Managed Care Organization Services Groups

(1) Managed Care Organization Assessment Liability. Managed care organization assessment liability will vary by managed care organization services group, whether Medicaid or non- Medicaid services, and for Medicaid services, by the size of the Medicaid services as determined by Medicaid total revenues. The three groups of managed care organization services for purposes of 101 CMR 515.00 are defined as follows. (a) Group I. Non-Medicaid assessed services and Medicaid assessed services provided in Massachusetts to members enrolled in out-of-state Medicaid programs; (b) Group II. Medicaid assessed services provided by a managed care organization with annual total paid claims less than or equal to $2,000,000,000; and (c) Group III. Medicaid assessed services provided by a managed care organization with annual total paid claims greater than $2,000,000,000. (2) Annual Application of Assessment. The assessment rate will be established annually and will apply to a managed care organization’s assessed services, based on the managed care organization’s assessed services in each assessment group described in 101 CMR 515.03(1), as such assessed services are reported each month by managed care organizations.