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Office of the Secretary of Health and Human Services
| DEPARTMENT | FY2012 Budgetary Recommendations |
FY2012 Federal, Trust, and ISF |
FY2012 Total Spending |
FY2012 Budgetary Non-Tax Revenue |
|---|---|---|---|---|
| Office of the Secretary of Health and Human Services | 7,723,292 | 1,290,136 | 9,013,428 | 5,023,411 |
| account | description | amount | ||||
|---|---|---|---|---|---|---|
| OFFICE OF THE SECRETARY OF HEALTH AND HUMAN SERVICES | 9,013,428,257 | |||||
| Budgetary Direct Appropriations | 7,723,292,050 | |||||
| Direct Appropriations | ||||||
| 4000-0050 | Personal Care Attendant Council
For the personal care attendant quality home care workforce council established under section 29 of chapter 118G of the General Laws |
167,708 | ||||
| 4000-0300 | Executive Office of Health and Human Services and Medicaid Administration
For the operation of the office of the secretary of health and human services, including the operation of the managed care oversight board; provided, that the executive office shall provide technical and administrative assistance to agencies under the purview of the secretariat receiving federal funds; provided further, that the executive office shall continue to develop and implement the common client identifier; provided further, that funds appropriated in this item shall be expended for administrative and contracted services related to the implementation and operation of programs authorized by chapter 118E of the General Laws; provided further, that in consultation with the division of health care finance and policy, no rate increase shall be provided to existing Medicaid provider rates without taking all measures possible under Title XIX of the Social Security Act to ensure that rates of payment to providers do not exceed the rates that are necessary to meet only those costs which must be incurred by efficiently and economically operated providers in order to provide services of adequate quality; provided further, that expenditures for the purposes of each item appropriated for programs authorized by chapter 118E shall be accounted for in the Massachusetts management accounting and reporting system not more than 10 days after the expenditures have been made by the Medicaid management information system; provided further, that no expenditures shall be made that are not federally reimbursable, including those related to Titles XIX or XXI of the Social Security Act or the MassHealth demonstration waiver approved under section 1115(a) of the act or the community first section 1115 demonstration waiver, whether made by the executive office or another commonwealth entity, except as explicitly authorized, or unless made for cost containment efforts the purposes and amounts of which have been submitted to the executive office for administration and finance and the house and senate committees on ways and means 30 days prior to making these expenditures; provided further, that the executive office may continue to recover provider overpayments made in the current and prior fiscal years through the Medicaid management information system, and that these recoveries shall be considered current fiscal year expenditure refunds; provided further, that the executive office may collect directly from a liable third party any amounts paid to contracted providers under chapter 118E for which the executive office later discovers another third party is liable if no other course of recoupment is possible; provided further, that no funds shall be expended for the purpose of funding interpretive services directly or indirectly related to a settlement or resolution agreement with the office of civil rights or any other office, group or entity; provided further, that interpretive services currently provided shall not give rise to enforceable legal rights for any party or to an enforceable entitlement to interpretive services; provided further, that the federal financial participation received from claims filed based on in-kind administrative services related to outreach and eligibility activities performed by certain community organizations, under the "covering kids initiative", and in accordance with the federal revenue criteria in 45 CFR 74.23 or any other federal regulation which provides a basis for federal financial participation, shall be credited to this item and may be expended, without further appropriation, on administrative services including those covered under an agreement with the organizations participating in the initiative; provided further, that notwithstanding any general or special law to the contrary, the state medicaid office is hereby authorized to conduct a trial to determine the effectiveness of various fraud management tools to identify potential fraud at claims submission and validation in order to reduce medicaid fraud prior to payment, provided further, any such trial may test innovative technologies to improve medicaid fraud detection and evaluate the efficacy of, among other things, a real-time, pro-active model to identify and investigate potential medicaid fraud cases