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General Assembly Substitute Bill No. 441
February Session, 2022
AN ACT CONCERNING A CREDIT FOR AMBULATORY SURGICAL
CENTERS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 12-263aaa of the 2022 supplement to the general 1
statutes is repealed and the following is substituted in lieu thereof 2
(Effective July 1, 2023, and applicable to calendar quarters commencing on or 3
after July 1, 2023): 4
(a) As used in this section and sections 12-263bbb to 12-263fff, 5
inclusive, unless the context otherwise requires: 6
(1) "Ambulatory surgical center" means any distinct entity that (A) 7
operates exclusively for the purpose of providing surgical services to 8
patients not requiring hospitalization and in which the expected 9
duration of services would not exceed twenty-four hours following an 10
admission, (B) has an agreement with the Centers for Medicare and 11
Medicaid Services to participate in Medicare as an ambulatory surgical 12
center, and (C) meets the general and specific conditions for 13
participation in Medicare set forth in 42 CFR Part 416, Subparts B and 14
C, as amended from time to time; 15
(2) "Ambulatory surgical center services" means only those 16
procedures or services included in a facility fee payment to an 17 Substitute Bill No. 441
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ambulatory surgical center facility associated with each surgical 18
procedure and that are not reimbursable ancillary or professional 19
procedures or services. "Ambulatory surgical services" includes facility 20
services only and does not include surgical procedures, physicians' 21
services, anesthetists' services, radiology services, diagnostic services or 22
ambulance services, if such procedures or services would be reimbursed 23
as a separate line item from facility services under 42 CFR 416.164(a), as 24
amended from time to time; 25
(3) "Gross receipts" means the amount received, whether in cash or in 26
kind, from patients, third-party payers and others for taxable 27
ambulatory surgical center services provided by the ambulatory 28
surgical center in the state, including retroactive adjustments under 29
reimbursement agreements with third-party payers, without any 30
deduction for any expense of any kind; 31
(4) "Net revenue" means gross receipts less payer discounts, charity 32
care and bad debts, to the extent the ambulatory surgical center 33
previously paid tax under this section on the amount of such bad debts; 34
(5) "Payer discounts" means the difference between an ambulatory 35
surgical center's published charges and the payments received by the 36
ambulatory surgical center from one or more health care payers for a 37
rate or method of payment that is different than or discounted from such 38
published charges. "Payer discounts" does not include charity care or 39
bad debts; 40
(6) "Charity care" means free or discounted health care services 41
rendered by an ambulatory surgical center to an individual who cannot 42
afford to pay for such services, including, but not limited to, health care 43
services provided to an uninsured patient who is not expected to pay all 44
or part of an ambulatory surgical center's bill based on income 45
guidelines and other financial criteria set forth in the general statutes or 46
in an ambulatory surgical center's charity care policies on file at the 47
office of such center. "Charity care" does not include bad debts or payer 48
discounts; 49 Substitute Bill No. 441
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(7) "Received" means received or accrued, construed according to the 50
method of accounting customarily employed by the ambulatory 51
surgical center; 52
(8) "Medicaid" means the program operated by the Department of 53
Social Services pursuant to section 17b-260 and authorized by Title XIX 54
of the Social Security Act, as amended from time to time; 55
(9) "Medicare" means the programs operated by the Centers for 56
Medicare and Medicaid Services in accordance with Title XVIII of the 57
Social Security Act, as amended from time to time, including, but not 58
limited to, those programs established pursuant to Parts A, B and C of 59
Title XVIII of said act, as amended from time to time; 60
(10) "Medicaid investment" means an amount, as selected by each 61
ambulatory surgical center, equal to (A) fifty per cent of the aggregate 62
Medicaid payments received by the ambulatory surgical center during 63
the applicable reporting period for the provision of ambulatory surgical 64
center services, or (B) fifty per cent of the difference between the 65
aggregate amount of Medicaid payments received by the ambulatory 66
surgical center during the applicable reporting period for the provision 67
of ambulatory surgical center services and the aggregate amount of 68
Medicaid payments that would have been received by a hospital during 69
the applicable reporting period if substantially similar services had been 70
performed at a hospital; 71
(11) "State health plan investment" means an amount equal to twenty-72
five per cent of the aggregate payments received, from or on behalf of 73
