CHA-RI ADVISORY FAQs
Advisory FAQs offer guidance about the program to payers and providers. Final FAQs will be published at the end of the implementation process and be updated, as needed, from time to time thereafter. These FAQ’s guide the administration of CHA-RI. At all times, however, they are subordinate to any Rhode Island Statute or Regulation.
The advisory FAQs are divided into four broad categories:
1. “A” means questions related to Assessments.
2. “C” means questions related to Contribution Enrollees.
3. “G” means questions related to Government Programs.
4. “P” means questions related to Payers.
A1. What does “assessed entity” mean?
“Assessed entity” means any healthcare insurer or other entity that contracts or offers to provide, deliver, arrange, pay for, or reimburse any of the costs of health services.
This includes: policies of accident and sickness insurance; nonprofit hospital and medical service plans; any person whose primary function is to provide diagnostic, therapeutic, or preventive services to a defined population on the basis of a periodic premium; all domestic, foreign, or alien insurance companies, mutual associations and organizations; health maintenance organizations, as defined by chapter 41 of title 27; all persons providing health benefits coverage on a self-insurance basis; all third-party administrators described in chapter 20.7 of title 27; and all persons providing health benefit coverage under Title XIX of the Social Security Act (Medicaid) as a Medicaid managed care organization offering managed Medicaid.
A4. How are an entity’s assessments determined?
CHA-RI will set an assessment rate for each child contribution enrollee. For more information on what is a “contribution enrollee,” click here.
Any over-payments in a one-year period will be applied to the next year’s assessment calculation
A5. What will the CHA-RI 2016/2017 assessment rate be?
The initial assessment rate has not been set at this point. It presently is scheduled to be set prior to the end of November. The payer community will be notified when it has been set. The assessment rate will be based on an on-line survey of assessable entities’ contribution enrollees during the months of July, August, and September 2016. Regular ongoing quarterly assessments are expected to commence January 30, 2017, using contribution enrollee counts, from the months of October, November, and December of 2016. We anticipate making options available by the end of November concerning the payment of amounts due under this new legislation from its January 1, 2016 effective date through October 30, 2016.
A7. When are assessment payments due?
After the initial quarterly billing period, the assessments will be calculated quarterly and due 30 days after the close of each quarter, meaning reports and payments will typically be due on or before January 30, April 30, July 30, and October 30 each year. Quarterly payments are based on the number of contribution enrollees an entity reports for the three months in each preceding quarter.
A8. Where do I go to complete the online assessment?
http://www.rivaccine.org/assessment. First-time users must register before they can log into the assessment system. After clicking the link above, you can register by entering your Federal Employer Identification Number, your e-mail address, and a private password of your choice.
Please note that because of the system’s security features, there may be a delay of up to 30 minutes before a new account can be accessed for data entry.
If you have previously registered through RIVAP, use the same login information created to access the RIVAP assessment system.
C1. What are “contribution enrollees”?
Contribution enrollee" means an individual residing in Rhode Island, with respect to whom an insurer administers, provides, pays for, insures, or covers health care services, unless excepted by this section.
C2. Who is not a “contribution enrollee”?
Contribution enrollee shall not include an individual whose healthcare services are paid or reimbursed by Part A or Part B of the Medicare program, a Medicare supplemental policy as defined in section 1882(g)(1) of the Social Security Act, 42 U.S.C. 1395ss(g) (1), or Medicare managed care policy, the federal employees' health benefit program, Tricare, CHAMPUS, the Veterans' healthcare program, the Indian health service program, or any local governmental corporation, district, or agency providing health benefits coverage on a self-insured basis.
C3. Must an entity file reports even if it does not provide medical benefits and therefore has zero contribution enrollees?
Yes, but the entity may be eligible to file an Annual or Permanent Zero Contribution Enrollees Report instead of the typical quarterly reports. Please note that if an entity has zero contribution enrollees for one quarter only, then it should file a normal quarterly report with “0” values.
If, however, an entity does not administer medical benefits or is otherwise exempt by Rhode Island statute so that it has zero contribution enrollees, it should file one of two types of Zero Contribution Enrollees Reports. For example, this type of report would be appropriate for entities such as those administering eye care or dental benefit only plans. If the entity has zero contribution enrollees and will continue to have zero contribution enrollees for the balance of the year, then it should file an Annual Zero Contribution Enrollees Report during the first quarter of the calendar year. No other report will be due until the first quarter of the following calendar year. If the entity has zero contribution enrollees and expects to never have contribution enrollees, it should file a Permanent Zero Contribution Enrollees Report to eliminate the need for further compliance follow up. A guide to Zero Contribution Enrollees Reports is available in the “Filing Guides” section under the “REFERENCE” tab.
C6. If my company filed a Permanent Zero Contribution Enrollees Report for RIVAP, should we file the same report for CHA-RI?
No, so long as you continue to have permanent zero covered lives and the Rhode Island law remains unchanged, you will not be required to make any filings or payments with respect to the CHA-RI assessment. Your work to confirm your status as a non-payer for RIVAP also confirms that status for CHA-RI with no further administrative requirement for your firm.
This remains the case as it relates to the current RIVAP & CHA-RI programs under current laws & regulations and administrative guidance KidsVax® has received to date. It does not have any applicability to any other state program administered by KidsVax® and may or may not be affected by any future change in law, regulation, or administrative ruling applicable to CHA-RI.
G1. What are the benefits of the Children’s Health Account?
The Children’s Health Account helps families with children with complex medical needs to maintain the family unit. The supportive services enable children to remain in their own home and caregivers to maintain employment while caring for their children. The Children’s Health Account also promotes cost effective and equitable funding by accessing multiple resources.
G2. Does CHA-RI replace RIVAP?
No, these are two different programs. CHA-RI covers certain services (different from and not including vaccines). CHA-RI does not replace immunization program (RIVAP). The RIVAP program remains unchanged.
G3. Is the Children’s Health Account a new assessment?
No, Rhode Island began assessing the Children’s Health Account in 2007. New legislation became effective on January 1, 2016 which created a different methodology for assessment of the children’s health account. KidsVax® has been contracted to implement this new methodology through CHA-RI..
G4. How does CHA-RI impact my taxes?
CHA-RI does not impact taxes because it is not funded by taxpayers. CHA-RI collects the costs of services covered by the Children’s Health Account and program expenses from insurers, third-party administrators, and other payers who are already obligated to pay healthcare costs for their beneficiaries. The costs for CHA-RI administration are built into the assessment rates.
P6. How do I submit my payment?
Your payment can be submitted via mail to the PO Box on the remittance form or via Automated Clearing House (ACH) transaction. The reference number can be found on the “CHA-RI Remittance Form,” which will appear after you submit your report, and this form can be printed and saved.
P7. What if I submit a late report or payment?
Please prepare your report as soon as possible. KidsVax® will report your late payment to EOHHS. EOHHS will take enforcement action, should that become necessary. Interest will be added to any late payments at a rate of 18% per year. See §42-7.4-6 and §44-1-7. As stated in statute §42-7.4-5: “If an insurer required to make the contribution pursuant to this chapter shall fail to pay a contribution within thirty (30) days of its due date, the secretary may request any agency of state government making payments to the insurer to set-off the amount of the delinquency against any payment or amount due the insurer from the agency of state government and remit the sum to the secretary.” Additionally, by statute §42-7.4-6: “If the failure [to pay] is due, in whole or part, to negligence or intentional disregard of the provisions of this section, a penalty of ten percent (10%) of the amount of the determination shall be added to the contribution. The secretary shall collect the contribution with interest.”