reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 2.000 - Massachusetts Refugee Resettlement Program › Section 2.805 - Conciliation

Current through Register 1525, July 5, 2024
(1)
Finding of Noncompliance
. Before a case manager issues a finding of noncompliance, he or she shall consult with the Case Management supervisor. If the supervisor agrees with a finding of noncompliance, the Case Management Provider shall initiate a conciliation period during which every effort shall be made to bring about a resolution of any disputes concerning participation.
(2)
Notice of Conciliation
. The Case Management Provider shall within one working day of the supervisor's concurrence with the finding of noncompliance, send the participant a notice of its finding and of its initiation of the conciliation period, and schedule an appointment for a meeting between the participant and the case manager.
The written notice shall include an explanation of the reason(s) for the finding of noncompliance, the consequences of failure or refusal to cooperate, a description of the conciliation process, the right to have a representative present, the right to have supervisory staff present, the timelines for action, the consequences of continued noncompliance, and the applicant's or participant's right to appeal an adverse finding. The conciliation period shall last a maximum of ten business days following the date of the Notice.
(3)
Conciliation Meeting
. The conciliation meeting shall be informal. The participant shall be given every opportunity to clarify his or her actions or inactions, including the opportunity to establish good cause even if this was previously rejected. The Case Management Provider shall explain the steps necessary to come into compliance and the consequences of failing to and shall address as many of the participant's concerns as possible. Every effort shall be made to resolve the matter at this meeting in a manner that will eliminate the need for further action.
(4)
Successful Conciliation
. The conciliation shall be considered successful if:
(a) after conciliation, the Case Management Provider, based upon additional or corrected facts received during the conciliation process, withdraws the finding of noncompliance; or
(b) during conciliation, the participant agrees, by signing the Conciliation Agreement, to cure the noncompliance and agrees to any revisions in the Family Self-sufficiency Plan that reflect the steps necessary to come into compliance.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 2.000 - Massachusetts Refugee Resettlement Program › Section 2.810 - Sanctions

Current through Register 1525, July 5, 2024
(1) If after the conciliation is completed, the Case Management Provider finds the participant(s) in noncompliance, it shall send a timely notice as follows:
(a) If the noncompliance is for failure to meet the requirements for participation in the Family Self-sufficiency Plan, in the case of a nonexempt participant, the notice shall terminate his or her portion of Refugee Cash Assistance and other services and benefits under the MRRP for a period of at least one month.
(b) If a nonexempt participant is in noncompliance for the first time for terminating employment or refusing an appropriate offer of employment without good cause, the notice shall terminate his or her portion of Refugee Cash Assistance and other services and benefits under MRRP for the participant for a period of at least one month. For a second noncompliance by the same participant for this reason, the notice shall terminate eligibility for the participant for Refugee Cash Assistance and other services and benefits under MRRP for at least two months.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 2.000 - Massachusetts Refugee Resettlement Program › Section 2.815 - Written Procedures

Current through Register 1525, July 5, 2024
Case Management Providers shall have for distribution to every participant, procedures written in English and in the participant's language which explain participation requirements, good cause, the procedures and sanctions for noncompliance, and outline the appeal process. Any notices not in a refugee's language shall contain a Provider statement confirming that the refugee received assistance translating program notices or letters.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.050 - Overview of Auxiliary Activities

Current through Register 1525, July 5, 2024
121 CMR 3.000 describes activities that affect the delivery of benefits and are required to ensure the proper and accurate direction of funds under the Massachusetts Refugee Resettlement Program (MRRP). Auxiliary activities include:
(a) Complaints and Inquiries, 121 CMR 3.100 through 3.150;
(b) Overpayments, Underpayments, Corrections and Recovery, 121 CMR 3.200 through 3.240;
(c) Prevention of False or Erroneous Representation, 121 CMR 3.300;
(d) Lost and Stolen Checks, 121 CMR 3.400 through 3.420; and
(e) Quality Control, 121 CMR 3.500.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.100 - Complaints

Current through Register 1525, July 5, 2024
(1) A complaint is an oral or written communication expressing dissatisfaction with or inquiring about the policies and procedures of MRRP or the practices of the Office for Refugees and Immigrants (ORI) or a Case Management Provider in administering it. Complaints may be made by persons, institutions, or other agencies. A complaint may be oral or in writing.
(2) Case Management Providers shall have written complaint procedures which at minimum shall:
(a) Be given to anyone who requests them;
(b) Provide that a complainant who is dissatisfied with a lower level staff response shall receive a response from the director of the agency; and
(c) Provide that if the complainant is dissatisfied with the Case Management Provider's response and requests further review, the complaint will be forwarded to ORI for response.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.150 - Inquiries

