Code of Massachusetts Regulations 129 CMR - HEALTH CARE QUALITY AND COST COUNCIL
129 CMR – Health Care Quality and Cost Council, the Massachusetts state regulations governing health-care data collection, disclosure, and use to promote quality and control costs:
🏛️ Structure of 129 CMR
129 CMR is divided into three main titles:
2.00 – Uniform Reporting System for Health Care Claims Data Sets
3.00 – Disclosure of Health Care Claims Data
4.00 – Disclosure of Health Care Claims Data to a Provider en.wikipedia.org+10law.cornell.edu+10regulations.justia.com+10sec.state.ma.us
1. 129 CMR 2.00 – Uniform Reporting System
Authority & Scope: Established under M.G.L. c. 6A, § 16L. Applies to all licensed carriers in Massachusetts malegislature.gov+4law.cornell.edu+4regulations.justia.com+4.
What must be submitted:
Member eligibility files, medical and pharmacy claims, HEDIS and CAHPS survey results mass.gov+1regulations.justia.com+1.
Third‑party payers below certain thresholds are exempt .
Protection & penalties:
Compliance with Fair Information Practices (M.G.L. c. 66A) for confidentiality law.cornell.edu+10mass.gov+10regulations.justia.com+10.
Timely submissions required (monthly or quarterly based on size); non‑compliance may trigger penalties up to $50,000/year mass.gov+1malegislature.gov+1.
Technical/data standards:
Detailed data formatting, edit checks, statistical plans, file organization standards (ASCII headers, trailers), plus member ID requirements and race/ethnicity reporting .
2. 129 CMR 3.00 – Disclosure of Claims Data
Data Access Levels:
Level 1: Public-use files with de‑identified aggregated data.
Level 2: More detailed, regulated data requiring Data Release Review Board (DRRB) approval.
Level 3: Identifiable data, only shared with state agencies under strict agreements .
DRRB oversight:
Reviews all Level 2/3 release requests based on criteria like privacy impact, competition risk, public interest, etc. .
Applicants must submit detailed proposals, security plans, justify data necessity, and pay/apply for waivers .
Decision criteria and appeal:
Uses factors like potential patient-identification risk, anticompetitive concerns, cost/quality benefits. Applicants can revise and resubmit rejected applications .
3. 129 CMR 4.00 – Disclosure to Providers
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