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Health Safety Net Assessments

SECTION 12.   (A) The definition of "Managed care organization" in section 64 of chapter 118E of the General Laws, as appearing in section 131 of chapter 224 of the acts of 2012, is hereby amended by inserting after the words "section 9D" the following words:- or an integrated care organization, as defined in section 9F.

(B) Clause (1) of the definition of "Payments subject to surcharge" in section 64 of said chapter 118E, as so appearing, is hereby amended by inserting after the words "age 65" the following words:- who are not enrolled in an ICO.

(C) Said definition of "Payments subject to surcharge" in said section 64 of said chapter 118E, as so appearing, is hereby further amended by striking out the word "division" and inserting in pace thereof the following words:- executive office.

(D) Said section 64 of said chapter 118E, as so appearing, is hereby further amended by inserting the following 2 definitions after the definition of "Surcharge payor":-

"Total acute hospital assessment amount", an amount equal to $160,000,000 plus 50 per cent of the estimated cost, as determined by the executive office, of administering the health safety net and related assessments in accordance with sections 65 to 69, inclusive.

"Total surcharge amount", an amount equal to $160,000,000 plus 50 per cent of the estimated cost, as determined by the executive office, of administering the health safety net and related assessments in accordance with sections 65 to 69, inclusive.

(E) Said chapter 118E is hereby further amended by striking out section 66 and inserting in place thereof the following section:-

Section 66. (a) There shall be established and set up on the books of the commonwealth a fund to be known as the Health Safety Net Trust Fund, in this section and in sections 67 to 69, inclusive, called the fund, which shall be administered by the office. Expenditures from the fund shall not be subject to appropriation unless otherwise required by law. The purposes of the fund shall be: (i) to maintain a health care safety net by reimbursing hospitals and community health centers for a portion of the cost of reimbursable health services provided to low-income, uninsured or underinsured residents; (ii) to support the estimated expenses of the executive office in administering the health safety net and related assessments in accordance with sections 65 to 69, inclusive; and (iii) to support a portion of the costs of the Medicaid program under this chapter and the commonwealth care health insurance program under chapter 118H. The office shall administer the fund using methods, policies, procedures, standards and criteria for the proper and efficient operation of the fund and programs funded by it in a manner designed to distribute the fund resources as equitably as possible. The secretary of administration and finance, , in consultation with the secretary of health and human services, shall determine annually the estimated expenses to administer the fund.

(b) The fund shall consist of all amounts paid by acute hospitals and surcharge payors under sections 67 and 68; all appropriations for the purpose of payments to acute hospitals or community health centers for health services provided to uninsured and underinsured residents; any transfers from the Commonwealth Care Trust Fund, established under section 2OOO of chapter 29; and all property and securities acquired by and through the use of monies belonging to the fund and all interest thereon. The office shall expend amounts in the fund, except for amounts transferred to the Commonwealth Care Trust Fund, for payments to hospitals and community health centers for reimbursable health services provided to uninsured and underinsured residents of the commonwealth, consistent with the requirements of this section and section 69 and the regulations adopted by the office. The office shall also expend annually for the fund the expenses of the executive office, including the health safety net office under subsection (a). The office shall also expend not more than $6,000,000 annually from the fund for demonstration projects that use case management and other methods to reduce the liability of the fund to acute hospitals. Any amounts collected from surcharge payors in any year in excess of the total surcharge amount, adjusted to reflect applicable surcharge credits, shall be transferred to the General Fund to support a portion of the costs of the Medicaid and commonwealth care health insurance programs. Any annual balance remaining in the fund after these payments have been made shall be transferred to the Commonwealth Care Trust Fund. All interest earned on the amounts in the fund shall be deposited or retained in the fund. The director shall from time to time requisition from the fund amounts that the director considers necessary to meet the current obligations of the office for the purposes of the fund and estimated obligations for a reasonable future period.

(F) The first sentence of subsection (a) of section 67 of said chapter 118E, as so appearing, is hereby amended by striking out clause (ii) and inserting in place thereof the following clause:- the total acute hospital assessment amount.

(G) The fourth sentence of subsection (a) of section 68 of said chapter 118E, as so appearing, is hereby amended by striking out the figure "$160,000,000" and inserting in place thereof the following words:- the total surcharge amount.

(H) The fifth sentence of said subsection (a) of said section 68 of said chapter 118E, as so appearing, is hereby amended by striking out the words "less than $150,000,000 or more than $170,000,000 in surcharge payments," and inserting in place thereof the following words:- less than the total surcharge amount minus $10,000,000, or more than the total surcharge amount plus $10,000,000.
 
 

Summary:
This section authorizes EOHHS to assess hospitals and insurers, as part of the Health Safety Net assessment, for the costs of administering the Health Safety Net and related assessments. This section also clarifies that integrated care organizations, and services provided to their enrollees, are not subject to the Health Safety Net payor surcharge.