reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 3.00 - Assessment on certain health care providers and surcharge payors › Section 3.04 - Surcharge Payor Assessment

Current through Register 1525, July 5, 2024
(1)
General
. The Center shall establish an assessment on
			 all Surcharge Payors.
(2)
Qualifying Surcharge Payor
. A Surcharge Payor is
			 subject to assessment if the Surcharge Payor's Payments Subject to Assessment
			 were at least $1 million during the last 12-month period for which complete
			 data was received by the Center. A Surcharge Payor that administers health
			 payments for health care services on behalf of a client plan in exchange for an
			 administrative fee will be deemed to use the client plan's funds to pay for
			 health care services whether the Surcharge Payor pays providers with funds from
			 the client plan, with funds advanced by the Surcharge Payor subject to
			 reimbursement by the client plan, or with funds deposited with the Surcharge
			 Payor by the client plan.
(3)
Payments Subject to Assessment
. Payments that are made
			 by Surcharge Payors to Hospitals and Ambulatory Surgical Centers pursuant to
			 M.G.L. c. 118E, § 68 are subject to assessment.
(4)
Calculation of the Surcharge
			 Payor Assessment Percentage
. Using the best information available
			 as determined by the Center, the Center shall calculate each Qualifying
			 Surcharge Payor's assessment percentage by dividing an individual Surcharge
			 Payor's Payments Subject to Assessment during the last fiscal year for which
			 complete data was received by the Center by the total of all such payments by
			 all Qualifying Surcharge Payors.
(5)
Surcharge Payor
			 Liability
. The assessment liability for each Qualifying Surcharge
			 Payor is the product of:
(a) the Surcharge
			 Payor Assessment Percentage as defined in 957 CMR 3.04(4); and
(b)
									½ of Center Expenses.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 3.00 - Assessment on certain health care providers and surcharge payors › Section 3.05 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
General
. Each Hospital, Ambulatory Surgical Center and
			 Surcharge Payor shall file or make available information that is required or
			 that the Center deems reasonably necessary for calculating and collecting the
			 assessment.
By June 30th of each year, each
				Hospital and Ambulatory Surgical Center shall file a report with the Center
				that documents its GPSR for the prior year ended September
				30th;
(2)
Audits
. The
			 Center may audit data submitted under 957 CMR 3.05(1) to ensure
			 accuracy.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 3.00 - Assessment on certain health care providers and surcharge payors › Section 3.06 - Special Provisions

Current through Register 1525, July 5, 2024
(1)
Transfer of Ownership
. All liabilities to the Center
			 by a Hospital, Ambulatory Surgical Center or Surcharge Payor shall, in the case
			 of a transfer of ownership, be assumed by the successor.
(2)
Debt Collection
.
			 If a Hospital, Ambulatory Surgical Center or Surcharge Payor has maintained an
			 outstanding liability to the Center for a period longer than 120 days, the
			 Center will pursue all legal remedies available to it, including those
			 available under M.G.L. c. 7A, § 3.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 3.00 - Assessment on certain health care providers and surcharge payors › Section 3.07 - Compliance and Penalties

Current through Register 1525, July 5, 2024
The Center will provide written notice to Hospitals, Ambulatory
				Surgical Centers and Surcharge Payors that fail to comply with the reporting
				deadlines established in
				957 CMR
				3.00.
(1) The
			 Center will notify Hospitals, Ambulatory Surgical Centers and Surcharge Payors
			 that failure to respond within two weeks of the written notice, without just
			 cause, may result in penalties. In accordance with M.G.L. c. 12C, § 11,
			 Hospitals, Ambulatory Surgical Centers and Surcharge Payors may be subject to a
			 penalty of up to $1,000 per week for each week that they fail to provide the
			 required health care data and information, up to an annual maximum of
			 $50,000.
(2) Any remedy available
			 under 957 CMR 3.07 is in addition to other sanctions and penalties that may
			 apply under the provisions of other statutes and regulations.
(3) Hospitals, Ambulatory Surgical Centers
			 and Surcharge Payors that fail to comply with the requirements of
			 957 CMR
			 3.00 will be subject to all penalties and remedies
			 allowed by law and the Center will take all necessary steps to enforce 957 CMR
			 3.07, including a petition to the Superior Court for an order enforcing the
			 same.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 3.00 - Assessment on certain health care providers and surcharge payors › Section 3.08 - Administrative Bulletins

