Timothy p. Murray lieutenant governor judyann bigby, md



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The Commonwealth of Massachusetts
Executive Office of Health and Human Services

Department of Public Health

Office of Patient Protection

250 Washington Street

Boston, MA 02108-4619
Phone: 1-800-436-7757

Fax: 617-624-5046



DEVAL L. PATRICK

GOVERNOR

TIMOTHY P. MURRAY

LIEUTENANT GOVERNOR

JUDYANN BIGBY, MD

SECRETARY

JOHN AUERBACH

COMMISSIONER


To: External Review Agencies under Contract with the Department of Public Health Pursuant to M.G.L. c. 176O, § 14
cc: Commercial Health Insurers, Blue Cross Blue Shield of Massachusetts, and Health Maintenance Organizations Accredited Pursuant to M.G.L. c. 176O
From: Carol Balulescu, Director, Office of Patient Protection
Re: External Review Decisions of Services Deemed to be Experimental/Investigational
Date: April 1, 2008

______________________________________________________________________________


The Office of Patient Protection (OPP) would like to clarify its expectations regarding the process of external review of services that a health plan has deemed to be investigational or experimental.
As noted in the advisory memo that OPP issued on December 11, 2002, OPP expects the following of external review agencies:



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