Health care provider tax rates applied for taxes levied as percentage of revenues other than net patient service revenues in state fiscal year 2011

State Tax rate 1 Health care services or providers subjected to health care provider tax rate 1 Description of tax rate 1 Tax rate 2 Health care services or providers subjected to health care provider tax rate 2 Description of tax rate 2 Tax rate 3 Health care services or providers subjected to health care provider tax rate 3 Description of tax rate 3 Tax rate 4 Health care services or providers subjected to health care provider tax rate 4 Description of tax rate 4 Tax rate 5 Health care services or providers subjected to health care provider tax rate 5 Description of tax rate 5 Tax rate 6 Health care services or providers subjected to health care provider tax rate 6 Description of tax rate 6 Tax rate 7 Health care services or providers subjected to health care provider tax rate 7 Description of tax rate 7 Tax rate 8 Health care services or providers subjected to health care provider tax rate 8 Description of tax rate 8 Tax rate 9 Health care services or providers subjected to health care provider tax rate 9 Description of tax rate 9
Alabama 5.380% Inpatient hospital services PER CENT OF NET PATIENT REVENUE . .   . .   . .   . .   . .   . .   . .   . .  
Arizona 2.000% Services of managed care organizations THE TAX RATE OF 2% IS APPLIED TO THE MANAGED CARE PREMIUM PAYMENTS . .   . .   . .   . .   . .   . .   . .   . .  
California 5.500% Intermediate care facility services for individuals with intellectual disabilities A QUALITY ASSURANCE FEE (QAF) IS IMPOSED, IN THE FORM OF A PERCENT, ON THE ENTIRE GROSS RECEIPTS FOR EACH INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY DISABLED (ICF-DD), HABILITATIVE (ICF-DD-H), AND NURSING (ICF-DD-N.) 6.000% Intermediate care facility services for individuals with intellectual disabilities A QUALITY ASSURANCE FEE (QAF) IS IMPOSED, IN THE FORM OF A PERCENT, ON THE ENTIRE GROSS RECEIPTS FOR EACH INTERMEDIATE CARE FACILITY FOR THE DEVELOPMENTALLY DISABLED (ICF-DD), HABILITATIVE (ICF-DD-H), AND NURSING (ICF-DD-N.) . .   . .   . .   . .   . .   . .   . .  
Colorado .4800% Outpatient hospital services OUTPATIENT FEES ARE ASSESSED ON GROSS REVENUE AS A PERCENTAGE OF TOTAL CHARGES AT LESS THAN 1% PER YEAR. SEE CLARIFICATION BELOW. IT WAS IMPLEMENTED IN SFY 2010. 5.000% Intermediate care facility services for individuals with intellectual disabilities FEES ARE LIMITED TO 5% OF AGGREGATE COST FOR ICFS/IID, AND THE FEE IS ASSESSED ON A PER DIEM BASIS. . .   . .   . .   . .   . .   . .   . .  
District of Columbia 1.500% Intermediate care facility services for individuals with intellectual disabilities 1-1/2 PERCENT OF THE PAYMENTS MADE IN EACH FISCAL YEAR FOR SERVICES RENDERED. 2.000% Other health care items or services not listed FEES COLLECTED FROM DISTRICT HEALTH INSURANCE COMPANIES . .   . .   . .   . .   . .   . .   . .  
Georgia 1.450% Inpatient hospital services A PERCENTAGE OF NET PATIENT REVENUE 1.450% Outpatient hospital services PERCENTAGE OF NET PATIENT REVENUE . .   . .   . .   . .   . .   . .   . .  
Idaho .2219% Inpatient hospital services PERCENTAGE OF NET PATIENT REVENUE _ THIS INCLUDES OUTPTIENT ALSO .2219% Outpatient hospital services PERCENTAGE OF NET PATIENT REVENUE INCLUDED IN INPATIENT . .   . .   . .   . .   . .   . .   . .  
Illinois 6.000% Intermediate care facility services for individuals with intellectual disabilities NET PATIENT REVENUE . .   . .   . .   . .   . .   . .   . .   . .  
