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
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