Adjusted Acquisition Cost

(A) The provider must disclose all discounts, as defined in 130 CMR 428.402, and must reflect such discounts in the provider’s claim for payment pursuant to M.G.L. c. 118E, § 41, and U.S.C. § 1320a-7b(b)(3)(A). Any provider who fails to disclose and pass on any discounts to the MassHealth agency may be subject to civil and criminal penalties, including imprisonment, in accordance with state and federal laws. (B) (1) Except where the manufacturer is the provider, the adjusted acquisition cost must not exceed the manufacturer’s current wholesale price and must be evidenced by the purchase price of the equipment or goods listed on a copy of the supplier’s invoice. (2) Where the manufacturer is the provider, the adjusted acquisition cost must not exceed the actual cost of manufacturing the items. (C) Where the manufacturer is the provider of any item covered under 130 CMR 428.000, the manufacturer must submit documentation that demonstrates to the MassHealth agency’s satisfaction the actual cost of manufacturing the item, as set forth in 130 CMR 428.422(B). (D) The provider must maintain the actual receipted invoice in the member’s record, and make it available to the Division and the Attorney General’s Medicaid Fraud Control Unit pursuant to 130 CMR 428.423 and 450.205: Recordkeeping and Disclosure. (E) The provider may group together low-cost items (those with an adjusted acquisition cost of less than $5 each) to equal $5 or less, and bill the total adjusted acquisition cost plus the allowable markup listed in 130 CMR 428.421(B).