Section 6.05 - Registration(1) A Provider Organization that meets the criteria set forth in 958 CMR 6.04(1) as of July 18, 2014 shall file an application for Registration with the Commission as specified in the Data Submission Manual, subject to the provisions of 958 CMR 6.04(2) and (3).(2) The following Provider Organizations that meet the criteria set forth in 958 CMR 6.04(1) shall begin and complete Initial Registration by no later than the dates specified in the Data Submission Manual:(a) A Provider Organization that negotiates, represents, or otherwise acts on behalf of one or more Providers or Provider Organizations, which may include itself, that is a physician group, Acute Hospital, rehabilitation hospital, long term acute care hospital, or that provides inpatient or outpatient Behavioral Health Services, to establish contracts for the payment of Health Care Services with Carriers or Third-party Administrators; and(b) A Risk-bearing Provider Organization. A Provider Organization specified in 958 CMR 6.05(2) that does not meet the criteria set forth in 958 CMR 6.04(1) as of July 18, 2014, but that meets these criteria at any time after July 18, 2014 shall complete Initial Registration not later than 180 calendar days after meeting the criteria set forth in 958 CMR 6.04(1), subject to the provisions of 958 CMR 6.04(2) and (3), unless otherwise authorized by the Commission in writing.
(3) A Provider Organization that meets the criteria set forth in 958 CMR 6.04(1) as of July 18, 2014 but that is not specified in 958 CMR 6.05(2) shall not be required to file an application for Registration until the Commission publishes a notice of deadline for Initial Registration, including in the Data Submission Manual and on the Commission's website. The Commission shall publish the notice of deadline for Initial Registration at least 180 calendar days prior to requiring such Provider Organization to file an application for Initial Registration.(4) Every two years after completing Initial Registration, a Registered Provider Organization that meets the criteria set forth in 958 CMR 6.04(1) shall file an application for Registration Renewal by the date specified in the Data Submission Manual, subject to the provisions of 958 CMR 6.04(2) and (3).(5) A Provider Organization's Registration shall be valid for a 24-month period, beginning on the date of the notice issued by the Commission pursuant to 958 CMR 6.05(10), unless otherwise specified by the Commission or as provided in 958 CMR 6.05(11).(6) A Provider Organization that negotiates, represents, or otherwise acts on behalf of one or more Providers or Provider Organizations, which may include itself, in contracting with Carriers or Third-party Administrators, that collectively received $25,000,000 or more in annual Net Patient Service Revenue from Carriers or Third-party Administrators in the prior Fiscal Year, but that does not have a collective Patient Panel of more than 15,000 as of the end of the prior Fiscal Year, shall submit to the Commission in writing, prior to the applicable deadline for Registration as established by the Commission, evidence that 958 CMR 6.00 does not apply to that Provider Organization, as specified by the Commission. After receiving such evidence from a Provider Organization, the Commission may require the Provider Organization to provide additional information. A Provider Organization shall respond to any such request for additional information within 21 calendar days of the date of the Commission's request, unless otherwise specified in writing by the Commission.(7) A Provider or Provider Organization not otherwise required to register by 958 CMR 6.04(1) and 6.05(2) may voluntarily submit an application for Registration.(8) The application for Registration shall be certified by two duly authorized representatives of the Provider Organization, one of whom shall be the Chief Executive Officer, Chief Operating Officer, Chief Financial Officer, or equivalent. Unless otherwise specified by the Commission, the application shall include the following information for the Provider Organization and any Entity with which it has a Corporate Affiliation or Contracting Affiliation, subject to the specifications and instructions detailed in the Data Submission Manual:(a) Information about ownership, governance, and operational structure, including, organizational charts, narrative descriptions of the type and kind of Corporate and Contracting Affiliations, information on incentive structures and compensation models, including Funds Flow within the Provider Organization, and information on the characteristics of any Clinical Affiliations and the role of Community Advisory Boards;(b) The number of Health Care Professional Full-time Equivalents by license type and specialty, each Health Care Professional's name, address of principal location of work, national provider identifier, or other identifying information, and whether the Health Care Professional is employed by or affiliated with the Provider or Provider Organization and the nature of that relationship, including whether provisions exist in physician participation or employment agreements such as referral requirements;(c) The name and address of each Facility and Practice Site, including by license number, license type, tax identification number, national provider identifier, and capacity in each Major Service Category;(d) For Risk-bearing Provider Organizations, a statement certifying that the RBPO has received a risk certificate or a waiver from the Division from the requirements of M.G.L. c. 176T or any regulations promulgated thereunder;(e) Information on utilization by Major Service Category;(f) Total revenue by payer under pay for performance arrangements, risk contracts, and other fee-for-service arrangements; and(g) A registration fee payable to the Health Policy Commission as specified by the Commission.(9) After receiving an application for Registration, the Commission may, within 30 calendar days, require an applicant to provide additional information to complete or supplement the application for completeness or clarification. A Provider Organization shall respond to any request for additional information from the Commission within 21 calendar days of the date of the Commission's request, unless otherwise specified in writing by the Commission.(10) The Commission shall determine whether an application is complete within 45 calendar days of receipt of the application or any supplementary material, whichever is later, and the Commission shall provide written notice of completed Registration to the applicant. An application will not be considered complete until all materials required by the Commission have been received by the Commission.(11) A Registered Provider Organization shall update its Registration on file with the Commission pursuant to 958 CMR 6.05(8) within 21 calendar days after the effective date of any change to the Registered Provider Organization that directly affects the Registration information on file with the Commission and: (a) required a Determination of Need by the Department of Public Health;(b) required a Material Change Notice to be filed with the Commission; or(c) required an essential health services filing with the Department of Public Health pursuant to 105 CMR 130.000: Hospital Licensure. The Commission may require in writing, at any time, additional information reasonable and necessary to determine the financial condition, organizational structure, business practices or market share of a Registered Provider Organization pursuant to M.G.L. c. 12C, § 9(d). A Registered Provider Organization shall respond to a request for additional information by the Commission within 21 calendar days of the date of the Commission's request, unless otherwise specified in writing by the Commission.
(12) The Registration requirements set forth in 958 CMR 6.05(8) may be fulfilled through the reporting of such information to other Commonwealth of Massachusetts agencies, as may be specified by the Commission.(13) The Commission may issue administrative bulletins necessary to implement 958 CMR 6.00.Adopted by Mass Register Issue 1265, eff. 7/18/2014.