Bill H.2990

HOUSE DOCKET, NO. 3010 FILED ON: 1/20/2017

HOUSE . . . . . . . . . . . . . . . No. 2990

By Mr. Lawn of Watertown, a petition (accompanied by bill, House, No. 2990) of John J. Lawn, Jr., and James B. Eldridge relative to surcharges assessed by acute hospitals and ambulatory surgical centers. Health Care Financing.

The Commonwealth of Massachusetts

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In the One Hundred and Ninetieth General Court
(2017-2018)

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An Act ensuring parity in assessments by the Health Safety Net Trust Fund.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:

SECTION 1. Section 64 of chapter 118E of the General Laws as appearing in the 2014 Official Edition, is hereby further amended by adding after the definition of “Health services” the following two definitions:--

“Limited services”, diagnosis, treatment, management and monitoring of acute and chronic disease, wellness and preventative services of a nature that may be provided within the scope of practice of a nurse practitioner using available facilities and equipment, including shared toilet facilities for point-of-care testing.

“Limited services clinic”, a clinic that provides limited services as defined by section 52 of chapter 111.

SECTION 2. Said section 64, as so appearing, is hereby further amended by adding the following two definitions:-

“Urgent Care”, a model of episodic care delivery that is primarily the immediate diagnosis, treatment, management or monitoring of acute and chronic disease, generally provided on a walk-in basis, and not intended as the patient’s primary care provider.

“Urgent care clinic”, a clinic that provides urgent care as defined by this section.

SECTION 3. Said section 64, as so appearing, is hereby 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 payors to acute hospitals for health services, ambulatory surgical centers for ambulatory surgical center services, urgent care clinics for urgent care services, and limited services clinics for limited services, as defined in this section; provided, however, that “payments subject to surcharge” shall not include: (i) payments, settlements and property or casualty insurance policies; and (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; provided further, that “payments subject to surcharge” shall include payments made by a managed care organization on behalf of Medicaid recipients under age 65 who are not enrolled in an integrated care organization; and provided further that “payments subject to surcharge” may exclude amounts established by regulations promulgated by the executive office for which the costs and efficiency of billing a surcharge payor or enforcing collection of the surcharge from a surcharge payor would not be cost effective.

SECTION 4. Said section 64, as so appearing, is hereby further amended by striking out the definition of “Reimbursable health services” and inserting in place thereof 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 part, under applicable regulations of the office; provided that the health services are provided by acute hospitals, including but not limited to emergency, urgent, or critical access services, or services provided by community health centers; and provided further, that such services shall not be eligible for reimbursement by any other public or private third-party payer.

SECTION 5. Said section 64, as so appearing, is hereby further amended by striking out the definition of “Surcharge payor” and inserting in place thereof the following definition:--

“Surcharge payor”, an individual or entity that pays for or arranges for the purchase of health care services provided by acute hospitals, ambulatory surgical center services provided by ambulatory surgical centers, urgent care services provided by urgent care clinics, and limited services provided by limited services clinics, as defined in this section; provided, however, that the term “surcharge payor” shall not include Title XVIII and Title XIX programs and their beneficiaries or recipients, other governmental programs of public assistance and their beneficiaries or recipients and the workers’ compensation program established by chapter 152.

SECTION 6. Clause (i) of subsection (b) of section 65 of said Chapter 118E, as so appearing, is hereby amended by striking the word “hospitals’” and inserting in place thereof the following words:--

hospitals’, ambulatory surgical centers’, urgent care clinics’, and limited services clinics’

SECTION 7. Subsection (b) of section 66 of said Chapter 118E, as amended by section 8 of chapter 115 of the acts of 2016, as amended by section 139 of chapter 133 of the acts of 2016, is hereby amended by inserting after the phrase “all amounts paid by acute hospitals” the following words:--

ambulatory surgical centers, urgent care clinics, and limited services clinics,

SECTION 8. Subsection (b) of section 66 of said Chapter 118E, as amended by section 8A of chapter 115 of the acts of 2016, is hereby amended by inserting after the phrase “all amounts paid by acute hospitals” the following words:--

ambulatory surgical centers, urgent care clinics, and limited services clinics,

SECTION 9. Section 67 of said Chapter 118E, is hereby amended by adding the following subsection:--

(c) Ambulatory surgical centers not otherwise owned by, a venture with, or affiliated with an existing acute care hospital in said hospital’s primary service area; urgent care clinics not otherwise owned by, a joint venture with, or affiliated with an existing acute care hospital in said hospital’s primary service area; and limited services clinics not otherwise owned by, a joint venture with, or affiliated with an existing acute care hospital in said hospital’s primary service area shall be liable to the health care safety net trust fund in the same manner as acute care hospitals. The office, in consultation with the division, shall establish through regulation the mechanism by which the liability of said providers is to be assessed, paid, monitored and enforced.

SECTION 10. Section 68 of said Chapter 118E, as so appearing, is hereby amended by striking out paragraphs (a) through (c), inclusive, and inserting in place thereof the following three paragraphs:--

(a) Acute hospitals, ambulatory surgical centers, urgent care clinics, and limited services clinics shall assess a surcharge on all payments subject to surcharge as defined in section 64. The surcharge shall be distinct from any other amount paid by a surcharge payor for the services of an acute hospital, ambulatory surgical center urgent care clinic, or limited services clinic. The surcharge amount shall equal the product of: (i) the surcharge percentage; and (ii) amounts paid for these services by a surcharge payor. The office shall calculate the surcharge percentage by dividing the total surcharge amount by the projected annual aggregate payments subject to the surcharge, excluding projected annual aggregate payments based on payments made by managed care organizations. The office shall determine the surcharge percentage before the start of each fund fiscal year and may re-determine the surcharge percentage before April 1 of each fund fiscal year if the office projects that the initial surcharge percentage established the previous October will produce less than the total surcharge amount minus $10,000,000 or more than the total surcharge amount plus $10,000,000 excluding payments made by managed care organizations. Before each succeeding October 1, the office shall re-determine the surcharge percentage incorporating any adjustments from earlier years. In each determination or redetermination of the surcharge percentage, the office shall use the best data available as determined by the office of Medicaid and may consider the effect on projected surcharge payments of any modified or waived enforcement under subsection (e). The office shall incorporate all adjustments, including, but not limited to, updates or corrections or final settlement amounts, by prospective adjustment rather than by retrospective payments or assessments.

(b) Each acute hospital, ambulatory surgical center, urgent care clinic, and limited services clinic shall bill a surcharge payor an amount equal to the surcharge described in subsection (a) as a separate and identifiable amount distinct from any amount paid by a surcharge payor for acute hospital, ambulatory surgical center, urgent care clinic, or limited services clinic services. Each surcharge payor shall pay the surcharge amount to the office for deposit in the Health Safety Net Trust Fund on behalf of said acute hospital or ambulatory surgical center. Upon the written request of a surcharge payor, the office may implement another billing or collection method for the surcharge payor; provided, however, that the office has received all information that it requests which is necessary to implement such billing or collection method; and provided further, that the office shall specify by regulation the criteria for reviewing and approving such requests and the elements of such alternative method or methods.

(c) The office shall specify by regulation appropriate mechanisms that provide for determination and payment of a surcharge payor's liability, including requirements for data to be submitted by surcharge payors, acute hospitals, ambulatory surgical centers, urgent care clinics, and limited services clinics.

Name:	District/Address:	Date Added:
John J. Lawn, Jr.	10th Middlesex	1/20/2017
James B. Eldridge	Middlesex and Worcester	2/2/2017