Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 516.00 - Behavioral Health Access and Crisis Intervention Trust Fund Surcharge › Section 516.02 - Definitions

Current through Register 1525, July 5, 2024
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 of Public Health
. The
				Massachusetts Department of Public Health.
EOHHS
. The Executive Office of Health
				and Human Services established under M.G.L. c. 6A.
Fund
. The Behavioral Health Access and
				Crisis Intervention Trust Fund established by M.G.L. c. 29 §
				2WWWWW.
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 Massachusetts
				Department of Public Health.
Hospital Services
. Services listed on
				an acute hospital's license issued by the Massachusetts 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
				101
				CMR 516.03(2).
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 does not include:
(a) payments, settlements, and judgments
			 arising out of third-party liability claims for bodily injury that 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 includes 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 EOHHS 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, § 69A.
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 includes a managed care
				organization; and provided further, that it does 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.
Total Behavioral Health Surcharge
				Amount
. An amount equal to $33,700,000.