C.M.R. 10, 144, ch. 101, ch. VI, 144-101-VI-03, subsec. 144-101-VI-0306
In addition to the documentation and reporting requirements of MBM, Chapter I, Section 1, and other reports that may be required by the Department, PCPs shall report as follows.
Each PCP shall submit documentation required by the Department and comply with other information-sharing requirements from the Department, initially and then annually, through a recertification process to determine their appropriate Tier (3.03).
PCPs shall maintain documentation of all requirements described in Section 3.03 and make the documents available upon request for review by the Department. If a PCP fails to fulfill requirements for the approved Tier level for more than thirty (30) continuous days, the PCP shall notify the Department in writing. The Department may (a) require an action plan from the PCP to address satisfaction of the requirement(s) and/or (b) adjust a PCP's Tier to ensure Tier assignment is consistent with maintenance of stated requirements. The Department may adjust the PCP's Tier if the PCP fails to comply with this rule. The Department shall provide notice to the PCP thirty (30) business days in advance of any Tier change.
PCPs shall provide any required practice and/or rendering provider information requested by the Department in order for the Department to accurately perform PCPlus attribution.
PCPs are eligible for payment based on outcomes of specified quality measures as set forth in Section 3.08-2. Data sources for measures may include, but are not limited to, claims, clinical data, and information submitted by the PCP. PCPs shall submit all data necessary to compile and report on PCPlus performance measures.
Providers who fail to submit performance, application and/or annual recertification-related data and/or reports may be terminated from the PCPlus program.
C.M.R. 10, 144, ch. 101, ch. VI, 144-101-VI-03, subsec. 144-101-VI-0306