Current through Register 1525, July 5, 2024
The Center may issue administrative bulletins to clarify
				policies and understanding of substantive provisions of
				957 CMR
				3.00 and specify information and documentation
				necessary to implement
				957 CMR
				3.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 3.00 - Assessment on certain health care providers and surcharge payors › Section 3.09 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				957 CMR
				3.00 are severable. If any provision or the
				application of any provision to any Hospital, Ambulatory Surgical Center or
				Surcharge Payor is held to be invalid or unconstitutional, any such invalidity
				shall not be construed to affect the validity or constitutionality of any
				remaining provisions of
				957 CMR
				3.00 or the application of such provisions to any
				Hospital, Ambulatory Surgical Center or Surcharge Payor in circumstances other
				than those held invalid.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 4.00 - Uniform Provider Reporting Of The Standard Quality Measure Set › Section 4.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 957 CMR 4.00 governs the
			 establishment, use of, and uniform reporting requirements for certain health
			 care provider performance measures included in the Standard Quality Measure
			 Set.
(2)
Authority
.
			 957 CMR 4.00 is adopted
			 pursuant to M.G.L. c. 12C.
(3)
Effective Date
.
			 957 CMR 4.00 is effective July
			 1, 2013.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 4.00 - Uniform Provider Reporting Of The Standard Quality Measure Set › Section 4.02 - Definitions

Current through Register 1525, July 5, 2024
Meaning of Terms
: All defined terms in
				957 CMR 4.00 are capitalized.
				As used in
				957 CMR 4.00, unless the
				context otherwise requires, terms have the following meanings:
The Betsy Lehman Center
. The Betsy
				Lehman Center for Patient Safety and Medical Error Reduction established under
				M.G.L. c. 12C, § 15(b).
The Center
. The Center for Health
				Information and Analysis established under M.G.L. c. 12C.
Data Submission Manual
.
A Provider-specific
Data Submission Manual
containing
				detailed specifications and submission guidelines.
Home Health Agencies
. Home health
				agencies as defined by
				42
				U.S.C. 1395x(o) of the
				Social Security Regulations.
Hospitals
. The teaching hospital of
				the University of Massachusetts Medical School and any acute Hospital licensed
				under M.G.L. c. 111, § 51 that contains a majority of medical-surgical,
				pediatric, obstetric and maternity beds, as defined by the Department of Public
				Health.
Provider
. A Home Health Agency,
				Hospital, Registered Provider Organization, or Skilled Nursing Facility, as
				defined by 957 CMR 4.02:
Skilled Nursing Facilities
				(SNFs)
.
Quality Measure
. A mechanism to assign
				a quantity to quality of care by comparison to a criterion.
Registered Provider Organizations
				(RPOs)
. A Provider Organization that has been registered in
				accordance with M.G.L. c. 6D, § 11.
Skilled Nursing Facilities (SNFs)
. A
				Medicare-certified nursing facility that has a Medicare provider agreement
				pursuant to
				42
				CFR 488.301.
Standard Quality Measure Set (SQMS)
. A
				standard set of health care quality measures as determined by the Executive
				Director of the Center, following recommendations of the Statewide Quality
				Advisory Committee.
Statewide Quality Advisory Committee
.
				The committee as established under M.G.L. c. 12C, § 14.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 4.00 - Uniform Provider Reporting Of The Standard Quality Measure Set › Section 4.03 - Establishment and Use of Standard Quality Measure Set

Current through Register 1525, July 5, 2024
(1)
Standard Quality Measure
			 Set
. The Executive Director of the Center shall designate the
			 quality measures in the SQMS, subsequent to the annual recommendations from the
			 Statewide Quality Advisory Committee in accordance with M.G.L. c.
			 12C.
(2)
Provider Data
			 Submission
. Providers shall submit data necessary to calculate
			 Provider performance on SQMS measures identified by the Center using a uniform
			 methodology developed by the Center. Data shall be reported to either the
			 Center or the Betsy Lehman Center, as specified in the
Data Submission
			 Manual.
(3)
Reporting of Provider Performance
. The Center shall
			 publicly report Provider performance on the SQMS periodically.
(4)
Data Release
.
			 Public reports on Provider performance on the SQMS will be limited to
			 Provider-reviewed results aggregated to the reporting Provider level as defined
			 in
			 957 CMR
			 4.04.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 4.00 - Uniform Provider Reporting Of The Standard Quality Measure Set › Section 4.05 - Other Provisions

Current through Register 1525, July 5, 2024
(1)
Administrative and Technical Information Bulletins
.
(a) The Center may revise specifications or
			 other administrative requirements in the
Data Submission Manual
from time to time by notice or administrative bulletin.
(b) The Center may issue measure-specific
			 guidance on data collection from time to time by notice or administrative
			 bulletin. Providers will be given 30 days to provide written comments before
			 any revisions to the
Data Submission Manual
are
			 finalized.
(c) The Center shall
			 specify the quality measures and quality measure sets for which Providers are
			 not required to report data to the Center from time to time by notice or
			 administrative bulletin.
(d) The
			 Center shall specify the schedule for written comments, data collection, data
			 validation and data release from time to time by notice or administrative
			 bulletin.
(e) The Center may
			 specify data submission requirements for measures that cannot be calculated
			 from existing datasets from time to time by revising the
Data
			 Submission Manual.
(f) The
			 Center shall specify whether data shall be submitted to the Center or the Betsy
			 Lehman Center in the
Data Submission Manual.
(g) The Center may issue administrative
			 bulletins to clarify its policies and understanding of substantive provisions
			 of
			 957 CMR 4.00 and specify
			 information and documentation necessary to implement
			 957 CMR 4.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.01 - General Provisions

