Calculation of Managed Care Organization Services Assessment

(1) Assessment Basis. To determine each managed care organization’s assessment liability, the assessment rates established in accordance with 101 CMR 515.04 are applied to the managed care organization’s monthly assessed services, calculated based on total claims paid by the managed care organization in the month assessed. (2) Assessment Rate. (a) For the assessment year beginning January 1, 2025, the assessment will be applied as follows. Assessment Group Assessment Group Description Assessment Rate Group I Commercial Services: Non-Medicaid assessed services and Medicaid assessed services rendered by out-of- state Medicaid managed care organizations 1.18% Group II Tier 1 Medicaid Services: Medicaid assessed services provided by a managed care organization with annual total paid claims of less than or equal to $2,000,000,000 8.00% Group III Tier 2 Medicaid Services: Medicaid assessed services provided by a managed care organization with annual total paid claims of greater than $2,000,000,000 0.50% (b) For assessment years beginning on or after January 1, 2026, the assessment rates for each group will be issued via administrative bulletin and determined by the total assessment amount to be collected each assessment year, taking into account any reconciliation for over- or under-assessment amounts from the previous assessment year; provided that each assessment year, assessment rates are set in a manner to meet the requirements of 42 CFR 433.68(e)(2) and 42 CFR 433.68(f). (3) Assessment Rate Annual Determination and Reconciliation. (a) Prior to each assessment year, EOHHS will determine the assessment rate for the assessment year, incorporating any necessary adjustments to account for rates set in prior assessment years that were insufficient or in excess to assess the total assessment amount. (b) EOHHS may prospectively redetermine the assessment rate during an assessment year, if EOHHS projects that the initial assessment rate established for the assessment year will produce significantly less or more than the total assessment amount. (c) In each determination or redetermination of the assessment rate, EOHHS will use the best data available, as determined by EOHHS. EOHHS will incorporate all adjustments, including, but not limited to, updates or corrections or final settlement amounts, by prospective adjustment rather than by retrospective payments or assessments.