Community Health Needs Assessment
A process through which a hospital or HMO, in partnership or consultation with representatives of its community, identifies community health needs using public health data, community surveys, focus groups and other community-initiated information and data gathering activities, and/or other relevant health status indicators and data.

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Community Benefits Plan
A formal plan to address the health needs of an identified community, developed in accordance with the principles of the Community Benefits Guidelines, with appropriate community participation, and approved by the hospital or HMO's governing board.

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Community Benefits Program
A program, grant or initiative developed in collaboration with community representatives or based upon a Community Health Needs Assessment that serves the needs of a Target Population identified in the hospital or HMO's Community Benefits Plan.

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Community Service Program
A program, grant or other initiative that advances the health care or social needs of Massachusetts communities, but is not related to the priorities or Target Population identified in the hospital or HMO's formal Community Benefits Plan.

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Net Charity Care/Uncompensated Care Pool Contribution
As defined under Section 1 of Chapter 118G of the Massachusetts General Laws, the amount of "free care" provided by a hospital as determined by its annual assessment plus any shortfall allocation in connection with administering the Uncompensated Care Pool Trust Fund, or an HMO's annual contribution to the Uncompensated Care Pool, as listed by the Massachusetts Division of Health Care Finance and Policy in its most current settlement for the reported fiscal year. Net Charity Care does not include hospital bad debt related to patients not eligible for free care, "shortfalls" related to Medicaid, Medicare or other health plan reimbursements that do not cover the full costs of a hospital's services or "shortfalls" related to an HMO's coverage of Plan Members enrolled through a Medicaid or Medicare program.

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HSN Assessment
The hospital or HMOs annual assessment to the Health Safety Net Trust Fund (HSN) pursuant to Chapter 118G and the amount, if any, of payment reductions subject to the shortfall allocation pursuant to 114.6CMR14.03 and the hospital’s assessment pursuant to section 5 of Chapter 118G;

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HSN Denied Claims
For acute hospitals, the cost of acute hospital services provided to low income patients billed to the HSN which have been denied payment pursuant to the HSN claims adjudication process. Cost of services shall be determined as follows:
o The total amount net charges billed to the HSN for the denied claims;
o Multiplied by the ratio of costs to charges calculated as the ratio of total patient care costs (Schedule II, Line 116 Column 5) to gross patient service revenue (Schedule II, Line 116 Column 11) as reported in the hospital’s most recent filing of the DHCFP- 403 Hospital Statement for Reimbursement.

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Free or Discounted Care
For hospitals, free or discounted health care provided to patients in accordance with a hospital’s criteria for financial assistance and who are thereby deemed unable to pay for all or a portion of the services, calculated as follows:
o The total amount of gross patient service revenue written off to the hospital’s charity care program less payments received pursuant to the hospital’s charity care program;
o Multiplied by the ratio of costs to charges calculated as the ratio of total patient care costs (Schedule II, Line 116 Column 5) to gross patient service revenue (Schedule II, Line 116 Column 11) as reported in the hospital’s most recent filing of the DHCFP- 403 Hospital Statement for Reimbursement.

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Total Net Charity Care
Total Charity Care = HSN Assessment + HSN Denied Claims + Free or Discounted Care

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Total Community Benefits Expenditures =
Community Benefits Expenditures (direct and associated) +
Determination of Need Expenditures +
Employee Volunteerism +
Other Leveraged Resources +
Corporate Sponsorships +
Charity Care

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Corporate Sponsorships
Cash or in-kind contributions that support the charitable activities of other organizations, and are not related to a Community Benefits Plan.

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Total Patient Care Related Expenses
Expenses, including capital, related to the care of patients as reported by hospitals to the Division of Health Care Finance and Policy on Schedule 18 of the 403 Cost Report for the reported fiscal year.

