practice in violation of chapters 93A and 176D.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 6b - Divorced or Separated Spouses; Continuation of Eligibility for Benefits

Section 6B. (a) In the event of the granting of a judgment absolute of divorce or of separate support to which a subscriber of a group nonprofit medical service plan is a party, the person who was the spouse of said subscriber prior to the issuance of such judgment shall be and remain eligible for benefits under said plan, whether or not said judgment was entered prior to the effective date of said plan, without additional premium or examination therefor, as if said judgment had not been entered; provided, however, that such eligibility shall not be required if said judgment so provides. Such eligibility shall continue through the subscriber's participation in the plan until the remarriage of either the subscriber or such spouse, or until such time as provided by said judgment, whichever is earlier.
(b) In the event of the remarriage of the group plan subscriber referred to in paragraph (a), the former spouse thereafter shall have the right, if so provided in said judgment, to continue to receive benefits as are available to the subscriber, by means of the addition of a rider to the family plan or the issuance of an individual plan, either of which may be at additional premium rates determined by the commissioner of insurance to be just and reasonable in accordance with the additional insuring risks involved.
(c) The name, address, and policy number of a person eligible for health insurance coverage pursuant to paragraph (a) or (b), if available, shall be forwarded by such nonprofit medical service corporation to the department of public welfare within thirty days of the date when coverage of said person under said paragraph (a) or (b) is commenced.
(d) Notice of cancellation of coverage of the divorced or separated spouse of a member shall be mailed to such divorced or separated spouse at such person's last known address, together with notice of the right to reinstate coverage retroactively to the date of cancellation.
(e) Claims paid on behalf of a divorced or separated spouse or on behalf of a dependent who is not residing with the member shall be paid to the physician, hospital or other provider of covered services or to the person on whose behalf such services were performed, unless the person is a minor child. In the event the person on whose behalf such services were performed is a minor, payment shall be made to the physician, hospital or other provider of such services or to the parent or custodian with whom the child resides.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 7a - Medicare Supplemental Group Coverage; Eligibility Due to Age or Disability

Section 7A. Any person who is eligible for Medicare coverage for both hospital and physician service due to age or disability, other than end-stage renal disease, shall be eligible for supplemental coverage to Medicare ninety days before and after the month of such person's Medicare effective date or of the month of loss of group or individual health coverage resulting from such person's retirement. Such supplemental coverage shall be effective no earlier than the effective date of Medicare coverage.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 7b - Medicare Supplemental Group Coverage; Medical Assistance Recipients

Section 7B. A medical service corporation governed by this chapter shall offer medicare supplemental group coverage to that group of medical assistance recipients designated from time to time by the department of public welfare. Such coverage shall be provided at a rate based on the projected experience of said group of recipients.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 7c - Retroactive Premium Rate Increase

Section 7C. For purposes of this section, retroactive premium rate increase shall mean any premium rate increase based upon an actual approved rate which is assessed to a subscriber after any payment has been made by said subscriber based upon an estimated premium rate for such period of coverage.
A medical service corporation governed by this chapter which offers medicare supplemental individual or group coverage shall, in the event of a retroactive premium rate increase for such coverage, allocate such increase among the remaining outstanding premium payments due; provided, however, that no finance charge or additional cost may be charged as a result of such allocation.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 7d - Retroactive Claims Denial for Behavioral Health Services

Section 7D. (a) For the purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:
''Behavioral health services'', as defined in section 1 of chapter 175, or ''services''.
''Provider'', (i) a mental health clinic or substance use disorder treatment program licensed by the department of public health under chapters 17, 111, 111B or 111E; or (ii) a behavioral, substance use disorder or mental health professional who is licensed under chapter 112 and accredited or certified to provide services and who has provided services under an express or implied contract or with the expectation of receiving payment, other than co-payment, deductible or co-insurance, directly or indirectly from the commission or other entity.
''Retroactive claims denial'', as defined in section 1 of chapter 175.
(b) A corporation shall not impose a retroactive claims denial for behavioral health services on a provider unless: (i) less than 12 months have elapsed from the time of submission of the claim by the provider to the corporation; (ii) the corporation has furnished the provider with a written explanation of the reason for the retroactive claims denial and, where applicable, a description of additional documentation or any other corrective action required for payment of the claim; and (iii) where applicable, the corporation allows the provider 30 days to submit additional documentation or to take any other corrective action required for payment of the claim.
(c) Notwithstanding subsection (b), a retroactive claims denial may be allowed after 12 months if: (i) the claim was submitted fraudulently; (ii) the claim, or services for which the claim was submitted, is the subject of legal action; (iii) the claim payment was incorrect because the provider was paid or the insured has already paid for the services identified in the claim; or (iv) the services identified in the claim were not delivered by the provider.
(d) If a retroactive claims denial is imposed because the claim payment is subject to adjustment due to expected payment from a payer other than the corporation or an entity with which the corporation contracts to provide or manage health care services, including mental health and substance use disorder services, the corporation shall notify the provider not less than 15 days before imposing the retroactive claims denial. The provider shall have 12 months from the date of denial to determine whether the claim is subject to payment by a secondary insurer; provided, however, that if the claim is denied by the secondary insurer due to the insured's transfer or termination of coverage, the corporation shall allow for resubmission of the claim.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 8 - Annual Statement; Verification, Form, Violations