Current through Register 1525, July 5, 2024
Scope and Purpose
.
				957 CMR 5.00 governs the
				disclosure of certain payer data, hospital case mix data and hospital charge
				data submitted by health care payers and providers pursuant to M.G.L. c. 12C.
				The purpose of
				957 CMR 5.00 is to
				specify:
(a) the process by which data
			 will be released to certain requesters as required by M.G.L. c. 12C;
			 and
(b) the application and data
			 release process for all other requests for certain payer, hospital case mix and
			 hospital charge data collected and maintained by the Center for Health
			 Information and Analysis.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.03 - Requests from Government Agencies

Current through Register 1525, July 5, 2024
(1)
			 All Government Agency requests for Data shall be made in writing as set forth
			 in an agreement between the parties or as provided on CHIA's Website.
(2) When requesting Protected Health
			 Information, Government Agencies shall identify the public purposes for which
			 the Data is sought and the security measures designed to protect the Data from
			 inadvertent and/or unauthorized disclosure.
(3) CHIA shall fulfill Government Agency
			 requests for Protected Health Information to the extent permissible under state
			 and federal laws protecting patient privacy and data security. To the extent
			 required by such laws, Government Agencies may be required to establish to
			 CHIA's satisfaction that they are seeking the minimum amount of Protected
			 Health Information necessary to accomplish the public purpose for which access
			 to such data is given and that appropriate data security measures are in
			 place.
(4) Government Agencies
			 requesting Protected Health Information of Medicaid recipients will be required
			 to demonstrate compliance with 42 U.S.C. § 1396a(a)(7) to the satisfaction
			 of both CHIA and the Executive Office of Health and Human Services.
(5) Government Agencies requesting Medicare
			 Data will be required to demonstrate compliance with CMS requirements regarding
			 access and use of such Data.
(6)
			 Prior to the receipt of any Data, Government Agencies shall enter into a
			 written agreement with CHIA governing its use and disclosure.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.04 - Requests from Payers, Providers, Provider Organizations and Researchers for De-identified Data

Current through Register 1525, July 5, 2024
(1) Requests from
			 Payers, Providers, Provider Organizations and Researchers for De-identified
			 Data shall be made in writing by filing an application with CHIA in a form
			 specified by CHIA as provided on its Website.
(2) CHIA shall fulfill requests from Payers,
			 Providers, Provider Organizations and Researchers for De-identified Data based
			 upon an application that establishes to CHIA's satisfaction that the Data will
			 exclusively be used for the purposes of lowering total medical expenses,
			 coordinating care, benchmarking, quality analysis and other research,
			 administrative or planning purposes. Such purposes exclude purposes that CHIA
			 determines are contrary to the public interest.
(3) Payer, Provider, Provider Organization
			 and Researcher requests for De-identified Data for any other uses, including
			 commercial uses involving the resale or re-use of Data, shall be reviewed under
			 957 CMR
			 5.06.
(4) Payers, Providers, Provider Organizations
			 and Researchers shall enter into a Data Use Agreement with CHIA prior to the
			 receipt of Data. The Data Use Agreement shall, at a minimum:
(a) restrict the use of the Data to those
			 uses identified in the application;
(b) require the Data Recipient to adhere to
			 processes and procedures aimed at preventing unauthorized disclosure or use of
			 the Data;
(c) require the Data
			 Recipient to notify CHIA of any unauthorized use or disclosure of the Data;
			 and
(d) permit CHIA, at its
			 discretion, to audit the Data Recipient's compliance with the provisions of the
			 Data Use Agreement.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.05 - Requests from Payers, Providers and Provider Organizations for Data with Direct Patient Identifiers for Treatment and Coordination of Care

