This is not the official budget document.

Budget Summary FY2009

Department of Elder Affairs
Data Current as of:  6/22/2009



FISCAL YEAR 2009 BUDGET SUMMARY ($000)
ACCOUNT FY2009
Conference		 FY2009
Vetoes		 FY2009
Overrides		 FY2009
GAA		 FY2009
Total
Spending
MassHealth Senior Care 2,175,860 -17,505 0 2,158,355 2,101,532  
MassHealth Nursing Home Supplemental Rates 288,500 0 0 288,500 288,200  
Department of Elder Affairs Administration 3,742 0 0 3,742 3,604  
Prescription Advantage 57,534 0 0 57,534 50,232  
Elder Enhanced Home Care Services Program 48,199 0 0 48,199 48,199  
Supportive Senior Housing Program 4,203 0 0 4,203 4,153  
Elder Home Care Purchased Services 106,716 0 0 106,716 102,521  
Elder Home Care Case Management and Administration 40,368 0 0 40,368 37,568  
Elder Protective Services 16,246 0 0 16,246 16,101  
Geriatric Mental Health Services Program 225 0 0 225 120  
Family Caregivers Program 250 0 0 250 0  
Congregate Housing Program 2,789 0 0 2,789 2,123  
Residential Placement for Homeless Elders 450 0 0 450 153  
Elder Nutrition Program 6,805 0 0 6,805 6,480  
Grants to Councils on Aging 8,615 0 0 8,615 7,543  
TOTAL    2,760,501 -17,505 0 2,742,996 2,668,531  

