Hawaii has created a provider fee that is imposed on health care items or services provided by nursing facilities in Hawaii, effective July 1, 2012 through June 30, 2013. The fee is based on the net patient services revenue of all nursing facilities subject to the sustainability fee and is calculated and paid on a per resident day basis. The fee may not exceed 4% of net patient service revenue. The Department of Human Services will determine the fee rate prospectively for the applicable fiscal year. The fee is due within 30 days after the end of each month. The initial payment is due on the later of July 31, 2012 or 45 days after the required federal approvals. A penalty of 2% of the fee will be assessed for failure to pay on time, in addition to other remedies, including suspension or revocation of a nursing facility license. Subject to federal approval, exemptions may apply for nursing facilities with 28 or fewer licensed beds, nursing facilities owned or operated by the Hawaii Health Systems Corporation, and continuing care retirement communities. (Act 156 (S.B. 2466), Laws 2012, effective as noted)