reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 113 CMR - HEALTH FACILITIES APPEALS BOARD › Title 113 CMR 1.00 - Rules Of Procedure › Section 1.02 - Commencement of Appeals

Current through Register 1525, July 5, 2024
(1)
Rule 4 -- Claims of Appea
l. Every appeal shall be commenced by the filing of six copies of a claim of appeal, so entitled, which shall state the name and address of the appellant, the names and addresses of all other parties, the specific matter or matters in which the appellant alleges to be aggrieved, the complete grounds and justification of the appeal, and whether suspension of 113 CMR 1.02(6) is sought and, if so, the basis for such request. The claim shall, when filed by ten taxpayers, also designate a spokesman from among their number, or an attorney who will represent them, and his business address. Defects in appeals shall be subject to provisions of 113 CMR 1.02(5).
(2)
Rule 5 -- Answers to Claims of Appea
l. Each party shall have the right to file an answer to a claim of appeal within 14 days after service of a copy of such claim upon the party. Any allegation contained in the claim shall be deemed denied by any party unless specifically admitted in an answer filed by the party.
(3)
Rule 6 -- Signatures
. Every paper filed or served pursuant to 113 CMR 1.02(4) shall be signed by the party making such filing or service or by his attorney. Such signature shall constitute certification by the signer that he has read the document, that to the best of his knowledge, information and belief there is good ground to support it, and that it is not interposed for delay.
(4)
Rule 7 -- Filing and Service of Papers
.
(a) Service of any paper relating to an appeal, including any claim of appeal, notice, motion, brief, or decision, shall be filed with the Board and, except for the record designated in accordance with 113 CMR 1.03(1), shall be served simultaneously by hand delivery or by first-class mail, postage prepaid, upon every party to the appeal.
(b) All papers filed with the Board shall be delivered by hand, or mailed first-class, to the Board's agent for filing at Room #980, Boston University School of Law, 765 Commonwealth Avenue, Boston, MA 02215 c/o William Kaleva, Administrator. A paper shall be deemed to be filed on the date stamped "Received" by the Board's agent for filing, provided that the paper contains a title indicating the appeal to which the paper relates and the names of all parties to the appeal. All papers shall be filed six copies.
(c) Whenever a paper is filed with the Board or with a hearing officer of the board, the person making such filing shall attach thereto a certificate that he has served a copy on all parties, as required by this rule. The certification shall list all such parties by name and address, and phone number , if available.
Code of Massachusetts Regulations › 113 CMR - HEALTH FACILITIES APPEALS BOARD › Title 113 CMR 1.00 - Rules Of Procedure › Section 1.03 - Conduct of Appeals

Current through Register 1525, July 5, 2024
(1)
Rule 11 -- Argument
.
(a) Parties shall have a right to argue appeals orally, but under such limitations regarding time and scope as may be imposed by the Board.
(b) Each party is encouraged to submit argument in writing to the Board in support of its claim of appeal or answer, as the case may be, provided that every such written argument is filed in six copies.
Code of Massachusetts Regulations › 113 CMR - HEALTH FACILITIES APPEALS BOARD › Title 113 CMR 2.00 - GENERAL INFORMATION › Section 2.01 - Description of Board and its Operation

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose of 113 CMR
. 113 CMR includes regulations adopted by the Health Facilities Appeals Board, in 113 CMR called the Board.
(2)
Scope and Purpose of 113 CMR 2.01
. 113 CMR 2.01 includes regulations describing the Board and it's operations.
(3)
Health Facilities Appeals Board
. The Board was established by M.G.L. c. 6, § 166, which took effect on June 1, 1972. It consists of five members appointed by the Governor for terms of three years. Three members are consumers of health care services who are not officers or employees of, and do not bear any fiduciary relationship to, a person or institution providing health care services. One such consumer member is an attorney and is designated by the Governor to serve as chairman of the Board.
(4)
Location, Hours, Telephone Number and Zip Code
. The offices of the Board are located at Rm. #980, Boston University School of Law, 765 Commonwealth Avenue, Boston, MA 02215 c/o William Kaleva, Administrator. Office hours are from 9:00 A.M. to 5:00 P.M., Monday through Friday, except legal holidays, the telephone number is (617) 353-2794. The postal zip code is 02215.
(5)
General Authority of the Board
. The Board hears appeals from determinations of need rendered by the Department of Public Health, in 113 CMR called the Department. Such appeals are filed under and governed by M.G.L. c. 111, § 25E. The Board issues final decisions in such appeals either denying the appeal or ordering the matter remanded to the Department for action consistent with the opinion of the Board.
(6)
Authority
. Each agency is required by M.G.L. c. 30A, § 6A to "make available for inspection ... a descriptive statement ... of its organization." This part is adopted to comply with this requirement.
Code of Massachusetts Regulations › 113 CMR - HEALTH FACILITIES APPEALS BOARD › Title 113 CMR 2.00 - GENERAL INFORMATION › Section 2.02 - Definitions

