Code of Massachusetts Regulations › 243 CMR - BOARD OF REGISTRATION IN MEDICINE › Title 243 CMR 3.00 - The Establishment Of And Participation In Qualified Patient Care Assessment Programs, Pursuant To M.G.L. c. 112, Section 5, and M.G.L. c. 111, Section 203 › Section 3.12 - Qualified Patient Care Assessment Program - Health Maintenance Organizations

Current through Register 1525, July 5, 2024
Notwithstanding any other provisions in
				243 CMR
				3.05 through
				3.08,
				a licensee may accept employment, practice, association for the purpose of
				providing patient care, or privileges at a Health Maintenance Organization
				(HMO), within the meaning of M.G.L. 176G, § 1, if the HMO has a Qualified
				Patient Care Assessment Program which meets or exceeds the criteria set forth
				below. The Board will consider such a Qualified Patient Care Assessment Program
				a
Risk Management Program
within the meaning of M.G.L.
				c. 112, § 5, requiring physicians to participate in risk management
				programs as a condition of licensure. In addition, a
Staff
				Model
HMO is not exempt from the requirements of
				243
				CMR 3.08.
(1)
Credentialing
.
			 An HMO shall not appoint or hire, contract with, contract with any entity to
			 obtain the services of, associate with for the purposes of providing patient
			 care, or grant privileges to a licensee, unless the HMO first performs the
			 following evaluation of the licensee.
(a) The
			 following provisions apply with respect to a licensee who has been or within 90
			 days will be credentialed or re-credentialed pursuant to
			 243 CMR
			 3.05 by a licensed or state hospital within
			 Massachusetts.
1. Prior to the date on which
			 a licensee commences to practice medicine on behalf of an HMO:
a. In the case of a staff-model HMO, the HMO
			 shall request and the licensee shall provide to the HMO a copy of his or her
			 most recent application for an initial or renewal license issued by the
			 Board.
b. In the case of a
			 staff-model or a non-staff-model HMO, the HMO shall request and the
			 Massachusetts hospital where the licensee spends the greatest proportion of his
			 or her time (the "primary hospital") shall provide to the HMO written
			 confirmation that the licensee has been credentialed by the primary hospital
			 pursuant to
			 243 CMR
			 3.05. The written confirmation shall be
			 provided to the HMO within 30 days after the later of: receipt of the HMO's
			 request or, subject to
			 243 CMR
			 3.13(1)(a), the date on
			 which the licensee is credentialed or re-credentialed pursuant to
			 243 CMR
			 3.05 by the primary hospital. The written
			 confirmation shall describe each of the following known to the primary
			 hospital:
i. pending or closed healthcare
			 facility or public agency disciplinary actions against the licensee;
ii. alterations in privileges resulting,
			 directly or indirectly, from concerns about the licensee's professional
			 performance, judgment or clinical skills; and
iii. any other concerns relating to the
			 licensee's professional performance, judgment, clinical skills, or mental or
			 physical status, and any impairment of the licensee related to chemical
			 dependency.
c. The
			 licensee shall provide to the HMO a release and waiver to allow the HMO access
			 to any information in which the licensee has an interest that may be requested
			 by the HMO pursuant to 243 CMR 3.12(1)(a)3.