reglab/statecodes huggingface dataset:
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 7.00 - Nursing Facilities Cost Reporting Requirements › Section 7.09 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				957 CMR 7.00 are severable. If
				any provision of
				957 CMR 7.00 or the
				application of any provision of
				957 CMR 7.00 is held invalid
				or unconstitutional, such provision will not be construed to affect the
				validity or constitutionality of any other provision of
				957 CMR 7.00 or the
				application of any other provision.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 8.00 - All Payer Claims Database (apcd) And Case Mix And Charge Data Submission › Section 8.01 - General Provisions

Current through Register 1525, July 5, 2024
Scope and Purpose
.
				957 CMR 8.00 governs the
				reporting requirements regarding health care data and information that health
				care Payers and Hospitals must submit pursuant to M.G.L. c. 12C in connection
				with the All Payer Claims Database (APCD) and the Acute Hospital Case Mix and
				Charge Data (Case Mix and Charge) Databases. The purpose of
				957 CMR 8.00 is to
				specify:
(a) the Health Care Claims
			 Data and Health Plan Information that Payers must submit;
(b) the Case Mix and Charge Data that
			 Hospitals must submit;
(c) the
			 procedures for submitting such health care data and information; and
(d) the time frame for submitting such health
			 care data and information.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 8.00 - All Payer Claims Database (apcd) And Case Mix And Charge Data Submission › Section 8.03 - Data Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
General
. Payers
			 and Hospitals shall submit health care data and information to CHIA as
			 specified in
			 957 CMR 8.00, a Data
			 Submission Guide, or an Administrative Bulletin.
(2)
Payer Reporting
			 Requirements
. Payers shall submit APCD Health Care Claims Data and
			 Health Plan Information.
(a)
APCD
			 Health Care Claims and Associated Data
. Payers shall provide data
			 relating to Medical Claims, Pharmacy Claims, Dental Claims, Member Eligibility
			 Files, Provider Files, Benefit Plan and Product Files. Payers must provide
			 claims-line detail for all health care services provided to Massachusetts
			 residents, whether or not the health care was provided within Massachusetts,
			 including out-of-state residents of a Massachusetts-based employer or
			 Massachusetts employment site, and out-of-state residents of a Massachusetts
			 licensed health care payer. Such data shall include but is not limited to
			 fully-insured and self-funded accounts, to the extent allowable under federal
			 law governing health care provided by employers to employees, and all
			 commercial medical products for all individuals and all group sizes.
(b) CHIA will issue Data Submission Guides
			 and associated Administrative Bulletins to delineate the reporting structure
			 and requirements for this data.
(c)
			 A Self-funded Employee Plan or third-party administrator or carrier providing
			 claims administration services to a Self-funded Employee Plan, shall not be
			 required to submit data pursuant to 957 CMR 8.03, provided, however, that such
			 data may be submitted on a voluntary basis in accordance with the Data
			 Submission Guides and associated Administrative Bulletins referenced in 957 CMR
			 8.03(2)(b).
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 8.00 - All Payer Claims Database (apcd) And Case Mix And Charge Data Submission › Section 8.04 - Data Submission Procedures

Current through Register 1525, July 5, 2024
(1)
General
. Payers
			 and Hospitals shall submit data and information to CHIA in accordance with the
			 procedures provided in
			 957 CMR 8.00, a Data
			 Submission Guide, or an Administrative Bulletin.
(2)
Data Submission
			 Guide
. CHIA will issue a Data Submission Guide which sets forth
			 the required data file format, record specifications, data elements,
			 definitions, code tables and edit specifications for health care data and
			 information submitted by Payers and Hospitals.
(3)
Data Submission
			 Administrative Bulletins
. CHIA may issue an Administrative
			 Bulletin which specifies filing requirements and data specifications for data
			 and information submitted by Payers and Hospitals. CHIA also may amend the
			 filing requirements and data specifications, including filing deadlines, by
			 Administrative Bulletin.
(4)
Amended Data Submissions
. Payers and Hospitals may
			 amend data submissions subject to the approval of CHIA upon notice of the
			 proposed changes and the reasons for such changes. Amended data submissions
			 shall be made in accordance with the procedures provided in a Data Submission
			 Guide, or an Administrative Bulletin.
(5)
Data Review and
			 Verification
. If necessary, Payers and Hospitals may be required
			 to review and verify certain data and information previously submitted. CHIA
			 will notify Payers and Hospitals of when such data and information must be
			 reviewed and verified and will provide to applicable Payers and Hospitals such
			 health care data and information, or summary reports of such data and
			 information, for review and verification.
(6)
Mergers
. Payers
			 and Hospitals must submit data for newly merged facilities in accordance with
			 Data Submission Guides. CHIA must approve organizational reporting structure
			 changes prior to implementation. The Payers and Hospital must notify CHIA in
			 writing as to any organization ID change, for approval, prior to a data
			 submission.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 8.00 - All Payer Claims Database (apcd) And Case Mix And Charge Data Submission › Section 8.05 - Data Reporting Schedule

