Section 71 Managed Care Organization Services Assessment 12

Chapter 118E of the General Laws is hereby amended by striking out section 68 and inserting in place thereof the following section:-
Section 68. (a) Subject to all required federal approvals, including any required waivers under 42 CFR 433.68, a MCO's annual liability to the fund shall be calculated in accordance with this section. The annual aggregate liability of all MCOs to the fund shall equal the total MCO services assessment amount.
(b) The assessment shall be paid to the fund by MCOs rendering MCO services subject to assessment on a monthly basis, and shall be assessed on all MCO services subject to assessment on a per member per month basis.
(c) All MCO services subject to assessment shall be divided into one of the following assessment groups; provided, however, that the secretary may, via regulation, establish further sub-groups within each of these assessment groups:
(1) MCO services subject to assessment provided by a MCO that is not a Medicaid MCO;
(2) MCO services subject to assessment provided by a Medicaid MCO that has an average total Medicaid member per month enrollment below a threshold established by the secretary via regulation; and
(3) MCO services subject to assessment provided by a Medicaid MCO that has an average total Medicaid member per month enrollment at or above a threshold established by the secretary via regulation.
(d) The assessment rates for each assessment group shall be multiplied by each MCO's MCO services subject to assessment, as determined by the secretary of health and human services. The total of the resulting products shall equal a MCO's annual assessment liability.
(e) Subject to receipt of all required federal approvals, the secretary 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 shall, at a minimum: (i) establish assessment groups, in accordance with subsection (c), into which all MCO 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 MCO services assessment amount; (iii) establish any necessary reporting requirements for MCOs; (iv) establish an appropriate mechanism for enforcing each MCO's liability to the fund if a MCO rendering MCO services subject to assessment does not make a scheduled payment to the fund; (v) specify an appropriate mechanism for determination and payment of a MCO's liability to the fund; (vi) identify the MCO services subject to assessment under each group established according to subsection (c); (vii) specify an appropriate mechanism for the determination of a MCO's liability in cases of merger or transfer of ownership; and (viii) specify an appropriate mechanism by which any amounts paid by a MCO in excess of its total annual assessment liability may be refunded or otherwise credited to the MCO.

This section, along with other related sections, creates a unified assessment mechanism for all managed care organization assessments.