956 CMR 9.05 - Collection of Surcharge

(1) Notification of Surcharge Liability. The Connector will notify Employers subject to Surcharge at the end of each Fiscal Year. The Notice will contain the following information:
(a) Employer name, FEIN, address;
(b) Name of State funded Employee. If Employee dependent, name of Employee;
(c) Name of provider that submitted claim;
(d) Dates of service;
(e) Provider charges;
(f) Amount of State funded Health Costs per State funded Employee;
(g) Total Amount of State funded Health Costs;
(h) Surcharge Amount determined in accordance with 956 CMR 9.04;
(i) Date payment is due;
(j) Remittance advice with directions to submit payment.
(2) If a State funded Employee is employed by more than one Non-providing Employer at the time State funded Health Services are delivered, the Connector will assess a prorated Surcharge to each Employer based on the best available data. If an individual is a Dependent of two State funded Employees, the Connector will assess a prorated Surcharge to each Employer.
(3) Review. An Employer may challenge the Connector's determination only if it can document either that an individual identified as a State funded Employee was not its Employee or Dependent of one of its Employees; or that the Employer is not a Non-providing Employer.
(a) The Employer must notify the Connector in writing within 14 days of the notice that it contests the Connector's determination. The Employer must submit documentation to support its claim with its notification.
(b) The Connector will review the documentation and make a determination based on its review of the documentation submitted and any other available data. The Connector will issue a written decision explaining its determination and any adjustment to the Employer Surcharge amount.
(c) If the Connector determines upon review that the Employer is not a Non-providing Employer or is not otherwise responsible for the State funded Health Costs, no surcharge will be assessed.
(d) If the Connector does not adjust the Surcharge amount upon review, payment is due within seven days of the notification of the Connector's decision. If the Connector adjusts the Surcharge amount upon review, payment is due within fourteen days of the Connector's decision.
(4) Penalties for nonpayment or late payment by the Non-providing Employer, including assessment of interest on the unpaid liability at a rate not to exceed an annual percentage rate of 18% and late fees or penalties at a rate not to exceed 5% per month.
(5) In the case of a transfer of ownership, a Non-providing Employer's surcharge liability shall be assumed by the successor in interest to the Non-providing Employer.
(6) All surcharge payments made under 956 CMR 9.05 shall be deposited into the Commonwealth Care Trust Fund, established by M.G.L. c. 29, § 2OOO.

Notes

956 CMR 9.05

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