101 CMR, § 514.03 - Hospital Groups
(1)
Hospital Assessment Liability. Hospital assessment
liability will vary by hospital group and by inpatient versus outpatient
revenues. The nine groups of hospitals for purposes of 101 CMR 514.00 are
defined as follows.
(a)
Group
I: Any acute hospital that had not less than 355 staffed beds in
fiscal year 2022 as reported by CHIA and that is identified as a group 1 safety
net hospital in the MassHealth demonstration waiver approved under Title XI of
the federal Social Security Act § 1115, subsection (a) in effect as of
October 1, 2022.
(b)
Group II: Any acute hospital that had less than 355
staffed beds in fiscal year 2022 as reported by CHIA and that is identified as
a group 1 safety net hospital in the MassHealth demonstration waiver approved
under Title XI of the federal Social Security Act § 1115, subsection (a)
in effect as of October 1, 2022.
(c)
Group III: Any
acute hospital that had not less than 355 staffed beds in fiscal year 2022 as
reported by CHIA and that is identified as a group 2 safety net hospital in the
MassHealth demonstration waiver approved under Title XI of the federal Social
Security Act § 1115, section(a) in effect as of October 1, 2022.
(d)
Group IV: Any
acute hospital that had less than 355 staffed beds in fiscal year 2022 as
reported by CHIA and that is identified as a group 2 safety net hospital in the
MassHealth demonstration waiver approved under Title XI of the federal Social
Security Act § 1115, subsection (a) in effect as of October 1,
2022.
(e)
Group
V: Any acute hospital that is a freestanding pediatric
hospital.
(f)
Group
VI: Any acute hospital that is an academic medical center,
teaching hospital, or specialty hospital, as determined by CHIA as of September
30, 2019, but excluding any high public payer hospital as defined by CHIA or
any hospital included in Group V.
(g)
Group VII: Any
private acute hospital operating as of September 30, 2019, but excluding any
hospital included in Groups I through VI.
(h)
Group VIII: The
Commonwealth's only non-state-owned public hospital, operating as of September
30, 2019.
(i)
Group
IX: Any nonpublic non-acute hospital operating as of September 30,
2019.
(2)
Consistent Application of Assessment. Hospitals will
remain in the group they are in as of October 1, 2024, and will be subject to
the same assessment rate established for their group, except as follows.
(a)
New Acute
Hospitals. New acute hospitals that come into operation subsequent
to October 1, 2022, or for whom there is no FY 2019 hospital-specific gross
patient service revenue data (as reported by CHIA based on the annual
collection of cost report data), or acute hospitals otherwise not included in
the approved waiver application, will be considered Group VI hospitals, under
101
CMR 514.03(1), until EOHHS
determines the hospital's group eligibility.
(b)
New Non-acute
Hospitals. New non-acute hospitals that come into operation
subsequent to October 1, 2022, or for whom there is no FY 2019
hospital-specific gross patient service revenue data (as reported by CHIA based
on the annual collection of cost report data), or non-acute hospitals otherwise
not included in the approved waiver application, will be considered Group IX
hospitals, under
101
CMR 514.03(1), until EOHHS
determines the hospital's group eligibility.
(c)
Hospital
Closures. If a hospital subject to the assessment closes, with no
successor in interest or assignee as determined by EOHHS consistent with the
criteria described in
101
CMR 514.03(2)(d), the former
hospital will no longer be subject to the assessment, provided that the
hospital is subject to the assessment up to and included its date of closure.
No changes will be made to the assessment rates for remaining assessed
hospitals as a result of a hospital's closure when there is no successor in
interest or assignee.
(d)
Mergers and Acquisitions. The original assessment
obligation of any hospital is applied to and becomes an obligation of any
successor in interest or assignee of such hospital, as determined by EOHHS. A
successor in interest may include, but is not limited to, any purchaser of the
assets or stock, any new licensee of an existing acute or non-acute hospital,
any surviving entity resulting from merger or liquidation, or any receiver or
any trustee of the original hospital. The assessment obligation of the
successor in interest or assignee with respect to the acquired or merged
hospital(s) will be equal to the assessment obligation of the affected
hospitals prior to the merger or acquisition. The assessment will be applied to
hospitals that merge, or hospitals that acquire another or are acquired, as if
no such merger or acquisition occurred.
(e)
Multi-factorial
Changes. The assessment obligation will follow the rules
established in
101
CMR 514.03(2)(a) through
(d), provided that:
1. In the event an existing hospital has
merged with or acquired only a portion of another existing hospital and the two
hospitals both continue to exist as hospitals after the merger or acquisition,
the original assessment obligations of the two hospitals will be applied
proportionally to each hospital based on the gross patient service revenue
attributable to each portion of each hospital after the merger or
acquisition.
2. In the event that a
new hospital opens and also acquires a portion or all of an existing hospital,
and the portion of the hospital that is new accounts for greater than 50% of
the gross patient service revenue of the total hospital entity, the hospital's
assessment obligation will be determined in accordance with
101
CMR 514.03(2)(a) or (b), as
applicable depending on the hospital's status as an acute or non-acute
hospital.