Current through Register 1525, July 5, 2024
(1)
General
. Payers and Hospitals shall submit data and
			 information to CHIA in accordance with the timeframe and schedule provided in,
			 a Data Submission Guide, or an Administrative Bulletin. In the event the data
			 submission deadline falls on a Saturday, Sunday or Commonwealth holiday, the
			 data shall be due on the business day immediately thereafter.
(2)
Resubmissions
.
			 Payers, and Hospitals will be required to resubmit data and information because
			 the submission was rejected due to errors or as part of the review,
			 verification process and quality analysis.
(3)
Extension
			 Requests
. CHIA may grant, for good cause, an extension in time to
			 Payers and Hospitals, to submit health care data and information.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 8.00 - All Payer Claims Database (apcd) And Case Mix And Charge Data Submission › Section 8.06 - Other Provisions

Current through Register 1525, July 5, 2024
(1)
Administrative Bulletins
. CHIA may issue
			 Administrative Bulletins to clarify its policies and procedures under
			 957 CMR 8.00. CHIA may also
			 issue Administrative Bulletins to specify or amend data and information
			 required to be submitted; to specify or amend the procedures for submitting
			 data and information; and to specify or amend the time frames for submitting
			 data and information.
(2)
Data Submission Guide
. CHIA may prepare a Data
			 Submission Guide which specifies data submission requirements including, but
			 not limited to, required fields, file layouts, file components, edit
			 specifications, instructions and other technical specifications.
(3)
Penalties
. CHIA
			 will provide written notice to Payers and Hospitals that fail to comply with
			 the reporting deadlines established in
			 957 CMR 8.00.
(a) CHIA will notify Payers and Hospitals
			 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,
			 Payers and Hospitals 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.
(b) Any remedy available under
			 957 CMR 8.07(3)
			  is in addition to other sanctions and
			 penalties that may apply under the provisions of other statutes and
			 regulations.
(c) Payers and
			 Hospitals that fail to comply with the requirements of
			 957 CMR 8.00 will be subject
			 to all penalties and remedies allowed by law and CHIA will take all necessary
			 steps to enforce
			 957 CMR 8.07(3)
			  including a petition to the Superior Court
			 for an order enforcing the same.
(d) Voluntary submitters pursuant to
			 957 CMR 8.03(2)(c)
			  shall not be subject to penalties.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 8.00 - All Payer Claims Database (apcd) And Case Mix And Charge Data Submission › Section 8.07 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				957 CMR 8.00 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 8.00 or the
				application of such provisions.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.01 - General Provisions

Current through Register 1525, July 5, 2024
Scope and Purpose
.
				957 CMR
				9.00 governs the financial reporting requirements for
				acute and non-acute hospitals, including their Parent Organization and
				Physician Organization(s) for the submissions of hospital cost reports, charge
				books, and quarterly and annual financial data filings.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.02 - Definitions

Current through Register 1525, July 5, 2024
All defined terms in 957 CMR 9.00 are capitalized. As used in 957 CMR 9.00, unless the context requires otherwise, the following terms shall have the following meanings:
Acute Hospital
. A hospital licensed under M.G.L. c. 111, § 51 which contains a majority of medical surgical, pediatric, obstetric, and maternity beds, as defined by the Department of Public Health, and the teaching hospital of the University of Massachusetts Medical School.
Audited Financial Statements
. A complete set of financial statements of an entity, including the notes to the financial statements, which are subject to an independent audit in accordance with
Generally Accepted Auditing Standards (GAAS)
. The independent auditor issues an opinion as to whether or not the accompanying financial statements are presented fairly in accordance with
Generally Accepted Accounting Principles (GAAP)
.
Charge
. The uniform price for each specific service within a revenue center of a hospital.
CHIA
. The Center for Health Information and Analysis established under M.G.L. c. 12C.
CMS
. The federal Centers for Medicare & Medicaid Services.
Consolidated Entity
. A group of entities that includes a parent and all its subsidiaries presented as those of a single economic entity.
Consolidating Schedule
. A document that accompanies the consolidated Audited Financial Statements, which includes detailed financial statements of subsidiary hospital(s) and the other organizations that comprise the consolidated entity.
Hospital Cost Report
. The Massachusetts Hospital Statement of Costs, Revenues, and Statistics.
Non-acute Hospital
. A hospital which is defined and licensed under M.G.L. c. 111, § 51, with less than a majority of medical-surgical, pediatric, maternity and obstetric beds, or any psychiatric facility licensed under M.G.L. c. 19, § 19, or any public health care facility.
Parent Organization
. An entity that has a controlling financial interest in one or more subsidiaries.
Physician Organization
. A medical practice or group of practices comprised of physicians organized to provide patient care services (regardless of its legal form or ownership) that is financially controlled by the same Parent Organization as the acute hospital.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.03 - General Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Required Reports for Acute and Non-acute Hospitals
.
			 Each Acute and Non-acute Hospital shall file with CHIA the following
			 information:
(a)
Hospital Cost
			 Report
. Each hospital's Hospital Cost Report shall be submitted
			 annually in accordance with
			 957 CMR
			 9.04.
(b)
Audited Financial
			 Statements
. Audited Financial Statements shall be submitted
			 annually in accordance with
			 957 CMR
			 9.05.
(c)
Other
			 Information
. Hospitals shall submit additional information in
			 accordance with
			 957 CMR
			 9.06.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.04 - Hospital Cost Reporting