Indiana 5.500% Intermediate care facility services for individuals with intellectual disabilities THE ICF/MRS TAX ASSESSMENT 6% OF THE TOTAL ANNUAL FACILITY REVENUE, AND IT CANNOT EXCEED THE PERCENTAGE DETERMINED ELIGIBLE FOR FFP).  THE ICF/MR ASSESSMENT WAS EFFECTIVE 7/1/2003, AND WAS 6% FROM THAT DATE UNTIL 1/1/2008, WHEN IT CHANGED TO 5.5% DUE TO CHANGES IN FEDERAL REGULATIONS.  IT WAS CHANGED BACK TO 6% EFFECTIVE 10/1/2011. . .   . .   . .   . .   . .   . .   . .   . .  
Kansas 1.830% Inpatient hospital services BASED ON AN ANNUAL ASSESSMENT ON INPATIENT SERVICES IS IMPOSED ON EACH HOSPITAL PROVIDER IN AN AMOUNT EQUAL TO 1.83% OF EACH HOSPITAL’S NET INPATIENT OPERATING REVENUE FOR THE HOSPITAL’S FISCAL YEAR 2001. . .   . .   . .   . .   . .   . .   . .   . .  
Kentucky 2.500% Inpatient hospital services PERCENTAGE RATE OF REVENUES 2.500% Outpatient hospital services PERCENTAGE RATE OF REVENUES 5.500% Nursing facility services PERCENTAGE RATE OF REVENUES 5.500% Other health care items or services not listed PERCENTAGE RATE OF REVENUES . .   . .   . .   . .   . .  
Louisiana 2.500% Services of managed care organizations PERCENTAGE (2.5%) OF PREMIUMS . .   . .   . .   . .   . .   . .   . .   . .  
Maine 2.230% Other health care items or services not listed THE HOSPITAL TAX IS BASED ON NET OPERATING REVENUE. 5.500% Nursing facility services THE NURSING FACILITY TAX IS BASED ON NET OPERATING REVENUE. 5.500% Intermediate care facility services for individuals with intellectual disabilities THIS TAX IS BASED ON GROSS PATIENT SERVICES REVENUE. 5.000% Other health care items or services not listed THIS TAX IS BASED ON THE VALUE OF SERVICES PROVIDED. . .   . .   . .   . .   . .  
Maryland 4.000% Nursing facility services THE DEPARTMENT MAY IMPOSE A QUALITY ASSESSMENT ON EACH FREESTANDING NURSING FACILITY IN THE STATE THAT HAS 45 OR MORE BEDS AND IS NOT A CCRC. THE AMOUNT ASSESSED IN THE AGGREGATE ON ALL NURSING HOMES MAY NOT EXCEED 6.0% OF TEH OPERAING REVENUE FOR ALL NURSING FACILITIES SUBJECT TO THIS SECTION FOR THE PREVIOUS FISCAL QUARTER. ON OR BEFORE THE 60TH DAY AFTER EACH QUARTER OF THE FISCAL YEAR, EACH NURSING FACILITY SHALL PAY TO THE COMPTROLLER AN AMOUNT DETERMINED BY THE DEPARTMENT BASED ON AN AMOUNT PER NON-MEDICARE DAY OF SERVICE FOR THE PREVIOUS FISCAL QUARTER. THE ASSESSMENT SHALL BE BASED ON AN AMOUNT PER PATIENT PER DAY, NOT INCLUDING MEDICARE DAYS. 1.150% Inpatient hospital services PERCENTAGE OF NET PATIENT REVENUE 2.000% Services of managed care organizations A 2% ASSESSMENT OF ALL PREMIUMS, INCLUDING GROSS RECEIPTS RECEIVED AS A RESULT OF CAPITATION PAYMENTS MADE TO A MANAGED CARE ORGANIZATION, SUPPLEMENTAL PAYMENTS, AND BONUS PAYMENTS, AND SUBSCRIPTION CHARGES OR OTHER AMOUNTS PAID TO A FOR-PROFIT HEALTH MAINTENANCE ORGANIZATION. .8300% Inpatient hospital services PERCENTAGE OF NET PATIENT REVENUE . .   . .   . .   . .   . .  
