January 03, 2024
The Department of Health posted the 2024 covered-lives assessment (CLA) rates for professional education under the Health Care Reform Act (HCRA). These rates are applicable to health claim payers (including self-insured plans) that elect to pay the assessment directly to the state rather than facing higher surcharges for in-state hospital expenses. The annual amount owed by the payer is calculated based on the number of covered individuals residing in the state.
The HCRA was enacted to provide financial assistance to hospitals through special taxes on health plans and medical services. The CLA is intended to support the funding of graduate medical education. CLA rates (or alternative surcharges) vary by state region. Accordingly, the applicable charge is based on where the covered individual resides or receives in-state care.
The CLA rates are in addition to the indigent care surcharge on services at state hospitals, diagnostic and treatment centers, and ambulatory surgery centers. The indigent care surcharge is payable regardless of the residency of the covered individual or group health plan sponsor. The current rate, which is effective for services rendered through December 31, 2026, is 9.63% for insurers and self-insured plan payors electing to pay the amount directly to the state Public Good Pool and an additional 28.27% for non-electing payers that pay the surcharge to healthcare providers.
Group health plan sponsors should be aware of the 2024 HCRA rates and surcharges applicable to medical and dental services provided at HCRA-designated facilities. Sponsors should consult with their carriers or third-party administrators, as applicable, for additional information regarding the rates, surcharges, elections, and related reporting requirements.
2024 Regional Covered Lives Assessment Rates
Indigent Care and Health Care Initiatives Surcharges by Payor
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
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