Amendment ID: S2519-76
Amendment 76
Credentialing
Mr. Tarr, Ms. Gobi, Messrs. Tran and O'Connor move that the proposed new draft be amended by striking section 31 and inserting in place thereof the following section:-
SECTION 31. Section 12 of said chapter 118E, as appearing in the 2018 Official Edition, is hereby amended by adding the following four paragraphs:-
The division, in consultation with the division of insurance, shall develop and implement a standard credentialing form substantially similar to the forms and process developed by the division of insurance for use by commercial plans for use by health care providers applying to participate in MassHealth. The division, all contracted entities, health maintenance organizations established under this section and any subcontracted entities shall accept the standard credentialing form as sufficient information necessary to conduct its credentialing process.
The division, in consultation with the division of insurance, shall establish uniform standards and methodologies for credentialing of health care providers. The standards shall include, but not be limited to, requirements that, for conducting a credentialing review of a health care provider, the division, all contracted entities, health maintenance organizations established under this section and any subcontracted entities shall: (i) use and accept only the credentialing forms designated by the commissioner; and (ii) review a submitted credentialing form for a health care provider and respond to the health care provider within 20 business days after receiving a completed credentialing request.
Nothing in this section shall prohibit the division, all contracted entities, health maintenance organizations established under this section and any subcontracted entities, from using a credentialing methodology that utilizes an internet webpage, internet webpage portal or similar electronic, internet and web-based system in lieu of a paper form; provided, however, that upon request, a carrier, or any entity that manages or administers benefits for a carrier, shall make a paper credentialing form available to a health care provider.
The division, all contracted entities, health maintenance organizations established under this section and any subcontracted entities, that contracts with another entity to perform some or all of the functions governed by this chapter shall be responsible for ensuring compliance by the contracted entity with this chapter. A failure by the contracted entity to meet the requirements of this chapter shall be the responsibility of the division to remedy and shall subject the carrier to enforcement actions, including financial penalties, authorized under this chapter.
And moves to further amend the bill by striking section 50 and inserting in place thereof the following section:-
SECTION 50. Said chapter 176O is hereby further amended by adding the following section:-
Section 29. (a) The bureau of managed care, in consultation with the division of medical assistance, shall develop and implement standard credentialing forms for health care providers. A carrier, or any entity that manages or administers benefits for a carrier, shall accept the standard credentialing form for contracting providers as sufficient information necessary to conduct its credentialing process.
(b) The bureau shall promulgate regulations establishing uniform standards and methodologies for credentialing of health care providers. The regulations shall include, but not be limited to, requirements that, for conducting a credentialing review of a health care provider, a carrier, or any entity that manages or administers benefits for a carrier, shall: (i) use and accept only the credentialing forms designated by the commissioner; and (ii) review a submitted credentialing form for a health care provider and respond to the health care provider within 20 business days after receiving a completed credentialing request.
Nothing in this section shall prohibit a carrier, or any entity that manages or administers benefits for a carrier, from using a credentialing methodology that utilizes an internet webpage, internet webpage portal or similar electronic, internet and web-based system in lieu of a paper form; provided, however, that upon request, a carrier, or any entity that manages or administers benefits for a carrier, shall make a paper credentialing form available to a health care provider.
(c) A carrier, or an entity that manages or administers benefits for a carrier, that contracts with another entity to perform some or all of the functions governed by this chapter shall be responsible for ensuring compliance by the contracted entity with this chapter. A failure by the contracted entity to meet the requirements of this chapter shall be the responsibility of the carrier to remedy and shall subject the carrier to enforcement actions, including financial penalties, authorized under this chapter.