prior to payment, and provided further the medicaid office may use actual claims data, in accordance with federal law, to identify specific suspicious provider billing patterns, document the results of any potential fraud findings and estimate anticipated savings and benefit to the commonwealth associated with such a fraud detection system, provided further, the executive office shall require the commissioner of mental health to approve any prior authorization or other restriction on medication used to treat mental illness in accordance with written policies, procedures and regulations of the department of mental health; and provided further, that any unexpended balance in items 4000-0430, 4000-0500, 4000-0600, 4000-0700, 4000-0870, 4000-0875, 4000-0880, 4000-0890, 4000-0895, 4000-0950, 4000-0990, 4000-1400 or 4000-1405 on June 30, 2012 shall revert to the General Fund |
84,000,300 | ||||
| 4000-0301 | MassHealth Auditing and Utilization Reviews
For the costs of MassHealth provider and member audit and utilization review activities including eligibility verification, disability evaluations, provider financial and clinical audits and other initiatives intended to enhance program integrity |
1,736,425 | ||||
| 4000-0430 | MassHealth CommonHealth Plan
For the CommonHealth program to provide primary and supplemental medical care and assistance to disabled adults and children under sections 9A, 16 and 16A of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to the recipients in prior fiscal years; provided further, that the executive office shall maximize federal reimbursement for state expenditures made on behalf of these adults and children; provided further, that children shall be determined eligible for the medical care and assistance if they meet the disability standards as defined by the executive office, which standards shall be no more restrictive than the standards in effect on July 1, 1996; and provided further, that the executive office shall process CommonHealth applications within 45 days of receipt of a completed application or within 90 days if a determination of disability is required |
130,439,637 | ||||
| 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 of chapter 118E of the General Laws and section 16C of said chapter 118E; 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, exceed 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 in this item; and provided further, that the executive office shall maximize federal reimbursements for state expenditures made to these providers |
3,872,835,669 | ||||
| 4000-0700 | MassHealth Fee-for-Service Payments
For health care services provided to medical assistance recipients under the executive office's health care indemnity/third party liability plan and 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 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 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 until they reach age 21; provided further, that funds shall be expended from this item for members who qualify for early intervention services; 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 the executive office shall maximize federal reimbursements for state expenditures made to these providers; 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; and 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 these activities are performed by a state agency, contractor, agent or provider |
2,026,206,633 | ||||
| 4000-0870 | MassHealth Basic Coverage
For health care services provided to adults participating in the medical assistance program under clause (g) of subsection (2) of section 9A of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to the recipients in prior fiscal years |
157,016,626 | ||||
| 4000-0875 | MassHealth Breast and Cervical Cancer Treatment
For the provision of benefits to eligible women who require medical treatment for either breast or cervical cancer in accordance with section 1902(a)(10)(A)(ii)(XVIII) of the Breast and Cervical Cancer Prevention and Treatment Act of 2000, Public Law 106-354, and in accordance with section 10D of chapter 118E of the General Laws; provided, that the executive office shall provide those benefits to women whose income, as determined by the executive office, does not exceed 250 per cent of the federal poverty level, subject to continued federal approval; provided further, that eligibility for the benefits shall be extended solely for the duration of the cancerous condition; provided further, that before the provision of any benefits covered by this item, the executive office shall require screening for either breast or cervical cancer at the comprehensive breast and cervical cancer early detection program operated by the department of public health, in accordance with item 4570-2500 of section 2D; and provided further, that funds may be expended from this item for health care services provided to these recipients in prior fiscal years |
4,770,999 | ||||
| 4000-0880 | MassHealth Family Assistance Plan