Current through Register 1525, July 5, 2024
(1)
General Inquiries.
The Case Management Provider and Employment Services Provider shall respond promptly to general inquiries related to the MRRP.
(2)
Case Inquiries.
The Case Management Provider and Employment Services Provider shall respond to case specific inquiries subject to the confidentiality requirements of M.G.L. c. 66A and 45 CFR 400.27.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.200 - Overpayments and Underpayments

Current through Register 1525, July 5, 2024
(1) An overpayment to an assistance unit is a payment for which the assistance unit is ineligible or a payment that exceeds the amount for which the assistance unit is eligible. An overpayment may result from ORI error; Case Management Provider error; participant error, misrepresentation or withholding of information, including failure to report changes affecting eligibility or grant amount within five working days of the change(s); or payment of assistance pending implementation of a fair hearing decision in which a proposed action is upheld.
(2) An underpayment is a payment to an assistance unit which is less than the amount for which the assistance unit was eligible or a failure to issue a payment due to an eligible assistance unit.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.210 - Correction of Overpayments and Underpayments

Current through Register 1525, July 5, 2024
(1)
Identification and Correction
. The Case Management Provider has the responsibility to identify and to correct overpayments and underpayments of cash assistance. If both an underpayment and an overpayment exist, the Case Management Provider may offset one against the other before correcting the payment if the existence and amount of both the underpayment and the overpayment can be promptly determined. Otherwise, the Case Management Provider shall proceed to correct the underpayment and overpayment independently.
(2)
Underpayments
. Upon notification by a Case Management Provider, ORI shall promptly correct underpayments. The Case Management Provider shall explain in writing to the participant the amount and cause of the underpayment and advise the participant of the right to request a fair hearing if he or she disputes the amount.
Retroactive corrections of underpayments are not income for purposes of determining eligibility and amount of assistance.
A refugee may request the correction of an underpayment, appeal the denial or failure to act on such request and appeal the amount determined to have been underpaid.
(3)
Overpayments
. All overpayments are subject to recovery. The Case Management Provider shall give the participant an opportunity for a conference in which the Case Management Provider shall give the reason(s) for the overpayment, describe the factual basis for the existence and amount of the overpayment, and explain, when appropriate, the methods of repayment available to the participant. The participant may furnish information concerning the amount of the overpayment.
The Case Management Provider shall give the participant timely notice ( 121 CMR 2.660:
Notice
), unless waived in writing by the refugee, before acting to recoup an overpayment.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.220 - Recovery from Current Participants

Current through Register 1525, July 5, 2024
(1)
Method of Recovery
.
(a) The Case Management Provider shall seek recovery of an overpayment from current and previous MRRP participants.
(b) The methods of recovery shall be by:
1. recoupment, which is the recovery of an overpayment by means of a reduction in the assistance unit's grant;
2. a lump sum payment;
3. installment payments; or
4. a combination of the three.
(c) If a participant refuses to pay or fails to comply with an agreement to repay through a lump sum payment or installment payments or a combination of methods, he or she shall be required to repay the remaining overpayment by recoupment.
(d) The Case Management Provider shall recover overpayments only from the assistance unit that was overpaid.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.230 - Recovery from Previous Participants

Current through Register 1525, July 5, 2024
Recovery shall continue after cash assistance terminates unless ORI determines it is no longer cost-effective. When cash assistance terminates while an overpayment is still due, or when an overpayment is discovered after the cash assistance terminates, the Case Management Provider shall attempt to arrive at an agreement with the refugee for repayment through installments or lump sum or combination of the two. If the Case Management Provider and refugee are unable to reach an agreement, or if they reach an agreement and the refugee fails to adhere to it, the overpayment shall be referred to ORI which may pursue it further, including taking legal action if appropriate.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.240 - Intentional Withholding of Information or Misrepresentation

Current through Register 1525, July 5, 2024
When the Case Management Provider has reason to believe that an overpayment was the direct result of a participant's intentional deception, it shall refer the matter to ORI for referral to the Bureau of Special Investigations.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.300 - Prevention of False or Erroneous Representation

