Section 68: Managed care organization services assessment; calculation of liability; payment to health safety net trust fund
535 words·~2 min read·
/ma/part-i/title-xvii/chapter-118e/68·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Section 68.
(a)Subject to all required federal approvals, including any required waivers under 42 CFR 433.68, a managed care organization's annual liability to the fund shall be calculated in accordance with this section. The annual aggregate liability of all managed care organizations to the fund shall equal the total managed care organization services assessment amount.
(b)The assessment shall be paid to the Health Safety Net Trust Fund, established in section 66, by managed care organizations rendering managed care organization services subject to assessment on a monthly basis and shall be assessed on all managed care organization services subject to assessment.
(c)All managed care organization services subject to assessment shall be divided into 1 of the following assessment groups; provided, however, that the secretary of health and human services may, by regulation, establish further sub-groups within each assessment group:
(i)managed care organization services subject to assessment that are not Medicaid managed care organization services subject to assessment provided by a managed care organization;
(ii)Medicaid managed care organization services subject to assessment provided by a managed care organization rendered below a threshold established by the secretary of health and human services in its regulations; and
(iii)Medicaid managed care organization services subject to assessment provided by a managed care organization rendered at or above a threshold established by the secretary of health and human services in its regulations.
(d)The assessment rates for each assessment group shall be multiplied by each managed care organization's managed care organization services subject to assessment, as determined by the secretary of health and human services. The total of the resulting products shall equal a managed care organization's annual assessment liability.
(e)Subject to receipt of all required federal approvals, the secretary of health and human services shall implement the assessment structure described in this section and shall promulgate regulations necessary to support implementation of said assessment structure. In promulgating such regulations, the secretary of health and human services shall, at a minimum:
(i)establish assessment groups, in accordance with subsection (c), into which all managed care organization services subject to assessment are divided;
(ii)set assessment rates for each such assessment group, sufficient in the aggregate to generate in each fiscal year the total managed care organization services assessment amount;
(iii)establish any necessary reporting requirements for managed care organizations;
(iv)establish an appropriate mechanism for enforcing each managed care organization's liability to the Health Safety Net Trust Fund, established in section 66, if a managed care organization rendering managed care organization services subject to assessment does not make a scheduled payment to the Health Safety Net Trust Fund;
(v)specify an appropriate mechanism for determination and payment of a managed care organization's liability to the Health Safety Net Trust Fund;
(vi)identify the managed care organization services subject to assessment under each group established pursuant to subsection (c);
(vii)specify an appropriate mechanism for the determination of a managed care organization's liability in cases of merger or transfer of ownership; and
(viii)specify an appropriate mechanism by which any amounts paid by a managed care organization in excess of its total annual assessment liability may be refunded or otherwise credited to the managed care organization.