3. In the event that a
new hospital opens and also acquires a portion or all of an existing hospital,
and the portion of the hospital that is new accounts for 50% or less of the
gross patient service revenue of the total hospital entity, the hospital's
assessment obligation will be equal to the portion of the assessment
attributable to the acquired portion of the hospital.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(1) Hospital Assessment Liability. Hospital assessment liability will vary by hospital group and by inpatient versus outpatient revenues. The nine groups of hospitals for purposes of 101 CMR 514.00 are defined as follows.
(a) Group I: Any acute hospital that had not less than 355 staffed beds in fiscal year 2022 as reported by CHIA and that is identified as a group 1 safety net hospital in the MassHealth demonstration waiver approved under Title XI of the federal Social Security Act § 1115, subsection (a) in effect as of October 1, 2022.
(b) Group II: Any acute hospital that had less than 355 staffed beds in fiscal year 2022 as reported by CHIA and that is identified as a group 1 safety net hospital in the MassHealth demonstration waiver approved under Title XI of the federal Social Security Act § 1115, subsection (a) in effect as of October 1, 2022.
(c) Group III: Any acute hospital that had not less than 355 staffed beds in fiscal year 2022 as reported by CHIA and that is identified as a group 2 safety net hospital in the MassHealth demonstration waiver approved under Title XI of the federal Social Security Act § 1115, section (a) in effect as of October 1, 2022.
(d) Group IV: Any acute hospital that had less than 355 staffed beds in fiscal year 2022 as reported by CHIA and that is identified as a group 2 safety net hospital in the MassHealth demonstration waiver approved under Title XI of the federal Social Security Act § 1115, subsection (a) in effect as of October 1, 2022.
(e) Group V: Any acute hospital that is a freestanding pediatric hospital.
(f) Group VI: Any acute hospital that is an academic medical center, teaching hospital, or specialty hospital, as determined by CHIA as of September 30, 2019, but excluding any high public payer hospital as defined by CHIA or any hospital included in Group V.
(g) Group VII: Any private acute hospital operating as of September 30, 2019, but excluding any hospital included in Groups I through VI.
(h) Group VIII: The Commonwealth's only non-state-owned public hospital, operating as of September 30, 2019.
(i) Group IX: Any nonpublic non-acute hospital operating as of September 30, 2019.
(2) Consistent Application of Assessment . Hospitals will remain in the group they are in as of October 1, 2024, and will be subject to the same assessment rate established for their group, except as follows.
(a) New Acute Hospitals. New acute hospitals that come into operation subsequent to October 1, 2022, or for whom there is no FY 2019 hospital-specific gross patient service revenue data (as reported by CHIA based on the annual collection of cost report data), or acute hospitals otherwise not included in the approved waiver application, will be considered Group VI hospitals, under 101 CMR 514.03(1), until EOHHS determines the hospital's group eligibility.
(b) New Non-acute Hospitals. New non-acute hospitals that come into operation subsequent to October 1, 2022, or for whom there is no FY 2019 hospital-specific gross patient service revenue data (as reported by CHIA based on the annual collection of cost report data), or non-acute hospitals otherwise not included in the approved waiver application, will be considered Group IX hospitals, under 101 CMR 514.03(1), until EOHHS determines the hospital's group eligibility.
(c) Hospital Closures. If a hospital subject to the assessment closes, with no successor in interest or assignee as determined by EOHHS consistent with the criteria described in 101 CMR 514.03(2)(d), the former hospital will no longer be subject to the assessment , provided that the hospital is subject to the assessment up to and included its date of closure. No changes will be made to the assessment rates for remaining assessed hospitals as a result of a hospital's closure when there is no successor in interest or assignee.
(d) Mergers and Acquisitions. The original assessment obligation of any hospital is applied to and becomes an obligation of any successor in interest or assignee of such hospital, as determined by EOHHS. A successor in interest may include, but is not limited to, any purchaser of the assets or stock, any new licensee of an existing acute or non-acute hospital , any surviving entity resulting from merger or liquidation, or any receiver or any trustee of the original hospital. The assessment obligation of the successor in interest or assignee with respect to the acquired or merged hospital(s) will be equal to the assessment obligation of the affected hospitals prior to the merger or acquisition. The assessment will be applied to hospitals that merge, or hospitals that acquire another or are acquired, as if no such merger or acquisition occurred.
(e) Multi-factorial Changes. The assessment obligation will follow the rules established in 101 CMR 514.03(2)(a) through (d), provided that:
1. In the event an existing hospital has merged with or acquired only a portion of another existing hospital and the two hospitals both continue to exist as hospitals after the merger or acquisition, the original assessment obligations of the two hospitals will be applied proportionally to each hospital based on the gross patient service revenue attributable to each portion of each hospital after the merger or acquisition.
2. In the event that a new hospital opens and also acquires a portion or all of an existing hospital, and the portion of the hospital that is new accounts for greater than 50% of the gross patient service revenue of the total hospital entity, the hospital's assessment obligation will be determined in accordance with 101 CMR 514.03(2)(a) or (b), as applicable depending on the hospital's status as an acute or non-acute hospital .
3. In the event that a new hospital opens and also acquires a portion or all of an existing hospital, and the portion of the hospital that is new accounts for 50% or less of the gross patient service revenue of the total hospital entity, the hospital's assessment obligation will be equal to the portion of the assessment attributable to the acquired portion of the hospital.