Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 327.00 - Rates of Payment for Ambulance and Wheelchair Van Services
Section 327.05 - Nonpublic Ambulance Supplemental Payment Provisions

(a) licensed under M.G.L. c. 111C, § 6, as defined by the Department of Public Health (DPH);

(b) a MassHealth enrolled ambulance provider; and

(c) in compliance with the payment conditions set forth in 101 CMR 327.05(2).

(a) Nonpublic ambulance service expenditures will be made only under federally approved payment methods and consistent with federal funding requirements and all federal payment limits as determined by the Secretary of Health and Human Services.

(b) Payments under the Trust Fund will only be made to eligible nonpublic ambulance providers that

(a) EOHHS may audit compliance with conditions of payment.

(b) EOHHS may, via administrative bulletin or other written issuance, establish standards governing various conditions of payment including, but not limited to, attestations, reporting requirements, compliance with payment conditions, penalties for noncompliance, and recovery.

(a) EOHHS will direct payments to eligible nonpublic ambulance providers from the Trust Fund each state fiscal year in which funding is available in the Trust Fund. Within 45 days of the end of each quarter, starting with the quarter beginning July 1, 2021, EOHHS will calculate and distribute payments to eligible nonpublic ambulance providers consistent with the payment methodology described in 101 CMR 327.05(5).

(b) Notwithstanding 101 CMR 327.05(4)(a), EOHHS will not make final supplemental payments to nonpublic ambulance providers, unless and until EOHHS receives notice of approval from the Centers for Medicare & Medicaid Services (CMS) for federal financial participation for expenditures related to the assessment described in 101 CMR 324.00: Nonpublic Ambulance Service Reimbursement Trust Fund Assessment and Funding. Upon receiving such approval, EOHHS will make supplemental payments for dates of service on or after July 1, 2021, within 180 days of such approval or the end of the relevant quarter, whichever is later.

(c) EOHHS may elect to make interim supplemental payments to nonpublic ambulance providers prior to receiving notice of approval from CMS for federal financial participation for expenditures related to the assessment. Any interim supplemental payment made to a provider is subject to adjustment to conform final supplement payments to the payment methodology ultimately approved by CMS. In the event CMS does not approve federal financial participation for such expenditures, EOHHS may recover any portion of the interim supplemental payment made to a provider. The adjustment or recovery may include, without limitation, the denial, reduction, or withholding of future payment to that provider or its successor in interest or any provider under common interest.

(a) To calculate the supplemental payments, EOHHS will assign eligible nonpublic ambulance providers to one of the following classifications and set the distribution factor percentage to be applied to the supplemental payments determined in 101 CMR 327.05(5)(b) as follows, provided that EOHHS may prospectively update the distribution factor percentage for a given quarterly payment by not more than plus or minus 5% via administrative bulletin or other written issuance.

(b) EOHHS will distribute 100 % of the payment to eligible nonpublic ambulance providers as follows, with the amount paid to each nonpublic ambulance provider equaling the product of

(c) The payments to eligible nonpublic ambulance providers described in 101 CMR 327.05(5)(b) may not exceed the sum of the difference between the Medicaid payments otherwise made to these providers for the provision of ground ambulance services and the amount that would have been paid at the equivalent average commercial rate (ACR) in aggregate, as determined by EOHHS, as follows: