§ 67 — Liability of acute hospital to fund

Massachusetts § 67

• Jurisdiction: Massachusetts
• Part I: ADMINISTRATION OF THE GOVERNMENT
• Title XVII: PUBLIC WELFARE
• Ch. 118E: DIVISION OF MEDICAL ASSISTANCE

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[ Text of section effective until the later of (i) one full calendar month following the calendar month in which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2024. For text effective upon the later of (i) one full calendar month following the calendar month in which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2024, see below.]Section 67. (a) Subject to all required federal approvals, including any required waivers under 42 CFR 433.68, a hospital's annual liability to the fund shall be calculated in accordance with this section. The annual aggregate liability of all hospitals to the fund shall equal the total hospital assessment amount.(b) [reserved].(c) The office shall promulgate regulations to establish an appropriate mechanism for enforcing each hospital's liability to the fund if a hospital does not make a scheduled payment to the fund.(d) For the purposes of the assessment described in this section, all hospitals in the commonwealth shall be divided into the following 5 groups:(i) safety net hospitals, defined for the purposes of this section as any hospital identified in the MassHealth demonstration waiver approved under subsection (a) of section 1115 of Title XI of the federal Social Security Act;(ii) academic, teaching and specialty hospitals, defined for the purposes of this section as any academic medical center, teaching hospital or specialty hospital, as determined by the center for health information and analysis as of September 30, 2019, but excluding any safety net hospital;(iii) private acute hospitals, defined for the purposes of this section as any private hospital licensed under section 51 of chapter 111 and that contains a majority of medical-surgical, pediatric, obstetric and maternity beds, as defined by the department of public health, and operating as of September 30, 2019, but excluding any safety net hospital or academic, teaching and specialty hospital;(iv) non-state public hospitals, defined for the purposes of this section as any non-state-owned public hospital in the commonwealth, as determined by the secretary; and(v) non-acute hospitals, defined for the purposes of this section as any nonpublic hospital licensed by the department of public health under said section 51 of said chapter 111 but not defined as an acute care hospital under section 25B of said chapter 111 or any nonpublic hospital licensed as an inpatient facility by the department of mental health under section 19 of chapter 19 and regulations promulgated thereunder but not categorized as a class VII licensee under the regulations.(e) Each of the 5 groups described in subsection (d) shall be subject to the following assessment rates: (i) safety net hospitals shall be subject to a rate of 16.05430 per cent for inpatient services and 1.19950 per cent for outpatient services; (ii) academic, teaching and specialty hospitals shall be subject to a rate of 4.66730 per cent for inpatient services and 0.74400 per cent for outpatient services; (iii) private acute hospitals shall be subject to a rate of 8.58690 per cent for inpatient services and 0.89340 per cent for outpatient services; (iv) non-state public hospitals shall be subject to a rate of 1.61490 per cent for inpatient services and 0.55320 per cent for outpatient services; and (v) non-acute hospitals shall be subject to a rate of 1.35000 per cent for inpatient services and 1.35000 per cent for outpatient services; provided, however, that the office shall increase each such rate by the amount necessary to generate 50 per cent of the estimated cost, as determined by the secretary of administration and finance, of administering the health safety net and related assessments in accordance with sections 65 to 69, inclusive.(f) The assessment rates described in subsection (e) shall be applied to each hospital's fiscal year 2019 assessed charges for inpatient and outpatient services, as determined by the secretary of health and human services; provided, however, that the term "assessed charges'' shall have the meaning ascribed to it in section 64. The total of the resulting products shall equal a hospital's annual assessment liability.(g) Subject to receipt of all required federal approvals, the executive office shall implement the assessment structure described in this section and shall promulgate regulations, in consultation with the Massachusetts Health and Hospital Association, Inc., necessary to support implementation of said assessment structure. In promulgating such regulations, and in consultation with the Massachusetts Health and Hospital Association, Inc., the executive office shall, at a minimum: (i) specify an appropriate mechanism for determination and payment of an acute hospital's liability to the fund; (ii) identify the hospitals that belong to each group identified in subsection (d); (iii) specify an appropriate mechanism for the determination of a hospital's liability in cases of merger or transfer of ownership; and (iv) specify an appropriate mechanism by which any amounts paid by a hospital in excess of a hospital's total annual assessment liability may be refunded or otherwise credited to the hospital.Chapter 118E: Section 67. Liability of hospital to fund[ Text of section as amended by 2024, 140, Sec. 129 effective upon the later of (i) one full calendar month following the calendar month in which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2024, until October 1, 2027. See 2024, 140, Sec. 248. For text effective until later of (i) one full calendar month following the calendar month in which the secretary receives all federal approvals deemed necessary to implement said sections; or (ii) October 1, 2024, see above. For text effective October 1, 2027, see below.]Section 67. (a) Subject to all required federal approvals, including any required waivers under 42 CFR 433.68, a hospital's annual liability to the fund shall be calculated in accordance with this section. The annual aggregate liability of all hospitals to the fund shall equal the total hospital assessment amount.