SB 441 — AN ACT CONCERNING A CREDIT FOR AMBULATORY SURGICAL CENTERS.

Senate General Assembly RaisedFile Bill No.

441617 February Session, 2022 LCOSubstitute Senate Bill No.

3078441 ReferredSenate, toApril 25, 2022 The Committee on FINANCE,Finance, REVENUERevenue ANDand BONDINGBonding Introducedreported by:through SEN.

(FIN)FONFARA ANof ACTthe CONCERNING1st ADist., CREDITChairperson FORof AMBULATORYthe SURGICALCommittee CENTERS.on the part of the Senate, that the substitute bill ought to pass.

AN ACT CONCERNING A CREDIT FOR AMBULATORY SURGICAL CENTERS.

(1) "Ambulatory surgical center" means any distinct entity that (A) operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed twenty-four hours following an admission, (B) has an agreement with the Centers for Medicare and Medicaid Services to participate in Medicare as an ambulatory surgical center,sSB441 and/ (C)File meets the general and specific conditions for participation in Medicare set forth in 42 CFR Part 416, Subparts B and LCO No.

3078617 1 ofsSB441 8File RaisedNo. Bill No.441 C, as amended from time to time;

617 center, and (C) meets the general and specific conditions for participation in Medicare set forth in 42 CFR Part 416, Subparts B and C, as amended from time to time;

(5) "Payer discounts" means the difference between an ambulatory surgical center's published charges and the payments received by the ambulatory surgical center from one or more health care payers for a rateormethodofpaymentthatisdifferentthanordiscountedfromsuchrateormethodofpaymentthatisdifferentthanordiscounted fromsuch published charges.

(6) "Charity care" means free or discounted health care services rendered by an ambulatory surgical center to an individual who cannot afford to pay for such services, including, but not limited to, health care services provided to an uninsured patient who is not expected to pay all orsSB441 part/ ofFile an ambulatory surgical center's bill based on income guidelines and other financial criteria set forth in the general statutes or LCO No.

3078617 2 ofsSB441 8File RaisedNo. Bill No.441 in an ambulatory surgical center's charity care policies on file at the office of such center.

617 or part of an ambulatory surgical center's bill based on income guidelines and other financial criteria set forth in the general statutes or in an ambulatory surgical center's charity care policies on file at the office of such center.

(10) "Medicaid investment" means an amount, as selected by each ambulatory surgical center, equal to (A) fifty per cent of the aggregate Medicaid payments received by the ambulatory surgical center during the applicable reporting period for the provision of ambulatory surgical center services, or (B) fifty per cent of the difference between the aggregate amount of Medicaid payments received by the ambulatory surgical center during the applicable reporting period for the provision of ambulatory surgical center services and the aggregate amount of Medicaid payments that would have been received by a hospital during theapplicable reporting periodperiodifsubstantially ifsubstantially similar servicesserviceshadbeen hadbeen performed at a hospital;

[(10)]sSB441 (12)/ "Commissioner"File means the Commissioner of Revenue LCO No.

3078617 3 ofsSB441 8File RaisedNo. Bill No.441 Services;

617 [(10)] (12) "Commissioner" means the Commissioner of Revenue Services;

(3)sSB441 (A)/ AnyFile ambulatory surgical center may file, on or before the due LCO No.

3078617 4 ofsSB441 8File RaisedNo. Bill No.441 date of a payment of tax imposed under this section, a request for a reasonable extension of time for such payment for reasons of undue hardship.

617 (3) (A) Any ambulatory surgical center may file, on or before the due date of a payment of tax imposed under this section, a request for a reasonable extension of time for such payment for reasons of undue hardship.

(5)sSB441 Nothing/ inFile this section shall prohibit an ambulatory surgical LCO No.

3078617 5 ofsSB441 8File RaisedNo. Bill No.441 center from seeking remuneration for the tax imposed by this section.

(c)617 Each(5) ambulatoryNothing surgicalin centerthis section shall beprohibit allowed,an forambulatory eachsurgical reportingcenter period,from aseeking creditremuneration againstfor the tax imposed underby subsectionthis (b)section. ofthissectionin anamountequaltothesumoftheMedicaidinvestment and the state health plan investment.

(c) Each ambulatory surgical center shall be allowed, for each reporting period, a credit against the tax imposed under subsection (b) ofthissectioninanamountequaltothesumoftheMedicaidinvestment and the state health plan investment.

LCOsSB441 / File No.

3078617 6 ofsSB441 8File RaisedNo. Bill No.441 (4) The commissioner shall notify the Commissioner of Social Services of any amount delinquent under this section and, upon receipt of such notice, the Commissioner of Social Services shall deduct and withhold such amount from amounts otherwise payable by the Department of Social Services to the delinquent ambulatory surgical center.

617 (4) The commissioner shall notify the Commissioner of Social Services of any amount delinquent under this section and, upon receipt of such notice, the Commissioner of Social Services shall deduct and withhold such amount from amounts otherwise payable by the Department of Social Services to the delinquent ambulatory surgical center.

[(e)] (f) For the fiscal year ending June 30, 2024, and each fiscal year thereafter, the Comptroller is authorized to record as revenue for each fiscal year the amount of tax imposed under the provisions of this section prior to the end of each fiscal year and which tax is received by the Commissioner of Revenue Services not later than five business days after the last day of July immediately following the end of each fiscal LCOsSB441 / File No.

3078617 7 ofsSB441 8File Raised Bill No.

441617 year.

(Effective from passage) Section 465 of public act 12-221-2 of the June special session shall take effect July 1, 2023, and shall be applicable to calendar quarters commencing on or after July 1, 2023.

2 from passage New section StatementFIN ofJoint Purpose:Favorable Subst.

TosSB441 establish/ aFile creditNo. for ambulatory surgical centers against the ambulatory surgical centers net revenue tax.

[Proposed617 deletions8 aresSB441 enclosedFile inNo. brackets.

Proposed617 additionsThe following Fiscal Impact Statement and Bill Analysis are indicatedprepared byfor underline,the exceptbenefit thatof whenthe members of the entireGeneral textAssembly, solely for purposes of ainformation, billsummarization orand resolutionexplanation orand ado sectionnot ofrepresent athe billintent orof resolutionthe isGeneral new,Assembly itor iseither notchamber underlined.]thereof LCOfor No.any purpose.

3078In 8general, fiscal impacts are based upon a variety of 8informational sources, including the analyst’s professional knowledge.

Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note State Impact:

Agency Affected Fund-Effect FY 23 $ FY 24 $ Department of Revenue Services GF - Revenue None 1.5 million Loss Note:

GF=General Fund Municipal Impact:

None Explanation The bill results in a state revenue loss of $1.5 million in FY 24 and annually thereafter by establishing a refundable tax credit against the ambulatory surgical centers gross receipt tax based on a portion of certain payments for services outlined in the bill.