Section 8. Every medical service corporation shall annually, on or before the first day of March, file in the office of the commissioner a statement, verified by at least two of the principal officers of said corporation, showing its condition as of the thirty-first day of December next preceding. Such statement shall be in such form and shall contain such matters as the commissioner shall prescribe. A corporation neglecting to file its annual statement within the time herein specified shall forfeit one hundred dollars for each day during which such neglect continues, and upon notice by the commissioner to that effect, its authority to do business shall cease while such default continues.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 8a - Financial Statements; Inclusion of Electronic Data Processing Equipment as Asset

Section 8A. In an account of its financial condition, a medical service corporation may include as an asset available for the payment of losses electronic data processing equipment, provided that the cost of such equipment at the time of acquisition is at least one hundred thousand dollars and that said cost is to be amortized in full over a period not to exceed ten years.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 10 - Investments, Sales, Loans and Places of Deposit; Approval; Acquisition of Real Estate; Leases; Tax Exemption; Limit; Special Contingent Surplus

Section 10. No investment, sale or loan shall be made by a medical service corporation which has not first been authorized by the board of directors, or by a committee thereof charged with the duty of investing or loaning the funds of the corporation; nor shall any deposit be made in a bank or banking institution unless such bank or banking institution has first been approved as a bank of deposit by the board of directors or said committee thereof, and unless the vote authorizing such investment, sale or loan or approval of the place of deposit has been duly recorded in the books of the corporation.
With the approval of the commissioner, a medical service corporation, alone or with one or more nonprofit corporations, the real estate of which is exempt from taxation, may acquire real estate it reasonably expects to use in whole or in part for conducting the business of such corporation or corporations. Real estate so acquired may be leased to other occupants, and when so leased, the exemption from taxation on real estate granted by this chapter or granted by any provisions of the general laws to a co-owner shall not apply to that portion of the real estate which is so leased unless such other occupant occupies the leased premises for its purposes and is (a) a charitable organization, as defined in section five of chapter fifty-nine, or (b) a nonprofit corporation organized under the laws of the commonwealth to provide any kind of health services, the real estate of which is exempt from taxation. Nothing in this paragraph shall limit the general investment powers set forth in this section.
The commissioner may require any such corporation after the first full year of doing business to accumulate and maintain a special contingent surplus, over and above its reserves and liabilities, in such amount as the commissioner may deem proper.
A medical service corporation may invest in, acquire and hold the capital stock of any corporation as a subsidiary which is an insurance company authorized to transact the business of providing health insurance to persons residing outside the commonwealth, and which is duly licensed by the commissioner of insurance, provided that the medical service corporation shall notify the commissioner at least thirty days prior to entering into any agreement or contract to make such investment or acquisition.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 11 - Salaries, Compensation or Emoluments

Section 11. No medical service corporation shall pay any salary, compensation or emolument to any officer, trustee or director thereof, nor any salary, compensation or emolument amounting in any year to more than twenty thousand dollars to any person, unless such payment be first authorized by a vote of its board of directors; provided, however, that the amount of such salaries, compensation or emoluments may be adjusted by the corporation to exceed such amount to reflect any decrease or increase in the cost of living since January first, nineteen hundred and sixty-nine, as measured by the Consumer Price Index for Urban Wage Earners and Clerical Workers, United States City Average, published by the Bureau of Labor Statistics of the United States Department of Labor. No such corporation shall make any agreement with any of its officers, trustees or employees whereby it agrees that for any services rendered or to be rendered he shall receive any salary, compensation or emolument for a period of more than three years from the date of such agreement; provided, however, that the payment of an amount not in excess of twelve and one half per cent of such annual salary, compensation or emolument, or a larger percentage if approved by the commissioner, may be deferred beyond such period.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 12 - Submission of Disputes or Controversies to Board; Privacy of Patient Information

