§ 12 — Negotiation of network contracts by unregistered provider or provider organization prohibited

Massachusetts § 12

• Jurisdiction: Massachusetts
• Part I: ADMINISTRATION OF THE GOVERNMENT
• Title II: EXECUTIVE AND ADMINISTRATIVE OFFICERS OF THE COMMONWEALTH
• Ch. 6D: HEALTH POLICY COMMISSION

Text

[ Subsection (a) effective until April 8, 2025. For text effective April 8, 2025, see below.]Section 12. (a) No provider or provider organization may negotiate network contracts with any carrier or third-party administrator except for a provider or provider organizations which are registered under this chapter and regulations promulgated under this chapter; provided, however, that nothing in this chapter shall require a provider or provider organization with a patient panel of 15,000 or fewer or which represents providers who collectively receive, less than $25,000,000 in annual net patient service revenue from carriers or third-party administrators to be registered if such provider or provider is not a risk-bearing provider organization.[ Subsection (a) as amended by 2024, 343, Sec. 23 effective April 8, 2025. For text effective until April 8, 2025, see above.](a) No provider or provider organization may negotiate network contracts with any carrier or third-party administrator except for a provider or provider organizations which are registered under this chapter and regulations promulgated under this chapter; provided, however, that nothing in this chapter shall require a provider or provider organization with a patient panel of 15,000 or fewer or which represents providers who collectively receive, less than $25,000,000 in annual net patient service revenue from payers to be registered if such provider or provider is not a risk-bearing provider organization.(b) Nothing in this chapter shall require a carrier to negotiate a network contract with a registered provider organization or with a registered provider or provider organization for all providers that are part of, or represented by, a registered provider organization.