each individual who is covered under a health plan pursuant to section 74
5-259, by an ambulatory surgical center during the applicable reporting 75
period for the provision of ambulatory surgical center services; 76
[(10)] (12) "Commissioner" means the Commissioner of Revenue 77
Services; and 78
[(11)] (13) "Department" means the Department of Revenue Services. 79 Substitute Bill No. 441
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(b) For each calendar quarter commencing on or after July 1, 2023, 80
there is hereby imposed a tax on each ambulatory surgical center in this 81
state to be paid each calendar quarter. 82
(1) The tax imposed by this section for each calendar quarter shall be 83
at the rate of three per cent of each ambulatory surgical center's net 84
revenue received during the calendar quarter, except that such tax shall 85
not be imposed on any amount of such net revenue that constitutes any 86
of the following: (A) Net revenue of a hospital that is subject to the tax 87
imposed under section 12-263q; (B) Medicaid payments received by the 88
ambulatory surgical center for the provision of ambulatory surgical 89
center services; and (C) Medicare payments received by the ambulatory 90
surgical center for the provision of ambulatory surgical center services. 91
(2) Each ambulatory surgical center doing business in the state shall, 92
on or before the last day of January, April, July and October of each year, 93
render to the commissioner a return, on forms prescribed or furnished 94
by the commissioner, reporting the name and location of such 95
ambulatory surgical center, the entire amount of net revenue received 96
by such ambulatory surgical center during the calendar quarter ending 97
on the last day of the preceding month and such other information as 98
the commissioner deems necessary for the proper administration of this 99
section. Except as provided in subdivision (3) of this subsection, the tax 100
imposed under this section shall be due and payable on the due date of 101
such return. Each ambulatory surgical center shall be required to file 102
such return electronically with the department and to make payment of 103
such tax by electronic funds transfer in the manner provided by chapter 104
228g, regardless of whether such ambulatory surgical center would 105
have otherwise been required to file such return electronically or to 106
make such tax payment by electronic funds transfer under the 107
provisions of chapter 228g. 108
(3) (A) Any ambulatory surgical center may file, on or before the due 109
date of a payment of tax imposed under this section, a request for a 110
reasonable extension of time for such payment for reasons of undue 111
hardship. Undue hardship shall be demonstrated by a showing that the 112 Substitute Bill No. 441
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ambulatory surgical center is at substantial risk of defaulting on a bond 113
or loan covenant or similar obligation if such ambulatory surgical center 114
were to make payment on the due date of the amount for which the 115
extension is requested. Such request shall be filed on forms prescribed 116
by the commissioner and shall include complete information of such 117
ambulatory surgical center's inability, due to undue hardship, to make 118
payment of the tax on or before the due date of such payment. The 119
commissioner shall not grant any extension for a general statement of 120
hardship by an ambulatory surgical center or for the convenience of an 121
ambulatory surgical center. 122
(B) The commissioner may grant an extension if the commissioner 123
determines an undue hardship exists. Such extension shall not exceed 124
three months from the original due date of the payment, except that the 125
commissioner may grant an additional extension not exceeding three 126
months from the initial extended due date of the payment (i) upon the 127
filing of a subsequent request by the ambulatory surgical center on or 128
before the extended due date of the payment, on forms prescribed by 129
the commissioner, and (ii) upon a showing of extraordinary 130
circumstances, as determined by the commissioner. 131
(4) If the commissioner grants an extension pursuant to subdivision 132
(3) of this subsection, no penalty shall be imposed and no interest shall 133
accrue during the period of time for which an extension is granted if the 134
ambulatory surgical center pays the tax due on or before the extended 135
due date of the payment. If the ambulatory surgical center does not pay 136
such tax by the extended due date, a penalty shall be imposed in 137
accordance with subsection [(c)] (d) of this section and interest shall 138
begin to accrue at a rate of one per cent per month for each month or 139
fraction thereof from the extended due date of such tax until the date of 140
payment. 141
(5) Nothing in this section shall prohibit an ambulatory surgical 142
center from seeking remuneration for the tax imposed by this section. 143
(c) Each ambulatory surgical center shall be allowed, for each 144 Substitute Bill No. 441