Current through Register 1525, July 5, 2024
The Case Management Provider shall periodically inform participants of their responsibility for prompt and complete reporting of changes that may affect their eligibility and the amount of their assistance grant.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.400 - Lost and Stolen Checks

Current through Register 1525, July 5, 2024
(1) When a participant reports that a check is lost or has not been received, the Case Management Provider shall determine the address to which the check was mailed and whether the check has been returned to ORI. If the participant has reason to believe that the check has been stolen, he or she must report the theft to the police.
(2) If a check has not been returned to ORI and four days (including the check date) have elapsed, the participant may request a replacement check by signing a check replacement request form prescribed by ORI. If he or she does so, he or she must be advised of the need to return the original check if it is received at a later date.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.410 - Authorization of a Replacement Check

Current through Register 1525, July 5, 2024
Unless the Case Management Provider has reason to doubt the validity of the claim, the Case Management Provider must approve a request for a replacement check when:
(a) The original check is reported lost or stolen and four days (including the check date) have elapsed; or
(b) The original check has been returned to the Case Management Provider or ORI and the participant has corrected the circumstances that made the check undeliverable.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.420 - Issuance of a Replacement Check

Current through Register 1525, July 5, 2024
Before issuing a replacement check, ORI shall:
(a) Request a stop payment order on the original check if the original check has not been cashed; or
(b) If the original check has been cashed, require that the participant sign a form prescribed by ORI stating that the endorsement is not his or hers.
Code of Massachusetts Regulations › 121 CMR - OFFICE FOR REFUGEES AND IMMIGRANTS › Title 121 CMR 3.000 - Auxiliary Activities › Section 3.500 - Quality Control

Current through Register 1525, July 5, 2024
(1) Quality Control is a system of review designed to measure the accuracy of decisions on eligibility and the amount of assistance for MRRP. ORI or its designee shall administer the review system.
(2) When an assistance unit is selected for review, the participant(s) is required to cooperate with the ORI Quality Control review process as a condition of continued eligibility. Cooperation includes, but is not limited to, a personal interview with the Quality Control reviewer and the furnishing of information necessary to determine eligibility and the amount of assistance.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.01 - Purpose

Current through Register 1525, July 5, 2024
The purpose of 122 CMR 1.00
et seq.
is to establish standardized policy and procedures for the Soldiers' Home in Massachusetts (CSH) and CSH funded programs regarding the review of criminal records of candidates under consideration for employment or regular volunteer or training positions. The Criminal History Systems Board (CHSB) has authorized Executive Office of Health and Human Services (EOHHS) agencies and their vendor agencies to receive criminal record information regarding present or prospective employees in any program funded or operated by such agencies.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.02 - Policy

Current through Register 1525, July 5, 2024
In order to ensure that employees or other persons regularly providing services or support services in any program or facility of the Soldiers' Home in Massachusetts or in vendor agency programs funded by CSH are appropriate for serving in their positions with potential for unsupervised contact, a Criminal Offender Record Information (CORI) check shall be performed on all candidates for positions or facilities as provided in 122 CMR 1.00. It is the policy of EOHHS and the Soldiers' Home in Massachusetts that convictions of certain crimes may pose an unacceptable risk to the vulnerable populations served by the Soldiers' Home in Massachusetts and its vendor agencies. 122 CMR 1.00 sets forth minimum standards.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.03 - Scope

Current through Register 1525, July 5, 2024
122 CMR 1.00 applies to candidates for positions which entail potential unsupervised contact in CHS funded or operated programs that provide people with CHS services, including volunteers and trainees. At the discretion of the hiring authority, the scope of 122 CMR 1.00 may be expanded to include residents, interns, students or other persons regularly offering support to any program or facility in either a paid or unpaid capacity whose services do not entail the potential for unsupervised client contact, upon appropriate certification by the CHSB.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.06 - Candidate Disclosure of Criminal Record Information

Current through Register 1525, July 5, 2024
All candidates for a position with CSH or a vendor agency program shall complete an application form that contains a section requiring the candidate to disclose whether or not he/she has a criminal record and what crimes, if any, he or she has been convicted of, consistent with M.G.L. c. 151B, § 4, para 9. The application shall not require a candidate to disclose:
(a) an arrest, detention, or disposition regarding any violation of law in which no conviction resulted; or
(b) a first conviction for any of the following misdemeanors: drunkenness, simple assault, speeding, minor traffic violations, affray, or disturbance of the peace; or
(c) any conviction of a misdemeanor where the date of such conviction or the completion of any period of incarceration resulting therefrom, whichever date is later, occurred five or more years prior to the date of such application for employment or such request for information, unless such person has been convicted of any offense within five years immediately preceding the date of such application for employment or such request for information. No application for employment shall be considered complete unless the candidate completes 122 CMR 1.06.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.07 - Community Service and Work Release Workers