Current through Register 1525, July 5, 2024
(1)
Reporting Requirements
. Each Acute and Non-acute
			 Hospital's Hospital Cost Report shall be submitted annually in accordance with
			 the Hospital Cost Report instructions and any pertinent administrative
			 bulletins issued by CHIA. Each hospital shall file one electronic copy of the
			 Hospital Cost Report.
(2)
Due Dates
. Each hospital shall file a Hospital Cost
			 Report with CHIA in accordance with the due dates specified in
			 957 CMR 9.04(2)(a) and
			 (b):
(a)
1. Hospitals with a fiscal year ending
			 between January 1st, and September
			 30th, shall file a Hospital Cost Report by March
			 1st of the following year.
2. Hospitals with a fiscal year ending
			 between October 1st, and December
			 31st, shall file a Hospital Cost Report within 150
			 days of the Medicare CMS year end.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.05 - Audited Financial Statements

Current through Register 1525, July 5, 2024
(1)
Reporting Requirements
.
(a) Each Acute and Non-acute Hospital shall
			 submit a copy of its Audited Financial Statements if an independent financial
			 statement audit occurs at the hospital-level.
(b) Each Parent Organization shall submit a
			 copy of the consolidated-level Audited Financial Statements as well as a
			 Consolidating Schedule if an independent financial statement audit occurs at a
			 consolidated level above that of the hospital. Consolidating Schedules must be
			 accompanied by a signed statement by the consolidated entity's chief financial
			 officer attesting that the information contained in the Consolidating Schedules
			 fairly represents, in all material respects, the financial condition and
			 results of operations of the subsidiary organizations.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.06 - Other Hospital Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Medicare 2552 Cost
			 Report
.
Due Date
. Each Acute and
			 Non-acute Hospital shall file electronically one copy of its Medicare 2552 Cost
			 Report, including any Home Office Cost Reports within 150 days after the end of
			 its fiscal year.
(2)
Charge Books
.
(a)
Reporting Requirements
. Each Acute and Non-acute
			 Hospital shall file with CHIA an electronic copy of its Charge book. Each
			 Charge book shall be accompanied by a statement from the hospital detailing
			 charge modifications implemented after the last filing.
(b)
Due Date
. Each
			 hospital shall file one electronic copy of its Charge book at the beginning of
			 each fiscal year and within 30 days following each quarter in which Charges are
			 revised. Such Charge book shall contain the Charges in effect on the last day
			 of said quarter.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.07 - Standardized Financial Filings

Current through Register 1525, July 5, 2024
(1)
General Reporting Requirements
. Each Acute Hospital,
			 Physician Organization, and their Parent Organization shall file financial data
			 as required by CHIA, as detailed in
			 957 CMR
			 9.07(2) and (3) Each entity
			 shall submit the required data electronically in accordance with CHIA's
			 instructions or administrative bulletins.
Standardized Financial Filing
				Requirements
. For Acute Hospitals and Parent Organizations,
				standardized filings shall include a balance sheet and a statement of
				operations. For Physician Organizations, standardized financial filings shall
				include a statement of operations. CHIA may request additional information
				regarding the financial condition of the Parent Organization, Acute Hospital,
				or the Physician Organization if necessary.
(2)
Quarterly Standardized
			 Financial Filing
.
(a)
Reporting Requirements
. Each Acute Hospital, Physician
			 Organization, and their Parent Organization shall submit Standardized Financial
			 Filings for the first three quarters of the entity's fiscal year. Entities
			 shall report cumulative year-to-date financial information ending with the most
			 recently completed fiscal quarter.
(b)
Due Dates
.
			 Quarterly Standardized Financial Filing shall be filed within 45 days after the
			 end of each quarter. CHIA may, for cause, extend the filing date in a response
			 to a written request for an extension of time. CHIA may note in its
			 publications the name of an entity that either failed to meet the filing
			 deadline, or that requested and received an extension of the filing
			 date.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.08 - Employee Compensation Reporting by Acute Hospitals