Current through Register 1525, July 5, 2024
(1) Payer, Provider
			 and Provider Organization requests for Data with Direct Patient Identifiers
			 shall be made in writing by filing an application with CHIA in a form specified
			 by CHIA as provided on its Website.
(2) CHIA shall fulfill Payer, Provider and
			 Provider Organization requests for Direct Patient Identifiers for Treatment and
			 Coordination of Care to the extent permissible under state and federal laws
			 protecting patient privacy and data security. Payers, Providers and Provider
			 Organizations may be required to establish to CHIA's satisfaction that Data
			 Subjects have consented to the release of the Data for the specific use
			 described in the Payer, Provider or Provider Organization's request.
(3) Payer, Provider and Provider Organization
			 requests for Protected Health Information for uses other than requests for
			 Direct Patient Identifiers for Treatment and Coordination of Care shall be
			 reviewed under
			 957 CMR
			 5.06.
(4) Payers, Providers and Provider
			 Organizations requesting Protected Health Information of Medicaid recipients
			 will be required to demonstrate compliance with 42 U.S.C. § 1396a(a)(7) to
			 the satisfaction of both CHIA and the Executive Office of Health and Human
			 Services.
(5) Payers, Providers and
			 Provider Organizations requesting Medicare Data will be required to demonstrate
			 compliance with CMS requirements regarding access to and use of such
			 Data.
(6) Payers, Providers and
			 Provider Organizations shall enter into a Data Use Agreement with CHIA prior to
			 the receipt of data with Direct Patient Identifiers. The Data Use Agreement
			 will strictly limit the use of such Data for Treatment and Coordination of Care
			 and will specify the security measures taken to protect the Data from further
			 disclosure. The Data Use Agreement shall also, at a minimum:
(a) commit the Data Recipient to return or
			 destroy the Data received from CHIA upon completion of the project for which
			 the use of the Data was approved. All Data destruction must comport with M.G.L.
			 c. 93I and any other applicable state or federal law;
(b) require the Data Recipient to adhere to
			 processes and procedures aimed at preventing unauthorized access, disclosure or
			 use of the Data;
(c) require the
			 Data Recipient to notify CHIA of any unauthorized use or disclosure of the
			 Data; and
(d) permit CHIA, at its
			 discretion, to audit the Data Recipient's compliance with the provisions of the
			 Data Use Agreement.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.06 - All Other Requests for Data

Current through Register 1525, July 5, 2024
(1) Requests for Data that do not fall under
			 the categories described in
			 957 CMR
			 5.03,
			 5.04
			 or
			 5.05
			 shall be made in writing by filing an application with CHIA in a form specified
			 by CHIA as provided on its Website.
(2) In any application for Data under 957 CMR
			 5.06, each Applicant shall:
(a) identify and
			 demonstrate a need for the Protected Health Information requested and for those
			 specific data elements CHIA deems necessary to protect individual
			 privacy;
(b) specify the purpose of
			 the request, including the intended use(s) of the Data, a detailed project
			 description that describes any other data sources to be used for the project
			 and, if applicable, the research methodology;
(c) specify security and privacy measures
			 that will be taken in order to safeguard patient privacy and prevent
			 unauthorized access to or use of the Data;
(d) specify the Applicant's methodology for
			 maintaining data integrity and accuracy; and
(e) describe how, or if, the results of the
			 Applicant's analysis will be published.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.07 - Requests for Summarized Data Reports

Current through Register 1525, July 5, 2024
(1) Applicants may request a report generated
			 by CHIA that is derived from Data (Summarized Data Reports). In determining
			 whether to compile such a report, CHIA will consider the public interest
			 served, the availability of its resources, the complexity of the request, and
			 privacy concerns,
i.e.,
that there is no more than a minimal
			 risk to individual privacy in the public release of the report.
(2) Summarized Data Reports will contain only
			 aggregate data (data summaries) and De-identified Data. Examples of Summarized
			 Data Reports include: counts; totals; rates per thousand; index values; and
			 other standardized metrics. Summarized Data Reports will be subject to CHIA's
			 cell suppression policy and accordingly no cell
(e.g.,
admittances, discharges, patients, services,
etc.)
less than
			 11 will be displayed, nor will percentages or other mathematical formulas
			 allowing calculation of a cell less than 11.
(3) The Executive Director or his or her
			 designee will approve or deny such requests. Such approval/denial is final and
			 not subject to further review or appeal.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.08 - Data Release Committee

Current through Register 1525, July 5, 2024
(1)
			 The Executive Director shall establish a Data Release Committee to advise the
			 Executive Director on best practices regarding data release, data security and
			 data protection.
(2) The Data
			 Release Committee shall include, but not be limited to, representatives from
			 health care plans, health care providers, health care provider organizations
			 and consumers. The Executive Director may appoint additional members to the
			 Committee.
(3) The Executive
			 Director shall convene the Data Release Committee as necessary to review
			 applications for Data and other issues related to the release of
			 Data.
(4) The Data Release
			 Committee shall review applications for Data submitted pursuant to
			 957 CMR
			 5.06.
(5) In reviewing each application for Data
			 submitted pursuant to
			 957 CMR
			 5.06, the Data Release Committee shall make a
			 recommendation to the Executive Director regarding whether the Applicant has
			 met the criteria for release specified in
			 957 CMR
			 5.06(9).
(6) CHIA will post information about the Data
			 Release Committee membership, scheduled meetings and meeting agendas on its
			 website.
(7) Data Release Committee
			 recommendations on applications are not binding on the Executive
			 Director.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.09 - Compliance and Penalties

