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Resource Use (Cost/Utilization) Measurement and Reporting in Massachusetts

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Massachusetts law requires the Division of Health Care Finance and Policy to collect and analyze data to monitor the financial conditions of hospitals. An annual report is published that analyzes hospital utilization, inefficiencies, and identifies those hospitals that are in financial distress.1  Other laws require the Division to develop uniform reporting standards for utilization of health care providers in order to identify trends in utilization across providers and specialties.2  In addition, the Division of Insurance requires health maintenance organizations to annually file cost, utilization, and other performance related reports.3

Footnotes

  • 1. M.G.L.A. 118G §6A
  • 2. M.G.L.A. 118G §6
  • 3. M.G.L.A. 176G §10

 

Resource Use (Cost/Utilization) Measurement and Reporting in Massachusetts

Subtopic Statute/Regulation Description
Required utilization/cost reporting 101. Mass. Code Regs. 204.07. - Reporting Requirements “Reporting Requirements”   This sections lists all the required costs reporting requirements for Residential Care providers. ...
105. Mass. Code Regs. 150.014. - Utilization Review “Utilization Review”   This section establishes that facilities, which provide Level I or II caremust review the services, quality...
114.1. Mass. Code Regs. 42.03. - General Reporting Requirements “General Reporting Requirements”   Provides that acute and non-acute hospitals must file the following documents with the Division...
114.2. Mass. Code Regs. 5.03. - Reporting Requirements “Reporting Requirements”   This sections lists all the required costs reporting requirements for Nursing Facility providers. ...
Mass. Gen. Laws. Ann. ch. 118E, §51 - Utilization review of care and services; data processing and collection procedures; liability in civil actions “Utilization review of care and services; data processing and collection procedures; liability in civil actions”   The division, in...
Mass. Gen. Laws. Ann. ch. 12C, § 10 - Reporting requirements for private and public health care payers and third-party administrators The Center for Health Information and Analysis must require the uniform reporting of information from public and private health care payers,...
Resource Use (Cost/Utilization) Measurement and Reporting Mass. Gen. Laws. Ann. ch. 111, § 228 - Advance disclosure of allowed amount or charge for admission, procedure or service Advance disclosure of allowed amount or charge for admission, procedure or service  A health care provider must disclose the allowed amount and...
Mass. Gen. Laws. Ann. ch. 12C, § 16 - Annual report based on information submitted under Secs. 8, 9, and 10; hearing Annual report based on information submitted under Secs. 8, 9, and 10; hearing The Center for Health Information and Analysis must publish an annual...
Mass. Gen. Laws. Ann. ch. 12C, § 8 - Reporting requirements for institutional providers and their parent organization and other affiliates The Center for Health Information and Analysis must require the uniform reporting of revenues, charges, costs, prices, and utilization of health care...
Mass. Gen. Laws. Ann. ch. 176G, § 10 - Mandatory report by potentially insolvent health maintenance organizations All health maintenance organizations are required to annually file with the Commissioner of Insurance, the following: Financial statements;...
Financial information data collection Mass. Gen. Laws. Ann. ch. 118E, §51 - Utilization review of care and services; data processing and collection procedures; liability in civil actions “Utilization review of care and services; data processing and collection procedures; liability in civil actions”   The division, in...
Provider cost reporting Mass. Gen. Laws. Ann. ch. 12C, § 10 - Reporting requirements for private and public health care payers and third-party administrators The Center for Health Information and Analysis must require the uniform reporting of information from public and private health care payers,...
Click on the individual state law in the table above to see our summary of the individual law.


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