Current through Register 1525, July 5, 2024
Meaning of Terms in 113 CMR
. As used in 113 CMR unless the context otherwise requires, terms shall have the meaning ascribed in 113 CMR 2.02.
Board
. "Board" means the Health Facilities Appeals Board.
Department
. "Department" means the Department of Public Health.
Determination of Need
. "Determination of Need" means the issuance of:
(a) a Certification of Need constituting official written notification of the Department of a determination that need exists for a project, in whole of in part, and containing the conditions incident to such determination; or
(b) an official notification that no need for a project has been found by the Department.
Paper
. "Paper" means an appeal, motion, brief or any other document relating to an appeal except the record designated in accordance with 113 CMR 1.03(7).
Comparable Applications
. "Comparable Applications" are those regular applications filed in the same filing period which propose similar or reasonably interchangeable health care services for applicable service areas which are the same in whole or in significant part.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope, Purpose and Effective Date
. 114. 1 CMR 39.00
			 governs the rates of payment effective October 1, 1996 for all care and
			 services rendered to publicly-assisted patients by Chronic and Rehabilitation
			 hospitals. 114. 1 CMR 39.00 also governs the fee for Residential Alcoholism
			 Treatment Programs.
114.1 CMR 39.00 does not
			 govern establishment of Medicaid and industrial accident rates of payment for
			 psychiatric, substance abuse or state-owned hospitals. 114. 1 CMR 39.00 does
			 govern establishment of Medicaid and Industrial accident rates of payment for
			 pediatric specialty hospitals which provide chronic and rehabilitation services
			 to pediatric patients.
114.1 CMR
			 39.00 does not apply to payments made to a chronic/rehabilitation hospital
			 under a direct contract with the Division of Medical Assistance for managed
			 care services provided to Medicaid recipients who are inpatients of such
			 hospital.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.03 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports.
(a)
			 Each hospital shall file with the Division , for each fiscal year, the
			 following documents, within 120 of the close of its fiscal year. The RSC-403
			 report is to be completed in accordance with the instructions set forth therein
			 and pursuant to requirements of 114. 1 CMR 4.00 and any pertinent
			 administrative bulletins issued by the Division.
1. two paper copies of its Hospital Statement
			 of Costs, Revenues, and Statistics, RSC-403,
2. one electronic copy of its Hospital
			 Statement of Costs, Revenues, and Statistics, RSC-403, and
3. two copies of a hospital's audited
			 financial statements.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.04 - Rates of Payment to Publicly Assisted Patients

Current through Register 1525, July 5, 2024
(1)
Payment Rates
. Payment for Inpatient Services to
			 Publicly Assisted Patients will be made at the Inpatient Rate determined
			 pursuant to 114. 1 CMR 39.05. Payment for Outpatient Services to Publicly
			 Assisted Patients will be made at the Outpatient Rate determined pursuant to
			 114. 1 CMR 39.06.
(2)
Applicability
. Rates of payment determined under the
			 rules of 114. 1 CMR 39.04 include:
(a)
			 Payment for all inpatient and outpatient hospital care and services which are
			 provided by a chronic/rehabilitation hospital to publicly-assisted
			 patients.
(b) Payment for
			 Administrative Days which are provided by a hospital to publicly-assisted
			 patients under Title XIX of the Social Security Act.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.05 - Determination of Inpatient Rate

Current through Register 1525, July 5, 2024
(1)
General
. The Division will determine an Inpatient Rate
			 for each chronic/rehabilitation hospital. Except for new hospitals and
			 hospitals which have closed the facility and now provide some services at a new
			 location under new management, the methodology for determining the Inpatient
			 Rate for non-Administrative Day Patients is set forth in 114. 1 CMR 39.05(2).
			 The methodology for determination of Inpatient Rate for new hospitals and
			 hospitals which have closed the facility and now provide some services at a new
			 location under new management is set forth in 114. 1 CMR 39.05(3). The rates
			 for Administrative Day Patients are set forth in 114. 1 CMR 39.05(4).
(2)
Determination of the
			 Inpatient Rate
.
(a)
Data Sources.
1. The
			 base year for Allowable Inpatient Costs will be FY 1993, and the Division will
			 utilize the costs reported in the FY 1993 RSC-403 cost report. For hospitals
			 which converted a majority of beds to long-term care beds during FY 1993, the
			 base year for Allowable Inpatient Costs will be FY 1994 deflated to FY 1993,
			 and the Division will utilize the costs reported in the FY 1994 RSC-403,
			 deflated to FY 1993 using a FY 1993 - FY 1994 inflation factor calculated
			 pursuant to the methodology set forth in 114. 1 CMR 39.05(2)(c)2.
2. Allowable Inpatient Costs include only
			 costs incurred or to be incurred in the provision of hospital care and
			 services, supplies and accommodations and determined in accordance with the
			 Principles of Reimbursement for Provider Costs under 42 U.S.C. §§ 1395
et seq
. as set forth in 42 CFR 413
et seq
. and
			 the Provider Reimbursement Manual, the HURM Manual, and Generally Accepted
			 Accounting Principles. Except where noted, all references to specific
			 Schedules, Columns and Lines of the RSC-403 are to the FY 1993 version of the
			 RSC-403.
3. The Division may adjust
			 reported costs used to determine Allowable Inpatient Costs upon audit of the
			 hospital's RSC-403. The Division may also request additional information, data
			 and documentation from the hospital as necessary to calculate rates. Failure to
			 submit the requested information in a timely manner will result in the
			 application of penalties as determined by 114. 1 CMR 39.03(2).
4. If the specified data source is
			 unavailable or inadequate, the Division will determine and use the best
			 alternative data source and/or shall perform a statistical analysis to ensure
			 comparability of data.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.06 - Determination of Publicly Assisted Outpatient Rate