Current through Register 1525, July 5, 2024
(1)
Reporting
			 Requirements
. Each Acute Hospital shall report to CHIA the total
			 compensation, including salary and benefits information, paid by the hospital
			 and/or any related organization to the top ten highest compensated employees of
			 the hospital. Filing instructions will be published on CHIA's website. The
			 reported information must include:
(a)
			 Employee name;
(b) Title and
			 position description(s);
(c)
			 Specialty;
(d) Base
			 compensation;
(e) Bonus and
			 incentive compensation;
(f) Other
			 reportable compensation;
(g)
			 Retirement and other deferred compensation;
(h) Non-taxable benefits; and
(i) Whether the individual is a current or
			 former employee as of the date of submitting the filing to CHIA.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.09 - Audits

Current through Register 1525, July 5, 2024
(1)
General
. All information provided by, or required
			 from, any Acute or Non-acute Hospital, Provider Organization, or Parent
			 Organization pursuant to
			 957 CMR
			 9.00 shall be subject to audit by CHIA. Each such
			 entity shall make available all books and records relating to its operations
			 for the audit period, as requested by CHIA. Each hospital shall submit all cost
			 information requested by CHIA, including information necessary to document
			 reported costs and monitor the hospital's financial condition.
(2)
Processing of Audit
			 Adjustments
.
(a)
Notification
. After audit, CHIA shall notify a
			 hospital, Physician Organization, or Parent Organization of its proposed audit
			 adjustments. The notification shall be in writing and shall contain a complete
			 listing of all proposed adjustments.
(b)
Objection
			 Process
.
1. A hospital, Physician
			 Organization, or Parent Organization may file a written objection to a proposed
			 audit adjustment within 15 business days of the notice.
2. The written objection must, at a minimum,
			 specify each adjustment to which there is an objection, the reason for each
			 objection, and include all supporting documentation.
3. CHIA may schedule a conference on
			 objections if it determines that a conference would promote resolution of the
			 disputed adjustments.
4. Upon
			 review of the objections, CHIA shall notify the hospital, Physician
			 Organization, or Parent Organization of its determination in writing. If CHIA
			 disagrees with the objections, in whole or in part, CHIA shall provide an
			 explanation of its reasoning. A hospital, Physician Organization or Parent
			 Organization may request an audit adjustment dispute hearing if it does not
			 agree with CHIA's determination.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.10 - Compliance and Penalties

Current through Register 1525, July 5, 2024
The Center will provide written notice to Acute Hospitals,
				Non-acute Hospitals, Physician Organizations, and Parent Organizations that
				fail to comply with the reporting deadlines established in
				957 CMR
				9.00.
(1) The
			 Center will notify Acute Hospitals, Non-acute Hospitals, Physician
			 Organizations, and Parent Organizations 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, Acute Hospitals, Non-acute Hospitals,
			 Physician Organizations, and Parent Organizations 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 9.10
			 is in addition to other sanctions and penalties that may apply under the
			 provisions of other statutes and regulations.
(3) Acute Hospitals, Non-acute Hospitals,
			 Physician Organizations, and Parent Organizations that fail to comply with the
			 requirements of
			 957 CMR
			 9.00 will be subject to all penalties and remedies
			 allowed by law and the Center will take all necessary steps to enforce 957 CMR
			 9.10, 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 9.00 - Hospital Financial Data Reporting Requirements › Section 9.11 - Administrative Bulletins

Current through Register 1525, July 5, 2024
CHIA may issue administrative bulletins from time to time to
				clarify, add to, or change reporting requirements under
				957 CMR
				9.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.12 - Nonpublic Information

Current through Register 1525, July 5, 2024
Information furnished pursuant to
				957 CMR
				9.05 under an assurance of confidentiality in
				accordance with M.G.L. c. 12C, § 5 shall not be subject to the disclosure
				provision of the public records law. Any reasonable segregable portion of a
				record filed pursuant to
				957 CMR
				9.00 shall be provided to any person requesting such
				records after deletion of the portions which are considered nonpublic under 957
				CMR 9.12.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 9.00 - Hospital Financial Data Reporting Requirements › Section 9.13 - Severability

Current through Register 1525, July 5, 2024
The provisions of
				957 CMR
				9.00 are severable. If any such provisions or the
				application of such provisions to any hospital or circumstances shall be 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
				9.00 or the application of such
				provisions.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 10.00 - HEALTH CARE PAYERS PREMIUMS AND CLAIMS DATA REPORTING REQUIREMENTS › Section 10.01 - General Provisions

Current through Register 1525, July 5, 2024
Scope and Purpose
. 957 CMR 10.00
				governs the reporting requirements for Private Health Care Payers to submit
				health care data and information to the Center for Health Information and
				Analysis in accordance with M.G.L. c. 12C.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 10.00 - HEALTH CARE PAYERS PREMIUMS AND CLAIMS DATA REPORTING REQUIREMENTS › Section 10.03 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
Payer Membership Reporting Requirements
. All Payers
			 shall provide aggregate Member Months data for the previous three Calendar
			 Years for all Private Commercial Plans by but not limited to the following
			 classifications:
(a) Insurance Funding
			 Type;
(b) Product Type;
(c) Benefit Design Type;
(d) Geographic area;
(e) Age and gender groupings; and
(f) Average Employer Size.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 10.00 - HEALTH CARE PAYERS PREMIUMS AND CLAIMS DATA REPORTING REQUIREMENTS › Section 10.04 - Data Submission Procedures

