956 CMR, § 11.04 - Determination of Annual Fair Share Employer Contribution

(1) Determination of Contribution Amount. The Annual Fair Share Employer Contribution Rate is the lower of:

(a) $295 per employee; or

(b) the sum of the Fair Share Employer Contribution and the Per Employee Cost of Unreimbursed Physician Care as calculated in accordance with 956 CMR 11.04. The Fair Share Employer Contribution Rate shall be determined annually by the Connector in consultation with the Director of the Department of Workforce Development using the best available data. The Annual Fair Share Employer Contribution Rate shall be adjusted to reflect a quarterly rate based on 25% of the annual fair share contribution rate applicable to that quarterly period.

(2) Fair Share Employer Contribution Rate. The Connector will determine the Annual Fair Share Employer Contribution Rate as follows:

(a) Determine the per user share of Private Sector Liability by dividing total Private Sector Liability for the Fiscal Year by the total number of users of the Health Safety Net in the most recent fiscal year.

(b) Determine the number of employee users that received services funded by the Health Safety Net;

(c) Multiply the total number of employee Health Safety Net users by the percentage of employers that are non-Contributing Employers.

(d) Determine the total cost of liability associated with employees of non-Contributing Employers by multiplying the number of users that are employees of non-Contributing Employers by the Per User Share of Private Sector Liability.

(e) Divide the total liability for employees of non-Contributing Employers by the total number of employees of non-Contributing Employers as determined by the Connector.

(f) Adjust by medical inflation as determined by the Connector.

(3) Per Employee Cost of Uncompensated Physician Care.

(a) The Connector will determine the total amount of uncompensated health care services provided by physicians to non-elderly, uninsured residents of the Commonwealth. The Connector will use the best available data, including survey data or other data source.

(b) The Connector will divide this amount by the number of employees of contributing Employers to determine the Per Employee Cost of Uncompensated Physician Care.

(4) The Sum of the Fair Share Employer Contribution and the Per Employee Cost of Uncompensated Physician Care is the Annual Fair Share Contribution Rate.

Notes

956 CMR, § 11.04