Current through Register 1525, July 5, 2024
(1) The Outpatient Rate for services provided
			 to publicly-aided patients will be an approved Cost-to-Charge Ratio which will
			 be determined for each hospital as follows:
(a) The Division will determine the actual FY
			 1993 operating and capital costs of providing Outpatient services as reported
			 in the RSC-403. The Division may adjust this amount upon audit.
(b) The Division will determine the actual FY
			 1993 charges for providing Outpatient services as reported in the RSC-403. The
			 Division may adjust this amount upon audit.
(c) The FY 1996 approved Cost-to-Charge Ratio
			 will be hospital's actual FY 1993 outpatient cost divided by the hospital's
			 actual FY 1993 outpatient charges.
(d) For Hospitals that have a FY 1996
			 approved Cost-to-Charge Ratio, the FY 1997 approved Cost-to-Charge Ratio will
			 be the FY 1996 approved Cost-to-Charge Ratio unless adjusted as described below
			 or until it is superseded by new regulation or contract with the Division of
			 Medical Assistance.
1. Determination of the
			 Medicaid Cost-to-Charge shall be made in accordance with the information filed
			 on the Hospital DHCFP-450 Form.
2.
			 The Cost-to-Charge Ratio shall be adjusted downward prospectively, pro-rated
			 for months remaining in the rate year, if the charge per visit as reported in
			 the Hospital DHCFP-450 Form increases beyond the FY 1996 to FY 1997 inflation
			 factor as calculated pursuant to the methodology in 114. 1 CMR 39.05(2)(c)2.
a. The adjustment factor shall equal the
			 inflation factor divided by the sum of one plus the percent increase in
			 charges.
b. The pro-rated
			 adjustment shall be determined as follows:
i.
			 Step One:
a) the adjustment factor multiplied
			 by the total number of months in the year that the increased charges are in
			 effect less b) the number of months that the increased charges are in effect
			 before the adjusted CCR will take effect.
ii. The pro-rated adjustment shall equal Step
			 One of the adjustment as calculated pursuant to 114. 1 CMR 39.06(1)(d)2.b.i.
			 divided by the number of months remaining in the year after the adjusted CCR
			 will take effect.
c. The
			 Adjusted Cost-to-Charge Ratio shall be the FY 1996 approved Cost-to-Charge
			 Ratio multiplied by the pro-rated adjustment factor as calculated pursuant to
			 39.06(1)(d)2.b.ii.
d. The Adjusted
			 Cost-to-Charge Ratio shall take effect the first day of the month following the
			 Division's approval.
(e) For Hospitals that do not have a FY 1996
			 approved Cost-to-Charge Ratio, the FY 1997 approved cost-to-Charge Ratio will
			 be the ratio of allowed outpatient costs, as determined by the Division, to
			 projected outpatient revenue.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.07 - Medicaid Disproportionate Share Adjustments

