Code of Massachusetts Regulations › 101 CMR - EXECUTIVE OFFICE FOR HEALTH AND HUMAN SERVICES › Title 101 CMR 614.00 - Health Safety Net Payments and Funding › Section 614.06 - Payments to Acute Hospitals

Current through Register 1525, July 5, 2024
(1)
General Provisions
.
(a) The Health Safety Net pays Acute
			 Hospitals based on claims in accordance with the requirements of
			 101 CMR
			 613.00:
Health Safety Net Eligible
			 Services.
The Health Safety Net Office monitors the volume of claims
			 submitted and may adjust or withhold payments if it appears that there has been
			 a substantial change in the Provider's service delivery patterns and/or billing
			 activity including, but not limited to, unbundling of services, upcoding, or
			 other billing maximization activities.
(b)
Payment Types
.
1. The Health Safety Net Office calculates
			 Health Safety Net payments for each Acute Hospital for the following categories
			 of claims for which the Health Safety Net is the primary payer:
a. Inpatient - Medical (under
			 101
			 CMR 614.06(2)(a) and (b))
			 ;
b. Inpatient - Psychiatric (under
			 101
			 CMR 614.06(2)(c))
			 ;
c. Inpatient - Rehabilitation
			 (under
			 101
			 CMR 614.06(2)(d))
			 ;
d. Outpatient Services (under
			 101
			 CMR 614.06(3)) ;
e. Physician Services (under
			 101
			 CMR 614.06(4)) ;
f. Dental Services (under
			 101
			 CMR 614.06(5)) ;
g. Acute Hospital Outpatient Pharmacies
			 (under
			 101
			 CMR 614.06(6)) ;
h. Vaccine Administration (under
			 101
			 CMR 614.06(7)) ;
i. Emergency Bad Debt - Inpatient Medical
			 (under
			 101
			 CMR 614.06(9)) ;
j. Emergency Bad Debt - Inpatient Psychiatric
			 (under
			 101
			 CMR 614.06(9)) ;
k. Emergency Bad Debt - Outpatient (under
			 101
			 CMR 614.06(9)) ;
			 and
l. Medical Hardship (under
			 101
			 CMR 614.06(10)).
2. Under
			 101
			 CMR 614.06(8), the Health
			 Safety Net Office establishes payments for claims which the Health Safety Net
			 is the secondary payer.
3. The
			 Health Safety Net Office reduces payments by the amount of Emergency Bad Debt
			 recoveries and investment income on free care endowment funds. The Health
			 Safety Net Office determines the offset of free care endowment funds by
			 allocating free care endowment income between Massachusetts residents and
			 nonresidents using the best data available and offsetting the Massachusetts
			 portion against Health Safety Net claims.
(c)
Method of
			 Payment
. The Health Safety Net may make payments to Acute
			 Hospitals for Eligible Services through a safety net care payment under the
			 Massachusetts Section 1115 Demonstration Waiver, a MassHealth supplemental
			 Acute Hospital rate payment, or a combination thereof. The Health Safety Net
			 Office may limit an Acute Hospital's payment for Eligible Services to comply
			 with requirements under the Massachusetts Section 1115 Demonstration Waiver
			 governing safety net care, including cost limits or any other federally
			 required limit on payments under
			 42 U.S.C. §
										1396a(a)(13) or
			 42 CFR
			 447.
(d)
Provider Preventable
			 Conditions
. The Health Safety Net does not pay for services
			 related to Provider Preventable Conditions defined in
			 42 CFR
			 447.26. The Health Safety Net Office may
			 issue administrative bulletins clarifying billing requirements and payment
			 specifications for Provider Preventable Conditions.