Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 324.00 - Nonpublic Ambulance Service Reimbursement Trust Fund Assessment and Funding
Section 324.04 - Nonpublic Ambulance Provider's Liability and Payment to the Nonpublic Ambulance Service Reimbursement Trust Fund

Universal Citation: 101 MA Code of Regs 101.324

Current through Register 1518, March 29, 2024

(1) Uniform Assessment. EOHHS will annually set the uniform assessment at a percentage not less than 0.25% lower than the maximum limit for a provider assessment pursuant to 42 CFR 433.68(f), inclusive of an annual amount of $500,000; provided, that the annual amount of $500,000 will be for administrative costs of EOHHS as described in 101 CMR 324.03(3). This percentage will be listed before October 1st of each year and will be set as a percentage of the nonpublic emergency ambulance assessed charges of each such nonpublic ambulance provider for its most recently completed fiscal year (unless EOHHS determines that the most recent fiscal year does not accurately represent typical total operating revenue for the nonpublic ambulance provider because of exceptional circumstances, in which case EOHHS may use nonpublic emergency ambulance assessed charges from an earlier completed fiscal year). Such uniform assessment will not be implemented unless and until EOHHS receives notice of approval from the Centers for Medicare & Medicaid Services of federal financial participation for expenditures related to the assessment. Upon receiving such approval, EOHHS may implement the assessment for the quarter beginning July 1, 2021, and later as described in 101 CMR 324.04(4)(c), and require payment within 45 days (or such additional period designated by EOHHS by administrative bulletin or other written guidance) of such approval or the end of the relevant quarter, whichever comes later.

(2) Applicability of Assessment. All nonpublic ambulance providers, regardless of payment model, are subject to the uniform assessment including, but not limited to, those nonpublic ambulance providers in fee-for-service and managed care arrangements. A nonpublic ambulance provider's liability to the fund will, in the case of a transfer of ownership or other change in control, be assumed by the successor in interest to the nonpublic ambulance provider or any provider under common interest.

(3) Reporting of Nonpublic Emergency Ambulance Assessed Charges.

(a) Each nonpublic ambulance provider is required to report its nonpublic emergency ambulance assessed charges each year. Such reporting will be completed through the filing of the Ambulance Cost Report with the Center, subject to all requirements under 957 CMR 6.00: Cost Reporting Requirements and using the total operating revenue for basic life and advanced life service of Schedule E of the Ambulance Cost Reports, or through an alternative reporting method designated by EOHHS via administrative bulletin or other written issuance.

(b) If a nonpublic ambulance provider fails to report nonpublic emergency ambulance assessed charges, or, if in the determination of EOHHS, the nonpublic ambulance provider has improperly reported its nonpublic emergency ambulance assessed charges or the assessed charges do not accurately represent typical total operating revenue for the nonpublic ambulance provider because of exceptional circumstances, EOHHS may calculate such amounts based on data within its possession or audit the nonpublic ambulance provider. If EOHHS determines through its review that a nonpublic ambulance assessed charges were materially different than reported, EOHHS may require a payment adjustment. Payment adjustments are subject to interest penalties and late fees, pursuant to 101 CMR 324.06(1), from the date the original payment was owed to the Trust Fund.

(4) Nonpublic Ambulance Provider Liability Calculation.

(a) Each nonpublic ambulance provider's gross liability to the Trust Fund is equal to the product of

1. the amount of nonpublic emergency ambulance assessed charges in the nonpublic ambulance provider's most recent fiscal year as reported on the Ambulance Service Cost Report, or as otherwise determined by EOHHS as described in 101 CMR 324.04(1) and (3); and

2. the uniform assessment.

(b) For each provider who has submitted its revenue to the Center or EOHHS by September 20th of each year, EOHHS will notify the nonpublic ambulance provider of its gross liability to the Trust Fund by September 30th, split into quarterly payments. EOHHS will update each nonpublic ambulance service's liability to the Trust Fund as updated information becomes available.

(5) Payment. Upon implementation of the uniform assessment consistent with the requirements of 101 CMR 324.04(1), each nonpublic ambulance provider must pay its quarterly gross liability to the Trust Fund within 45 days (or such additional period designated by EOHHS by administrative bulletin or other written guidance) of the end of each calendar quarter, starting with the quarter beginning July 1, 2021. The nonpublic ambulance provider may adjust the amount owed for any over- or under-payments in a previous period.

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