Current through Register 1525, July 5, 2024
The Medicaid program will assist hospitals which carry a
				disproportionate financial burden of caring for the uninsured and low income
				persons of the Commonwealth. In accordance with Title XIX rules and
				requirement, Medicaid will make an additional payment adjustments to hospitals
				which qualify for such an adjustment under any one or more of the following
				classification. Eligibility requirements for each type of disproportionate
				share adjustment and the methodology for calculating these adjustments are
				described in 114. 1 CMR 39.07.
(1) To
			 qualify for any type of disproportionate payment adjustment, a hospital must
			 have a Medicaid inpatient utilization rate (calculated by dividing Medicaid
			 patient days by total patient days) of not less than 1%.
(2) The total of all disproportionate share
			 payments awarded to a particular hospital under 114. 1 CMR 39.07 shall not
			 exceed the costs incurred during the year of furnishing hospital services to
			 individuals who either are eligible for Medicaid or have no health insurance or
			 source of third part coverage, less payments by Medicaid and by uninsured
			 patients.
(3)
Data
			 Sources
. The Division shall determine for each fiscal year a
			 federally-mandated Medicaid disproportionate share adjustment, for all eligible
			 hospitals, using the data and methodology described below. The Division shall
			 use the following data sources in its disproportionate share adjustment, unless
			 the specified data source is unavailable. If the specified data source is
			 unavailable, the Division shall determine and use the best alternative data
			 source.
(a) The prior year RSC-403 report
			 shall be used to determine Medicaid days, total days, Medicaid inpatient net
			 revenues, total inpatient net revenues, total inpatient charges and free care
			 charge-offs. If said RSC-403 report is not available, the Division shall use
			 the most recent available previous RSC-403 report to estimate these
			 variables.
(b) The hospital's
			 audited financial statements for the prior year shall be used to determine the
			 state and/or local government cash subsidy.
(c) The prior year claims data residing on
			 the Division of Medical Assistance's Massachusetts Medicaid Information System
			 shall be used to determine exceptionally high costs and exceptionally long
			 lengths of stay for the outlier adjustment for medically necessary inpatient
			 hospital services involving exceptionally high costs or exceptionally long
			 lengths of stay of individuals under six years of age pursuant to 114. 1 CMR
			 39.07(7).
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.08 - Administrative Adjustment to Inpatient Per Diem Rate

Current through Register 1525, July 5, 2024
(1) A hospital may apply for a discretionary
			 administrative adjustment to its Inpatient Per Diem Rate. Any such application,
			 except for those related to New Governmental Requirements and Disaster Losses,
			 must be based upon the grounds set forth below and must be filed within 90 days
			 of initial rate approval to receive consideration. Applications for New
			 Governmental Requirements and Disaster Losses must be based upon the grounds
			 set forth below and must be filed within 60 days from the date the costs were
			 incurred to receive consideration. Except for adjustments granted for
			 Mechanical Error, adjustments shall be effective on the later of 1) the
			 beginning of the quarter (October 1, January 1, April 1, July 1) in which a
			 complete application is received or 2) the date the costs will be incurred.
			 Adjustments granted for Mechanical Error shall be effective on the date the
			 rate containing the error went into effect Adjustments granted for New
			 Governmental Requirements and Disaster Losses shall be effective on the date
			 the costs were incurred.
(2) In
			 order to qualify for an administrative adjustment, the hospital must
			 demonstrate the following:
(a) the timing and
			 amount of the increase in costs is reasonably certain; and
(b) the category of cost for which an
			 administrative adjustment is sought is not included in the base year
			 cost;
(c) the amount requested is
			 greater than 1% of the hospital's total patient care costs. Multiple unrelated
			 requests for administrative adjustments may be grouped together to meet the
			 materiality limit; however, each individual item must equal or exceed 1/10 of
			 1% (.10%).
(d) the adjustment is
			 necessary for the appropriate provision of services. The Division will consider
			 a cost "necessary" only if it can be demonstrated to the satisfaction of the
			 Division that such costs cannot be met through efficient management and
			 economic operation at the existing reimbursable cost level.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.09 - Fee for Residential Alcoholism Treatment Programs

Current through Register 1525, July 5, 2024
(1)
Fee
. The fee for
			 a residential alcoholism treatment program shall be equal to the actual charge
			 times the Payment on Account Factor most recently approved by the Commission
			 pursuant to 114. 1 CMR 28.00 or 114.1 CMR 37.00, unless adjusted as described
			 below, or until it is superseded by a new regulation, or unless a lesser amount
			 is established by any valid order of a court of competent jurisdiction upon a
			 written finding of indigence or in ability to pay pursuant to St. 1 9 8 2 , c.
			 3 9 3 . The Commonwealth shall pay to the hospital any difference between the
			 payment made by the individual served and the approved charge times the Payment
			 on Account Factor.
(a) The Payment on Account
			 Factor shall be adjusted downward prospectively, pro-rated for months remaining
			 in the rate year, if the charge per visit as reported in the DHCFP-450 Form
			 increases beyond the FY 1996 to FY 1997 inflation factor calculated pursuant to
			 the methodology in 114. 1 CMR 39.05(2)(c)2..
(b) Determination of the Medicaid Payment on
			 Account Factor shall be made in accordance with the information filed on the
			 DHCFP-450 Form.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.10 - Administrative Review