(b) [reserved].(c) The office shall promulgate regulations establishing an appropriate mechanism for enforcing each hospital's liability to the fund if a hospital does not make a scheduled payment to the fund.(d) For the purposes of the assessment in this section, all hospitals in the commonwealth shall be divided into the following groups, as determined by the secretary: (i) large group 1 safety net hospitals which, for the purposes of this section, shall mean, any group 1 safety net hospital that had not less than 355 staffed beds in fiscal year 2022, as reported by the center for health information and analysis; (ii) small group 1 safety net hospitals which, for the purposes of this section, shall mean any group 1 safety net hospital that had less than 355 staffed beds in fiscal year 2022 as reported by the center for health information and analysis; (iii) large group 2 safety net hospitals which, for the purposes of this section, shall mean any group 2 safety net hospital that had not less than 355 staffed beds in fiscal year 2022 as reported by the center for health information and analysis; (iv) small group 2 safety net hospitals which, for the purposes of this section, shall mean any group 2 safety net hospital that had less than 355 staffed beds in fiscal year 2022 as reported by the center for health information and analysis; (v) freestanding pediatric acute hospitals; (vi) academic, teaching and specialty hospitals which, for the purposes of this section, shall mean an academic medical center, teaching hospital or specialty hospital as determined by the center for health information and analysis as of September 30, 2019, but excluding any high public payer hospital; (vii) private acute hospitals which, for the purposes of this section, shall mean a private hospital licensed under section 51 of chapter 111 that contains a majority of medical-surgical, pediatric, obstetric and maternity beds as defined by the department of public health and operating as of September 30, 2019, but excluding any safety net hospital or academic, teaching and specialty hospital; (viii) non-state public hospitals which, for the purposes of this section, shall mean any non-state-owned public hospital in the commonwealth as determined by the secretary; and (ix) non-acute hospitals which, for the purposes of this section shall mean any nonpublic hospital licensed by the department of public health under said section 51 of said chapter 111; provided, however, that non-acute hospital shall not include an acute care hospital under section 25B of said chapter 111 or a nonpublic hospital licensed as an inpatient facility by the department of mental health under section 19 of chapter 19 and regulations promulgated thereunder but not categorized as a class VII licensee under the regulations.(e) Each of the groups described in subsection (d) shall be subject to the following assessment rates: (i) large group 1 safety net hospitals shall be subject to a rate of 24.000 per cent for inpatient services and 5.950 per cent for outpatient services; (ii) small group 1 safety net hospitals shall be subject to a rate of 14.500 per cent for inpatient services and 5.500 per cent for outpatient services; (iii) large group 2 safety net hospitals shall be subject to a rate of 18.000 per cent for inpatient services and 18.200 per cent for outpatient services; (iv) small group 2 safety net hospitals shall be subject to a rate of 18.000 per cent for inpatient services and 10.200 per cent for outpatient services; (v) freestanding pediatric acute hospitals shall be subject to a rate of 4.800 per cent for inpatient services and 4.250 per cent for outpatient services; (vi) academic, teaching and specialty hospitals shall be subject to a rate of 4.701 per cent for inpatient services and 1.065 per cent for outpatient services; (vii) private acute hospitals shall be subject to a rate of 8.500 per cent for inpatient services and 1.045 per cent for outpatient services; (viii) non-state public hospitals shall be subject to a rate of 1.615 per cent for inpatient services and 1.500 per cent for outpatient services; and (ix) non-acute hospitals shall be subject to a rate of 3.300 per cent for inpatient services and 3.300 per cent for outpatient services; provided, however, that the office shall increase each such rate by the amount necessary to generate 50 per cent of the estimated cost as determined by the secretary of administration and finance, of administering the health safety net and related assessments in accordance with sections 65 to 69, inclusive. If hospital closures or hospital changes in status to a different type of provider would result in a reduction of total hospital assessment amount, the secretary may, by regulation, adjust the assessment rates to ensure the total hospital assessment amount is not reduced by more than $10,000,000 on an annual basis; provided, however, that any such adjustments to the rates shall ensure the rates remain in the same proportion to each other as established herein.