Current through Register 1525, July 5, 2024
(1)
General
. Payers shall submit annually health care data
			 and information to the Center in accordance with the procedures provided in 957
			 CMR 10.00, a Data Submission Manual, or an Administrative Bulletin.
(2)
Data Submission
			 Manual
. The Center will release a draft Data Submission Manual
			 prior to requiring data submissions from Payers. Payers will be given at least
			 14 days to submit written comments on the draft Data Submission Manual. The
			 Center will issue a final Data Submission Manual following the deadline for
			 written comments and will notify Payers of its availability.
(3)
Data Submission
			 Process
. Each Payer shall submit data directly to the Center or
			 the Center's designated contractor in the format specified by the Data
			 Submission Manual. Data submissions must conform to specifications set forth in
			 the Data Submission Manual by the Center. The Center or its contractor will
			 notify a Payer whether the submission has been accepted or rejected. Payers
			 must correct and resubmit rejected data in a timely manner until notified that
			 the submission has been accepted.
(4)
Data Review and
			 Verification
. Data submissions are subject to review and
			 verification through whatever mechanisms the Center deems necessary, including
			 but not limited to matching and validating data from the Massachusetts Division
			 of Insurance's "Annual Comprehensive Financial Statement", the US Consumer
			 Information and Insurance Oversight's (CCIIO) "Medical Loss Ratio Reporting
			 Form", the National Association of Insurance Commissioners (NAIC) "Supplemental
			 Health Care Exhibit", the Center's "Enrollment Trends" reporting, and the
			 Center's "Total Medical Expenses" reporting.
(5)
Filing
			 Deadlines
. Each Reporting Year, Payers must submit finalized,
			 acceptable data (per 957 CMR 10.04(3) ) for the previous three Calendar Years
			 by May 10th, unless otherwise instructed in the Data
			 Submission Manual or by Administrative Bulletin.
(6)
Extension
			 Requests
. The Center may grant, for good cause, data submission
			 extensions for Payers to submit health care data and information.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 10.00 - HEALTH CARE PAYERS PREMIUMS AND CLAIMS DATA REPORTING REQUIREMENTS › Section 10.05 - Audits

Current through Register 1525, July 5, 2024
(1)
General
. Submissions under 957 CMR 10.00 may be
			 subject to Audit by the Center to ensure accuracy and consistency in reporting.
			 Payers must submit additional data, information and related documentation as
			 requested by the Center.
(2)
Audit Adjustment
. If necessary, the Center will work
			 with Payers to adjust reporting to address discrepancies uncovered through the
			 Audit process.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 10.00 - HEALTH CARE PAYERS PREMIUMS AND CLAIMS DATA REPORTING REQUIREMENTS › Section 10.06 - Other Provisions

Current through Register 1525, July 5, 2024
(1)
Administrative and Technical Information Bulletins
.
			 The Center may revise the specifications or other administrative requirements
			 from time to time by notice or Administrative Bulletin.
(2)
Confidentiality
.
			 Except as specifically provided otherwise by the Center or M.G.L. c. 12C,
			 health care data and information collected pursuant to M.G.L. c. 12C, § 10
			 and 957 CMR 10.00 shall not be a public record. Except as otherwise provided,
			 the Center will not disclose or release specific health plan actuarial
			 assumptions submitted in accordance with 957 CMR 10.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 10.00 - HEALTH CARE PAYERS PREMIUMS AND CLAIMS DATA REPORTING REQUIREMENTS › Section 10.07 - Compliance and Penalties

Current through Register 1525, July 5, 2024
(1) The Center
			 will provide written notice to Payers that fail to comply with the reporting
			 deadlines established in 957 CMR 10.00. The Center will notify Payers that
			 failure to provide reportable data, including corrected data as described in
			 957 CMR 10.04(3), within two weeks of the written notice, without just cause,
			 may result in penalties. In accordance with M.G.L. c. 12C, § 11, Payers
			 may be subject to a penalty of up to $1,000 per week for each week that the
			 Payer fails to provide the required health care data and information, up to an
			 annual maximum of $50,000.
(2) Any
			 remedy available under 957 CMR 10.07 is in addition to other sanctions and
			 penalties that may apply under the provisions of other statutes and
			 regulations.
(3) The Center may
			 notify the Attorney General's Office to enforce the provisions of 957 CMR
			 10.07.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 10.00 - HEALTH CARE PAYERS PREMIUMS AND CLAIMS DATA REPORTING REQUIREMENTS › Section 10.08 - Severability

