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.