Section 122 Managed Care Organization Services Assessment 9
Said section 64 of said chapter 118E, as so appearing, is hereby further amended by striking out the definitions of "Managed care organization" and "Payments subject to surcharge" and inserting in place thereof the following definitions:-
"Health safety net managed care organization revenue amount", an amount equal to $160,000,000 plus 50 per cent of the estimated cost, as determined by the secretary for administration and finance, of administering the health safety net and related assessments in accordance with sections 65 to 69, inclusive.
"Immunization revenue amount", the estimated costs to purchase, store and distribute vaccines for routine childhood immunizations and to administer the Vaccine Purchase Fund, established in section 24N of chapter 111, and the computerized immunization registry, established in section 24M of chapter 111, taking into consideration the limitations on expenditures described in subsection (b) of section 24N of chapter 111, as well as any anticipated surplus or deficit in said Vaccine Purchase Fund, but excluding any costs anticipated to be covered by federal contribution.
"Managed care organization", any of the following entities, as defined in regulations promulgated by the secretary of health and human services: (i) an entity that is accredited pursuant to chapter 176O and that is: (A) licensed or otherwise authorized to transact accident or health insurance pursuant to chapter 175; (B) a nonprofit hospital service corporation organized pursuant to chapter 176A; (C) a nonprofit medical service corporation organized pursuant to chapter 176B; (D) a health maintenance organization organized pursuant to chapter 176G; or (E) an organization entering into a preferred provider arrangement pursuant to chapter 176I; (ii) a Medicaid managed care organization; (iii) a health care organization, as defined in section 2 of chapter 32A; (iv) a self-insured group for which a carrier provides administrative services pursuant to section 21 of chapter 176O; and (v) a health insurance plan that contracts with the commonwealth health insurance connector authority.
"Managed care organization reinvestment revenue amount", a fixed amount equal to $246,000,000.
"Managed care organization services subject to assessment", services rendered by a managed care organization for which a premium or membership payment is made by or on behalf of the member; provided, however, that managed care organization services subject to assessment shall not include services: (i) rendered to members enrolled per month in Medicare managed care organizations; (ii) rendered to members dually enrolled per month in both Medicaid and Medicare; (iii) rendered to members in a Medicaid managed care organization who are age 65 or older; (iv) rendered as part of limited benefit plans, including, but not limited to, dental only or vision only member months, which are paid for as part of a subcontract under another managed care organization; or (v) services which are preempted from taxation by 5 U.S.C. section 8909(f); and provided further, that managed care organization services subject to assessment may be based on a tax base of managed care organization member months, premiums, claims, or charges, as determined by the secretary of health and human services and established consistently across the assessment groups that may be established pursuant to section 68.
"Massachusetts Child Psychiatry Access Project revenue amount", an amount equal to the amounts expended for the Massachusetts Child Psychiatry Access Project that are related to services provided on behalf of commercially insured clients.
"Medicaid managed care organization", a managed care organization, as defined in 42 CFR 438.2, that contracts with MassHealth pursuant to an approved state plan or federal waiver.
"Medicaid managed care organization services subject to assessment", managed care organization services subject to assessment provided to a Medicaid member.