Current through Register 1525, July 5, 2024
The provisions of 957 CMR 10.00 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 10.00 or the
				application of such provisions.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 11.00 - Registered Provider Organizations Reporting Requirements › Section 11.01 - General Provisions

Current through Register 1525, July 5, 2024
Scope and Purpose
. 957 CMR 11.00
				governs the reporting requirements for Registered Provider Organizations to
				submit data and information in accordance with M.G.L. c. 12C.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 11.00 - Registered Provider Organizations Reporting Requirements › Section 11.03 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
General Reporting Requirements
. Each Registered
			 Provider Organization shall provide information, as specified in the most
			 recent
Data Submission Manual
, which may include:
(a) Information regarding ownership,
			 governance, and operational structure, including, organizational charts and
			 narrative descriptions of the type and kind of Corporate and Contracting
			 Affiliations; information regarding incentive structures and compensation
			 models, including Funds Flow within the Registered Provider Organization; and
			 information regarding the characteristics of any Clinical Affiliations and the
			 role of Community Advisory Boards;
(b) Information regarding the number of
			 affiliated Health Care Professional Full-time Equivalents by license type,
			 specialty, each Health Care Professional's name, address of principal location
			 of work, national provider identifier, or other identifying information, and
			 whether the Health Care Professional is employed by or affiliated with the
			 Registered Provider Organization and the nature of that relationship, including
			 whether provisions exist in physician participation or employment agreements
			 such as referral requirements;
(c)
			 The name and address of each Facility and Practice Site, by license number,
			 license type, tax identification number, national provider identifier, and
			 capacity in each Major Service Category, or by any other relevant
			 characteristic as defined in the
Data Submission
			 Manual
;
(d) Information
			 regarding utilization by Major Service Category;
(e) Comprehensive financial statements,
			 including Audited Financial Statements, Consolidating Schedules and
			 standardized filings that shall include a balance sheet, a statement of
			 operations, and a cash flow statement;
(f) Information on stop-loss insurance and
			 any non-fee-for-service payment arrangements;
(g) Information on clinical quality, care
			 coordination and patient referral practices;
(h) Information regarding expenditures and
			 funding sources for payroll, teaching, research, advertising, taxes or
			 payments-in-
lieu
-of-taxes and other non-clinical functions;
(i) Information regarding
			 charitable care and community benefit programs;
(j) For any risk-bearing provider
			 organization, a certificate from the Division under M.G.L. c. 176U;
(k) Information regarding any discounts,
			 rebates or any other type of refunds or remuneration in exchange for, or in any
			 way related to, the provision of heath care services; and
(l) Such other information as the MA-RPO
			 Program considers appropriate.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 11.00 - Registered Provider Organizations Reporting Requirements › Section 11.04 - Submission Procedures

Current through Register 1525, July 5, 2024
(1)
General
. Each Registered Provider Organization shall
			 submit annually data and information to the MA-RPO Program in accordance with
			 the procedures provided in the
Data Submission
			 Manual
.
(2)
Data Submission Process
. Each Registered Provider
			 Organization shall submit data and information at the time and in the manner
			 specified in the
Data Submission Manual
and in conformance
			 with the specifications set forth in the
Data Submission
			 Manual
. In accordance with the procedures set forth in the
Data Submission Manual
, the MA-RPO Program will notify a
			 Registered Provider Organization as to whether the submission has been accepted
			 or rejected and whether the Registered Provider Organization must correct and
			 resubmit data or information.
(3)
Filing Deadlines
. Each year, each Registered Provider
			 Organization must submit the required data and information on the dates
			 specified in the
Data Submission Manual
.
(4)
Certification of
			 Submissions
. Each individual that submits information in
			 accordance with 957 CMR 11.00 on behalf of a Registered Provider Organization
			 must represent and warrant that he or she is duly authorized and has full
			 authority to make the submissions.
(5)
Waivers
. The
			 Center may grant waivers from certain annual reporting requirements based on
			 the criteria specified in the
Data Submission
			 Manual
.
(6)
Fees
. The Center may assess administrative fees on
			 Registered Provider Organizations in an amount to defray the Center's costs in
			 collecting Registered Provider Organization data and information pursuant to
			 957 CMR 11.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 11.00 - Registered Provider Organizations Reporting Requirements › Section 11.05 - Submission Review

Current through Register 1525, July 5, 2024
Submissions under 957 CMR 11.00 may be subject to review by the
				MA-RPO Program to ensure accuracy and consistency in reporting. The MA-RPO
				Program will work with Registered Provider Organizations, as necessary, to
				address discrepancies uncovered through such review and, in doing so, may
				require Registered Provider Organizations to submit additional data,
				information and related documentation.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 11.00 - Registered Provider Organizations Reporting Requirements › Section 11.06 - Compliance and Penalties

