(1)
Assessment
Basis. To determine each managed care organization's assessment
liability, the assessment rates established in accordance with
101
CMR
515.04 are applied to the managed care
organization's monthly assessed services, calculated based on total claims paid
by the managed care organization in the month assessed.
(2)
Assessment Rate.
(a) For the assessment year beginning January
1, 2025, the assessment will be applied as follows.
|
Assessment
Group
|
Assessment Group
Description
|
Assessment
Rate
|
|
Group I
|
Commercial Services: Non-Medicaid assessed
services
|
1.18%
|
|
Group II
|
Tier 1 Medicaid Services: Medicaid assessed services
rendered by managed care organizations with annual revenues of less than or
equal to $2,000,000,000
|
8.00%
|
|
Group III
|
Tier 2 Medicaid Services: Medicaid assessed services
rendered by managed care organizations with annual revenues of greater than
$2,000,000,000
|
0.50%
|
(b)
For assessment years beginning on or after January 1, 2026, the assessment
rates for each group will be issued
via administrative
bulletin and determined by the total assessment amount to be collected each
assessment year, taking into account any reconciliation for over-or
under-assessment amounts from the previous assessment year; provided that each
assessment year, assessment rates are set in a manner to meet the requirements
of 42 CFR
433.68(e)(2) and
42 CFR
433.68(f).
(3)
Assessment Rate
Annual Determination and Reconciliation.
(a) Prior to each assessment year, EOHHS will
determine the assessment rate for the assessment year, incorporating any
necessary adjustments to account for rates set in prior assessment years that
were insufficient or in excess to assess the total assessment amount.
(b) EOHHS may prospectively
redetermine the assessment rate during an assessment year, if EOHHS projects
that the initial assessment rate established for the assessment year will
produce significantly less or more than the total assessment amount.
(c) In each determination or redetermination
of the assessment rate, EOHHS will use the best data available, as determined
by EOHHS. EOHHS will 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.
Notes
Adopted by
Mass
Register Issue 1543, eff.
2/26/2025
(EMERGENCY).
Amended by
Mass
Register Issue 1549, eff.
2/26/2025
(EMERGENCY).
