[Expires 7/1/2024]

As used in this part:

(1) “Annual coverage assessment” means the annual assessment imposed on covered hospitals as set forth in this part;
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Terms Used In Tennessee Code 71-5-2002

  • Annual coverage assessment: means the annual assessment imposed on covered hospitals as set forth in this part. See Tennessee Code 71-5-2002
  • Annual coverage assessment base: means a covered hospital's net patient revenue as shown in its medicare cost report for its fiscal year that ended during calendar year 2019, on file with CMS as of September 30, 2021, subject to the following qualifications:
    (A) If a covered hospital does not have a full twelve-month medicare cost report for 2019 on file with CMS but has a full twelve-month cost report for a subsequent year, then the first full twelve-month medicare cost report for a year following 2019 on file with CMS is the annual coverage assessment base. See Tennessee Code 71-5-2002
  • Bureau: means the bureau of TennCare. See Tennessee Code 71-5-2002
  • CMS: means the federal centers for medicare and medicaid services. See Tennessee Code 71-5-2002
  • Contract: A legal written agreement that becomes binding when signed.
  • control: means indirect or direct ownership of ten percent (10%) or more of a covered hospital. See Tennessee Code 71-5-2002
  • Covered hospital: means a hospital licensed under title 33 or title 68, as of July 1, 2023, but does not include an excluded hospital. See Tennessee Code 71-5-2002
  • Excluded hospital: means :
    (A) A hospital that has been designated by CMS as a critical access hospital as of July 1, 2023. See Tennessee Code 71-5-2002
  • Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
  • Medicare cost report: means CMS-2552-10 or a subsequent form adopted by CMS for medicare cost reporting, the cost report for electronic filing of hospitals, for the period applicable as set forth in this section. See Tennessee Code 71-5-2002
  • Person: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
  • State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
  • Year: means a calendar year, unless otherwise expressed. See Tennessee Code 1-3-105
(2) “Annual coverage assessment base” means a covered hospital‘s net patient revenue as shown in its medicare cost report for its fiscal year that ended during calendar year 2019, on file with CMS as of September 30, 2021, subject to the following qualifications:

(A) If a covered hospital does not have a full twelve-month medicare cost report for 2019 on file with CMS but has a full twelve-month cost report for a subsequent year, then the first full twelve-month medicare cost report for a year following 2019 on file with CMS is the annual coverage assessment base;
(B) If a covered hospital does not have a full twelve-month medicare cost report for 2019 on file with CMS and does not have a full twelve-month cost report for a subsequent year, but has a cost report for 2019 that covers at least nine (9) months of 2019, then the assessment base is calculated by annualizing the 2019 cost report data;
(C) If a covered hospital was first licensed in 2019 or later and did not replace an existing hospital, and if the hospital has a medicare cost report on file with CMS, then the hospital’s initial cost report on file with CMS is the base for the hospital assessment. If the hospital does not have an initial cost report on file with CMS but does have a complete twelve-month joint annual report (JAR) filed with the department of health, then the net patient revenue from the first twelve-month JAR is the annual coverage assessment base. If the hospital does not have a medicare cost report or a full twelve-month JAR filed with the department of health, then the annual coverage assessment base is the covered hospital’s projected net patient revenue for its first full year of operation as shown in its certificate of need application filed with the health services and development agency;
(D) If a covered hospital was first licensed in 2019 or later and replaced an existing hospital, then the annual coverage assessment base is the replacement hospital’s initial medicare cost report on file with CMS. If the hospital does not have a medicare cost report on file with CMS, then the hospital’s annual coverage assessment base is either the predecessor hospital’s net patient revenue as shown in its medicare cost report for its fiscal year that ended during calendar year 2019, or, if the predecessor hospital does not have a 2019 medicare cost report, then the cost report for the first fiscal year following 2019 on file with CMS;
(E) If a covered hospital is not required to file an annual medicare cost report with CMS, then the hospital’s annual coverage assessment base is its net patient revenue for the fiscal year ending during calendar year 2019 or the first fiscal year that the hospital was in operation after 2019 as shown in the covered hospital’s joint annual report filed with the department of health; and
(F) If a covered hospital’s fiscal year 2019 medicare cost report is not contained in a CMS healthcare cost report information system file, and if the hospital does not meet another qualification listed in subdivisions (2)(A)-(E), then the hospital must submit a copy of the hospital’s 2019 medicare cost report to the bureau in order to allow for the determination of the hospital’s net patient revenue for the state fiscal year 2023-2024 annual coverage assessment;
(3) “Bureau” means the bureau of TennCare;
(4) “CMS” means the federal centers for medicare and medicaid services;
(5) “Controlling person” means a person who, by ownership, contract, or otherwise, has the authority to control the business operations of a covered hospital. As used in this subdivision (5), “control” means indirect or direct ownership of ten percent (10%) or more of a covered hospital;
(6) “Covered hospital” means a hospital licensed under title 33 or title 68, as of July 1, 2023, but does not include an excluded hospital;
(7) “Excluded hospital” means:

(A) A hospital that has been designated by CMS as a critical access hospital as of July 1, 2023;
(B) A mental health hospital owned by this state;
(C) A hospital providing primarily rehabilitative or long-term acute care services;
(D) A children’s research hospital that does not charge patients for services beyond that reimbursed by third-party payers; and
(E) A hospital that is determined by the bureau as eligible to certify public expenditures for the purpose of securing federal medical assistance percentage payments;
(8) “Medicare cost report” means CMS-2552-10 or a subsequent form adopted by CMS for medicare cost reporting, the cost report for electronic filing of hospitals, for the period applicable as set forth in this section; and
(9) “Net patient revenue” from the medicare cost report means the amount calculated in accordance with generally accepted accounting principles for hospitals that is reported on Worksheet G-3, Column 1, Line 3, of the 2019 medicare cost report, excluding long-term care inpatient ancillary and other non-hospital revenues, or, in the case of a hospital that did not file a 2019 medicare cost report, comparable data from the first complete cost report filed after 2019 by the hospital.
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