Current through Register 1525, July 5, 2024
(1) If a
			 Registered Provider Organization fails to submit required data and information
			 to the MA-RPO Program on a timely basis, or fails to correct submissions
			 rejected because of errors, the Center shall provide written notice to the
			 Registered Provider Organization. If the Registered Provider Organization fails
			 to provide the required information within two weeks of written notice, the
			 Center will take all necessary steps to enforce 957 CMR 11.06 to the fullest
			 extent of the law.
(2) Registered
			 Provider Organizations that do not comply with the reporting requirements of
			 957 CMR 11.00 are subject to a penalty of up to $1,000 per week for each week
			 that the Registered Provider Organization fails to provide the required data,
			 up to a maximum of $50,000 in accordance with M.G.L. c. 12C, §
			 11.
(3) The Center will notify the
			 Attorney General's Office to enforce the provisions of 957 CMR 11.06 and may
			 provide notice of noncompliance to other Governmental Units.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 11.00 - Registered Provider Organizations Reporting Requirements › Section 11.07 - Administrative Bulletins

Current through Register 1525, July 5, 2024
The Center may issue administrative bulletins from time to time
				to clarify, add to, or change reporting requirements under 957 CMR
				11.00.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 11.00 - Registered Provider Organizations Reporting Requirements › Section 11.08 - Nonpublic Information

Current through Register 1525, July 5, 2024
Information furnished pursuant to 957 CMR 11.03(1)(e) or 11.05
				under an assurance of confidentiality in accordance with M.G.L. c. 12C, §
				5 shall not be subject to the disclosure provision of the public records law.
				Any reasonable segregable portion of a record filed pursuant to this regulation
				shall be provided to any person requesting such records after deletion of the
				portions which are considered nonpublic under 957 CMR 11.08.
Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 11.00 - Registered Provider Organizations Reporting Requirements › Section 11.09 - Severability

Current through Register 1525, July 5, 2024
The provisions of 957 CMR 11.00 are severable. If any such
				provisions or the applicability thereof is held to be invalid or
				unconstitutional by any court of competent jurisdiction, such invalidity shall
				not be construed to affect the validity or constitutionality of any remaining
				provisions of 957 CMR 11.00 or the application of such
				provisions.
Code of Massachusetts Regulations › 958 CMR - HEALTH POLICY COMMISSION › Title 958 CMR 2.00 - One-time Assessment On Certain Qualifying Hospitals And Qualifying Surcharge Payors › Section 2.01 - General Provisions

Current through Register 1525, July 5, 2024
(1)
Scope and Purpose
. 958 CMR 2.00 governs payments to the Health Policy Commission from certain Acute Hospitals and Surcharge Payors.
(2)
Authority
. 958 CMR 2.00 is adopted pursuant to St. 2012, c. 224, § 241 and M.GL. c. 6D.
Code of Massachusetts Regulations › 958 CMR - HEALTH POLICY COMMISSION › Title 958 CMR 2.00 - One-time Assessment On Certain Qualifying Hospitals And Qualifying Surcharge Payors › Section 2.03 - Acute Hospital Assessment

Current through Register 1525, July 5, 2024
(1)
General
. The Commission shall establish a one-time surcharge assessment on all Qualifying Hospitals. The surcharge amount to be paid to the Commission by each Qualifying Hospital is the product of:
(a) $60,000,000; and
(b) the hospital surcharge percentage as defined in 958 CMR 2.03(2).
Code of Massachusetts Regulations › 958 CMR - HEALTH POLICY COMMISSION › Title 958 CMR 2.00 - One-time Assessment On Certain Qualifying Hospitals And Qualifying Surcharge Payors › Section 2.04 - Surcharge Payor Assessment

Current through Register 1525, July 5, 2024
(1)
General
. The Commission shall establish a one-time surcharge assessment on all Qualifying Surcharge Payors. The surcharge amount to be paid to the Commission by each Qualifying Surcharge Payor is the product of:
(a) $165,000,000; and
(b) the surcharge payor surcharge percentage as defined in 958 CMR 2.04(2).
Code of Massachusetts Regulations › 958 CMR - HEALTH POLICY COMMISSION › Title 958 CMR 2.00 - One-time Assessment On Certain Qualifying Hospitals And Qualifying Surcharge Payors › Section 2.05 - Distribution of Funds

Current through Register 1525, July 5, 2024
(1)
General
. Revenue collected by the Commission under 958 CMR 2.03 and 2.04 shall be immediately distributed by the comptroller in the following manner:
(a) 5% of all revenue collected shall first be transferred to the Health Care Payment Reform Fund, established under St. 2011, c. 194, § 100.
(b) The remaining revenue shall be distributed in the following manner:
1. 60% shall be transferred to the Distressed Hospital Trust Fund, established under M.G.L. c. 29, § 2GGGG;
2. 26 2/3% shall be transferred to the Prevention and Wellness Trust Fund, established under M.G.L. c. 111, § 2G ; and
3. 13 1/3% shall be transferred to the e-Health Institute Fund, established under M.G.L. c. 40J, § 6E.
Code of Massachusetts Regulations › 958 CMR - HEALTH POLICY COMMISSION › Title 958 CMR 2.00 - One-time Assessment On Certain Qualifying Hospitals And Qualifying Surcharge Payors › Section 2.06 - Penalties