Current through Register 1525, July 5, 2024
(1)
Purpose of Administrative Review
. If the Division
			 receives information from any source that indicates that a provider's rate may
			 be based upon inaccurate or outdated information, it may initiate an
			 administrative review to determine if a rate reduction is warranted. The
			 reasons for which the Division may initiate the review include, but are not
			 limited to: to ensure that costs included in the rate were actually incurred,
			 to ensure that costs were properly reported, or to determine whether a rate
			 should be adjusted to reflect a major change in services which occurred after
			 the base year.
(2)
Notice of Administrative Review
. The Division may at
			 any time review the rates upon notice to the hospital. the Division shall
			 initiate administrative review by notifying the hospital and the purchasers
			 that it intends to conduct an administrative review. The notification shall be
			 in writing and shall include a statement of reason for the review.
(3)
Request for
			 Information
. The Division may request that the provider submit
			 books, records and other information necessary for its review.
(4)
Results of Administrative
			 Review
. After review, the Division will render a written decision
			 and statement of reasons for its decision.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.11 - Appeal

Current through Register 1525, July 5, 2024
A hospital which is aggrieved by an action or failure to act
				under 114. 1 CMR 39.00 may file an appeal within 30 days to the Division of
				Administrative Law Appeals pursuant to the requirements of M.G.L. c. 118G and
				M.G.L. c. 7, § 4H. The pendency of an appeal does not limit the Division's
				right to undertake administrative review of charges under 114. 1 CMR
				39.00.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.12 - Severability

Current through Register 1525, July 5, 2024
The provisions of 114. 1 CMR 39.00 are hereby declared to be
				severable and if such provisions or the application of such provisions to any
				person or circumstances shall be held to be invalid or unconstitutional, such
				invalidity or unconstitutionality shall not be construed to affect the validity
				or constitutionality of any of the remaining provisions of 114. 1 CMR 39.00 or
				the application of such provisions to hospitals or circumstances other than
				those held invalid.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 39.00 - CHRONIC AND REHABILITATION PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 39.13 - Administrative Information Bulletins

Current through Register 1525, July 5, 2024
The Division may, from time to time, issue administrative
				information bulletins to clarify its policy upon and understanding of
				substantive provisions of 114. 1 CMR 39.00. In addition, the Division may issue
				administrative information bulletins which specify the information and
				documentation necessary to implement 114. 1 CMR 39.00 if necessary for informed
				consideration of charge requests, charge adjustments, and charge review under
				114. 1 CMR 39.00.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope, Purpose and Effective Date
. The purpose of
			 114.1 CMR 40.00 is to set forth regulations for the establishment of certain
			 non-acute hospital publicly assisted rates of payment, and the fee for
			 residential alcoholism treatment programs. 114.1 CMR 40.00 shall be effective
			 on October 1, 1996. 114.1 CMR 40.00 shall not apply to chronic/rehabilitation
			 hospitals governed by 114.1 CMR 39.00. 114.1 CMR 40.00 shall not apply to
			 managed care services provided to Medicaid recipients who are inpatients of a
			 non-acute hospital under a direct contract with the Division of Medical
			 Assistance.
(2)
Authority
. 114.1 CMR 40.00 is adopted pursuant to
			 M.G.L. c. 118G; and M.G.L. c. 30A, § 2.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.03 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Reporting Requirements
.
(a) Each non-acute hospital shall file with
			 the Division one electronic copy and two paper copies of its Hospital Statement
			 of Costs, Revenues, and Statistics, RSC-403, for each fiscal year within 120 of
			 the close of its fiscal year. Two copies of a hospital's audited financial
			 statements must also be submitted within 120 days of the close of its fiscal
			 year. This report is to be completed in accordance with the instructions set
			 forth there in and pursuant to requirements of 114.1 CMR 4.00 and any pertinent
			 administrative bulletins issued by the Division. A copy of the RSC-403 and
			 instructions is incorporated in 114.1 CMR 4.00 and any pertinent administrative
			 bulletins.
(b) Each non-acute
			 hospital shall file with the Division two copies of the DHCFP-450, the Report
			 of Charges and Volume, for the period 7/1/95 through 6/30/96 and the period
			 7/1/96 through 9/30/96 by January 1, 1997.
(c) Beginning 10/1/96, each non-acute
			 hospital shall file with the Division two copies of the DHCFP-450 within 30
			 days of the close of the rate year quarter.
(d) Each non-acute hospital shall file with
			 the Division two copies of the hospital's charge book at the beginning of each
			 rate year and at the end of each quarter during which the hospital makes
			 changes.
(e) Each non-acute
			 hospital shall make available all books and records relating to its operation
			 for audit, if requested by the Division.
(f) All reports, schedules, reporting forms,
			 budget information, books and records which are filed with or made available to
			 the Division shall be certified under pains and penalties of perjury as true,
			 correct and accurate by the chief executive officer or financial officer of the
			 hospital.
(g) The Division may, for
			 cause, extend the filing date for the submission of reports, schedules,
			 reporting forms, budget information, books and records.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.04 - Rates of Payment for Services Provided to Publicly-Aided Individuals

