Code of Massachusetts Regulations › 801 CMR - EXECUTIVE OFFICE FOR ADMINISTRATION AND FINANCE › Title 801 CMR 52.00 - Municipal Health Insurance › Section 52.06 - Health Insurance Review Panel Review Process

Current through Register 1525, July 5, 2024
(1) At any time before the panel has made
			 decisions in accordance with 801 CMR 52.06, the parties may agree in writing,
			 with copies to the panel and the Secretary, to terminate or suspend the review
			 process for a stated period of time because they have reached an agreement,
			 would like additional time to negotiate an agreement under
			 801 CMR
			 52.04, have mutually decided to return to
			 collective bargaining pursuant to M.G.L. c. 150E or have mutually decided to
			 resume negotiations under M.G.L. c. 32B, § 19.
(2) If both parties have not mutually agreed
			 to terminate the review process, within two business days after receipt of
			 notice of submission to the panel, the impartial member of the review panel
			 shall fix a time, date, and place for the panel to convene and shall give
			 notice to the parties.
(3)
Meetings of the Panel Shall be Conducted Under the Open Meeting
			 Law
. The impartial member shall serve as chair of the panel and
			 shall arrange for suitable records to be kept. The impartial member shall
			 ensure that each member receives advance notice of the time, place and agenda
			 for each meeting. All decisions shall be by recorded vote.
(4) The panel has ten days to complete its
			 required task once the panel members receive the appropriate public authority's
			 original proposal. When the panel convenes on the date and time set by the
			 impartial panel member, the panel shall do the following:
(a) Review the public authority's proposed
			 changes.
1. Within ten calendar days of
			 receiving proposed changes under M.G.L. c. 32B, §§ 22 or 23, the
			 panel shall determine whether the proposed increased dollar amounts for
			 co-payments, deductibles, and other cost-sharing plan design features for the
			 non-Medicare plan under M.G.L. c. 32B, § 22 exceed the dollar amounts of
			 the plan design features for the same or most similar benefits offered by the
			 commission for the non-Medicare plan under M.G.L. c. 32A, § 4 with the
			 largest subscriber enrollment. If such increased amounts do not exceed the
			 dollar amounts of the plan design features for the same or most similar
			 benefits offered by the commission for the non-Medicare plan under M.G.L. c.
			 32A, § 4 with the largest subscriber enrollment, the panel shall approve
			 the appropriate public authority's immediate implementation of the proposed
			 changes under M.G.L. c. 32b, § 22, subject to
			 801
			 CMR 52.07. Where the political subdivision is
			 not proposing a tiered provider network, the determination shall be made by
			 comparing the savings that would result if the dollar amounts of the co-pays,
			 deductibles and other cost-sharing plan design features in the political
			 subdivision's plan equaled the dollar amounts of the co-pays, deductibles and
			 other cost-sharing plan design features under tier 2 of the commission's
			 most-subscribed plan. Where the political subdivision currently is proposing a
			 tiered provider network that is tiered differently from the tiering in the
			 commission's most-subscribed plan, the determination shall be made by assuming
			 the co-pays, deductibles and cost-sharing plan design features in each tier of
			 the political subdivision's plan are equal to those in the same tier of the
			 commission's most-subscribed plan, beginning with a comparison of the highest
			 tier. If the political subdivision's plan has fewer tiers than the commission's
			 plan, the political subdivision's highest tier shall be compared to the
			 commission's tier 3, and the second highest tier to the commission's tier
			 3.
2. Within ten calendar days of
			 receiving proposed changes under M.G.L. c. 32B, §§ 22 or 23, the
			 panel shall determine whether the proposed increased dollar amounts for
			 co-payments and deductibles proposed for a Medicare-extension plan under M.G.L.
			 c. 32B, § 22 exceed the dollar amounts of the plan design features for the
			 same or most similar benefits offered by the commission for the
			 Medicare-extension plan under M.G.L. c. 32A, §§ 10C and 14 with the
			 largest subscriber enrollment. If such increased amounts do not exceed the
			 dollar amounts of the plan design features for the same or most similar
			 benefits offered by the commission for the Medicare-extension plan under M.G.L.
			 c. 32A, § 4 with the largest subscriber enrollment, the panel shall
			 approve the appropriate public authority's immediate implementation of the
			 proposed changes under M.G.L. c. 32B, § 22, subject to
			 801
			 CMR 52.07.
3. Where the political subdivision is not
			 proposing a tiered provider network, the determination shall be made by
			 comparing the savings that would result if the dollar amounts of the co-pays,
			 deductibles and other cost-sharing plan design features in the political
			 subdivision's plan equaled the dollar amounts of the co-pays, deductibles and
			 other cost-sharing plan design features under tier 2 of the commission's
			 most-subscribed plan. Where the political subdivision currently is proposing a
			 tiered provider network that is tiered differently from the tiering in the
			 commission's most-subscribed plan, the determination shall be made by assuming
			 the co-pays, deductibles and cost-sharing plan design features in each tier of
			 the political subdivision's plan are equal to those in the same tier of the
			 commission's most-subscribed plan, beginning with a comparison of the highest
			 tier. If the political subdivision's plan has fewer tiers than the commission's
			 plan, the political subdivision's highest tier shall be compared to the
			 commission's tier 3, and the second highest tier to the commission's tier
			 2.
4. If the panel does not approve
			 implementation because the appropriate public authority's proposal fails to
			 meet the criteria detailed in 801 CMR 52.06(4)(a)1. and 2., the appropriate
			 public authority may submit a new proposal to the public employee committee and
			 restart the process from that point pursuant to
			 801 CMR
			 52.03.