For MassHealth benefits under clause (c) of subsection (2) of section 9A and section 16C of chapter 118E of the General Laws for children and adolescents whose family incomes as determined by the executive office are above 150 per cent of the federal poverty level; provided, that funds may be expended from this item for health care services provided to the children and adolescents in prior fiscal years |
218,925,814 | ||||
| 4000-0890 | MassHealth Premium Assistance and Insurance Partnership Program
For the cost of health insurance subsidies paid to employees and employers of small businesses in the insurance reimbursement program under section 9C of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to these persons in prior fiscal years |
58,181,956 | ||||
| 4000-0895 | Healthy Start Program
For the healthy start program to provide medical care and assistance to pregnant women and infants residing in the commonwealth under section 10E of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to these persons in prior fiscal years |
13,800,000 | ||||
| 4000-0950 | Children's Behavioral Health Initiative
For the purposes of administrative and program expenses associated with the children's behavioral health initiative, in accordance with the settlement agreement in the case of Rosie D. et al. v. Romney, United States District Court for the District of Massachusetts civil action No. 01-30199-MAP, to provide comprehensive, community-based behavioral health services to children suffering from severe emotional disturbances; provided, that funds may be expended from this item for health care services provided to these persons in prior fiscal years |
214,743,708 | ||||
| 4000-0990 | Children's Medical Security Plan
For the children's medical security plan to provide primary and preventive health services for uninsured children from birth through age 18; provided, that the executive office shall prescreen enrollees and applicants for Medicaid eligibility; provided further, that no applicant shall be enrolled in the program until the applicant has been denied eligibility for the MassHealth program; provided further, that the MassHealth benefit request shall be used as a joint application to determine the eligibility for both MassHealth and the children's medical security plan; provided further, that the executive office shall maximize federal reimbursements for state expenditures made on behalf of the children; provided further, that the executive office shall expend all necessary funds from this item to ensure the provision of the maximum benefit levels for this program, as authorized by section 10F of chapter 118E of the General Laws; provided further, that the maximum benefit levels for this program shall be made available only to those children who have been determined by the executive office to be ineligible for MassHealth benefits; and provided further, that funds may be expended from this item for health care services provided to these persons in prior fiscal years |
12,600,000 | ||||
| 4000-1400 | MassHealth HIV Plan
For the purposes of providing MassHealth benefits to persons with a diagnosis of human immunodeficiency virus with incomes up to 200 per cent of the federal poverty level; provided, that funds may be expended from this item for health care services provided to these persons in prior fiscal years |
18,541,135 | ||||
| 4000-1405 | MassHealth Essential
For the operation of a program of preventive and primary care for chronically unemployed persons who are not receiving unemployment insurance benefits and who are not eligible for medical assistance but who are determined by the executive office of health and human services to be long-term unemployed; provided, that such persons shall meet the eligibility requirements of the MassHealth program established in section 9A of chapter 118E of the General Laws; provided further, that persons eligible under subsection (7) of section 16D of said chapter 118E shall also be eligible to receive benefits under this item; provided further, that the income of these persons shall not exceed 100 per cent of the federal poverty level; provided further, that the eligibility requirements shall not exclude from eligibility persons who are employed intermittently or on a non-regular basis; provided further, that the provision of care to persons under this program may, taking into account capacity, continuity of care, and geographic considerations, be restricted to certain providers; provided further, that the secretary may limit or close enrollment if necessary in order to ensure that expenditures from this item do not exceed the amount appropriated in this item; provided further, however, that no such limitation shall be implemented unless the secretary has given 90 days notice to the house and senate committees on ways and means and the joint committee on health care financing; and provided further, that funds may be expended from this item for health care services provided to recipients in prior fiscal years |
389,757,408 | ||||
| 4000-1420 | Medicare Part D Phased Down Contribution
For the purposes of making payment to the federal Centers for Medicare and Medicaid Services in compliance with Title XIX of the Social Security Act |
211,370,985 | ||||
