Code of Massachusetts Regulations
114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY
Title 114.1 CMR 41.00 - RATES OF PAYMENT FOR SERVICES PROVIDED TO INDUSTRIAL ACCIDENT PATIENTS BY HOSPITALS
Section 41.02 - Definitions

Meaning of Terms. As used in 114.1 CMR 41.00, unless the context requires otherwise, terms shall have the meanings set forth in 114.1 CMR 41.02:

Acute Hospital. A Hospital licensed under M.G.L. c. 111, § 51, which contains a majority of medical-surgical, pediatric, obstetric, and maternity beds, as defined by the Department of Public Health.

Acute Median Payment on Account Factor. The median of all Payment on Account Factors determined for each Acute Hospital.

Base Year. The Hospital fiscal year for which DHCFP-403 data is used to compute the Payment on Account Factor. Only data from a complete or non-partial fiscal year is used in the computation of the Payment on Account Factor. If the Division determines that the data source is inadequate or not representative of the Hospital's ongoing costs, the Division may consider alternative data sources to determine Base Year costs. Criteria for such review will include but shall not be limited to peer group analysis.

Charge. A Hospital's uniform price for each specific service within a revenue center as filed with the Division.

DHCFP-403. The Hospital Statement of Costs, Revenues and Statistics.

Division. The Division of Health Care Finance and Policy as established under M.G.L. c. 118G.

Governmental Unit. The Commonwealth, any division, department, agency, board or commission of the Commonwealth, and any political subdivision of the Commonwealth.

Gross Patient Service Revenue. The total dollar amount of a Hospital's Charges for services rendered in a fiscal year.

Health Safety Net. The fund established under M.G.L. c. 118G, § 36 to pay Acute Hospitals and community health centers for health services provided to low-income uninsured and under insured individuals.

Hospital. An Acute Hospital or a Non-acute Hospital

Hospital Uniform Assessment Percentage. Massachusetts Acute Hospitals' liability to the Health Safety Net, expressed as a percentage of statewide Acute Hospital private sector revenue. An individual Acute Hospital's gross liability to the Health Safety Net equals the Hospital Uniform Assessment Percentage multiplied by that Hospital's gross private sector Charges.

Implanted Durable Medical Equipment (DME). Implanted prosthetic devices, replacement parts (external or internal), accessories and supplies for implanted DME.

Industrial Accident Patient. A person who receives services for which an employer or insurer is in whole or part liable under M.G.L. c. 152, the Workers' Compensation Act.

New Hospital. A Hospital that was not licensed and operated as a Hospital in the base year or which did not report a full year of data for that year.

Non-acute Median Payment on Account Factor. The median of all Payment on Account Factors determined for each Non-acute Hospital.

Non-acute Hospital. A Hospital that is defined and licensed under M.G.L. c. 111, § 51, with less than a majority of medical-surgical, pediatric, maternity and obstetric beds, or any psychiatric facility licensed under M.G.L. c. 19, §19, or any public health care facility.

Observation Services. Outpatient services ordered by a physician that consist of intermittent monitoring by professional licensed staff that are reasonable and necessary to evaluate a patient's condition to determine the potential need for admission to the hospital.

Payment on Account Factor (PAF). The percentage applied to total Charges for services rendered to an Industrial Accident Patient to calculate payment as determined in accordance with 114.1 CMR 41.03.

Private Sector GPSR. Total Hospital Charges attributable to Industrial Accident, Managed Care and Non-managed Care payer groups.

Public Health Care Facility. A facility operated by the Department of Public Health, the Department of Mental Health or a County of the Commonwealth.

Rate Year. For all Hospitals, the fiscal year beginning October 1st.

Rehabilitation Services. Comprehensive services performed to achieve objectives of improved health and welfare with the realization of optimal physical, social and vocational potential.

Restorative Services. Physical Therapy (PT), Occupational Therapy (OT) or Speech Therapy (ST) services rendered for maximum reduction of physical and/or speech disability and restoration of optimal functionality.

Speech/Language Pathology Services. The evaluation and treatment of communicative disorders of articulation (including aphasia and dysarthria, language, voice and fluency).