Section 25 Nursing homes; assessment for non-medicare reimbursed patient days; quarterly reporting; audits of assessment records; appeal of assessment; penalties
Section 25. (a) For the purposes of this section, the following words shall have the following meanings:—
“Assessment”, the user fee imposed pursuant to this section. For all nursing homes, the user fee shall be imposed per non Medicare reimbursed patient day. A Medicare-reimbursed patient day is a Medicare Part A patient day paid for under either an indemnity fee-for-service arrangement or a Medicare health maintenance organization contract.
“Nursing home”, a nursing home or a distinct part of a nursing unit of a hospital or other facility licensed by the department of public health pursuant to section 71 of chapter 111.
“Patient day”, a day of care provided to an individual patient by a nursing home.
(b) Each nursing home shall pay an assessment per non-Medicare reimbursed patient day. The assessment shall be sufficient in the aggregate to generate $145 million in each fiscal year. The assessment shall be implemented as a broad based health care-related fee as defined in 42 U.S.C. § 1396b(w)(3)(B). The assessment shall be paid to the division quarterly. The division may promulgate regulations that authorize the assessment of interest on any unpaid liability at a rate not to exceed an annual percentage rate of 18 per cent and late fees at a rate not to exceed 5 per cent per month. The receipts from the assessment, any federal financial participation received by the commonwealth as a result of expenditures funded by these assessments and interest thereon shall be credited to the General Fund.
(c) The commissioner shall prepare a form on which each nursing home shall report quarterly its total patient days and shall calculate the assessment due. The commissioner shall distribute the forms to each nursing home at least annually. The failure to distribute the form or the failure to receive a copy of the form shall not stay the obligation to pay the assessment by the date specified in this section. The division may require additional reports, including but not limited to monthly census data, as it considers necessary to monitor collections and compliance.
(d) The division shall have the authority to inspect and copy the records of a nursing home for purposes of auditing its calculation of the assessment. In the event that the division determines that a nursing home has either overpaid or underpaid the assessment, the division shall notify the nursing home of the amount due or refund the overpayment. The division may impose per diem penalties if a nursing home fails to produce documentation as requested by the division.
(e) In the event that a nursing home is aggrieved by a decision of the division as to the amount due, the nursing home may file an appeal to the division of administrative law appeals within 60 days of the date of the notice of underpayment or the date the notice was received, whichever is later. The division of administrative law appeals shall conduct each appeal as an adjudicatory proceeding pursuant to chapter 30A, and a nursing home aggrieved by a decision of the division of administrative law appeals shall be entitled to judicial review pursuant to section 14 of said chapter 30A.
(f) The commissioner may enforce the provisions of this section by notifying the department of public health of unpaid assessments. Within 45 days after notice to a nursing home of amounts due, the department shall revoke licensure of a nursing home that fails to remit delinquent fees.
(g) The division, in consultation with the division of medical assistance, shall promulgate regulations necessary to implement this section.