Code of Massachusetts Regulations 958 CMR - HEALTH POLICY COMMISSION
Here’s a comprehensive overview of 958 CMR — Health Policy Commission:
📘 What is 958 CMR?
958 CMR is the section of the Code of Massachusetts Regulations that encompasses regulations overseen by the Massachusetts Health Policy Commission (HPC). It covers twelve chapters (1.00–12.00) addressing various areas in healthcare oversight (mass.gov).
🔍 Summary of Key Chapters (1.00–12.00)
| Chapter | Focus Area | Notes |
|---|---|---|
| 2.00 | One-time assessment on qualifying hospitals and surcharge payors | Assesses financing obligations (mass.gov, casetext.com) |
| 3.00 | Health Insurance Consumer Protection | Governs internal/external grievance processes |
| 4.00 | Health Insurance Open Enrollment Waivers | Issued Dec 2015 |
| 5.00 | Administration of the Distressed Hospital Trust Fund | Established Oct 2013 |
| 6.00 | Registration of Provider Organizations | Criteria & process for HPC registration |
| 7.00 | Notices of Material Change & Cost‑Market Impact Reviews | Requires filings for mergers, acquisitions, alliances |
| 8.00 | ICU Nurse‑to‑Patient Assignment Limits | 1:1 or 1:2 ratios based on patient acuity |
| 9.00 | Ongoing assessments on healthcare providers and payors | Assessed annually after 2016 |
| 10.00 | Performance Improvement Plans | Guidance issued April 2017 |
| 11.00 | Appeals processes for risk‑bearing organizations | ACO certification and appeals (Sept 2018) |
| 12.00 | Drug Pricing Review | Final regulation from March 2020 |
🧾 Selected Chapter Summaries
958 CMR 3.00
Covers health insurance consumer protections, spelling out both internal grievance and external medical necessity review processes (law.cornell.edu).
958 CMR 7.00
Details Material Change Notices and Cost & Market Impact Reviews for provider organizations with ≥ $25 M in revenue. Includes timing (60-day notice), confidentiality, and benchmarks for price/market dominance (mass.gov).
958 CMR 8.00
Implements nurse-to-patient limits in ICUs (1:1 or 1:2), effective July 3, 2015, based on patient acuity tools certified by DPH (mass.gov).
🔗 Where to Access the Full Text
Trial Court Law Libraries (unofficial free version) (mass.gov)
Massachusetts Secretary’s Bookstore (official printed CMR, purchase required) (sec.state.ma.us)
Massachusetts Health Policy Commission site includes PDFs and guidance bulletins (masshpc.gov)
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