Mass. General Laws c.118E § 67A

Non-public ambulance service reimbursement

This is an unofficial version of a Massachusetts General Law. For more information on this topic, please see: Law about Medicaid (MassHealth)

Updates

Added by St.2020, c.254, § 2, effective December 31, 2020

(a)

As used in this section, the following words shall, unless the context clearly requires otherwise, have the following meanings:

“Ambulance service”, as defined in section 1 of chapter 111C.

“Executive office”, the executive office of health and human services.

“Gross patient service revenue”, the total dollar amount of nonpublic ambulance charges for services rendered in a fiscal year.

“Nonpublic ambulance assessed charges”, gross patient service revenue attributable to all patients less bad debt, charity care and payer discounts.

“Nonpublic ambulance service”, ambulance services which are not provided by a city or town, county, district or other governmental body and are licensed pursuant to section 6 of chapter 111C.

“Total nonpublic ambulance service assessment amount”, an amount not less than 1-quarter of 1 per cent lower than the maximum limit for a provider assessment pursuant to 42 C.F.R. 433.68(f), inclusive of an annual amount of $500,000; provided, that the annual amount of $500,000 shall be for administrative costs of the executive office.

(b)

A nonpublic ambulance service’s liability to the Nonpublic Ambulance Service Reimbursement Trust Fund, established in section 2KKKKK of chapter 29, shall equal the product of: (i) the ratio of its nonpublic ambulance assessed charges to all nonpublic ambulance services’ nonpublic ambulance assessed charges statewide; and (ii) the total nonpublic ambulance service assessment amount. Annually, before October 1, the executive office shall establish each nonpublic ambulance service’s liability to said fund using the best data available as determined by the executive office and shall update each nonpublic ambulance service’s liability to said fund as updated information becomes available. The executive office shall specify, by regulation an appropriate mechanism for interim determination and payment of a nonpublic ambulance service's liability to the fund. A nonpublic ambulance service's liability to the fund shall, in the case of a transfer of ownership, be assumed by the successor in interest to the nonpublic ambulance service.

(c)

There shall be imposed in each fiscal year a uniform assessment upon the nonpublic ambulance assessed charges of all nonpublic ambulance services. Such uniform assessment shall not be implemented unless and until the executive office receives notice of federal matching funds approval from the federal Centers for Medicare and Medicaid Services.

(d)

All nonpublic ambulance services, regardless of payment model, shall be subject to the uniform assessment pursuant to subsection (c), including, but not limited to, those nonpublic ambulance services in fee-for-service and managed care arrangements. The uniform assessment shall be set as a percentage of the nonpublic ambulance assessed charges of each such nonpublic ambulance service and, for each fiscal year, the percentage shall be equal to the ratio of: (i) the total nonpublic ambulance service assessment amount for the same fiscal year; to (ii) the total nonpublic ambulance assessed charges in the same fiscal year and as the amount of those charges is determined by the executive office under this section. A nonpublic ambulance service’s liability to the fund shall, in the case of a transfer of ownership, be assumed by the successor in interest to the nonpublic ambulance service.

(e)

The executive office shall establish an appropriate mechanism for enforcing each nonpublic ambulance service’s liability to the fund in the event that a nonpublic ambulance service does not make a scheduled payment to the fund.

(f)

For purposes of this section, the following words shall have the following meanings unless the context clearly requires otherwise:

“Provider”, an individual or facility licensed, certified or otherwise authorized or permitted by law to administer health care in the ordinary course of business or professional practice acting within the scope of their license.

“Therapeutic equivalent”, a contraceptive drug, device or product that is: (i) approved as safe and effective; (ii) pharmaceutically equivalent to another contraceptive drug, device or product in that it contains an identical amount of the same active drug ingredient in the same dosage form and route of administration and meets compendial or other applicable standards of strength, quality, purity and identity; and (iii) assigned the same therapeutic equivalence code as another contraceptive drug, device or product by the FDA.

Last updated:	December 31, 2020