Section 12. Any dispute or controversy arising between a medical service corporation and any participating physician, participating chiropractor, or any other participating provider of health services licensed under the laws of the commonwealth, or any subscriber, or any person whose subscription certificate has been canceled or to whom such corporation has refused to issue such certificate may within thirty days after such dispute or controversy arises be submitted by any person aggrieved to a board serving in the division of insurance and consisting of the commissioner or a person designated by him, the chairman of the board of registration and discipline in medicine or any person designated by him, and the attorney general or a person designated by him, for its decision with respect thereto. All decisions and orders of the board or of the commissioner made under any provision of this chapter may be revised as justice and equity may require upon a petition in equity filed, within ten days after the promulgation of such decision or order in the superior court within and for the county of Suffolk by any party aggrieved by such decision or order. If the board fails to resolve a dispute or controversy not involving a medical service corporation's methods of compensating such participating physician or provider within one year, any such participating physician or other participating provider of health services and any such subscriber or person may commence an action against such medical service corporation with respect to such dispute or controversy by filing a complaint in the superior court for the county in which he resides, which action may be maintained as a class action, subject to the provisions of rule twenty-three of the Massachusetts rules of civil procedure and shall be assigned by the court for a speedy completion of the pleadings, pretrial discovery, and hearing on the merits.
Any dispute or controversy arising between a medical service corporation and any participating psychiatrist, psychologist or social worker licensed under the laws of the commonwealth, or any subscriber, which is submitted by any aggrieved person to a board established pursuant to the provisions of this section shall be heard by such board in such a manner as to protect the privacy of all patient information which is the subject of such dispute or controversy or which comes to the attention of the board in its review. In furtherance of the protection of such privacy a board may and is hereby authorized to exclude the public during its hearing and deliberation of such cases.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 13 - Grounds for Enjoining Transaction of Business; Receivers

Section 13. If the commissioner is satisfied, as to any medical service corporation, that (1) it has failed to comply with the provisions of its charter, or (2) it is being operated for profit, or (3) it is fraudulently conducted, or (4) its condition is such as to render its further transaction of business hazardous to the public or to its subscribers, or (5) its officers and agents have refused to submit to an examination under section nine, or (6) it has exceeded its powers, or (7) it has violated any provision of law, or (8) it has compromised, or is attempting to compromise, with its creditors on the ground that it is financially unable to pay its claims in full, or (9) it is insolvent, he may apply to the supreme judicial court for an injunction restraining it from further proceeding with its business.
If the right of any person or group of persons to become a participating physician, chiropractor, or nurse midwife, as defined in section one, is denied because of arbitrary or unfair discrimination, any such person or group of persons so aggrieved may apply to the supreme judicial court for an injunction restraining such corporation from further proceeding with its business.
The court may, after application by the commissioner or any person or group of persons aggrieved as aforesaid, forthwith issue a temporary injunction restraining the transaction of any business, and it may, after a full hearing, make the injunction permanent, and appoint one or more receivers to take possession of the books, papers, moneys and other assets of the corporation, settle its affairs, and distribute its funds to those entitled thereto, subject to such rules and orders as the court may prescribe.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 14 - Liability of Corporation; Exemption From Insurance Laws; Tax Exemption

Section 14. Every medical service corporation is hereby declared to be a charitable corporation. No such corporation shall be liable for injuries resulting from negligence or malpractice on the part of any participating physician, participating chiropractor or any other participating provider of health services under the laws of the commonwealth or of any of its employees, nor shall it be liable for the cost of medical services, chiropractic services or other health services under the laws of the commonwealth to which the subscriber or covered dependent may be entitled under the provisions of chapter 152. Every such corporation shall be exempt from all provisions of the insurance laws of the commonwealth, except as otherwise provided in this chapter. The property of every such corporation shall, except as hereinafter provided, be exempt from all state and local taxes.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 16 - Operators of Medical Service Plan

Section 16. It shall be unlawful for any person, firm, corporation or association, except a medical service corporation, to establish, maintain or operate a non-profit medical service plan; provided, however, that this chapter shall not render unlawful or affect any operation or activity of any company organized under the provisions of chapter one hundred and seventy-five, of any society or fraternal benefit society organized under the provisions of chapter one hundred and seventy-six or subject to any of the provisions thereof, of any non-profit hospital service or medical service corporation organized under the provisions of chapter one hundred and seventy-six A or one hundred and seventy-six C, or of any corporation organized or to be organized under chapter one hundred and eighty, the existence, purposes, activities and operations of which were lawful or would be lawful notwithstanding the provisions of this chapter.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 16a - Payroll Deductions of Governmental Employees

