Reporting Requirements

(1) General. Each managed care organization must file or make available information that EOHHS deems reasonably necessary for calculating and collecting the assessment. (2) Required Reporting for Managed Care Organizations with Change of Status. Any new managed care organization, merging managed care organization, acquiring or acquired managed care organization, or managed care organization ceasing to operate or provide managed care organization services, must inform EOHHS of its change in status at least 14 days prior to such change in status. Any such managed care organization entities must provide projected annual revenue information and any additional supporting documentation, as requested by EOHHS, in the form and format requested by EOHHS within 30 days of beginning operations. (3) Additional Documentation. Each managed care organization must submit any additional documentation requested by EOHHS or its designee to verify the accuracy of the data submitted. (4) Audit. EOHHS or its designee may inspect and copy the records of a managed care organization for purposes of auditing its calculation of the assessment. If EOHHS or its designee determines that a managed care organization has either overpaid or underpaid the assessment, it will notify the managed care organization of the amount due or refund the overpayment. (5) Penalties. EOHHS may impose a per diem penalty of $100 per day if a managed care organization fails to furnish documentation required or requested under 101 CMR 515.06 within the timeframes specified in 101 CMR 515.06(2) or as specified by EOHHS upon request, or in administrative bulletins or other written issuances. (6) Enforcement Provisions. In addition to interest and late fees imposed under 101 CMR 515.06(5), EOHHS may take enforcement actions against the managed care organization rendering assessed services, whether or not such managed care organization is the entity paying the assessment directly, or whether the managed care organization has designated one or more subcontractors of the managed care organization, third party administrators, or other such entities to administer its managed care organization services or to pay claims or the assessment on behalf of the managed care organization. The managed care organization rendering assessed services is liable for all assessment amounts, late fees, penalties, and enforcement actions. The enforcement actions that may be implemented in addition to interest, late fees, and penalties include, but are not limited to, the following: (a) for managed care organizations licensed by the department of insurance, notifying the department of the unpaid assessments and such information may be considered by the department when reviewing managed care organizations’ financial reports or conducting other regulatory oversight; (b) creating, after demand for payment, a lien in favor of the commonwealth in an amount not to exceed the delinquent fees owed, including any interest, penalties, and reasonable attorneys’ fees; encumbering the building in which the delinquent managed care organization is located; encumbering the real property upon which the delinquent managed care organization is located, including fixtures, equipment, or goods used in the operation of the delinquent managed care organization; or encumbering any real property in which the delinquent managed care organization holds an interest; or (c) take any other action, through EOHHS or in partnership with other state agencies, to collect on the delinquent debt permissible under law.