Code of Massachusetts Regulations
101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES
Title 101 CMR 614.00 - Health Safety Net Payments and Funding
Section 614.03 - Sources and Uses of Funds

Universal Citation: 101 MA Code of Regs 101.614

Current through Register 1531, September 27, 2024

(1) Available Revenue.

(a) Except as provided in 101 CMR 614.03(1)(b), revenue available to fund Provider payments from the Health Safety Net Trust Fund consists of
1. revenue produced by Acute Hospital and Non-acute Hospital assessments and the surcharge on Hospital Services and Ambulatory Surgical Center Services payments, less
a. 50% of the estimated cost, as determined by the Secretary of Administration and Finance, of administering the Health Safety Net and related assessments in accordance with M.G.L. c. 118E, §§ 65 through 69;

b. any amount designated to be transferred to the MassHealth Delivery System Reform Trust Fund pursuant to M.G.L. c. 118E, § 66 or otherwise required by law; and

c. any amount designated to be transferred to the Non-acute Care Hospital Reimbursement Trust Fund established in M.G.L. c. 29, § 2WWWW pursuant to M.G.L. c. 118E, § 66 or otherwise required by law;

2. funds authorized to be transferred from the Commonwealth Care Trust Fund;

3. amounts previously transferred from the Uncompensated Care Trust Fund;

4. any interest on monies in the Health Safety Net Trust Fund; and

5. any additional funding made available through appropriation or otherwise.

(b) Any amounts collected from Surcharge Payers in any Fiscal Year in excess of the Total Surcharge Amount, adjusted to reflect applicable surcharge credits based on prior year collections, are transferred to the General Fund to support a portion of the costs of the MassHealth program.

(2) Payments from the Health Safety Net Trust Fund.

(a) Payment Adjustments. Acute Hospital payments established under 101 CMR 614.06 may be adjusted to reflect additional funding made available during the Fiscal Year or to reflect the shortfall allocation in accordance with 101 CMR 614.03(2). The Health Safety Net may reserve up to 10% of available funding to ensure that funding is available for the entire Fiscal Year. The Health Safety Net may reserve an additional amount of available funding to ensure that funds are available to pay for claims that were denied or held during the Fiscal Year, but are later remediated in a subsequent Fiscal Year.

(b) Shortfall Allocation. The Health Safety Net Office, using the best data available, estimates the projected total Reimbursable Health Services provided by Acute Hospitals and Community Health Centers; total Medical Hardship services; total Bad Debt for Emergency and Urgent Care Services; and total Health Safety Net administrative expenses. If the Health Safety Net Office determines that, after adjusting for projected Community Health Center payments and administrative expenses, Health Safety Net payments to Acute Hospitals will exceed available funding, the Health Safety Net Office allocates the funding in a manner that reflects each Acute Hospital's proportional Financial Requirements for Health Safety Net payments through a graduated payment system. The Health Safety Net Office allocates the shortfall to Disproportionate Share Hospitals and other Acute Hospitals as follows.
1. Disproportionate Share Hospital. The Health Safety Net Office determines Disproportionate Share Hospital status using data reported on the Hospital Cost Report for the Source Year.

2.. Allocation Method. The Health Safety Net Office allocates the shortfall as follows.
a. Determine the ratio of each Acute Hospital's total Patient care costs to the sum of all Acute Hospitals' total Patient care costs.

b. Multiply this ratio by the total Shortfall Amount.

c. If calculated amount is greater than an Acute Hospital's allowable Health Safety Net payments, then the shortfall allocation is limited to the Acute Hospital's allowable Health Safety Net payments. If an Acute Hospital's allowable Health Safety Net payment is a negative amount, then the shortfall allocation is limited to zero.

d. The Health Safety Net's gross liability to each Acute Hospital is limited by the Acute Hospital's allowable Health Safety Net payments less the Shortfall Amount calculated in 101 CMR 614.03(2)(b)2.a. through c.

e. Each Disproportionate Share Hospital is paid the greater of
i. 85% of its allowable Health Safety Net payments; or

ii. the revised payment calculated according to the shortfall methodology in 101 CMR 614.03(2)(b)2.a. through e.

(c) Final Settlement. The Health Safety Net Office may implement a final settlement between the Health Safety Net and an Acute Hospital for the Fiscal Year. The final settlement is calculated based on the Health Safety Net's gross liability to the Acute Hospital calculated pursuant to 101 CMR 614.06, and the payments made to the Acute Hospital during the Fiscal Year. The final settlement may occur when the Health Safety Net Office determines that it has sufficiently completed relevant claims adjudication and audit activity. For the purposes of the final settlement, the Health Safety Net Office may cease paying for claims that exceed the billing deadlines or other billing rules established at 101 CMR 613.00: Health Safety Net Eligible Services.

Disclaimer: These regulations may not be the most recent version. Massachusetts may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.