Current through Register 1525, July 5, 2024
(1)
Sanctions
. If a Data Recipient fails to comply with
			 any of the requirements and conditions for receiving Data under
			 957 CMR 5.00, CHIA may:
(a) deny future access to Data;
(b) terminate current access to all Data;
			 and/or
(c) demand and secure the
			 destruction or return of all Data.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.10 - Administrative Bulletins

Current through Register 1525, July 5, 2024
CHIA may, from time to time, issue Administrative Bulletins to
				clarify its policies and procedures under
				957 CMR 5.00 and to establish
				fees.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.11 - Other Provisions

Current through Register 1525, July 5, 2024
(1)
Fees
. CHIA shall charge a fee to all non-governmental
			 entities requesting Data or a Summarized Data Report, as established under
			 M.G.L. c. 12C, § 12(b). Fee schedules will be issued by CHIA by
			 Administrative Bulletin and updated from time to time.
(2)
Other
			 Disclosures
. CHIA may make other disclosures of Data as required
			 by law including, but not limited to, disclosures made pursuant to Civil
			 Investigative Demands, law enforcement subpoenas or court orders.
(3)
Confidentiality
.
			 Data, as defined in
			 957 CMR 5.02,
			 released by CHIA pursuant to
			 957 CMR 5.00 are not a public
			 record.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.12 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				957 CMR 5.00 are severable. If
				any provision or the application of any provision is held to be invalid or
				unconstitutional, such invalidity shall not be construed to affect the validity
				or constitutionality of any remaining provisions of
				957 CMR 5.00 or the
				application of such provisions.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
.
			 957
			 CMR 6.00 governs the filing requirements for certain
			 Providers to report their costs and other data to the Center for Health
			 Information and Analysis.
(2)
Interpretation of Regulatory References
. Any
			 references to 114 CMR: Division of Health Care Finance and Policy shall, if
			 necessary, be construed as referring to analogous regulations issued by EOHHS
			 under the authority of M.G.L. c. 118E and appearing in 101 CMR: Executive
			 Office of Health and Human Services.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.03 - Reporting Requirements for Type I Providers

Current through Register 1525, July 5, 2024
Each Type I Provider shall file:
(1) An annual Uniform Financial Statement and
			 Independent Auditor's Report (UFR) completed in accordance with:
(a) The filing requirements and schedule of
			 808 CMR 1.00: Compliance,
			 Reporting and Auditing for Human and Social Services; and
(b) Any special instructions appearing in the
			 UFR Audit & Preparation Manual which may require that certain providers
			 distinguish among certain of their cost centers or programs by filing separate
			 UFR-Schedule Bs for each cost center or program; and
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.04 - Reporting Requirements for Type II Providers

Current through Register 1525, July 5, 2024
Each Type II Provider shall file the applicable reports listed
				in
				957
				CMR 6.00. Reports by Type II Providers are due within
				the timeframe specified by the Center or, if applicable, within the timeframe
				provided in
				957
				CMR 6.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.05 - Reporting Requirements for Type III Providers

Current through Register 1525, July 5, 2024
Each Type III Provider shall file upon request of the Center
				and within the timeframe specified by the Center a complete and accurate Cost
				Report, budget, certified financial statements, records and books relating to
				its operations, data or other information as the Center may reasonably
				require.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.06 - 340B Covered Entities

Current through Register 1525, July 5, 2024
Each 340B Covered Entity shall file within 90 days following
				the end of its fiscal year a complete and accurate Cost Report and certified
				financial statements in the format specified by the Center. Each Provider shall
				also make available within the timeframe specified by the Center all records
				and books relating to said operations, including such data, statistics, and
				records as the Center may from time to time request.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.07 - Adult Day Health

Current through Register 1525, July 5, 2024
An ADH Provider that was paid by a Governmental Unit for Adult
				Day Health Services provided in a prior Fiscal Year, and whose program operated
				for the entire prior fiscal year must submit the following information to the
				Center:
(1) A complete Adult Day
			 Health Center Cost Report for the prior Fiscal Year;
(2) Financial Statements certified by a
			 certified public accountant. In the absence of certified statements, the ADH
			 Provider may submit uncertified financial statements or a Balance Sheet and
			 Operating Statement prepared by the agency, and approved by the Center;
			 and
(3) Statistical data which
			 shall be designated by the Center, including but not limited to the total
			 number of resident days.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.08 - Home Health Services