Current through Register 1525, July 5, 2024
CSH or any vendor agency that participates in either a criminal justice related community service program or a work release program shall require all individuals who participate to disclose his/her criminal record in conformance with 122 CMR 1.06. In addition, as a condition of participation, the candidate's criminal justice official must conclude in writing that the individual will not pose an unacceptable risk of harm to CHS clients or will be supervised at all times.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.08 - Hiring Authority Responsibilities

Current through Register 1525, July 5, 2024
(1) The hiring authority shall ensure that each candidate provides consent to a CORI investigation as part of his/her application, and to the periodic conduct of further CORI investigations during the course of employment with CHS or the vendor agency program. The hiring authority shall also inform the candidate that his or her CORI may be utilized by the criminal justice official or qualified mental health professional conducting themselves in conformance with 122 CMR 1.07, 1.11(1), (2) (3) and CHS personnel responsible for carrying out the provisions of 122 CMR 1.15 and 1.16. Such consent and notification shall be included in the hiring authority's employment application form.
(2) The hiring authority shall require, as a condition of an offer of employment, the completion of the CORI investigation. The hiring authority shall confirm an offer of employment only after the hiring authority receives written confirmation that the criminal record investigation has resulted in a finding of "no record" or until the hiring authority has complied with the requirements of 122 CMR 1.09, 1.11 and 1.12.
(3) The hiring authority shall not permit any candidate to commence employment or volunteer service until after the candidate is cleared as a result of the CORI investigation in accordance with 122 CMR 1.00.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.09 - CORI Investigations

Current through Register 1525, July 5, 2024
(1) All candidates shall complete a CORI Supplement form.
(2) After the hiring authority makes a preliminary decision to hire or accept the services of an individual, the completed CORI Supplement (authorization) form or electronic equivalent shall be sent to the CHSB EOHHS CORI Unit.
(3) All CORI investigations that result in a finding of "no record" shall be transmitted back to the hiring authority and shall be sufficient evidence of suitability for hire for 45 business days. A "no record" finding may be valid for consideration for other positions during such 45 days.
(4) All CORI investigations that show findings of criminal records shall be sent immediately to the hiring authority for review and action consistent with 122 CMR.
(5) All hiring authorities shall develop procedures which will ensure that EOHHS can audit compliance with 122 CMR 1.00 pursuant to 122 CMR 1.15.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.10 - Findings from CORI Investigations

Current through Register 1525, July 5, 2024
(1) If the CORI investigation reveals a finding of "no record," such finding shall be documented in the candidate's file.
(2) If the CORI investigation reveals a "lifetime presumptive disqualification" on the candidate's record, the candidate shall be informed by the hiring authority that he or she is ineligible for any position which has the potential for unsupervised contact with persons receiving services in an CHS funded or operated program, unless the provisions of 122 CMR 1.11 and 1.12 are complied with.
(3) If the CORI investigation reveals a "ten year presumptive disqualification" on the candidate's record, the candidate shall be informed by the hiring authority that he or she is ineligible for any position which has the potential for unsupervised contact with persons receiving services in an CHS funded or operated program, unless the provisions of 122 CMR 1.11 and 1.12 are complied with.
(4) If the CORI investigation reveals a "five year presumptive disqualification" on the candidate's record, the candidate shall be informed by the hiring authority that he or she is ineligible for any position which has the potential for unsupervised contact with persons receiving services in an CHS funded or operated program, unless the provisions of 122 CMR 1.11 and 1.12 are complied with.
(5) If the CORI investigation reveals a "discretionary disqualification" on the candidate's record, the candidate shall be informed by the hiring authority that he or she is ineligible for any position which has the potential for unsupervised contact with persons receiving services in an CHS funded or operated program, unless the provisions of 122 CMR 1.11 and 1.12 are complied with.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.11 - Disqualifications

