957 CMR 3.02 - Definitions

Current through Register 1466, April 1, 2022

Meaning of Terms. All defined terms in 957 CMR 3.00 are capitalized. As used in 957 CMR 3.00, unless the context otherwise requires, terms have the following meanings:

Ambulatory Surgical Center. Any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and meets the U.S. Centers for Medicare and Medicaid (CMS) requirements for participation in the Medicare program.

Center. The Center for Health Information and Analysis as established under M.G.L. c. 12C.

Center Expenses. The amount appropriated by the general court for the expenses of the Center minus amounts collected from:

(a) filing fees;

(b) fees and charges generated by the Center's publication or dissemination of reports and information; and

(c) federal matching revenues received for these expenses or received retroactively for expenses of predecessor agencies. Center expenses shall include an amount equal to the cost of fringe benefits and indirect expenses, as established by the comptroller.

Gross Patient Service Revenue (GPSR). The total dollar amount of a Hospital's or an Ambulatory Surgical Center's charges for services rendered in a fiscal year.

Hospital. The teaching hospital of the University of Massachusetts Medical School and any acute hospital licensed under M.G.L. c. 111, § 51 that contains a majority of medical-surgical, pediatric, obstetric and maternity beds, as defined by the Department of Public Health.

MassHealth. The medical assistance program administered by the Executive Office of Health and Human Services Office of Medicaid pursuant to M.G.L. c. 118E and in accordance with Titles XIX and XXI of the Federal Social Security Act, and a § 1115 Demonstration Waiver.

Medicare Program. The medical insurance program established by Title XVIII of the Social Security Act.

Payment. A check, draft or other paper instrument, an electronic fund transfer, or any order, instruction, or authorization to a financial institution to debit one account and credit another.

Surcharge Payor. A Surcharge Payor is an individual or entity, including a Managed Care Organization, that pays for or arranges for the purchase of Health Services provided by Hospitals and Ambulatory Surgical Center Service provided by Ambulatory Surgical Centers; provided, however, that the term "Surcharge Payor" shall not include:

(a) Title XVIII and Title XIX programs and their beneficiaries or recipients;

(b) other governmental programs of public assistance and their beneficiaries or recipients; and

(c) the workers' compensation program established pursuant to M.G.L. c. 152.

Notes

957 CMR 3.02
Amended by Mass Register Issue 1368, eff. 6/29/2018.

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