Current through Register 1525, July 5, 2024
(1)
Required Reports
. Each Home Health Provider or Home
			 Health Agency must file the following information in a format specified by the
			 Center:
(a) The Nursing Service Cost Report
			 for the agency's most recent fiscal year; and
(b) A home health agency Cost Report (CMS
			 1728) in which the Continuous Skilled Nursing hours and costs are separated
			 from the Home Health skilled nursing visits, costs and other statistics, and
			 any supplemental schedules as supplied and/or required by the Center.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.09 - Intermediate Care Facilities

Current through Register 1525, July 5, 2024
(1)
			 On an annual basis, each ICF shall file with the Center one copy of the ICF
			 Cost Report in portable document format, within 120 days of the close of its
			 fiscal year. The ICF Cost Report is to be completed in accordance with the
			 instructions set forth therein and pursuant to requirements of Administrative
			 Bulletin 97-1 and any pertinent administrative bulletins issued by EOHHS
			 pursuant to
			 101 CMR
			 129.09: Administrative Bulletins.
(2) Each ICF shall file, when required, trial
			 balances and supplemental financial information to support the facility's ICF
			 Cost Report filing.
(3) Each ICF
			 shall make available all books and records relating to its operation for audit
			 and/or screening, if requested by the Center.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.10 - Ambulance Services

Current through Register 1525, July 5, 2024
Each Eligible Provider of Ambulance and Chair Car Services,
				except Governmental Units, shall complete and file an ambulance service Cost
				Report and supplemental schedules as specified by the Center and within 60 days
				of the close of the Provider's fiscal year. The submission must include
				financial statements audited, certified, reviewed or compiled by a certified
				public accountant or copies of tax returns filed with the Internal Revenue
				Service for the reporting year.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.11 - Community Health Centers

Current through Register 1525, July 5, 2024
(1)
Required Reports: Existing CHC Providers
.
(a) Unless exempted, each CHC shall file with
			 the Center the following information in a format specified by the Center:
1.A community health center Cost Report and
			 any supplemental schedules as supplied and/or required by the Center;
			 and
2.A financial statement
			 certified by a certified public accountant. In the absence of certified
			 statements, the agency may submit uncertified statements or a Balance Sheet and
			 Operating Statement prepared by the health center;
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.13 - Resident Care Facilities

Current through Register 1525, July 5, 2024
(1)
Required Reports
.
(a)
Resident Care Facility Cost Report
. Each Resident Care
			 Facility must complete and file a Residential Care Cost Report each calendar
			 year with the Center, containing the Resident Care Facility's claim for
			 reimbursement and the complete financial condition of the Resident Care
			 Facility, including all applicable management company, central office, and real
			 estate expenses.
(b)
Realty Company Cost Report
. A Resident Care Facility
			 that does not own the real property of the Resident Care Facility, and pays
			 rent to an affiliated or non-affiliated realty trust or other business entity,
			 must file or cause to be filed a realty company Cost Report with the Center. If
			 no report is filed, the Center will recommend that EOHHS should not reimburse
			 the costs associated with the Resident Care Facility's rental
			 expense.
(c)
Management
			 Company Cost Report
. A Resident Care Facility that claims
			 management or central office expenses must file a separate management company
			 Cost Report with the Center for each entity for which it claims management or
			 central office expenses. If these costs are claimed for reimbursement, the
			 Resident Care Facility must certify that costs are reasonable and necessary for
			 the care of Publicly-aided Residents in Massachusetts.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.15 - Additional Information

Current through Register 1525, July 5, 2024
Each Provider shall also make available all records, books and
				reports relating to its operations, including such data and statistics as the
				Center may from time to time request, whether or not that Provider is of a type
				specifically listed in
				957
				CMR 6.00 or
				957
				CMR 6.00: Appendix A.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.16 - Accuracy of Reported Data

Current through Register 1525, July 5, 2024
All reports, schedules, additional information, books and
				records that are filed or made available to the Center will be certified under
				the penalties of perjury as true, correct, and accurate by the Executive
				Director, Financial Officer, owner, partner, or other officer or director of
				the Provider, as the Center may specify.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.17 - Audits

Current through Register 1525, July 5, 2024
The Center may conduct Desk Audits or Field Audits to ensure
				accuracy and consistency in reporting. Providers may be required to submit
				additional data and documentation relating to the Cost Report, the operations
				of the Provider and any Related Party as requested during a Desk or Field Audit
				even if the Center has accepted the Provider's Cost Reports. All Providers must
				maintain supporting documentation sufficient to demonstrate compliance with all
				provisions of
				957
				CMR 6.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.18 - Extensions of Deadlines, Exemptions from Filing and Alternate Cost Reports

Current through Register 1525, July 5, 2024
(1) The Center may
			 at its discretion grant allowances that:
(a)
			 Extend the filing due date to any Provider;
(b) Exempt any Provider from some or all of
			 the Cost-Reporting requirements of
			 957
			 CMR 6.00; or
(c) Allow any Provider to file alternate Cost
			 Reports in lieu of the Cost Reports specified in
			 957
			 CMR 6.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.19 - Penalties