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MA Plan Members (HMOs)
The average of the total number of members, as defined in Chapter 176G of the Massachusetts General Laws, enrolled in an HMO's health plans, as reported to the Division of Insurance in the four quarterly reports for the periods of time occurring during the reported fiscal year.

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Direct Expenses
May include (1) the salary and fringe benefits (or a portion thereof) of a Community Benefits Manager and his or her staff; (2) the value of employee time devoted to a Community Benefits Program or Community Service Program during paid work hours or leave time (calculated either at the rate of the employees' pay or using the averages set forth below in the definition of Employee Volunteerism); (3) any purchased services or supplies directly attributable to the Community Benefits or Community Service Program, including contractual and non-contractual agreements with other organizations or individuals to develop, manage or provide the benefit or service, including leases/rentals of equipment or building space; (4) the costs associated with generating Other Leveraged Resources; (5) dues subsidies and other financial assistance aimed at making health coverage more affordable for the uninsured or those at risk of losing health coverage, and (6) grants to third parties in furtherance of a community benefit or community service objective.

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Associated Expenses
May include (1) depreciation or amortization related to the use of major movable equipment purchased or leased directly for the Community Benefits or Community Service Program, and (2) a share of any fixed depreciation on a building or space therein used solely or in major part for a community benefit or service.

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DON Expenditures
Direct or Associated Expenses related to Community Benefits Programs or Community Service Programs provided by a hospital in fulfillment of a specific determination of need condition established by the Massachusetts Department of Public Health pursuant to 105 CMR 100.

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Employee Volunteerism
An employee's voluntary activities in connection with a hospital or HMO Community Benefits Program or Community Service Program that take place during unpaid time as the result of a formal hospital or HMO initiative to organize or promote voluntary participation in the particular activity among its employees. The value of free or reduced-fee direct health care or public health services volunteered by health care providers employed by the hospital or HMO should be calculated using either (a) the rate of the employee's pay, or (b) the average hourly rate for Massachusetts health care workers as calculated by the Centers for Medicare and Medicaid Services for purpose of the Medicare Area Wage Index during the reported fiscal year ($25.00 in 2001). The value of non-health care services volunteered by any employee should be calculated using the standard hourly rate set by the Independent Sector, a Washington, D.C.-based coalition of voluntary organizations, foundations and corporate giving programs, during the reported fiscal year ($15.39 in 2001).

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Other Leverage Resources
Funds and services contributed by third parties for the express purpose of supporting a hospital or HMO's Community Benefits or Community Service Programs. These include: (1) services provided by non-salaried physicians or other individual providers free of charge to free-care eligible patients in connection with a hospital's free care program, or at no charge or reduced fee to low-income patients in connection with other hospital or HMO programs (calculated using a standard cost-to-charge ratio of .60); (2) grants received from private foundations, government agencies or other third parties for the specific purpose of supporting a hospital or HMO Community Benefits or Community Service Program; and (3) monies raised from or collected by third parties as the result of a fund-raising activity sponsored by a hospital or HMO in connection with a Community Benefits or Community Service Program.

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Total Revenues (for hospitals)
Net patient service revenues from Schedule 5A of the hospital cost report.

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HMO Administrative Expenses
Expenses of the plan not related to hospital and medical benefits, including product development and marketing, Information Technology, customer service, claims administration, medical administration and case management, community benefit and other general expenses, excluding community benefit expenses. (Line 21 on the NAIC Health Form Statement of Revenue and Expenses minus community benefit expenditures).

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HMO Hospital, Medical and Other Health Care Costs
Include hospital and medical benefits, professional medical services, outside referrals, emergency room and out-of area services, prescription drugs, other medical costs less net reinsurance recoveries plus claims adjustment expense. (Lines 18 + 20 on the NAIC Health Form Statement of Revenue and Expenses).

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HMO Total Revenues
The combined amount of premium income and other revenue collected related to the delivery of health care benefits. (Line 8 on the NAIC Health Form Statement of Revenue and Expenses).

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