Current through Register 1525, July 5, 2024
(1)
Lifetime Presumptive Disqualification
. A candidate shall be ineligible for a position in a CHS funded or operated program which entails potential unsupervised contact with persons receiving services if he or she has been convicted of any of the crimes listed in 122 CMR 1.18:
Table A,
has any pending charges involving crimes listed in 122 CMR 1.18:
Table A,
or has any outstanding warrants unless:
(a)
1. the candidate's criminal justice official concludes in writing that the candidate, within the position sought in a CHS or the vendor agency program, does not pose an unacceptable risk of harm to the persons served by the program; or
2. if the candidate's criminal justice official has been determined by the hiring authority to be unavailable or has indicated to the hiring authority that she has insufficient information to render an assessment, then the hiring authority may seek an assessment (the cost of which shall be borne by the hiring authority) of the candidate's risk of harm from a qualified mental health professional and the qualified mental health professional concludes in writing that the candidate, within the position sought in an CHS funded or operated program, does not pose an unacceptable risk of harm to the persons served by the program; and
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.12 - Provisions for Review of a Candidate in any Discretionary Disqualification Category

Current through Register 1525, July 5, 2024
(1) Every candidate for whom the CORI investigation reveals a "lifetime presumptive disqualification", a "ten year presumptive disqualification," a "five year presumptive disqualification," or a "discretionary disqualification", and who has otherwise met the requirements for further consideration, if any, of 122 CM 1.11, shall receive additional review by the hiring authority to determine if the candidate poses an unacceptable risk of harm to the persons served by the program within the position sought. In reviewing the candidate's appropriateness for employment given the concern for client safety, due weight shall be given to the following factors:
(a) Age of the conviction;
(b) Age of the candidate at the time of the offense;
(c) Seriousness and specific circumstances of the offense;
(d) Relationship of the criminal act to the nature of the work to be performed;
(e) The number of offenses;
(f) Any relevant evidence of rehabilitation or lack thereof;
(g) Any other relevant information, including information submitted by the candidate; the hiring authority shall inform the candidate of the opportunity to submit other relevant information.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.13 - Exemption from Certain Requirements

Current through Register 1525, July 5, 2024
CHS may grant a funded or operated program an exemption from the requirements of 122 CMR 1.11(2)(a) and (3)(a)  upon a determination by CHS that an exemption is warranted following consideration of the following criteria:
(1) the service needs and level of vulnerability of the clients served by the program;
(2) the potential benefits and risks to those clients as a result of the exemption;
(3) the hiring authority's capacity to perform the review required by 122 CMR 1.12.
Whenever CHS grants an exemption, it shall document, in writing, the basis for determining that the exemption is warranted, including providing its assessment of the level of vulnerability of the clients served by the program. No program shall be eligible for an exemption pursuant to 122 CMR 1.13 if it serves clients 16 years of age or younger or if it serves a population that is primarily 65 years of age or older:
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.14 - Dissemination

Current through Register 1525, July 5, 2024
CORI records may be disseminated only to individuals certified by the CHSB to receive such information, such as the hiring authority or CORI Coordinator. The Hiring Authority shall maintain a listing of persons so certified. Willful dissemination of Criminal Offender Record Information to unauthorized individuals is punishable by a jail sentence of up to one year and/or a fine of $5,000 in addition to civil penalties, pursuant to M.G.L. c. 6, § 178.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.15 - Agency Audits

Current through Register 1525, July 5, 2024
EOHHS shall periodically review statistical information on all CORI requests and investigations maintained by each hiring authority in accordance with EOHHS policy and procedures. In addition, EOHHS may establish further requirements for checking CORI findings and the interpretation of such findings by the hiring authority.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.16 - Incidents

Current through Register 1525, July 5, 2024
Any hiring authority who receives an allegation that a CHS or vendor agency employee with a positive CORI history has harmed an CHS client shall immediately report the allegation to the General Counsel of EOHHS. Notification shall include documentation of the hiring decision of the hiring authority.
Code of Massachusetts Regulations › 122 CMR - SOLDIERS' HOME IN MASSACHUSETTS (CSH) › Title 122 CMR 1.00 - Criminal Offender Record Checks › Section 1.17 - Severability

Current through Register 1525, July 5, 2024
If any provisions of 122 CMR 1.01 through 1.18, or the applications of such provisions to any person or circumstance are held invalid or unconstitutional, the other provisions of said 122 CMR 1.01 through 1.18, or the application of such provisions to any person or circumstance other than that as to which it is held invalid or unconstitutional, shall not be affected thereby.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.01 - Authority