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reporting period, a credit against the tax imposed under subsection (b) 145
of this section in an amount equal to the sum of the Medicaid investment 146
and the state health plan investment. If the amount of the credit allowed 147
pursuant to this subsection exceeds the ambulatory surgical center's tax 148
liability for the tax imposed under subsection (b) of this section, the 149
ambulatory surgical center shall file a claim for refund in accordance 150
with the provisions of section 12-263ccc. Upon verification of the claim, 151
the commissioner shall treat such excess as an overpayment and shall 152
refund such excess, without interest, to the ambulatory surgical center. 153
[(c)] (d) (1) Except as provided in subdivision (3) of subsection (b) of 154
this section, if any ambulatory surgical center fails to pay the amount of 155
tax reported to be due on such ambulatory surgical center's return 156
within the time specified under the provisions of this section, there shall 157
be imposed a penalty equal to ten per cent of such amount due and 158
unpaid or fifty dollars, whichever is greater. The tax shall bear interest 159
at the rate of one per cent per month or fraction thereof from the due 160
date of such tax until the date of payment. 161
(2) If any ambulatory surgical center has not filed its return within 162
one month of the due date of such return, the commissioner may file 163
such return at any time thereafter, according to the best information 164
obtainable and according to the forms prescribed. There shall be added 165
to the tax imposed upon the basis of such return an amount equal to ten 166
per cent of such tax or fifty dollars, whichever is greater. The tax shall 167
bear interest at the rate of one per cent per month or fraction thereof 168
from the due date of such tax until the date of payment. 169
(3) Subject to the provisions of section 12-3a, the commissioner may 170
waive all or part of the penalties provided under this subsection when 171
it is proven to the commissioner's satisfaction that the failure to pay any 172
tax on time was due to reasonable cause and was not intentional or due 173
to neglect. 174
(4) The commissioner shall notify the Commissioner of Social 175
Services of any amount delinquent under this section and, upon receipt 176 Substitute Bill No. 441
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of such notice, the Commissioner of Social Services shall deduct and 177
withhold such amount from amounts otherwise payable by the 178
Department of Social Services to the delinquent ambulatory surgical 179
center. 180
[(d)] (e) (1) Any person required under this section to pay any tax, file 181
a return, keep any records or supply any information and who wilfully 182
fails, at the time required by law, to pay such tax, file such return, keep 183
such records or supply such information shall, in addition to any other 184
penalty provided by law, be fined not more than one thousand dollars 185
or imprisoned not more than one year, or both. As used in this 186
subsection, "person" includes any officer or employee of an ambulatory 187
surgical center under a duty to pay such tax, file such return, keep such 188
records or supply such information. Notwithstanding the provisions of 189
section 54-193, no person shall be prosecuted for a violation of the 190
provisions of this subsection committed on or after July 1, 1997, except 191
within three years after such violation has been committed. 192
(2) Any person who wilfully delivers or discloses to the commissioner 193
or the commissioner's authorized agent any list, return, account, 194
statement or other document, known by such person to be fraudulent 195
or false in any material matter, shall, in addition to any other penalty 196
provided by law, be guilty of a class D felony. No person shall be 197
charged with an offense under both this subdivision and subdivision (1) 198
of this subsection in relation to the same tax period but such person may 199
be charged and prosecuted for both such offenses upon the same 200
information. 201
[(e)] (f) For the fiscal year ending June 30, 2024, and each fiscal year 202
thereafter, the Comptroller is authorized to record as revenue for each 203
fiscal year the amount of tax imposed under the provisions of this 204
section prior to the end of each fiscal year and which tax is received by 205
the Commissioner of Revenue Services not later than five business days 206
after the last day of July immediately following the end of each fiscal 207
year. 208 Substitute Bill No. 441
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Sec. 2. (Effective from passage) Section 465 of public act 21-2 of the June 209
special session shall take effect July 1, 2023, and shall be applicable to 210
calendar quarters commencing on or after July 1, 2023.211
This act shall take effect as follows and shall amend the following
sections:
Section 1 July 1, 2023, and
applicable to calendar
quarters commencing on or
after July 1, 2023
12-263aaa
Sec. 2 from passage New section
FIN Joint Favorable Subst.