(f) The assessment rates described in subsection (e) shall be applied to each hospital's fiscal year 2019 assessed charges for inpatient and outpatient services as determined by the secretary of health and human services; provided, however, that the term "assessed charges'' shall have the meaning ascribed to it in section 64. The total of the resulting products shall equal a hospital's annual assessment liability.(g) Subject to receipt of all required federal approvals, the executive office shall implement the assessment structure described in this section and shall promulgate regulations, in consultation with the Massachusetts Health and Hospital Association, Inc., necessary to support implementation of said assessment structure. In promulgating such regulations, and in consultation with the Massachusetts Health and Hospital Association, Inc., the executive office shall, at a minimum: (i) specify an appropriate mechanism for determination and payment of an acute hospital's liability to the fund; (ii) identify the hospitals that belong to each group identified in subsection (d); (iii) specify an appropriate mechanism for the determination of a hospital's liability in cases of merger or transfer of ownership; and (iv) specify an appropriate mechanism by which any amounts paid by a hospital in excess of a hospital's total annual assessment liability may be refunded or otherwise credited to the hospital.(h) The secretary of health and human services may enforce the payment of required assessments under this section: (i) for hospitals licensed by the department of health, by notifying the department of the unpaid assessments and such information shall be considered by the department in determining suitability in accordance with section 51 of chapter 111 for the hospital or its affiliate provider entities; (ii) by offsetting payments from the office of Medicaid against the claims for payment by the delinquent hospital, against other hospitals or MassHealth-contracted entities under common ownership as the delinquent hospital or against any successor in interest to the hospital or such provider entities under common ownership, in the amount of the delinquent fees owed, including any interest, penalties and reasonable attorneys' fees, and by transferring such funds into the fund; or (iii) creating, after demand for payment, a lien in favor of the commonwealth in an amount not to exceed the delinquent fees owed, including any interest, penalties and reasonable attorneys' fees, encumbering the building in which the delinquent hospital is located, encumbering the real property upon which the delinquent hospital is located, including fixtures, equipment or goods used in the operation of the delinquent hospital, or encumbering any real property in which the delinquent hospital holds an interest.Chapter 118E: Section 67. Liability of acute hospital to fund[ Text of section as amended by 2022, 126, Sec. 63 effective October 1, 2027 applicable as provided by 2022, 126, Sec. 186 and 2024, 140, Sec. 239. For text effective until October 1, 2027, see above.]Section 67. (a) An acute hospital's liability to the fund shall equal the product of: (i) the ratio of its assessed charges to all acute hospitals' assessed charges; and (ii) the total acute hospital assessment amount. Annually, not later than October 1, the executive office shall establish each acute hospital's liability to the fund using the best data available as determined by the health safety net office and shall update each acute hospital's liability to the fund as updated information becomes available. The executive office shall specify by regulation an appropriate mechanism for interim determination and payment of an acute hospital's liability to the fund. An acute hospital's liability to the fund shall, in the case of a transfer of ownership, be assumed by the successor in interest to the acute hospital.(b) There shall be imposed in each fiscal year a uniform assessment upon the assessed charges of all: (i) nonpublic hospitals licensed by the department of public health under section 51 of chapter 111 but not defined as acute care hospitals under section 25B of said chapter 111; and (ii) nonpublic hospitals licensed as inpatient facilities by the department of mental health under section 19 of chapter 19 and regulations promulgated thereunder but not categorized as class VII licensees under the regulations; provided, however, that such uniform assessment shall be set as a percentage of the assessed charges of each such hospital and, for each fiscal year, the percentage shall be equal to the ratio of: (A) the total acute hospital assessment amount as defined in section 64 for the same fiscal year; to (B) the total assessed charges as defined in said section 64 of acute care hospitals in the same fiscal year and as the amount of those charges is determined by the health safety net office under this section. A non-acute hospital's liability to the fund shall, in the case of a transfer of ownership, be assumed by the successor in interest to the non-acute hospital.(c) The executive office shall establish by regulation an appropriate mechanism for enforcing each hospital's liability to the fund in the event that a hospital does not make a scheduled payment to the fund.