Code of Massachusetts Regulations
956 CMR - COMMONWEALTH HEALTH INSURANCE CONNECTOR AUTHORITY
Title 956 CMR 11.00 - Employer Fair Share Contribution
Section 11.04 - Determination of Annual Fair Share Employer Contribution
Universal Citation: 956 MA Code of Regs 956.11
Current through Register 1531, September 27, 2024
(1) Determination of Contribution Amount. The Annual Fair Share Employer Contribution Rate is the lower of:
(a) $295 per employee; or
(b) the sum of the Fair Share Employer
Contribution and the Per Employee Cost of Unreimbursed Physician Care as
calculated in accordance with 956 CMR 11.04. The Fair Share Employer
Contribution Rate shall be determined annually by the Connector in consultation
with the Director of the Department of Workforce Development using the best
available data. The Annual Fair Share Employer Contribution Rate shall be
adjusted to reflect a quarterly rate based on 25% of the annual fair share
contribution rate applicable to that quarterly period.
(2) Fair Share Employer Contribution Rate. The Connector will determine the Annual Fair Share Employer Contribution Rate as follows:
(a) Determine the per user share of Private
Sector Liability by dividing total Private Sector Liability for the Fiscal Year
by the total number of users of the Health Safety Net in the most recent fiscal
year.
(b) Determine the number of
employee users that received services funded by the Health Safety
Net;
(c) Multiply the total number
of employee Health Safety Net users by the percentage of employers that are
non-Contributing Employers.
(d)
Determine the total cost of liability associated with employees of
non-Contributing Employers by multiplying the number of users that are
employees of non-Contributing Employers by the Per User Share of Private Sector
Liability.
(e) Divide the total
liability for employees of non-Contributing Employers by the total number of
employees of non-Contributing Employers as determined by the
Connector.
(f) Adjust by medical
inflation as determined by the Connector.
(3) Per Employee Cost of Uncompensated Physician Care.
(a)
The Connector will determine the total amount of uncompensated health care
services provided by physicians to non-elderly, uninsured residents of the
Commonwealth. The Connector will use the best available data, including survey
data or other data source.
(b) The
Connector will divide this amount by the number of employees of contributing
Employers to determine the Per Employee Cost of Uncompensated Physician
Care.
(4) The Sum of the Fair Share Employer Contribution and the Per Employee Cost of Uncompensated Physician Care is the Annual Fair Share Contribution Rate.
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