40000500 - MassHealth Managed Care

Account Description FY2009
GAA
FY2009  
Total  
Spending
  
4000-0500 MassHealth Managed Care
For health care services provided to medical assistance recipients under the executive office's primary care clinician/mental health and substance abuse plan or through a health maintenance organization under contract with the executive office and for MassHealth benefits provided to children, adolescents and adults under clauses (a) to (d), inclusive and clause (h) of subsection (2) of section 9A and section 16C of chapter 118E of the General Laws; provided, that no funds shall be expended from this item for children and adolescents under clause (c) of said subsection (2) of said section 9A of said chapter 118E whose family incomes, as determined by the executive office, exceeds 150 per cent of the federal poverty level; provided further, that funds may be expended from this item for health care services provided to the recipients in prior fiscal years; provided further, that expenditures from this item shall be made only for the purposes expressly stated herein; provided further, that not less than $2,000,000 shall be expended to an acute care hospital located in Holyoke that provides clinical training programs for nurses, allied health professionals and technicians through affiliations with community colleges and private universities; provided further, that the secretary of health and human services and the commissioner of mental health shall report quarterly to the house and senate committees on ways and means relative to the performance of the managed care organization under contract with the executive office to administer the mental health and substance abuse benefit; provided further, that such quarterly reports shall include, but not be limited to, analyses of utilization trends, quality of care and costs across all service categories and modalities of care purchased from providers through the mental health and substance abuse program, including those services provided to clients of the department of mental health; provided further, that in conjunction with the new Medicaid management information system project, said executive office shall continue to study the feasibility of modifying its claim payment system, in collaboration with the MassHealth behavioral health contractor, to routinely process for payment valid claims for medically-necessary covered medical services to eligible recipients with psychiatric and substance abuse diagnoses on a timely basis in an effort to avoid delay and expenses incurred by lengthy appeals processes; provided further, that said secretary shall report to the house and senate committee on ways and means any proposed modifications to said payment system, and a timeline of steps to be taken to implement said modifications; provided further, that notwithstanding any general or special law to the contrary, the secretary of health and human services shall not reassign to a managed care plan under contract with the office of MassHealth the behavioral health benefit of any eligible person when the benefit is managed by MassHealth's specialty behavioral health managed care contactor, after the benefit is elected by or initially assigned to that person, unless the person provides written or verbal consent to the reassignment; provided further, that the executive office shall implement payments required pursuant to chapter 58 of the acts of 2006 for the public entity in fiscal year 2009; provided further, that not less than $10,000,000 shall be expended as payments for pediatric specialty hospitals and units, including pediatric chronic rehabilitation hospitals; provided further, that $8,000,000 of said $10,000,000 shall be expended for disproportionate share payments for inpatient services provided at pediatric specialty hospitals and units, including pediatric chronic and rehabilitation long-term care hospitals as allowable under federal law; provided further, that $2,000,000 of said $10,000,000 shall be expended for a grant to said pediatric chronic and rehabilitation long-term care hospitals for which federal financial participation and federal approval need not be obtained; and provided further, that $5,950,000 shall be expended on disproportionate share payments to high public payer hospitals

3,121,385,000 3,148,377,825  

Veto Explanation: I am striking language which earmarks funding for Holyoke Hospital, rates for High Public Payer Hospitals and Pediatric Specialty Hospitals that are not recommended. The reduction in the item incorporates the amount of the stricken earmarked funds.

 
 
HISTORICAL SPENDING CATEGORIES ($000)
column definitions
SPENDING CATEGORY
FY2005
Expended

FY2006
Expended

FY2007
Expended

FY2008
Expended

FY2009
GAA
FY2009
Budget
Reductions
Public Assistance 2,277,552 2,280,366 2,695,033 3,061,514 3,121,385 -95,341
TOTAL 2,277,552 2,280,366 2,695,033 3,061,514 3,121,385 -95,341

 

FY2009 Spending Category Chart

Pie Chart: Public Assistance=100%