Section 16A. The pertinent provisions of section one hundred and thirty-eight A of chapter one hundred and seventy-five shall apply to deductions on pay-roll schedules from the salary of any state, county or municipal employee for the payment of the amount payable by such an employee under a subscription certificate issued to him as a subscriber by a medical service corporation.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 18 - Contracts for Administrative or Other Services; Loans and Investments

Section 18. Any medical service corporation may contract with any person for the purpose of providing administrative or other services relating to the providing of medical or other health services or reimbursement therefor. In addition, with the approval of the commissioner who shall consider the effect upon subscriber agreements and subscriber rates, a medical service corporation may, after being authorized by its board of directors, or by a committee thereof, charged with the duty of authorizing transactions under this section, make loans to, guarantee loans of and make investments in hospitals and providers of other health services for the purpose of improving efficiency, reducing costs, or increasing benefits in the delivery of health services to subscribers and others.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 19 - Payment of Sums Owed Subscriber's Estate

Section 19. A medical service corporation which, upon the death of a subscriber, owes the subscriber's estate an aggregate sum not exceeding two thousand dollars under any medical service agreement, may, at any time not less than sixty days after the subscriber's death, pay such sum to the husband, wife and next of kin of the subscriber and any such payment made in good faith shall fully discharge the corporation to the extent thereof; provided, however, that this section shall not apply if, prior to the time of such payment, the corporation has received a written claim under the subscriber's medical service agreement from any executor, administrator, or special administrator of the subscriber's estate.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 22 - Statement Provided to Individuals Provided With Creditable Coverage; Report

Section 22. Pursuant to section 8B of chapter 62C, any corporation subject to this chapter 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.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176b - Medical Service Corporations › Section 24 - Disclosure of Patient-Level Data and Contracted Prices of Individual Health Care Services by Carriers to Providers

Section 24. To the extent permissible under applicable state and federal privacy laws, every medical service corporation shall disclose patient-level data to providers in their network solely for the purpose of carrying out treatment, coordinating care among providers and managing the care of their own patient panel; provided, that an individual provider shall only receive patient-level data related to patients treated by said provider. Patient-level data shall include, but not be limited to, health care service utilization, medical expenses, and demographics.
The division of insurance shall develop procedures and a standard format for disclosing such patient-level information. The division may require every medical service corporation to disclose such information through the all-payer claims database established under section 12 of chapter 12C if the division and the center for health information and analysis determine that the all-payer claims database is an efficient means to provide such information.
Medical service corporations shall make available to any provider with whom they have entered into an alternative payment contract, the contracted prices of individual health care services within such payer's network for the purpose of referrals.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176c - Non-Profit Medical Service Plans › Section 1 - Definitions

Section 1. In this chapter the following words and phrases shall have the following meanings:
''Medical service plan'', any plan or arrangement whereby members of the public pay regular subscription amounts and are entitled in return therefor to medical services.
''Medical service corporation'', any non-profit corporation which receives subscription payments from subscribing members and in return therefor makes available to subscribing members the benefits of any agreements which the corporation has with a medical organization for the rendering of care to its members.
''Medical organization'', any medical society or partnership of physicians whose members are members of the Massachusetts Medical Society or other recognized association of physicians, or whose members are members of the staff of any hospital approved by the American College of Surgeons, and which agrees to provide medical services to the subscribing members of a medical service plan.
''Associated physician'', any physician duly licensed to practice medicine in the commonwealth who complies with the qualifications, rules and regulations of a medical organization approved by the department of public health or any chiropractor registered under the provisions of chapter one hundred and twelve and who agrees in writing with the medical organization to perform any of the medical services specified in the form of subscribing members' agreement issued by a medical service corporation, and who agrees to accept compensation therefor in the manner hereinafter set forth.
''Recognized association of physicians'', an organized medical society or association, membership in which is contingent upon established professional qualifications and which is nationally recognized in the medical profession.
''Subscribing member'', any member of the public who is accepted as a subscribing member, with or without dependents, by a medical service corporation and who pays regular subscription dues to such corporation.
2023 Massachusetts General Laws › Part I - Administration of the Government › Title XXII - Corporations › Chapter 176c - Non-Profit Medical Service Plans › Section 2 - Application of Chapter; Exemption From Insurance Laws; Exemption From Practice of Medicine Provisions

Section 2. Any medical service plan, and any medical service corporation or medical organization operating in connection with a medical service plan, under the laws of the commonwealth, shall be governed by this chapter and shall, except as otherwise provided by this chapter, be exempt from all provisions of the insurance laws of the commonwealth. Any medical service corporation operating under this chapter shall not be deemed to be practicing medicine and shall be exempt from the provisions of chapter one hundred and twelve relating to the practice of medicine.