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 614.08 - Reporting Requirements

Universal Citation: 101 MA Code of Regs 101.614

Current through Register 1531, September 27, 2024

(1) General. Each Provider, Surcharge Payer, and Ambulatory Surgical Center must file with or make available to the Health Safety Net Office or to an entity designated by the Health Safety Net Office to collect data, as applicable, information that is required or that the Health Safety Net Office deems reasonably necessary for implementation of 101 CMR 614.00.

(a) The Health Safety Net Office may revise the data specifications, the data collection scheduled, or other administrative requirements by administrative bulletin.

(b) The Health Safety Net Office or its designee may audit data submitted under 101 CMR 614.00 to ensure accuracy. The Health Safety Net Office may adjust payments to reflect audit findings. Providers must maintain records sufficient to document compliance with all documentation requirements of 101 CMR 613.00: Health Safety Net Eligible Services and 614.00.

(2) Acute Hospitals.

(a) The Health Safety Net Office may require Acute Hospitals to submit interim data on revenues and costs to the Health Safety Net or to an entity designated by the Health Safety Net Office to collect data to monitor compliance with federal upper limit, cost limit, and disproportionate share payment limits. Such data may include, but not be limited to, gross and net patient service revenue for Medicaid non-managed care, Medicaid managed care, the Premium Assistance Payment Program Operated by the Health Connector, and all payers combined; and total patient service expenses for all payers combined.

(b) Surcharge Payment Data.
1. Unmatched Payer Report. Each Acute Hospital must submit to the Health Safety Net Office a quarterly Unmatched Payer Report. The Acute Hospital must report the total amount of payments for services received from each Institutional Payer that does not appear on the Registered Payer List. The Acute Hospital must report these data in an electronic format specified by the Health Safety Net Office.

2. Quarterly Report for Private Sector Payments. Each Acute Hospital must report to the Health Safety Net Office total payments made by the largest Institutional Surcharge Payers. The Health Safety Net Office specifies the Institutional payers for which reporting is required, the periods for which reporting is required, and the reporting format. The Health Safety Net Office may modify the reporting requirements by administrative bulletin.

(c) Penalties. The Health Safety Net Office may deny payment for Eligible Services to any Acute Hospital that fails to comply with the reporting requirements of 101 CMR 613.00: Health Safety Net Eligible Services or 614.00 until such Acute Hospital complies with the requirements. The Health Safety Net Office notifies such Acute Hospital in advance of its intention to withhold payment.

(3) Community Health Centers. The Health Safety Net Office may deny payment for Eligible Services to any Community Health Center that fails to comply with the reporting requirements of 101 CMR 613.00: Health Safety Net Eligible Services or 614.00 until such Community Health Center complies with the requirements. The Health Safety Net Office notifies such Community Health Center in advance of its intention to withhold payment.

(4) Surcharge Payers.

(a) Monthly Surcharge Payment Report. The Health Safety Net Office may require that an Institutional Payer submit to the Health Safety Net Office monthly reports of payments to Acute Hospitals and Ambulatory Surgical Centers.

(b) Third Party Administrators. A Third Party Administrator Surcharge Payer that makes payments to Acute Hospitals and Ambulatory Surgical Centers on behalf of one or more insurance carriers must file an annual report with the Health Safety Net Office. The report must include the name of each insurance carrier for which it makes surcharge payments. The Health Safety Net Office may also specify additional reporting requirements concerning payments made on behalf of self-insured plans. Reports must be in an electronic format specified by the Health Safety Net Office. Said reports must be filed by July 1st of each year for the time period requested by the Health Safety Net Office.

(c) Penalties. Any Surcharge Payer that fails to file data, statistics, schedules, or other information with the Health Safety Net Office pursuant to 101 CMR 614.08(4) or that falsifies same, is subject to a civil penalty of not more than $5,000 for each day on which such violation occurs or continues, which penalty may be assessed in an action brought on behalf of the Commonwealth in any court of competent jurisdiction. The Attorney General brings any appropriate action, including injunction relief, as may be necessary for the enforcement of the provisions of 101 CMR 614.00.

(5) Ambulatory Surgical Centers.

(a) Unmatched Payer Report. Each Ambulatory Surgical Center must submit a quarterly Unmatched Payer Report to the Health Safety Net Office in accordance with a schedule specified by the Health Safety Net Office. The Ambulatory Surgical Center must report the total amount of payments for services received from each Institutional Surcharge Payer that does not appear on the Registered Payer List. The Ambulatory Surgical Center must report these data in an electronic format specified by the Health Safety Net Office.

(b) Quarterly Report for Private Sector Payments. Each Ambulatory Surgical Center must report to the Health Safety Net Office total payments made by the largest Institutional Surcharge Payers. The Health Safety Net Office specifies the Institutional Payers for which reporting is required, the periods for which reporting is required, and the reporting format. The Health Safety Net Office may modify the reporting requirements by administrative bulletin.

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