Massachusetts 1.550% Other health care items or services not listed AN ACUTE HOSPITAL PAYS AN ASSESSMENT WHICH IS THE PRODUCT OF (A) THE HOSPITAL'S RATIO OF PRIVATE SECTOR CHARGES TO ALL ACUTE HOSPITALS' PRIVATE SECTOR CHARGES; AND (B) $160 MILLION. 1.550% Other health care items or services not listed INDIVIDUALS OR ENTITIES THAT PAY FOR OR ARRANGE FOR THE PURCHASE OF HEALTH CARE SERVICES PROVIDED BY ACUTE HOSPITALS AND AMBULATORY SURGICAL CENTERS ARE REQUIRED TO PAY A SURCHARGE ON THESE PAYMENTS. SURCHARGE PAYERS INCLUDE INSURERS, HEALTH MAINTENANCE ORGANIZATIONS, SELF-INSURED PLANS, MEDICAID MANAGE CARE ORGANIZATIONS, AND SELF-PAYING INDIVIDUALS. PUBLIC PAYERS ARE EXEMPT FROM THE SURCHARGE.\R\NSURCHARGE PAYERS PAY A SPECIFIED PERCENTAGE OF THEIR TOTAL ACUTE HOSPITAL AND AMBULATORY SURGICAL CENTER PAYMENTS. . .   . .   . .   . .   . .   . .   . .  
Michigan 3.000% Inpatient hospital services PERCENTAGE OF NON-MEDICARE PATIENT REVENUE. 4.700% Nursing facility services PERCENTAGE OF NON-MEDICARE REVENUE. . .   . .   . .   . .   . .   . .   . .  
Minnesota 1.560% Inpatient hospital services 1.56 PERCENT OF NET PATIENT REVENUES. .6000% Services of managed care organizations .6 PERCENT OF TOTAL PREMIUM REVENUE. 2.000% Other health care items or services not listed 2% OF GROSS PATIENT REVENUE . .   . .   . .   . .   . .   . .  
Missouri 1.970% Outpatient prescription drugs GROSS RETAIL PRESCRIPTION SALES 1.820% Outpatient prescription drugs GROSS RETAIL PRESCRIPTION SALES 5.450% Inpatient hospital services PERCENTAGE OF INPATIENT AND OUTPATIENT ADJUSTED NET REVENUES . .   . .   . .   . .   . .   . .  
Nebraska 5.500% Intermediate care facility services for individuals with intellectual disabilities 6% OF REVENUE . .   . .   . .   . .   . .   . .   . .   . .  
New Jersey 2.000% Services of managed care organizations 2% TAX .5300% Inpatient hospital services 0.53% ON PATIENT REVENUE 5.300% Intermediate care facility services for individuals with intellectual disabilities GROSS RECEIPTS 2.950% Other health care items or services not listed 2008-2010: ASSESSMENT = 3.5% OF GROSS RECEIPTS (CAPPED AT $200,000). FACILITIES WITH GROSS RECEIPTS LESS THAN $300,000 ARE EXEMPT FROM THE TAX. 2011-2012: ASSESSMENT = 2.95% OF GROSS RECEIPTS (CAPPED AT $350,000). FACILITIES WITH GROSS RECEIPTS LESS 6.000% Other health care items or services not listed GROSS RECEIPTS FROM THE COSMETIC MEDICAL PROCEDURE . .   . .   . .   . .  
New York 1.000% Inpatient hospital services THE AMOUNTS COLLECTED UNDER THE 1% ASSESSMENT ON INPATIENT NET REVENUES ARE USED TO FUND VARIOUS HEALTH CARE PROGRAMS IN THE STATE’S HEALTH CARE REFORM ACT (HCRA) FUND. A SMALL AMOUNT OF THIS FUND (APPROXIMATELY 10-15%) GOES TOWARDS INDIGENT CARE POOL PAYMENTS, WHICH IS A DSH PROGRAM. 7.040% Inpatient hospital services THE TAX "IS A 7.04% ASSESSMENT ON MEDICAID INPATIENT REVENUES AND A 9.63% ON OTHER NON-MEDICARE REVENUES (I.E. ALL MEDICARE REVENUES ARE EXCLUDED FROM THE TAX)." 9.630% Inpatient hospital services THE TAX "IS A 7.04% ASSESSMENT ON MEDICAID INPATIENT REVENUES AND A 9.63% ON OTHER NON-MEDICARE REVENUES (I.E. ALL MEDICARE REVENUES ARE EXCLUDED FROM THE TAX)." 7.040% Outpatient hospital services SAME AS 7B, EXCEPT THIS ASSESSMENT APPLIES TO OUTPATIENT REVENUES (SAME RATES AS 7B). 