Current through Register 1525, July 5, 2024
(1)
Applicability
.
			 Rates of payment determined under the rules of 114.1 CMR 40.04 shall include:
(a) Payment for all inpatient, outpatient,
			 and well-newborn hospital care and services which are provided by a non-acute
			 hospital to publicly-aided patients.
(b) Payment for administrative days which are
			 provided by a non-acute hospital to publicly aided individuals under Title XIX
			 of the Social Security Act.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.05 - Residential Alcoholism Treatment Programs

Current through Register 1525, July 5, 2024
(1)
Fee
.
(a) The FY 1996
			 fee for a residential alcoholism treatment program shall be equal to the
			 approved charge times the ratio of RFR determined pursuant to 114.1 CMR 40.06
			 to the Approved GPSR for the corresponding rate year, as approved under 114.1
			 CMR 38.00. If a hospital's approved GPSR is revised pursuant to 114.1 CMR
			 38.00, the ratio shall be revised to reflect the new approved GPSR. The ratio
			 shall not be revised to reflect changes in RFR made pursuant to 114.1 CMR
			 38.00.
(b) The FY 1997 fee for a
			 residential alcoholism treatment program shall be equal to the charge times the
			 PAF calculated pursuant to 114.1 CMR 40.04(4).
(c) This fee shall be paid in full by the
			 individual served, unless a lesser amount is established by any valid order of
			 a court of competent jurisdiction upon a written finding of indigence or
			 inability to pay pursuant to St. 1982, c. 373. The Commonwealth shall pay to
			 the hospital any difference between the payment made by the individual served
			 and the fee determined under 114.1 CMR 40.05.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.06 - Determination of Reasonable Financial Requirements (RFR)

Current through Register 1525, July 5, 2024
(1)
Purpose.
The
			 Division shall determine the Reasonable Financial Requirement (RFR) in
			 accordance with CMR 114.1 40.06 for the purposes defined in 114.1 CMR
			 40.01.
(2)
Method of
			 Determination of RFR.
The Division will determine the RFR for each
			 non-acute hospital for a rate year by summing [a] the rate year operating
			 requirements, [b] the rate year capital requirement, [c] the rate year working
			 capital requirement, and then subtracting [d] the labor cost recovery pursuant
			 to 40.08(2)(b). The calculation of these elements of RFR is described below.
(a) The rate year operating requirement is
			 the sum of:
1. The base year allowed operating
			 cost under 114.1 CMR 40.07(2), and
2. The adjusted base year to rate year
			 adjustments calculated pursuantto 114.1 CMR 40.08.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.07 - Determination of Allowed Base Year Cost

Current through Register 1525, July 5, 2024
(1)
Purpose
. Except for new non-acute hospitals which have
			 not yet been assigned a base year, the commission will determine Allowed base
			 year Operating Cost for the purpose of establishing a hospital's RFR pursuant
			 to 114.1 CMR 40.07.
(2)
Calculation of Allowed Base Year Operating Cost
.
(a) For DMH and DPH hospitals only the base
			 year for operating costs shall be FY 1993, and the Division shall utilize the
			 costs reported in audited FY 1993 RSC-403 cost report. For all other hospitals,
			 the base year for operating costs shall be the year recognized by the Division
			 as the base year during FY 1996. For hospitals with a later base year assigned
			 pursuant to 114.1 CMR 40.09, the Division shall utilize the costs reported in
			 the audited RSC-403 cost report for that year.
1. Allowable operating costs include only
			 costs incurred or to be incurred in the provision of hospital care and
			 services, supplies and accommodations and determined in accordance with the
			 Principles of Reimbursement for Provider Costs under
			 42 U.S.C. §§
											1395
et seq
. as set forth in
			 42 CFR 413
et seq
. and the Provider Reimbursement Manual, the
			 HURM Manual and Generally Accepted Accounting Principles.
2. Allowable operating costs do not include
			 costs of personnel or consultants where the primary purpose is, either directly
			 or indirectly, to persuade or seek to persuade hospital employees to support or
			 oppose unionization.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.08 - Determination of Base to Rate Year Adjustment of Costs