Current through Register 1525, July 5, 2024
(1)
Late Payment Penalty
. If a Qualifying Hospital or Qualifying Surcharge Payor fails to make a scheduled payment pursuant to 958 CMR 2.03 and 2.04, the Commission shall impose an additional 2.5% interest penalty on the outstanding balance. The interest shall be calculated from the due date option selected under 958 CMR 2.03(3)(b)  or 2.04(3)(b), whichever applies. For each 30 calendar days a payment remains delinquent, an additional 2.5% penalty shall accrue against the outstanding balance, including prior penalties. The Commission shall credit partial payments first to the current outstanding liability, and second to the amount of the penalties.
(2)
Offset Collection
. If a Qualifying Hospital or Qualifying Surcharge Payor is more than 45 calendar days late with a payment due pursuant to the schedule set forth in 958 CMR 2.03(3)(b)  or 958 CMR 2.04(3)(b), the Commission may notify the Executive Office and the Office of Medicaid that such payments are past due. The Executive Office may reassign to the Commission any payments to the Qualifying Hospital or Qualifying Surcharge Payor in the amount of the unpaid assessment, including any interest and penalties.
The Commission shall notify any Qualifying Hospital or Qualifying Surcharge Payor at least 15 calendar days prior to notifying the Executive Office under 958 CMR 2.06(2).
Code of Massachusetts Regulations › 958 CMR - HEALTH POLICY COMMISSION › Title 958 CMR 2.00 - One-time Assessment On Certain Qualifying Hospitals And Qualifying Surcharge Payors › Section 2.07 - Reporting Requirements

Current through Register 1525, July 5, 2024
(1)
General
. Each Acute Hospital and Surcharge Payor shall file or make available information that is required or that the Commission deems reasonably necessary for implementation of 958 CMR 2.00.
(a) The Commission may revise the data specifications, the data collection scheduled, or other administrative requirements by administrative bulletin.
(b) The Commission may audit data submitted under 958 CMR 2.00 to ensure accuracy.
Code of Massachusetts Regulations › 958 CMR - HEALTH POLICY COMMISSION › Title 958 CMR 2.00 - One-time Assessment On Certain Qualifying Hospitals And Qualifying Surcharge Payors › Section 2.08 - Special Provisions

Current through Register 1525, July 5, 2024
(1)
Transfer of Ownership
. All liabilities to the Commission by a Qualifying Hospital or Qualifying Surcharge Payor shall, in the case of a transfer of ownership, be assumed by the successor.
(2)
Acute Hospital Rates
. A Qualifying Hospital shall not seek an increase in rates to offset the surcharge assessment under 958 CMR 2.03. The Commission may require a Qualifying Hospital to submit a jurat or an attestation signed under the pains and penalties of perjury by a person with legal authority to bind the entity, who attests to compliance with this obligation.
(3)
Surcharge Payor Premiums
. A Qualifying Surcharge Payor shall not seek an increase in premiums to offset the surcharge assessment under 958 CMR 2.04. The Commission may require a Qualifying Surcharge Payor to submit a jurat or an attestation signed under the pains and penalties of perjury by a person with legal authority to bind the entity, who attests to compliance with this obligation.
(4)
Severability
. The provisions of 958 CMR 2.00 are severable. If any provision or the application of any provision to any Acute Hospital or Surcharge Payor or circumstances is held to be invalid or unconstitutional, and such invalidity shall not be construed to affect the validity or constitutionality of any remaining provisions of 958 CMR 2.00 or the application of such provisions to Acute Hospitals or Surcharge Payors in circumstances other than those held invalid.
(5)
Administrative Bulletins
. The Commission may issue administrative bulletins to clarify policies and understanding of substantive provisions of 958 CMR 2.00 and specify information and documentation necessary to implement 958 CMR 2.00.
Code of Massachusetts Regulations › 958 CMR - HEALTH POLICY COMMISSION › Title 958 CMR 3.000 - Health Insurance Consumer Protection › Section 3.001 - Scope and Purpose

Current through Register 1525, July 5, 2024
958 CMR
				3.000 applies to all carriers subject to the
				requirements of M.G.L. c. 1760.
				958 CMR
				3.000 establishes requirements for carriers in
				administering their internal grievance procedures and establishes the
				requirements for the conduct of external reviews of carriers' medical necessity
				adverse determinations.
				958 CMR
				3.000 also sets out requirements for continuity of
				care, referral to specialty care, and carrier reporting
				requirements.