9.630% Outpatient hospital services SAME AS 7B, EXCEPT THIS ASSESSMENT APPLIES TO OUTPATIENT REVENUES (SAME RATES AS 7B). 7.040% Nursing facility services THIS IS AN ASSESSMENT ON NURSING HOME NON-MEDICARE NET PATIENT SERVICE REVENUES. THESE TAX COLLECTIONS ARE DEPOSITED INTO THE GENERAL FUND AND ARE USED TO SUPPORT THE MEDICAID PROGRAM, SO IT WOULD BE ACCURATE TO SAY THEY ARE USED FOR CAPITATION PAYMENT FOR MANAGED LONG TERM CARE AND FOR FEE-FOR-SERVICE MEDICAID PAYMENTS. 9.630% Nursing facility services THIS IS AN ASSESSMENT ON NURSING HOME NON-MEDICARE NET PATIENT SERVICE REVENUES. THESE TAX COLLECTIONS ARE DEPOSITED INTO THE GENERAL FUND AND ARE USED TO SUPPORT THE MEDICAID PROGRAM, SO IT WOULD BE ACCURATE TO SAY THEY ARE USED FOR CAPITATION PAYMENT FOR MANAGED LONG TERM CARE AND FOR FEE-FOR-SERVICE MEDICAID PAYMENTS. .3500% Inpatient hospital services THE TAX IS ASSESSED ON "ALL INPATIENT SERVICES REVENUES, INCLUDING MEDICARE" .3500% Outpatient hospital services THE TAX IS ASSESSED ON "ALL OUTPATIENT SERVICES REVENUES, INCLUDING MEDICARE"
North Carolina 1.870% Inpatient hospital services THE TAX RATE IS APPLIED TO THE INPATIENT HOSPITAL EXPENSES. 1.930% Outpatient hospital services TAX RATE IS APPLIED TO THE OUTPATIENT EXPENSES . .   . .   . .   . .   . .   . .   . .  
Ohio 1.400% Inpatient hospital services BASIS IS ADJUSTED TOTAL FACILITY COSTS MINUS MEDICARE COST. (ADJUSTED TOTAL FACILITY COSTS = TOTAL FACILITY COSTS MINUS NON-HOSPITAL SERVICE COSTS). . .   . .   . .   . .   . .   . .   . .   . .  
Oklahoma 2.500% Inpatient hospital services % OF NET PATIENT REVENUE 2.500% Outpatient hospital services % OF NET PATIENT REVENUE . .   . .   . .   . .   . .   . .   . .  
Oregon 2.320% Inpatient hospital services THIS ASSESSEMENT IS FOR DRG HOSPITALS, BASED ON THEIR NET PATIENT REVENUE. 1.000% Services of managed care organizations TAX IS BASED ON GROSS PREMIUMS COLLECTED BY HEALTH PLANS AND INSURERS. 5.500% Nursing services BASED ON NURSING FACILITY REVENUE. . .   . .   . .   . .   . .   . .  
Pennsylvania 3.220% Inpatient hospital services PERCENTAGE OF NET INPATIENT REVENUE 3.450% Inpatient hospital services PERCENTAGE OF HOSPITAL'S NET INPATIENT REVENUE EXCLUDING MEDICARE REVENUE 3.930% Inpatient hospital services PERCENTAGE OF HOSPITAL'S NET INPATIENT REVENUE EXCLUDING MEDICARE REVENUE 3.450% Outpatient hospital services PERCENTAGE OF HOSPITAL'S NET OUTPATIENT REVENUE EXCLUDING MEDICARE REVENUE 3.930% Outpatient hospital services PERCENTAGE OF HOSPITAL'S NET OUTPATIENT REVENUE EXCLUDING MEDICARE REVENUE 6.000% Intermediate care facility services for individuals with intellectual disabilities THE NON-STATE ICF/ID AND ICF/ORC ASSESSMENT IS BASED ON THE REVENUE SUBMITTED BY THE PROVIDERS ON THEIR MOST RECENTLY ACCEPTED COST REPORTS AND ON THE MOST RECENTLY IDENTIFIED COST APPORTIONMENT REPORT FOR THE STATE CENTERS. 5.500% Intermediate care facility services for individuals with intellectual disabilities THE NON-STATE ICF/ID AND ICF/ORC ASSESSMENT IS BASED ON THE REVENUE SUBMITTED BY THE PROVIDERS ON THEIR MOST RECENTLY ACCEPTED COST REPORTS AND ON THE MOST RECENTLY IDENTIFIED COST APPORTIONMENT REPORT FOR THE STATE CENTERS. . .   . .  
