Code of Massachusetts Regulations 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY
114 CMR — Division of Health Care Finance and Policy
Overview
114 CMR contains regulations established by the Massachusetts Division of Health Care Finance and Policy (DHCFP), which is responsible for:
Monitoring health care costs in Massachusetts
Collecting and reporting health care data
Regulating health care facilities and insurers
Setting health care payment and reimbursement policies
Promoting transparency in health care pricing and quality
The regulations ensure that health care delivery is cost-effective, transparent, and accountable while protecting patients and the public.
Major Areas of 114 CMR
1. Administration
Establishes the authority and powers of the DHCFP.
Defines duties, organization, and staff responsibilities.
Rules for adopting, amending, and enforcing regulations.
2. Health Care Facilities and Insurers Reporting
Mandatory reporting requirements for hospitals, insurers, and providers.
Includes cost reports, utilization data, financial statements, and other operational metrics.
Ensures accuracy and completeness of health care data for analysis and policy decisions.
3. Health Care Cost Containment
Establishes programs and policies to control and monitor health care costs.
Sets limits or guidelines for rate setting for hospitals and insurers.
Provides methodology for evaluating the cost-effectiveness of health care services.
4. Price and Quality Transparency
Requires hospitals and insurers to report prices and charges for health care services.
Ensures the public and regulators can access comparative information on cost and quality.
Includes requirements for public disclosure of performance metrics.
5. Health Policy Planning
DHCFP evaluates health system trends and identifies areas for improvement.
Develops policies to increase access, efficiency, and quality in health care delivery.
Supports statewide initiatives like Medicaid, public health programs, and payment reform.
6. Public Hearings and Rulemaking
Provides procedures for stakeholder input on proposed regulations or rate adjustments.
Includes notice requirements, comment periods, and appeal processes.
Ensures regulatory decisions are transparent and accountable.
7. Enforcement and Compliance
DHCFP has authority to investigate non-compliance with reporting or cost control requirements.
Can issue orders, fines, or penalties for violations.
Includes procedures for appealing enforcement actions.
Purpose of 114 CMR
To collect accurate health care data and make it publicly available.
To monitor and regulate health care costs in the state.
To ensure fair and transparent practices in health care finance.
To support policy decisions that improve health care quality and access.
Summary of Key Points
DHCFP regulates costs, prices, and reporting for health care facilities and insurers.
Regulations cover administration, reporting, transparency, planning, and enforcement.
The goal is to control health care costs while maintaining quality and access.
Applies to hospitals, insurers, providers, and related entities in Massachusetts.
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