Definitions

All defined terms in 958 CMR 10.00 are capitalized. As used in 958 CMR 10.00, these terms have the following meaning: Board. The governing board of the Commission established in M.G.L. c. 6D, § 2(b). Center or CHIA. The Center for Health Information and Analysis established in M.G.L. c. 12C. CHIA-identified Entity. Any Health Care Entity that is identified by the Center under M.G.L. c. 12C, § 18 as an entity whose increase in health status adjusted total medical expense is considered excessive and who threatens the ability of the state to meet the health care cost growth benchmark established under M.G.L. c. 6D, § 9. Commission. The Health Policy Commission established in M.G.L. c. 6D. Cost and Market Impact Review. A review conducted by the Commission pursuant to M.G.L. c. 6D § 13 and 958 CMR 7.00: Notices of Material Change and Cost and Market Impact Reviews and 10.00. Executive Director. The Executive Director of the Commission. Health Care Entity. A clinic, hospital, ambulatory surgical center, physician organization, accountable care organization or payer; provided, however, that physician contracting units with a patient panel of 15,000 or fewer, or which represents providers who collectively receive less than $25,000,000 in annual net patient service revenue from carriers shall be exempt. (MA REG. # 1337, Dated 4-21-17) Performance Improvement Plan or PIP. A plan submitted to the Commission by a PIP Entity pursuant to M.G.L. c. 6D, § 10 and 958 CMR 10.00. PIP Entity. Any CHIA-identified Entity from which the Commission has voted to require a Performance Improvement Plan, but which has neither successfully completed the Performance Improvement Plan nor obtained a waiver from the requirement to implement a Performance Improvement Plan. PIP Notice. Written notice issued by the Commission pursuant to 958 CMR 10.05 informing a CHIA-identified Entity that the Commission is requiring it to submit a Performance Improvement Plan. Provider Organization. Any corporation, partnership, business trust, association or organized group of persons, which is in the business of health care delivery or management, whether incorporated or not, that represents one or more health care providers in contracting with carriers or third-party administrators for the payments of heath care services; provided, that a Provider Organization shall include, but not be limited to, physician organizations, physician-hospital organizations, independent practice associations, provider networks, accountable care organizations and any other organization that contracts with carriers for payment for health care services.