(a) As used in this section and sections 12-263bbb to 12-263fff, inclusive, unless the context otherwise requires:
(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, 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;
(2) “Ambulatory surgical center services” means only those procedures or services included in a facility fee payment to an ambulatory surgical center facility associated with each surgical procedure and that are not reimbursable ancillary or professional procedures or services. “Ambulatory surgical services” includes facility services only and does not include surgical procedures, physicians' services, anesthetists' services, radiology services, diagnostic services or ambulance services, if such procedures or services would be reimbursed as a separate line item from facility services under 42 CFR 416.164(a), as amended from time to time;
(3) “Gross receipts” means the amount received, whether in cash or in kind, from patients, third-party payers and others for taxable ambulatory surgical center services provided by the ambulatory surgical center in the state, including retroactive adjustments under reimbursement agreements with third-party payers, without any deduction for any expense of any kind;
(4) “Net revenue” means gross receipts less payer discounts, charity care and bad debts, to the extent the ambulatory surgical center previously paid tax under this section on the amount of such bad debts;
(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 rate or method of payment that is different than or discounted from such published charges. “Payer discounts” does not include charity care or bad debts;
(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 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. “Charity care” does not include bad debts or payer discounts;
(7) “Received” means received or accrued, construed according to the method of accounting customarily employed by the ambulatory surgical center;
(8) “Medicaid” means the program operated by the Department of Social Services pursuant to section 17b-260 and authorized by Title XIX of the Social Security Act, as amended from time to time;
(9) “Medicare” means the programs operated by the Centers for Medicare and Medicaid Services in accordance with Title XVIII of the Social Security Act, as amended from time to time, including, but not limited to, those programs established pursuant to Parts A, B and C of Title XVIII of said act, as amended from time to time;
(10) “Commissioner” means the Commissioner of Revenue Services; and
(11) “Department” means the Department of Revenue Services.
(b) For each calendar quarter commencing on or after July 1, 2023, there is hereby imposed a tax on each ambulatory surgical center in this state to be paid each calendar quarter.
(1) The tax imposed by this section for each calendar quarter shall be at the rate of three per cent of each ambulatory surgical center's net revenue received during the calendar quarter, except that such tax shall not be imposed on any amount of such net revenue that constitutes any of the following: (A) Net revenue of a hospital that is subject to the tax imposed under section 12-263q; (B) Medicaid payments received by the ambulatory surgical center for the provision of ambulatory surgical center services; and (C) Medicare payments received by the ambulatory surgical center for the provision of ambulatory surgical center services.
(2) Each ambulatory surgical center doing business in the state shall, on or before the last day of January, April, July and October of each year, render to the commissioner a return, on forms prescribed or furnished by the commissioner, reporting the name and location of such ambulatory surgical center, the entire amount of net revenue received by such ambulatory surgical center during the calendar quarter ending on the last day of the preceding month and such other information as the commissioner deems necessary for the proper administration of this section. Except as provided in subdivision (3) of this subsection, the tax imposed under this section shall be due and payable on the due date of such return. Each ambulatory surgical center shall be required to file such return electronically with the department and to make payment of such tax by electronic funds transfer in the manner provided by chapter 228g, regardless of whether such ambulatory surgical center would have otherwise been required to file such return electronically or to make such tax payment by electronic funds transfer under the provisions of chapter 228g.
(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. Undue hardship shall be demonstrated by a showing that the ambulatory surgical center is at substantial risk of defaulting on a bond or loan covenant or similar obligation if such ambulatory surgical center were to make payment on the due date of the amount for which the extension is requested. Such request shall be filed on forms prescribed by the commissioner and shall include complete information of such ambulatory surgical center's inability, due to undue hardship, to make payment of the tax on or before the due date of such payment. The commissioner shall not grant any extension for a general statement of hardship by an ambulatory surgical center or for the convenience of an ambulatory surgical center.
(B) The commissioner may grant an extension if the commissioner determines an undue hardship exists. Such extension shall not exceed three months from the original due date of the payment, except that the commissioner may grant an additional extension not exceeding three months from the initial extended due date of the payment (i) upon the filing of a subsequent request by the ambulatory surgical center on or before the extended due date of the payment, on forms prescribed by the commissioner, and (ii) upon a showing of extraordinary circumstances, as determined by the commissioner.
(4) If the commissioner grants an extension pursuant to subdivision (3) of this subsection, no penalty shall be imposed and no interest shall accrue during the period of time for which an extension is granted if the ambulatory surgical center pays the tax due on or before the extended due date of the payment. If the ambulatory surgical center does not pay such tax by the extended due date, a penalty shall be imposed in accordance with subsection (c) of this section and interest shall begin to accrue at a rate of one per cent per month for each month or fraction thereof from the extended due date of such tax until the date of payment.
(5) Nothing in this section shall prohibit an ambulatory surgical center from seeking remuneration for the tax imposed by this section.
(c) (1) Except as provided in subdivision (3) of subsection (b) of this section, if any ambulatory surgical center fails to pay the amount of tax reported to be due on such ambulatory surgical center's return within the time specified under the provisions of this section, there shall be imposed a penalty equal to ten per cent of such amount due and unpaid or fifty dollars, whichever is greater. The tax shall bear interest at the rate of one per cent per month or fraction thereof from the due date of such tax until the date of payment.
(2) If any ambulatory surgical center has not filed its return within one month of the due date of such return, the commissioner may file such return at any time thereafter, according to the best information obtainable and according to the forms prescribed. There shall be added to the tax imposed upon the basis of such return an amount equal to ten per cent of such tax or fifty dollars, whichever is greater. The tax shall bear interest at the rate of one per cent per month or fraction thereof from the due date of such tax until the date of payment.
(3) Subject to the provisions of section 12-3a, the commissioner may waive all or part of the penalties provided under this subsection when it is proven to the commissioner's satisfaction that the failure to pay any tax on time was due to reasonable cause and was not intentional or due to neglect.
(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.
(d) (1) Any person required under this section to pay any tax, file a return, keep any records or supply any information and who wilfully fails, at the time required by law, to pay such tax, file such return, keep such records or supply such information shall, in addition to any other penalty provided by law, be fined not more than one thousand dollars or imprisoned not more than one year, or both. As used in this subsection, “person” includes any officer or employee of an ambulatory surgical center under a duty to pay such tax, file such return, keep such records or supply such information. Notwithstanding the provisions of section 54-193, no person shall be prosecuted for a violation of the provisions of this subsection committed on or after July 1, 1997, except within three years after such violation has been committed.
(2) Any person who wilfully delivers or discloses to the commissioner or the commissioner's authorized agent any list, return, account, statement or other document, known by such person to be fraudulent or false in any material matter, shall, in addition to any other penalty provided by law, be guilty of a class D felony. No person shall be charged with an offense under both this subdivision and subdivision (1) of this subsection in relation to the same tax period but such person may be charged and prosecuted for both such offenses upon the same information.
(e) 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 year.
(June Sp. Sess. P.A. 21-2, S. 463.)
History: June Sp. Sess. P.A. 21-2 effective July 1, 2023, and applicable to calendar quarters commencing on or after July 1, 2023.