Code of Massachusetts Regulations › 104 CMR - DEPARTMENT OF MENTAL HEALTH › Title 104 CMR 30.00 - Fiscal Administration › Section 30.08 - Massachusetts Child Psychiatry Access Program Assessment

Current through Register 1525, July 5, 2024
(1)
Scope and
			 Purpose
.
			 104
			 CMR 30.08 governs the procedures for
			 collecting an assessment to fund the Massachusetts Child Psychiatry Access
			 Program (MCPAP) Assessment. The assessment is a surcharge on certain payments
			 made to Massachusetts acute hospitals and ambulatory surgical
			 centers.
(2)
Definitions
.
Ambulatory Surgical Center
. Any
				distinct entity located in Massachusetts that operates exclusively for the
				purpose of providing surgical services to patients not requiring
				hospitalization and meets the U.S. Centers for Medicare and Medicaid (CMS)
				requirements for participation in the Medicare program.
Ambulatory Surgical Center Services
.
				Services described for purposes of the Medicare program pursuant to
				42 U.S.C. §
										1395k(a)(2)(F)(i). These
				services include only facility services and do not include physician
				fees.
Department
. The Massachusetts
				Department of Mental Health.
Department of Public Health
. The
				Massachusetts Department of Public Health.
General Appropriations Act
. The act of
				the General Court, or any subsequent amendment or supplemental act enacting the
				Commonwealth's fiscal year budget.
Hospital
. An 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.
Hospital Services
. Services listed on
				an acute hospital's license issued by the Department of Public Health.
Indirect Payment
. A payment made by a
				payer to a group of providers, including one or more Massachusetts acute care
				hospitals or ambulatory surgical centers, that then forward the payment to
				member hospitals or ambulatory surgical centers; or a payment made to an
				individual to reimburse him or her for a payment made to a hospital or
				ambulatory surgical center.
Managed Care Organization
. A managed
				care organization as defined in M.G.L. c. 118E, § 64.
Medicaid
. The medical assistance
				program administered by the Executive Office of Health and Human Services
				Office of Medicaid pursuant to M.G.L. c. 118E and in accordance with Titles XIX
				and XXI of the Federal Social Security Act, and a Section 1115 Demonstration
				Waiver.
Medicare Program
. The medical
				insurance program established by Title XVIII of the Social Security Act.
Payer
. A surcharge payer that meets
				the criteria set forth in
				104
				CMR 30.08(4)(b).
Payment
. A check, draft, or other
				paper instrument, an electronic fund transfer, or any order, instruction, or
				authorization to a financial institution to debit one account and credit
				another.
Payments Subject to Surcharge
. All
				amounts paid, directly or indirectly, by surcharge payers to acute hospitals
				for health services and ambulatory surgical centers for ambulatory surgical
				center services; provided however, that it shall not include:
(a) payments, settlements and judgments
			 arising out of third-party liability claims for bodily injury which are paid
			 under the terms of property or casualty insurance policies; and
(b) payments made on behalf of Medicaid
			 recipients, Medicare beneficiaries or persons enrolled in policies issued under
			 M.G.L. c. 176K or similar policies issued on a group basis; provided further,
			 that it shall include payments made by a managed care organization on behalf
			 of:
1. Medicaid recipients younger than 65
			 years old; and
2. enrollees in the
			 Commonwealth care health insurance program; and provided further, that it may
			 exclude amounts established under regulations promulgated by the Department for
			 which the costs and efficiency of billing a surcharge payer or enforcing
			 collection of the surcharge from a surcharge payer would not be cost
			 effective.
Surcharge
. The surcharge on payments
				made to hospitals and ambulatory surgical centers established by M.G.L. c.
				118E, § 68.
Surcharge Payer
. An individual or
				entity that pays for or arranges for the purchase of health care services
				provided by acute hospitals and ambulatory surgical center services provided by
				ambulatory surgical centers; provided however, that it shall include a managed
				care organization; and provided further, that it shall not include Title XVIII
				and Title XIX programs and their beneficiaries or recipients, other
				governmental programs of public assistance and their beneficiaries or
				recipients and the workers' compensation program established under M.G.L. c.
				152.
Third-party Administrator
. An entity
				that administers payments for health care services on behalf of a client plan
				in exchange for an administrative fee. A third-party administrator may provide
				client services for a self insured plan or an insurance carrier's plan. A
				third-party administrator will be deemed to use a client plan's funds to pay
				for health care services whether the third-party administrator pays providers
				with funds from a client plan, with funds advanced by the third-party
				administrator subject to reimbursement by the client plan, or with funds
				deposited with the third-party administrator by a client plan.