Section 8: Open Enrollment Waivers

(a) There is hereby established within the department an office of patient protection. The office shall: (1) have the authority to administer and enforce the standards and procedures established by sections 13, 14, 15 and 16 of chapter 176O, and to promulgate regulations therefor. Such regulations shall protect the confidentiality of any information about a carrier or utilization review organization, as defined in said chapter 176O, which, in the opinion of the office, and in consultation with the division of insurance, is proprietary in nature. The regulations authorized by this section shall be consistent with, and not duplicate or overlap with, regulations promulgated by the bureau of managed care established in the division of insurance pursuant to said chapter 176O; (2) establish a site on the internet and through other communication media in order to make managed care information collected by the office readily accessible to consumers. Said internet site shall, at a minimum, include (i) the health plan report card developed pursuant to section 24 of chapter 118G, (ii) a chart, prepared by the office, comparing the information obtained on premium revenue expended for health care services as provided pursuant to subsection (3) of paragraph (b) of section 7 of chapter 176O, for the most recent year for which information is available, and (iii) data collected pursuant to paragraph (c); (3) assist consumers with questions or concerns relating to managed care, including but not limited to exercising the grievance and appeals rights established by sections 13 and 14, of said chapter 176O; (4) monitor Authorizes the Office of Patient Protection to grant waivers for certain individuals to enroll in a managed care health plan outside of a mandatory open enrollment period; (5) regulate the establishment and functions of review panels established by section 14 of chapter 176O; (6) periodically advise the commissioner, the managed care oversight board established by section 16D of chapter 6A, the joint committee on health care and the joint committee on insurance on actions, including legislation, which may improve the quality of managed care health insurance plans; and (7) administer and grant enrollment waivers under paragraph (4) of subsection (a) of section 4 of chapter 176J; provided, however, that the office of patient protection may grant a waiver to an eligible individual who certifies, under penalty of perjury, that such individual did not intentionally forego enrollment into coverage for which the individual is eligible and that is at least actuarially equivalent to minimum creditable coverage; provided further, that the office shall establish by regulation standards and procedures for enrollment waivers.

(b) The commissioner shall establish an external review system for the review of grievances submitted by or on behalf of insureds of carriers pursuant to section 14 of chapter 176O.

(c) Each entity that compiles the health plan employer data and information set, so-called, for the National Committee on Quality Assurance, or collects other information deemed by the entity as similar or equivalent thereto, shall, upon submitting said data and information set to the division of health care finance and policy pursuant to section 24 of chapter 118G, concurrently submit to the office of patient protection a copy thereof excluding, at the entity's option, proprietary financial data.

Summary: 
Authorizes the Office of Patient Protection (OPP) to grant waivers, according to standards and procedures it sets, for people to enroll in a managed care health plan outside of a mandatory open enrollment period. To get a waiver, individuals must certify under the penalty of perjury that they did not intentionally forego enrollment into coverage, and the plan must meet minimum creditable coverage standards.

The Office of Patient Protection was created to assist individuals enrolled in a Massachusetts managed care health plan with questions or problems in obtaining covered services. The OPP may also assist individuals in appealing a denial of an insurance claim or access to service. In addition to monitoring quality-related health insurance plan information relating to managed care practices, the OPP must publish on its website the health plan report cards and a chart comparing premium amounts various health insurance companies spend on health care services for consumers.