Current through Register 1525, July 5, 2024
129 CMR 2.00 is promulgated in accordance with the authority granted to the Health Care Quality and Cost Council by M.G.L. c. 6A, § 16L.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.02 - Purpose and Scope

Current through Register 1525, July 5, 2024
129 CMR 2.02 contains the provisions for submission of health care claims data sets from third-party payers, third-party administrators, and carriers that provide only administrative services for a plan sponsor.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.05 - Reporting Requirements for All Licensed Carriers

Current through Register 1525, July 5, 2024
(1)
HEDIS Reporting Requirements
. Each carrier that collects data for use in calculating health plan employer data and information set managed care measures shall report those data that are collected and that pertain to Massachusetts resident members or subscribers who receive their benefits under a policy or plan issued in Massachusetts. The carrier shall use the NCQA tool for submission of HEDIS data.
(2)
CAHPS Reporting Requirements
. Each carrier that collects CAHPS survey data shall report those data collected that are collected and that pertain to Massachusetts resident members or subscribers who receive their benefits under a policy or plan issued in Massachusetts. The carrier shall use the NCQA format for submission of the CAHPS survey data.
(3)
Health Claims Dataset
. Each carrier shall submit to the Council, or its designee, a completed health care claims data set for all Massachusetts resident members who receive services under a policy issued in Massachusetts. Each carrier shall also submit all health care claims processed by any subcontractor on its behalf. The health care claims data set shall include a member eligibility file, a medical claims file, and a pharmacy claims file.
(4) Health care claims processors may submit all of the data submissions required of carriers under 129 CMR 2.00, in accordance with the specifications in 129 CMR 2.05(1) through (4), to the extent permitted by law and contractual requirements.
(5)
Exceptions to Reporting Requirements.
(a) Third party payers that write less than $250,000 in insured accident and health premiums in Massachusetts on an annual basis shall not be required to submit their health care claims data set, their HEDIS data, or their CAHPS survey data.
(b) Third party administrators that administer insured health insurance plans covering fewer than 200 Massachusetts lives in total shall not be required to submit their health claims data.
(c) Carriers shall not be required to submit claims for stand-alone insurance policies that cover only one or more of the types of services listed in 129 CMR 2.05(5)(c)1. through 8.; however claims for these types of services shall be included in the medical claims file submission if they are covered by a comprehensive medical insurance policy.
1. Specific Disease;
2. Accident;
3. Injury;
4. Hospital Indemnity;
5. Disability;
6. Long-term Care;
7. Vision Coverage; or
8. Durable Medical Equipment.
(d) In instances where more than one entity is involved in the administration of a policy, the health carrier shall be responsible for submitting the claims data on policies that it has written, and the third party administrator shall be responsible for submitting claims data on self-insured plans that it administers.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.06 - Protection of Confidentiality

Current through Register 1525, July 5, 2024
The Council shall institute appropriate administrative procedures and mechanisms to ensure that it is in compliance with the provisions of M.G.L. c. 66A, the Fair Information Practices Act, to the extent that the data collected thereunder are "personal data" within the meaning of that statute. In addition, the Council shall ensure that any contract entered into with other parties for the purposes of processing and analysis of data collected under 129 CMR 2.00 shall contain assurances such other parties shall also comply with the provisions of M.G.L. c. 66A.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.07 - Data Filing and Penalties

Current through Register 1525, July 5, 2024
(1)
Filing Periods
. The filing period for each claims data file listed shall be determined by the total number of covered lives who are Massachusetts residents for whom claims are being paid or processed by each carrier or health claims processor. For those carriers having 2,000 or more Massachusetts covered lives, data shall be submitted monthly. For those carriers or health care claims processors having fewer than 2,000 Massachusetts covered lives, data shall be submitted quarterly.
(2)
Testing of Files
. At least 30 days prior to the initial submission of the files, each carrier shall submit to the Council, or its designee, a data set for determining compliance with the standards for data submission. The size, based upon a calendar period of one month, or quarter of the data files submitted shall correspond to the filing period established for that carrier.
(3)
Rejection of Files
. Failure to conform to the requirements for submission shall result in the rejection and return of the applicable data file(s). All rejected and returned files shall be resubmitted in the appropriate, corrected form to the Council, or its designee, within ten days.
(4)
Replacement of Data Files
. No carrier shall replace a complete data file submission more than one year after the end of the month in which the file was submitted unless it can establish exceptional circumstances for the replacement. Any replacements after this period shall be approved by the Council. Individual adjustment records shall be submitted with a monthly data file submission.
(5)
Penalties
. If any carrier fails to submit required data to the council on a timely basis, or fails to correct submissions rejected because of excessive errors, the council or its designee shall provide written notice to the carrier or health care claims processor. Pursuant to M.G.L. c. 6A, § 16L(d), if the carrier or health care claims processor fails, without just cause, to provide the required information within two weeks following receipt of said written notice, the Council may require the carrier to pay a penalty of $1,000 for each week of delay; provided, however, that the maximum penalty under 129 CMR 2.07 shall be $50,000 per year. The Statistical Plan developed pursuant to 129 CMR 2.08 shall include the standards the Council or its designee will use to assess penalties for failure to submit required data, and shall define "just cause" for delays in providing required data.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.08 - Compliance with Data Standards