Current through Register 1525, July 5, 2024
(1)
Purpose
. The
			 Division will make a Base to Rate Year Adjustment of Costs in order to
			 determine RFR pursuant to 114.1 CMR 40.06. The Division will make a year to
			 year adjustment to base year costs for additional costs that are projected to
			 occur in the rate year due to inflation, changes in volume, costs beyond
			 reasonable control , and new services.
(2)
Inflation
. The
			 Division shall make an adjustment for inflation prospectively. The Division
			 will adjust allowed operating costs from the base year through the rate year
			 using a composite index comprised of two cost categories: labor and non-labor.
			 These categories shall be weighted according to the weights used by the Health
			 Care Financing Administration for PPS-exempt hospitals. The inflation proxy for
			 the labor cost category shall be the Massachusetts Consumer Price Index. The
			 inflation proxy for the non-labor cost category shall be the non-labor portion
			 of the HCFA market basket for non-acute hospitals. There will be no adjustment
			 upward or downward to account for over or under-projection.
(a) The composite inflation index as
			 calculated in accordance with the preceding paragraph will be increased by .02
			 pursuant to M.G.L. c. 118G.
(b) The
			 Division will recover the additional labor costs for which hospitals were
			 reimbursed according to the provisions of 114.1 CMR 40.07(2)(a), but were not
			 expended on the compensation of technicians, nurses, nursing aides, orderlies
			 and attendants, and occupational, speech, recreational, physical, and
			 respiratory therapists, as required by M.G.L. c. 118G. The Division will
			 recover these costs according to the following procedure:
1. Hospitals will report upon the request of
			 the Division, the rate year expenditure of staff positions defined above . Any
			 amount not expended will be excluded from the rate year RFR.
2. The Division may further adjust a
			 hospital's RFR upon audit.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.09 - New Hospitals

Current through Register 1525, July 5, 2024
(1) For hospitals
			 which were not licensed and/or operated as non-acute hospitals in FY 1993, or
			 did not report a full year of actual costs in FY 1993, the base year for
			 operating and capital costs shall be the year used in the hospital's first RFR
			 calculation.
(2) If the base year
			 RFR was not based on a full year of actual costs, the Division shall determine
			 whether to utilize base year RFR information, establish a different base year
			 in accordance with Medicare regulations at
			 42
			 CFR 413.40(f)(1)(i), or to
			 evaluate the hospital's projected operating and capital costs for
			 reasonableness. Criteria for such review will include, but are not limited to,
			 peer group analysis of costs incurred by comparable facilities.
(3) For new hospitals where base year RFR
			 information is not used, the Division shall make any necessary adjustments to
			 the provisions of 114.1 CMR 40.07 and/or 114.1 CMR 40.08 to reflect the use of
			 a different data source.
(4) For
			 new hospitals, which were not licensed and/or operated as non-acute hospitals
			 in FY 1996, or did not have a base year previously established, the base year
			 for operating and capital cost shall be the first full year of hospital cost
			 pursuant to 114.1 CMR 40.06. 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 will not be limited to peer group analysis of
			 costs incurred and the determination of approved rates for comparable
			 facilities.
(5) For FY 1997, the
			 PAF shall be based upon projected cost determined by 114.1 CMR 40.09(4) and
			 projected GPSR. The projected inpatient GPSR shall be reviewed by the Division
			 for reasonableness against the Charge per Medicaid Inpatient Day for comparable
			 facilities.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.10 - Medicaid Disproportionate Share Adjustments

Current through Register 1525, July 5, 2024
The Medicaid program will assist hospitals which carry a
				disproportionate financial burden of caring for the uninsured and low income
				persons of the Commonwealth. In accordance with Title XIX rules and
				requirements, Medicaid will make an additional payment adjustment to hospitals
				which qualify for such an adjustment under any one or more of the following
				classifications. Eligibility requirements for each type of disproportionate
				share adjustment and the methodology for calculating these adjustments are
				described in 114.1 CMR 40.12 through 114.1 CMR 40.13.
(1) To qualify for any type of
			 disproportionate share payment adjustment, a hospital must have a Medicaid
			 inpatient utilization rate (calculated by dividing Medicaid patient days by
			 total patient days) of not less than 1%.
(2) The total of all disproportionate share
			 payments awarded to a particular hospital under 114.1 CMR 40.11 through 114.1
			 CMR 40.13 shall not exceed the costs incurred during the year of furnishing
			 hospital services to individuals who either are eligible for Medicaid or have
			 no health insurance or source of third party coverage, less payments by
			 Medicaid and by uninsured patients.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.11 - Federally Mandated Disproportionate Share Adjustments

Current through Register 1525, July 5, 2024
(1)
Data Sources
.
			 The Division shall determine for each fiscal year a federally-mandated Medicaid
			 disproportionate share adjustment for alleligible hospitals, using the data and
			 methodology described below. The Division shall use the following data sources
			 in its disproportionate share adjustment, unless the specified data source is
			 unavailable. If the specified data source is unavailable, then the Division
			 shall determine and use the best alternative data source.
(a) The prior year RSC-403 report shall be
			 used to determine Medicaid days, total days, Medicaid inpatient net revenues,
			 total inpatient net revenues, total inpatient charges and free care
			 charge-offs. If said RSC-403 report is not available, the Division shall use
			 the most recent available previous RSC-403 report to estimate these
			 variables.
(b) The hospital's
			 audited financial statements for the prior year shall be used to determine the
			 state and/or local government cash subsidy.
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.12 - Extraordinary Disproportionate Share Adjustment for Psychiatric Hospitals

