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Budget Summary FY2015

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40000700 - MassHealth Fee-for-Service Payments
Data Current as of:  10/17/2014





Account Description FY2014
Spending
FY2015
GAA
4000-0700 MassHealth Fee-for-Service Payments
For health care services provided to medical assistance recipients under the executive office's health care indemnity or third party liability plan, to medical assistance recipients not otherwise covered under the executive office's managed care or senior care plans and for MassHealth benefits provided to children, adolescents and adults under section 9 of chapter 118E of the General Laws and clauses (a) to (d), inclusive, and clause (h) of subsection (2) of section 9A of said chapter 118E and section 16C of said chapter 118E; provided, that no payments for special provider costs shall be made from this item without the prior written approval of the secretary of administration and finance; provided further, 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 exceed 150 per cent of the federal poverty level; provided further, that children who have aged out of the custody of the department of children and families shall be eligible for benefits through the age limit specified in MassHealth's approved state plan; provided further, that in calculating rates of inpatient and outpatient services for neonatal intensive care units, also known as (NICU), with at least 55 licensed beds with-in an acute hospital that has at least 109 pediatric intensive NICU beds, the executive office shall make a supplemental payment of not less than $200,000; provided further, that funds may be expended from this item for health care services provided to the recipients in prior fiscal years; provided further, the funds appropriated in item 4000-0265 of section 2A of chapter 142 of the acts of 2011 shall again be appropriated for the same dollar amount as in said line item 4000-0265 and shall be distributed in and managed in the same manner as designated in section 60 of chapter 118 of the acts of 2012; provided further, that MassHealth shall provide an additional 5 per cent of its standard payment amount per discharge, or SPAD, above rate year 2013, or of reimbursement provided under any subsequent inpatient payment methodologies and to provide an additional 5 per cent of its outpatient payment amount per episode or PAPE above rate year 2013, or of reimbursement provided under any subsequent outpatient payment methodologies to any acute care hospital that has greater than 63 per cent of its gross patient service revenue from governmental payers and free care as determined by the executive office of health and human services; provided further, that MassHealth shall provide a supplemental payment of at least $12,307,769 for inpatient and outpatient behavioral and mental health services provided by any acute care hospital that has greater than 63 per cent of its gross patient service revenue from governmental payers and free care as determined by the executive office of health and human services; provided further, that such behavioral and mental health supplemental payments shall be subject to all required federal approvals and the availability of federal financial participation and shall be prioritized for services provided to children and adolescents; provided further, that if federal financial participation is not available for said behavioral and mental health supplemental payments, the executive office of health and human services shall make a payment of not less than $6,153,885; provided further, that the executive office shall not, in fiscal year 2015, fund programs relating to case management with the intention of reducing length of stay for neonatal intensive care unit cases; provided further, that notwithstanding the foregoing, funds may be expended from this item for the purchase of third party insurance including, but not limited to, Medicare for any medical assistance recipient; provided further, that the executive office may reduce MassHealth premiums or copayments or offer other incentives to encourage enrollees to comply with wellness goals; provided further, that funds may be expended from this item for activities relating to disability determinations or utilization management and review, including patient screenings and evaluations, regardless of whether such activities are performed by a state agency, contractor, agent, or provider; provided further, that not later than March 3, 2015, the executive office shall report to the house and senate committee on ways and means on the dental coverage available to MassHealth recipients as of January 1, 2015 as it compares to dental coverage available to MassHealth recipients on January 1, 2010; provided further, that the executive office shall maintain full-year coverage for adult dental fillings; and provided further, that the executive office shall implement adult denture coverage not later than May 15, 2015
2,144,775,985 2,381,458,986