Current through Register 1525, July 5, 2024
(1) The Center may
			 impose a fine of up to $500 on Providers that knowingly fail to file or that
			 knowingly file falsified data.
(2)
			 If a Provider has without justifiable cause refused to furnish the Center with
			 information, as required by
			 957
			 CMR 6.00, the Center may petition the Superior Court
			 to issue an order directing all Governmental Units to withhold payment to the
			 Provider until further order of the Court.
(3) The Center may refer delinquent Providers
			 to EOHHS, with recommendations that EOHHS impose penalties, including:
(a) Reduction in delinquent Providers'
			 rates;
(b) Removal of delinquent
			 Providers from the list of eligible Providers;
(c) Any other penalty authorized by M.G.L. c.
			 118E or applicable regulations.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.20 - Administrative Bulletins

Current through Register 1525, July 5, 2024
The Center may issue Administrative Bulletins to clarify its
				policies on and understanding of substantive provisions of
				957
				CMR 6.00 and to specify information and documentation
				necessary to implement
				957
				CMR 6.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Section 6.21 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				957
				CMR 6.00 are severable. If any provision or the
				application of any provision is held to be invalid or unconstitutional, such
				invalidity shall not be construed to affect the validity or constitutionality
				of any remaining provisions of
				957
				CMR 6.00 or the application of such
				provisions.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 6.00 - Cost Reporting Requirements › Appendix A

Current through Register 1525, July 5, 2024
Part 1 - Type I Providers
101 CMR 356.00: Money
				Follows the Person Demonstration Services
101 CMR
				357.00: Money Follows the Person Waiver Services
101 CMR 411.00: Placement and Support Services
101 CMR 412.00: Family Transitional Support Services
101 CMR 414.00: Family
				Stabilization Services
101 CMR 417.00: Certain
				Elder Care Services
101 CMR 418.00: Youth
				Short-term Stabilization and Emergency Placement Services
101 CMR 419.00: Supported
				Employment Services
101 CMR 420.00: Adult Long
				Term Residential Services
101 CMR 346.00: Substance
				Abuse Programs
101 CMR 352.00: Children's
				Behavioral Health Services
114. 3 CMR 6.00: Mental Health Services Provided in Community
				Health Centers and Mental
Health Centers
114. 3 CMR 7.00: Psychiatric Day Treatment Center Services
114. 3 CMR 8.00: Outpatient Tuberculosis Control Center
				Services
114. 3 CMR 9.00: Independent Living Services for the Personal
				Care Attendant Program
114. 3 CMR 48.00: Day Habilitation Program Service
114. 3 CMR 49.00: Early Intervention Program Services
114. 3 CMR 54.00: Acquired Brain Injury Waiver and Related
				Services
114. 4 CMR 10.00: Competitive Integrated Employment Services
				114. 4 CMR 13.00: Youth Intermediate-term Stabilization Services 114. 4 CMR
				15.00: Community Based Day Support Services
114. 4 CMR 16.00: Clubhouse Services
Part II - Type III Providers
101 CMR 334.00: Prostheses,
				Prosthetic Devices and Orthotic Devices
101 CMR
				343.00: Hospice Services
114. 3 CMR 13.00: Freestanding Clinics Providing Abortion and
				Sterilization Services
114. 3 CMR 20.00: Clinical Laboratory Services
114. 3 CMR 22.00: Durable Medical Equipment, Oxygen, and
				Respiratory Therapy Equipment
114. 3 CMR 31.00: Prescribed Drugs
114. 3 CMR 37.00: Chronic Maintenance Dialysis Treatments and
				Home Dialysis Supplies
114. 3 CMR 39.00: Rehabilitation Center Services, Audiological
				Services, Restorative Services
114. 3 CMR 47.00: Freestanding Ambulatory Surgical Facilities
114. 3 CMR 55.00: Freestanding Birth Centers Services
114. 5 CMR 4.00: Social, Rehabilitation and Health Care
				Services 101 CMR [Pending]: Group Adult Foster Care
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 7.00 - Nursing Facilities Cost Reporting Requirements › Section 7.03 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Cost Reports
.
(a)
Nursing Facility Cost
			 Report
. Each Provider must complete and file a Nursing Facility
			 cost report each calendar year with the Center. The Nursing Facility cost
			 report must contain the complete financial condition of the Provider, including
			 all applicable management company, central office, and real estate expenses. If
			 a Provider has closed on or before November 30th,
			 the Provider is not required to file an HCF-1 report.
(b)
Realty Company Cost
			 Report
. A Provider that does not own the real property of the
			 Nursing Facility and pays rent to an affiliated or non-affiliated realty trust
			 or other business entity must file or cause to be filed a realty company cost
			 report with the Center.
(c)
Management Company Cost Report
. A Provider must file a
			 separate management company cost report with the Center for each entity for
			 which it reports management or central office expenses related to the care of
			 Massachusetts Publicly-aided Residents. If the Provider identifies such costs,
			 the Provider must certify that costs are reasonable and necessary for the care
			 of Publicly-aided Residents in Massachusetts.
(d)
Financial
			 Statements
. If a Provider or its parent organization is required
			 or elects to obtain independent audited financial statements for purposes other
			 than
			 957 CMR 7.00, the Provider
			 must file a complete copy of its audited financial statements with the Center,
			 that most closely correspond to the Provider's Nursing Facility cost report
			 fiscal period. If the Provider or its parent organization does not obtain
			 audited financial statements but is required or elects to obtain reviewed or
			 compiled financial statements for purposes other than
			 957 CMR 7.00, the Provider
			 must file with the Center a complete copy of its financial statements that most
			 closely correspond to the Nursing Facility cost report fiscal period. Financial
			 statements must accompany the Provider's Nursing Facility cost report filing.
			 Nothing in this section shall be construed as an additional requirement that
			 nursing homes complete audited, reviewed, or compiled financial statements
			 solely to comply with the Center's reporting requirements.
(e)
CMS-2540
			 Reports
. State operated Nursing Facilities that meet the
			 definition in
			 42 CFR
			 433.50(a)(i) must file a
			 CMS-2540 report with the Center annually. The State operated Nursing Facility
			 must report the final disposition made by the Medicare intermediary.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 7.00 - Nursing Facilities Cost Reporting Requirements › Section 7.04 - Filing Deadlines