Current through Register 1525, July 5, 2024
The Division shall determine for FY 1996 and succeeding years
				an extraordinary disproportionate share adjustment for all eligible psychiatric
				hospitals, using the data and methodology described in 114.1 CMR 40.12.
(1)
Data Sources
.
			 The Division shall use the RSC-403 report for the fiscal year two years prior
			 to the fiscal year of the calculation of the disproportionate share adjustment
			 to determine the cost, free care, charge, patient day, and net revenue amounts.
			 If said RSC-403 report is not available, the Division shall use the most recent
			 available previous RSC-403 report to estimate these variables. If the specified
			 data source is unavailable, then the Division shall determine and use the best
			 alternative data source.
(2)
Determination of Eligibility
.
(a) In order to be eligible for the
			 extraordinary disproportionate share payment adjustment, a psychiatric hospital
			 must:
1. specialize in providing
			 psychiatric/psychological care and treatment;
2. provide for special active treatment such
			 as treatment of deafness, developmental disabilities, and the
			 elderly;
3. accept all patients
			 without regard to their ability to pay;
4. consist partly or wholly of locked
			 wards;
5. meet requirements for the
			 receipt of federal matching funds;
6. meet the low-income standard as set forth
			 in 114.1 CMR 40.12(2)(b); and
7.
			 meet the unreimbursed cost standard as set forth in 114.1 CMR
			 40.12(2)(c).
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.13 - Extraordinary Disproportionate Share Adjustment for State Owned Special Population Hospitals

Current through Register 1525, July 5, 2024
The Division shall determine for FY 1996 and succeeding years
				an extraordinary disproportionate share adjustment for all eligible state owned
				special population hospitals using the data and methodology described
				below.
(1)
Data
			 Sources
. The Division shall use the RSC-403 report for the fiscal
			 year two years prior to the fiscal year of the calculation of the
			 disproportionate share adjustment to determine the cost, free care, charge,
			 patient day, and net revenue amounts. If said RSC-403 report is not available,
			 the Division shall use the most recent available previous RSC-403 report to
			 estimate these variables. If the specified data source is unavailable, then the
			 Division shall determine and use the best alternative data source.
(2)
Determination of
			 Eligibility
.
(a) In order to be
			 eligible for the extraordinary disproportionate share payment adjustment, a
			 state owned special population hospital must:
1. specialize in providing treatment to
			 people with AIDS, tuberculosis patients, the medically needy homeless, multiply
			 handicapped pediatric patients and patients with combined medical and
			 psychiatric needs;
2. provide for
			 special active treatment such as treatment of deafness, developmental
			 disabilities, and the elderly;
3.
			 accept all patients without regard to their ability to pay;
4. meet requirements for the receipt of
			 federal matching funds;
5. meet the
			 low-income standard as set forth in 114.1 CMR 40.13(2)(b); and
6. meet the unreimbursed cost standard as set
			 forth in 114.1 CMR 40.13(2)(c).
Code of Massachusetts Regulations › 114 CMR - DIVISION OF HEALTH CARE FINANCE AND POLICY › Title 114.1 CMR 40.00 - NON-ACUTE HOSPITAL PUBLICLY ASSISTED RATES OF PAYMENT AND THE FEE FOR RESIDENTIAL ALCOHOLISM TREATMENT PROGRAMS › Section 40.14 - Administrative Adjustment

Current through Register 1525, July 5, 2024
(1) A hospital may
			 apply at any time during the rate year for an administrative adjustment if
			 there has been an arithmetic error in the calculation of the PAF or residential
			 alcoholism treatment program fee. The Division will not entertain an
			 application for an administrative adjustment, if the applicant hospital is
			 seeking to reverse a substantive determination pursuant to 114.1 CMR
			 40.00.
(2) A hospital may apply at
			 any time during the first nine months of the rate year for an administrative
			 adjustment based on a request for a CBC pursuant to 114.1 CMR 40.08(4) or a new
			 service pursuant to 114.1 CMR 40.08(5).
(3) An application for an administrative
			 adjustment shall be made to the Chairman of the Division in writing and shall
			 contain the following:
(a) The name and
			 address of the hospital.
(b) The
			 rate or rates sought to be reviewed.
(c) A clear, concise statement of reasons for
			 the application for administrative adjustment.
(d) A detailed statement of financial,
			 statistical, and related information in support of the application.
(e) If the application concerns a requested
			 CBC or new service, all relevant documentation for that CBC or new
			 service.
(f) Such other books,
			 records and information as the Division may require.