| 4000-1700 | Health and Human Services Information Technology Costs
For the provision of information technology services within the executive office of health and human services |
83,197,047 | ||||
| account | description | amount | ||||
|---|---|---|---|---|---|---|
| Retained Revenues | ||||||
| 4000-0320 | MassHealth Recoveries from Current and Prior Fiscal Years Retained Revenue
The executive office of health and human services may expend for medical care and assistance rendered in the current year an amount not to exceed $225,000,000 from the monies received from recoveries and collections of any current or prior year expenditures; provided, that notwithstanding any general or special law to the contrary, the balance of any personal needs accounts collected from nursing and other medical institutions upon a medical assistance member's death and held by the executive office for more than 3 years may be credited to this item |
225,000,000 | ||||
| account | description | amount | ||||
|---|---|---|---|---|---|---|
| Intragovernmental Service Spending | 59,531,770 | |||||
| 4000-0102 | Chargeback for Human Services Transportation
For the cost of transportation services for health and human services clients and the operation of the health and human services transportation office
|
8,086,443 | ||||
| 4000-0103 | Chargeback for Human Services Administration
For the costs of core administrative functions performed within the executive office of health and human services; provided, that the secretary of health and human services may, notwithstanding any general or special law to the contrary, identify administrative activities and functions common to the separate agencies, departments, offices, divisions and commissions within the executive office and designate them "core administrative functions" in order to improve administrative efficiency and preserve fiscal resources; provided further, that common functions that may be designated core administrative functions include, without limitation, human resources, financial management and leasing and facility management; provided further, that all employees performing functions so designated may be employed by the executive office and the executive office shall charge the agencies, departments, offices, divisions and commissions for these services; provided further, that upon the designation of a function as a core administrative function, the employees of each agency, department, office or commission who perform these core administrative functions may be transferred to the executive office of health and human services; provided further, that the reorganization shall not impair the civil service status of any transferred employee who immediately before the effective date of this act either holds a permanent appointment in a position classified under chapter 31 of the General Laws or has tenure in a position by reason of section 9A of chapter 30 of the General Laws; and provided further, that nothing in this section shall be construed to impair or change an employee's status, rights, or benefits under chapter 150E of the General Laws
|
20,003,583 | ||||
| 4000-1701 | Chargeback for Health and Human Services Information Technology Costs
For the cost of information technology services provided to agencies of the executive office of health and human services
|
31,441,744 | ||||
| account | description | amount |
|---|---|---|
| Federal Grant Spending | 14,015,115 | |
| 4000-0024 | Affordable Care Act
For the purposes of a federally funded grant entitled, Affordable Care Act |
742,888 |
| 4000-0323 | Personal and Home Care Aid State Training Program
For the purposes of a federally funded grant entitled, Personal and Home Care Aid State Training Program |
738,993 |
| 4000-0544 | CHIPRA Quality Demonstration
For the purposes of a federally funded grant entitled, CHIPRA Quality Demonstration |
2,666,404 |
| 4000-0748 | Money Follows the Person Planning Grant
For the purposes of a federally funded grant entitled, Money Follows the Person Planning Grant |
199,905 |
| 4000-7560 | Medicaid Emergency Diversion Grant
For the purposes of a federally funded grant entitled, Medicaid Emergency Diversion Grant |
103,445 |
| 4000-7570 | Medicaid Transformation Grant
For the purposes of a federally funded grant entitled, Medicaid Transformation Grant |
67,937 |
| 4000-9058 | My Child
For the purposes of a federally funded grant entitled, My Child |
1,875,000 |
| 4000-9401 | Community Mental Health Services
For the purposes of a federally funded grant entitled, Community Mental Health Services |
7,620,543 |
| account | description | amount |
|---|---|---|
| Trust and Other Spending | 1,216,589,322 | |
| 4000-1068 | Medical Assistance Trust Fund | 394,025,000 |
| 4000-1069 | Health Insurance Technology Trust Fund | 56,000,000 |
| 4000-3113 | Fiscal Intermediary Expendable Trust | 50,000 |
| 4000-4000 | Health Insurance Portability and Accountability Act Fund | 7,000,000 |
| 4000-4005 | Youth at Risk Expendable Trust | 2,500 |
| 4000-5819 | Commonwealth Care Trust Fund | 759,511,822 |
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