Current through Register 1525, July 5, 2024
(1)
Statistical Plan
. The Council shall approve and publish a Statistical Plan.
(a) The Statistical Plan shall include the methodology to be used by carriers to create unique member identification numbers.
(b) The Statistical Plan shall include the edit specifications that the Council or its designee will use to verify the accuracy of data submissions, as well as the standards that the Council or its designee will use to reject submissions because of excessive errors. The Statistical Plan will specify the format of an edit report displaying detail for all errors found in a submission, as well as a summary report containing certain aggregate data for review and verification. The Council or its designee shall provide these reports to each carrier.
(c) The Statistical Plan shall include a method for carriers to submit a limited number of late claims paid during a prior submission period. The Statistical Plan shall include rules for submitting denied claims. The Statistical Plan shall include rules for submitting claims for medical services that include pharmacy codes.
(d) The Statistical Plan shall list the HEDIS and CAHPS measures that carriers are required to report.
(e) The Council will establish compliance standards for submission of race, ethnicity and language data by Administrative Bulletin.
(f) Race, ethnicity and language data submitted by carriers shall be based on data self-reported by the member. Carriers may report race, ethnicity and language data acquired from a third party provided that:
1. such data is self-reported by members or guardians; and
2. the carrier submits a technical plan to the Council or its designee that specifies how the date was collected by the third party and obtained by the third party.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.10 - Registration and Transmission Requirements

Current through Register 1525, July 5, 2024
(1)
Registration Form.
(a) Each health care claims processor and each carrier shall submit a registration form to the Council, or its designee. The Council shall develop and publish the registration form, and may make changes from year to year. The form shall contain the information listed in 129 CMR 2.10(1)(a)1. through 6.:
1. Company name;
2. NAIC code;
3. Mailing address;
4. Information about whether the company conducts health insurance related business;
5. Number of Massachusetts members covered; and
6. Name, e-mail address and address of the person completing the form.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.11 - Health Care Claims Data Filing Format

Current through Register 1525, July 5, 2024
(1)
File Format
. Each data file submission shall be an ASCII file, variable field length, and asterisk delimited. When asterisks are used in any field values, they shall be enclosed in double quotes.
(2)
Header and Trailer Records
. Each member eligibility file and each medical claims file, and pharmacy claims file that is submitted shall contain a header record and a trailer record. The "Header record" means the first record of each separate file that is submitted and the "Trailer record" means the last record of each submitted file. The header and trailer record format shall conform to the record specifications in 129 CMR 2.11(2)(a):
(a)
Record Specifications
. Carriers shall use the record specifications in 129 CMR 2.11(2)(a) through (d) in submitting their claims records. The file header record layout shall be submitted using the data elements in 129 CMR 2.11(2)(a)1. through 8.:
1.
HD001
. This element is named "record type". The data type of this element is text. Its length is 2.
2.
HD002
. This element is named "payer". The data type of this element is text. Its length is 6. Carriers shall code according to payer submitting payments, Council submitter code.
3.
HD003
. This element is named "National Plan ID". The data type of this element is text. Its length is 30. Carriers shall code according to CMS National Plan ID.
4.
HD004
. This element is named "type of file". The data type of this element is text. Its length is 2. Carriers shall code according to ME member eligibility, MC medical claims, PC pharmacy claims.
5.
HD005
. This element is named "period beginning date". The data type of this element is integer. Its length is 6. Carriers shall code according to CCYYMM, beginning of paid period for claims , beginning of month covered for eligibility.
6.
HD006
. This element is named "period ending date". The data type of this element is integer. Its length is 6. Carriers shall code according to CCYYMM, end of paid period for claims, end of month covered for eligibility.
7.
HD007
. This element is named "record count". The data type of this element is integer. Its length is 10. Carriers shall code according to total number of records submitted in this file, with the header and trailer record excluded from the count.
8.
HD008
. This element is named "comments". The data type of this element is text. Its length is 80. Carriers shall code according to their own option.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 2.00 - Uniform Reporting System For Health Care Claims Data Sets › Section 2.13 - Administrative and Technical Bulletins and Severability

