Amendment #285 to H5150

Ambulance Provider Assessment Program

Mr. Golden of Lowell moves to amend H.5150 by inserting after section 13 the following section:-

SECTION 13A. Chapter 29 of the General Laws is hereby amended by inserting after section 2CCCCC the following section:

Section 2DDDDD. (a) There shall be established and set up on the books of the commonwealth a separate fund known as the Nonpublic Ambulance Service Reimbursement Trust Fund to be administered by the secretary of health and human services. There shall be credited to the fund: (i) all revenues generated from the funds collected under subsection (b) of section 67A of chapter 118E; (ii) an amount equal to any federal financial participation revenues claimed and received by the commonwealth for eligible expenditures made from the fund; (iii) any revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; and (iv) interest earned on any money in the fund. Amounts credited to the fund shall be expended, without further appropriation, for Medicaid payments to nonpublic ambulance services licensed by the department of public health under section 6 of chapter 111C.

(b) Revenues generated from clauses (i) and (ii) of subsection (a) shall be expended exclusively for nonpublic ambulance services licensed under said section 6 of said chapter 111C and shall not be used to replace payment commitments between the nonpublic ambulance services and the commonwealth. The expenditures shall be established by the executive office of health and human services in a manner consistent with the requirements and conditions of federal financial participation under 42 U.S.C. 1396b(w) and 42 C.F.R. 433.68, including the prohibitions against hold harmless provisions as defined under 42 U.S.C. 1396b(w)(4) and 42 C.F.R. 433.68(f) and shall be made only under federally-approved payment methods and consistent with federal funding requirements and all federal payment limits as determined by the secretary of health and human services. Federal financial participation shall be sought in a manner that achieves the maximum amount of federal revenue such that the assessment amount equals the state share of the qualifying Medicaid ambulance service payments related to this section.

(c) The schedule of payment amounts to be established and distributed by the executive office of health and human services under this section shall be developed in a manner that: (i) promotes the provider capacity, access and quality management needs of the MassHealth program as those needs are determined by the secretary of health and human services; (ii) considers the cost of services delivered by providers for which the providers are not fully reimbursed or otherwise compensated, including, but not limited to, free care and services delivered in good faith reliance on authorization; (iii) considers existing Medicaid reimbursement rates; (iv) closes the gap between Medicaid rates and average commercial rates; and (v) is proportional, to the extent possible, to the respective ambulance assessed amounts paid by each ambulance service relative to this section. The executive office shall consult with the Massachusetts Ambulance Association in the development and implementation of the payments. In order to accommodate timing discrepancies between the receipt of revenue and related expenditures, the comptroller may certify for payment amounts not to exceed the most recent revenue estimates as certified by the secretary of health and human services to be transferred, credited or deposited under this section. Money remaining in the fund at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in subsequent fiscal years.

And moves to further amend the bill by inserting after section 23 the following new sections:-

SECTION 23A. Chapter 118E of the General Laws is hereby amended by inserting after section 67 the following sections:

Section 67A. (a) An ambulance service’s liability to the fund shall equal the product of: (i) the ratio of its ambulance assessed charges to all ambulance services’ ambulance assessed charges statewide; and (ii) the total ambulance service assessment amount. Annually, before October 1, the executive office shall establish each ambulance service’s liability to the fund using the best data available as determined by the office and shall update each ambulance service’s liability to the fund as updated information becomes available. The office shall specify an appropriate mechanism for interim determination and payment of an ambulance service's liability to the fund. An 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 ambulance service.

(b) There shall be imposed in each fiscal year a uniform assessment upon the assessed charges of all nonpublic ambulance services licensed by the department of public health under section 6 of chapter 111C. Such assessment shall not be implemented unless and until the executive office receives notice of federal matching funds approval from the Centers for Medicare and Medicaid Services.

(c) All nonpublic ambulance services, regardless of payment model, are subject to such uniform assessment including, but not limited to, those nonpublic ambulance services in fee-for-service and managed care arrangements. Such uniform assessment shall be set as a percentage of the ambulance assessed charges of each such ambulance service and, for each fiscal year, the percentage shall be equal to the ratio of: (i) the total ambulance service assessment amount as defined in section 64 for the same fiscal year; to (ii) the total ambulance assessed charges as defined in said section 64 of in the same fiscal year and as the amount of those charges is determined by the office under this section. An 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 ambulance service.

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

SECTION 23B: Section 64 of said chapter 118E of the General Laws is hereby amended by inserting after the definition of “Total acute hospital assessment amount” the following definition:

“Total ambulance service assessment amount”, An amount not less than one-quarter of one percent (.25%) lower than the maximum limit for a provider assessment pursuant to 42 C.F.R. 433.68(f), inclusive of an annual amount of five hundred thousand dollars ($500,000) for the Executive Office of Health and Human Services to help offset the cost of the administration of the Nonpublic Ambulance Service Reimbursement Trust Fund in accordance with section 67A.

SECTION 23C: Said Section 64 of said chapter 118E, as so appearing is hereby further amended by inserting after the definition of “Allowable reimbursement” the following definition:

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

Additional co-sponsor(s) added to Amendment #285 to H5150

Ambulance Provider Assessment Program