Rhode Island 5.500% Nursing facility services PERCENTAGE OF GROSS PATIENT REVENUE 2.000% Services of managed care organizations PERCENTAGE OF PREMIUM . .   . .   . .   . .   . .   . .   . .  
South Dakota 5.500% Intermediate care facility services for individuals with intellectual disabilities NET PATIENT REVENUE . .   . .   . .   . .   . .   . .   . .   . .  
Tennessee 5.500% Intermediate care facility services for individuals with intellectual disabilities % OF MONTHLY GROSS RECEIPTS FOR ICF/IID BEDS 5.500% Services of managed care organizations % OF GROSS AMOUNTS OF ALL DOLLARS COLLECTED ON BEHALF OF ENROLLEES 3.520% Other health care items or services not listed HOSPITAL ASSESSMENT BASED ON % OF NET PATIENT REVENUES . .   . .   . .   . .   . .   . .  
Texas 5.500% Intermediate care facility services for individuals with intellectual disabilities QUALITY ASSURANCE FEE (QAF) IS ASSESSED ON THE ICF/ID PROVIDERS. THE FEE IS ASSESSED AT 5.5% OF GROSS RECEIPTS. GROSS RECEIPTS CONSISTS OF MONEY PAID TO A FACILITY FOR SERVICES PROVIDED TO RESIDENTS, INCLUDING DAILY RATE CLAIMS, PATIENT APPLIED INCOME, PAYMENTS FROM PRIVATE-PAY RESIDENTS, AND BED-HOLD REVENUE. . .   . .   . .   . .   . .   . .   . .   . .  
Vermont 5.500% Inpatient hospital services HOSPITAL PROVIDER TAX RATE IS BASED ON NET PATIENT REVENUES (IP AND OP). 17.69% Home health care services HOME HEALTH AGENCY PROVIDER TAX RATE IS BASED ON NET OPERATING REVENUES. 5.500% Intermediate care facility services for individuals with intellectual disabilities ICFMR PROVIDER TAX RATE IS BASED ON NET PATIENT REVENUES. . .   . .   . .   . .   . .   . .  
West Virginia 2.500% Inpatient hospital services TAX IS ASSESED BASED ON PROVIDER FILED GROSS RECEIPTS. 2.500% Outpatient hospital services TAX IS ASSESED BASED ON PROVIDER FILED GROSS RECEIPTS. 5.500% Nursing facility services TAX IS ASSESED BASED ON PROVIDER FILED GROSS RECEIPTS. 5.500% Intermediate care facility services for individuals with intellectual disabilities TAX IS ASSESED BASED ON PROVIDER FILED GROSS RECEIPTS. 1.750% Ambulatory surgical center services PROVIDER GROSS RECEIPTS 5.000% Other health care items or services not listed GROSS RECEIPTS 5.000% Laboratory and x-ray services PROVIDER GROSS RECEIPTS . .   . .  
Wisconsin 1.613% Inpatient hospital services PERCENTAGE OF GROSS PATIENT REVENUE 1.613% Outpatient hospital services PERCENTAGE OF GROSS PATIENT REVENUE 4.379% Ambulatory surgical center services % OF GROSS PATIENT REVENUE 4.180% Ambulatory surgical center services % OF GROSS PATIENT REVENUE . .   . .   . .   . .   . .  

Source: GAO analysis of state-reported data. | GAO-15-227SP
 
Note: Some states reported taxes based on net patient revenues, which are listed in this section. They are not listed in Section 5 tables, because they did not specify that the tax was a percentage of net patient service revenues. When counting the total number of taxes, we counted a tax more than once when a tax was levied using different tax rates during a given year. For example, if for 6 months of the year a tax was levied at 4 percent of net patient service revenues, and for the other 6 months the tax was levied at 6 percent of net patient service revenues, we counted this as two taxes. For taxes that were reported as not being levied as a percentage of net patient service revenues, we used a similar approach in counting these taxes.

 

Definition
 
Health care provider taxes are taxes, licensures or other fees, assessments, or other mandatory payments, imposed on health care services or providers, as defined in Section 1903 of the Social Security Act and in 42 C.F.R. § 433.55 - Health Care-Related Taxes Defined.