Current through Register 1525, July 5, 2024
(1)
Administrative and Technical Information Bulletins
The Council may revise the specifications or other administrative requirements from time to time by notice or administrative bulletin.
(2)
Severability
. The provisions of 129 CMR 2.00 are declared to be severable and if any such provisions or the application of such provisions to any carrier or circumstances are held invalid or unconstitutional, such invalidity or unconstitutionality shall not be construed to affect the validity or unconstitutionality of any of the remaining provisions of 129 CMR 2.00 or of such provisions to carriers or circumstances other than those as to which it is held invalid.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 3.00 - Disclosure Of Health Care Claims Data › Section 3.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Authority
. 129 CMR 3.00 is promulgated under the authority of and in conformity with M.G.L. c. 6A, §§16J, 16K and 16L.
(2)
Scope and Purpose
. 129 CMR 3.00 governs the disclosure of Health Care Claims Data submitted by carriers and third-party administrators to the Health Care Quality and Cost Council pursuant to 129 CMR 2.00. The purpose of 129 CMR 3.00 is to protect the privacy of data subjects and the confidentiality of health care claims data while permitting limited access to such data where such access serves the public interest. Pursuant to M.G.L. c. 6A, § 16K(f), all data collected by the Council is not a public record, and no public disclosure of any data shall be made except in accordance with M.G.L. c. 6A, § 16K and 129 CMR 3.00.
(3)
Effective Date
. 129 CMR 3.00 is effective on January 8, 2010.
Code of Massachusetts Regulations › 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL › Title 129 CMR 3.00 - Disclosure Of Health Care Claims Data › Section 3.02 - Definitions

Current through Register 1525, July 5, 2024
The following words shall have the following meanings:
Applicant
. An individual, group of individuals, or organization which formally requests the release of Health Care Claims Data in accordance with 129 CMR 3.03.
Board
. The Council's Data Release Review Board established pursuant to 129 CMR 3.03.
Carrier
. Any entity subject to the insurance laws and rules of Massachusetts, or subject to the jurisdiction of the commissioner of insurance that contracts or offers to provide, deliver, arrange for, pay for, or reimburse any of the costs of health services, and includes an insurance company, a health maintenance organization, a nonprofit hospital services corporation, a medical service corporation, third-party administrator or any other entity arranging for or providing insured health coverage.
CMS
. The federal Centers for Medicare and Medicaid Services.
Council
. The Health Care Quality and Cost Council established under M.G.L. c. 6A, § 16K.
Data Use Agreement
. A document detailing restrictions on the disclosure and use of Health Care Claims Data.
Disclosure
. The release, transfer, provision of, access to, or divulging in any other manner of information outside the entity holding the information.
Encryption
. The use of an algorithmic process to transform data into a form in which there is a low probability of assigning meaning without use of a confidential process or key.
Health Care Claims Data
. Information consisting of, or derived directly from, member eligibility information, medical claims, pharmacy claims, and all other data submitted by health care claims processors pursuant to 129 CMR 2.00.
Health Care Claims Processor
. A third-party payer, third-party administrator, or carrier that provides administrative services for a plan sponsor.
Provider
. A health care practitioner, health care facility, health care group, medical product vendor or pharmacy.
Public Use File
. A health care data set which contains a selected number of variables as specified in 129 CMR 3.03(1).
Third-party Administrator.
Any person or entity that, on behalf of a plan sponsor, health care services plan, nonprofit hospital or medical service organization, health maintenance organization or insurer, receives or collects charges, contributions or premiums for, or adjusts or settles claims on behalf of the residents of the state.
Third-party Payer
. A health insurer, nonprofit hospital or medical services organization, or managed care organization or any other entity licensed in the Commonwealth of Massachusetts that pays for health care services or products.