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Account	Description	FY07 GAA	FY08 GAA
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), (b), (c), (d) and (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 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 not less than $14,000,000 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 not less than $2,000,000 of said $14,000,000 shall be expended as a grant to said pediatric chronic and rehabilitation long-term care hospital for which federal financial participation and federal approval need not be obtained; provided further, that $11,900,000 shall be expended on disproportionate share payments to high public payer hospitals; provided further, that the executive office shall ensure that actuarially sound rates for a publicly-operated entity pursuant to section 122 of chapter 58 of the acts of 2006 are implemented in fiscal year 2008; and 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, no later than December 1, 2007, the office of Medicaid shall submit a Medicaid Transformation Grant, federal funding opportunity number HHS-2007-CMS-MTG-0010, to the Centers for Medicare & Medicaid Services (CMS) to fund a MassHealth e-Prescribing pilot project to introduce electronic prescription writing (e-prescribing) to Medicaid providers for developing, piloting, evaluating and rolling out a real-time decision support solution that can be integrated into providers' workflow that will be accomplished by integrating prior authorization, preferred drug lookup, and other components of Affiliated Computer Services'(ACS, Mass Health's claims processing contractor) application used by MassHealth providers with the Rx Gateway for prescription routing and related services already under development by MA-SHARE (Massachusetts Simplifying Healthcare Among Regional Entities), the commonwealth's public-private collaborative for health information exchange; and provided further, that the office of Medicaid shall forward a copy of this application to the house and senate committee on ways and means and the house and senate chairpersons of the joint committee on health care financing	2,520,227,848	2,884,675,464

 
 

HISTORICAL SPENDING CATEGORIES ($000)

SPENDING CATEGORY	FY04 Spending	FY05 Spending	FY06 Spending	FY07 Spending	FY08 GAA
Public Assistance	2,213,444	2,277,552	2,280,366	2,722,883	2,884,675
TOTAL	2,213,444	2,277,552	2,280,366	2,722,883	2,884,675

* FY07 Projected Spending includes the budget plus nearly $1 billion in spending from FY06 supplemental budgets.

 

 

Earmarks

EARMARK DESCRIPTION	FY08
High Public Payer DSH	11,900,000
Pediatric DSH	12,000,000
Pediatric DSH - Franciscan's	2,000,000