GENERAL INSTRUCTIONS
The attached form should be used by a Provider or Provider Organization to provide a Notice of Material
Change (“Notice”) to the Health Policy Commission (“Commission”), as required under M.G.L. c. 6D, § 13
and 958 CMR 7.00, Notices of Material Change and Cost and Market Impact Reviews. To complete the
Notice, it is necessary to read and comply with 958 CMR 7.00, a copy of which may be obtained on the
Commission’s website at www.mass.gov/hpc. Capitalized terms in this Notice are defined in 958 CMR
7.02. Additional sub-regulatory guidance may be available on the Commission’s website (e.g., Technical
Bulletins, FAQs). For
further assistance, please contact the Health Policy Commission at HPC-
Notice@state.ma.us. This form is subject to statutory and regulatory changes that may take place from time
to time.
REQUIREMENT TO FILE
This Notice must be submitted by any Provider or Provider Organization with $25 million or more in Net
Patient Service Revenue in the preceding fiscal year that is proposing a Material Change, as defined in 958
CMR 7.02. Notice must be filed with the Commission not fewer than 60 days before the consummation or
closing of the transaction (i.e., the proposed effective date of the proposed Material Change).
SUBMISSION OF NOTICE
One electronic copy of the Notice, in a portable document form (pdf), should be submitted to the following:
Health Policy Commission HPC-Notice@state.ma.us;
Office of the Attorney General HCD-6D-NOTICE@state.ma.us;
Center for Health Information and Analysis CHIA-Legal@state.ma.us
PRELIMINARY REVIEW AND NOTICE OF COST AND MARKET IMPACT REVIEW
If the Commission considers the Notice to be incomplete, or if the Commission requires clarification of any
information to make its determination, the Commission may, within 30 days of receipt of the Notice, notify
the Provider or Provider Organization of the information or clarification necessary to complete the Notice.
The Commission will inform each notifying Provider or Provider Organization of any determination to
initiate a Cost and Market Impact Review within 30 days of its receipt of a completed Notice and all
required information, or by a later date as may be set by mutual agreement of the Provider or Provider
Organization and the Commission.
CONFIDENTIALITY
Information on this Notice form itself shall be a public record and will be posted on the Commission’s website.
Pursuant to 958 CMR 7.09, the Commission shall keep confidential all nonpublic information and documents
obtained in connection with a Notice of Material Change and shall not disclose the information or documents
to any person without the consent of the Provider or Payer that produced the information or documents,
except in a Preliminary Report or Final Report of a Cost and Market Impact Review if the Commission
believes
that such disclosure should be made in the public interest after taking into account any privacy,
trade secret or
anti-competitive considerations. The confidential information and documents shall not be
public records and shall be exempt from disclosure under M.G.L. c. 4, § 7 cl. 26 or M.G.L. c. 66, § 10.