Outside Section 23

Transfer of the Health Safety Net Office to HCFP (2 of 3)

SECTION 23.   Section 1 of chapter 118G of the General Laws, as amended by sections 22 and 23 of chapter 324 of the acts of 2006, is hereby amended by inserting after the definition of "Acute hospital" the following definition:-
"Allowable reimbursement", payments to acute hospitals and community health centers for health services provided to uninsured patients of the commonwealth under section 38 and any further regulations adopted by the office.

and is further amended by striking out the definition of "Bad debt" and inserting in place thereof the following definition:-
"Bad debt", an account receivable based on services furnished to a patient which: (i) is regarded as uncollectible, following reasonable collection efforts consistent with regulations of the office, which regulations shall allow third party payers to negotiate with hospitals to collect the bad debts of its enrollees; (ii) is charged as a credit loss; (iii) is not the obligation of a governmental unit or the federal government or any agency thereof; and (iv) is not a reimbursable health care service.

and is hereby further amended by inserting after the definition of "Dependent" the following definition:-
"Director", the director of the health safety net office.

and is further amended by striking out the definition of "Emergency bad debt" and inserting in place thereof the following definition:-
"Emergency bad debt", bad debt resulting from emergency services provided by an acute hospital to an uninsured or underinsured patient or other individual who has an emergency medical condition that is regarded as uncollectible, following reasonable collection efforts consistent with regulations of the office.

and is further amended by striking out the definition of "Financial requirements" and inserting in place thereof the following definition:-
"Financial requirements", a hospital's requirement for revenue which shall include, but not be limited to, reasonable operating, capital and working capital costs, and the reasonable cost associated with changes in medical practice and technology.

and is hereby further amended by inserting after the definition of "Free care" the following 2 definitions:-

"Fund", the Health Safety Net Trust Fund, established by section 35.

"Fund fiscal year", the 12-month period starting on October 1 and ending on September 30.

and is hereby further amended by inserting striking out the definition of "medically necessary services" and inserting in place thereof the following definition:-
"Medically necessary services" or "health services", medically necessary inpatient and outpatient services as mandated under Title XIX. Health services shall not include: (i) non-medical services, such as social, educational and vocational services; (ii) cosmetic surgery; (iii) cancelled or missed appointments; (iv) telephone conversations and consultations; (v) court testimony; (vi) research or the provision of experimental or unproven procedures, including, but not limited to, treatment related to sex reassignment surgery and pre-surgery hormone therapy; and (vii) the provision of whole blood, but the administrative and processing costs associated with the provision of blood and its derivative shall be payable.

and is hereby further amended by inserting after the definition of "Non-providing employer" the following definition:-
"Office", the health safety net office, established by section 34.

and is further amended by striking out the definition of "Payments from non-providing employers" and inserting in place thereof the following definition:-
"Payments from non-providing employers", all amounts paid to the Commonwealth Care Trust Fund by non-providing employers.

and is further amended by striking out the definition of "Payments subject to surcharge" and inserting in place thereof the following definition:-
"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, but "payments subject to surcharge" shall not include: (i) payments, settlements and judgments arising out of third party liability claims for bodily injury which are paid under the terms of property or casualty insurance policies; (ii) payments made on behalf of Medicaid recipients, Medicare beneficiaries, or persons enrolled in policies issued under chapter 176K or similar policies issued on a group basis; and "payments subject to surcharge" may exclude amounts established by regulation adopted by the division for which the cost and efficiency of billing a surcharge payer or enforcing collection of the surcharge from a surcharge payer would not be cost effective.

and is hereby further amended by inserting after the definition of "Purchaser" the following definition:-
"Reimbursable Health Services", health services provided to uninsured and underinsured patients who are determined to be financially unable to pay for their care, in whole or in part, under applicable regulations of the office; provided that the health services are emergency, urgent and critical access services provided by acute hospitals or services provided by community health centers; and provided further, that the services shall not be eligible for reimbursement by any other public or private third party payer.

and is hereby further amended by inserting after the definition of "Title XIX" the following definition:-
"Underinsured patient", a patient whose health insurance plan or self-insurance health plan does not pay, in whole or in part, for health services that are eligible for reimbursement from the Health Safety Net Trust Fund, provided that the patient meets income eligibility standards set by the office.

and is hereby further amended by striking out the definition of "Uninsured patient" and inserting in place thereof the following definition:-
"Uninsured patient", a patient who is a resident of the commonwealth, who is not covered by a health insurance plan or a self-insurance health plan and who is not eligible for a medical assistance program.
 
 

Summary:
This section (2 of 3) amends health care reform legislation to allow the Division of Health Care Finance and Policy, located with the Executive Office of Health and Human Services, to administer the Health Safety Net Trust Fund (formerly the Uncompensated Care Pool). This change will ensure continued federal reimbursement fot these payments.