Current through Register 1525, July 5, 2024
(1)
General
. Except as provided below, Providers must file
			 required Cost Reports for the calendar year by 5:00 P.M. of April
			 1st of the following calendar year. If April
			 1st falls on a weekend or holiday, the reports are
			 due by 5:00 P.M. of the following business day.
(a)
Hospital-based Nursing
			 Facilities
. Hospital-based Nursing Facilities must file Cost
			 Reports no later than 90 days after the close of the hospital's fiscal
			 year.
(b)
Appointment
			 of a Resident Protector Receiver
. If a receiver is appointed
			 pursuant to M.G.L. c. 111, § 72N, the Provider must file Cost Reports for
			 the current reporting period or portion thereof, within 60 of the receiver's
			 appointment.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 7.00 - Nursing Facilities Cost Reporting Requirements › Section 7.05 - Incomplete Submissions

Current through Register 1525, July 5, 2024
If the Cost Reports are incomplete, the Center will notify the
				Provider in writing within 120 days of receipt. The Center will specify the
				additional information that the Provider must submit to complete the Cost
				Reports. The Provider must file the required information within 25 days of the
				date of notification or by April 1st of the year the
				Cost Reports are filed, whichever is later. If the Center fails to notify the
				Provider within the 120-day period, the Cost Reports will be considered
				complete and will be deemed to be filed on the date of
				receipt.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 7.00 - Nursing Facilities Cost Reporting Requirements › Section 7.06 - Audits

Current through Register 1525, July 5, 2024
The Center and EOHHS may conduct Desk Audits or Field Audits to
				ensure accuracy and consistency in reporting. Providers must submit additional
				data and documentation relating to the cost report, the operations of the
				Provider and any Related Party as requested during a Desk or Field Audit even
				if the Center has accepted the Provider's Cost Reports.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 7.00 - Nursing Facilities Cost Reporting Requirements › Section 7.07 - Penalties

Current through Register 1525, July 5, 2024
(1) The Center may
			 impose a fine of up to $500 on Providers that knowingly fail to file or that
			 knowingly file falsified data.
(2)
			 If a Provider has without justifiable cause refused to furnish the Center with
			 information as required by
			 957 CMR 7.00, the Center may
			 petition the Superior Court to issue an order directing all Governmental Units
			 to withhold payment to the Provider until further order of the Court.
(3) The Center may refer delinquent Providers
			 to EOHHS, with recommendations that EOHHS impose penalties, including:
(a) Reduction in delinquent Providers'
			 rates;
(b) Removal of delinquent
			 Providers from the list of eligible Providers; and
(c) Any other penalty authorized by M.G.L. c.
			 118E or applicable regulations.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 7.00 - Nursing Facilities Cost Reporting Requirements › Section 7.08 - Administrative Bulletins

Current through Register 1525, July 5, 2024
The Center may issue Administrative Bulletins to clarify its
				policies on and understanding of substantive provisions of
				957 CMR 7.00 and to specify
				information and documentation necessary to implement the data collection
				requirements of
				957 CMR 7.00. Such bulletins
				shall be deemed to be incorporated in the provisions of
				957 CMR
				7.00.