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account description amount
DEPARTMENT OF ELDER AFFAIRS 2,668,530,686
Budgetary Direct Appropriations  
4000-0600 MassHealth Senior Care
For health care services provided to MassHealth members who are seniors, and for the operation of the senior care options program under section 9D of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to these recipients in prior fiscal years; provided further, that funds shall be expended for the 'community choices' initiative; provided further, that no payment 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 benefits for this demonstration project shall not be reduced below the services provided in fiscal year 2008; provided further, that the eligibility requirements for this demonstration project shall not be more restrictive than those established in fiscal year 2008; provided further, that the executive office of health and human services shall submit a report to the house and senate committees on ways and means detailing the projected costs and the number of individuals served by the 'community choices' initiative in fiscal year 2009 delineated by the federal poverty level; provided further, that the report shall be submitted not later than February 2, 2009; provided further, that notwithstanding any general or special law to the contrary, not less than $5,000,000 shall be expended from this item for the purpose of providing an increase to $72.80 per month in the personal needs allowance for individuals residing in nursing homes and rest homes who are eligible for MassHealth, Emergency Aid to the Elderly Disabled and Children program or Supplemental Security Income; provided further, that notwithstanding any general or special law to the contrary, the regulations, criteria and standards for determining admission to and continued stay in a nursing home in fiscal year 2009 shall not be more restrictive than those regulations, criteria and standards in effect on January 1, 2004 until the executive office of health and human services and the executive office of elder affairs submit a multi-year plan to the house and senate committees on ways and means and the joint committee on health care financing detailing the suggested timeline for phasing in changes to nursing home clinical criteria, provided that these changes shall not adversely affect current nursing home residents and shall not jeopardize the effectiveness of the 2176 home and community based waiver; provided further, care management under section 3 of chapter 211 of the Acts of 2006 shall be implemented through Aging & Disability Resource Consortiums, which shall include a combination of one or more Aging Services Access Points and Independent Living Centers, and section 2 of section 211, the pre-admission counseling and assessment program, established pursuant to the last paragraph of section 9 of chapter 118E of the General Laws, shall be implemented through the development of said aging and disability resource consortiums; provided further, that notwithstanding any general or special law to the contrary, for any nursing home or non-acute chronic disease hospital that provides kosher food to its residents, the department, in consultation with the division, in recognition of the unique special innovative program status granted by the executive office, shall continue to make the standard payment rates established in fiscal year 2006 to reflect the high dietary costs incurred in providing kosher food; provided further, that funds shall be expended for the purpose of a housing with services demonstration project known as the 'Caring Homes' initiative designed to delay or prevent nursing home placement by providing care-giving services to an elder; provided further, that under said demonstration project, eligible MassHealth enrollees shall be able to live in the home of an individual or relative, with the exception of spouses and dependent children, to provide for their long term supports, pursuant to regulations promulgated by said executive office; provided further that effective July 1, 2008 for the fiscal year ending June 30, 2009, the division of health care finance and policy shall establish nursing facility MassHealth rates that are $45 million in payments above the payments made to nursing facilities for the fiscal year ended 2008, for the purpose of funding inflationary labor and benefit costs, funded by any additional funds that may become available in this item due to a decrease in Medicaid utilization and that are not otherwise projected to be expended for other services from this item; provided further, that in the event said additional funds that may become available in this item do not total at least $45 million, said nursing facility MassHealth rate increase shall be proportionally reduced; provided further, that the secretary of elder affairs and the director of the office of Medicaid shall report monthly to the secretary of administration and finance and to the house and senate committees on ways and means the total projected expenditures from this item and the extent to which said $45 million nursing facility MassHealth rate increase may be funded in fiscal year 2009; and provided further, that the secretary of elder affairs and the director of the office of Medicaid shall provide a monthly report to the secretary of administration and finance and to the house and senate committees on ways and means showing Medicaid nursing facility utilization in the current fiscal year compared to Medicaid nursing facility utilization in the same period for the prior fiscal year
 2,101,532,200
4000-0640 MassHealth Nursing Home Supplemental Rates
For nursing facility Medicaid rates; provided, that notwithstanding any general or special law to the contrary, in fiscal year 2009 the division of health care finance and policy shall establish nursing facility Medicaid rates that cumulatively total $288,500,000 more than the annual payment rates established by the division under the rates in effect as of June 30, 2002; provided further, that the division shall adjust per diem rates to reflect any reductions in Medicaid utilization; provided further, that $287,950,000 shall be expended for the purposes of Medicaid per diem rate payments to nursing homes participating in the MassHealth program for services provided to MassHealth members during fiscal year 2009; provided further, that the payments made pursuant to this item shall be allocated in the following manner in fiscal year 2009: (1) effective July 1, 2008, an annual amount of $99,000,000 in the aggregate to fund the use of 2000 base year cost information for rate determination purposes; provided, that not more than $9,000,000 of this amount shall be expended for purposes of reimbursing nursing facilities for up to 10 bed hold days for patients of the facility on medical and non-medical leaves of absence; (2) effective July 1, 2008, an annual amount of $122,500,000 for enhanced payment rates to nursing homes; (3) effective July 1, 2008, an annual amount of $50,000,000 to fund a rate add-on for wages, hours and benefits and related employee costs of direct care staff of nursing homes; provided further, that as a condition for such rate add-on, the division shall require that each nursing home document to the division that such funds are spent only on direct care staff by increasing the wages, hours and benefits of direct care staff, increasing the facility's staff-to-patient ratio, or by demonstrably improving the facility's recruitment and retention of nursing staff to provide quality care, which shall include expenditure of funds for nursing facilities which document actual nursing spending that is higher than the median nursing cost per management minute in the base year used to calculate Medicaid nursing facility rates; provided further, that a facility's direct care staff shall include all nursing personnel including registered nurses, licensed practical nurses, and certified nurses' aides hired by the facility from any temporary nursing agency or nursing pool registered with the department of public health; provided further, that the division shall credit wage increases that are over any previously collectively-bargained wage increases; provided further, that in monitoring compliance for this rate add-on, the division's regulations shall adjust any spending compliance test to reflect any Medicaid nursing facility payment reductions including, but not limited to, rate reductions imposed on or after October 1, 2002; provided further, that the expenditure of these funds shall be subject to audit by the division in consultation with the department of public health and the executive office of health and human services; provided further, that in implementing this section, the division shall consult with the Nursing Home Advisory Council; (4) effective July 1, 2008, an annual amount of $16,450,000: (a) to fund rate adjustments for reasonable capital expenditures by nursing homes, giving priority to nursing homes located or constructed in under-bedded areas as determined by said executive office, in consultation with the division, that meet quality standards established by the executive office of health and human services in conjunction with the department of public health and the division for the purposes of encouraging the upgrading and maintenance of quality of care in nursing homes; and (b) to fund rate adjustments to eligible nursing homes that meet utilization standards established by the executive office of health and human services in conjunction with the division for the purpose of reducing unnecessary nursing home admissions and facilitating the return of nursing homes residents of non-institutional settings; provided further, that to the extent that the annual amount of $16,450,000 in this clause is not fully allocated, the division shall first provide operating or capital rate adjustments for publicly operated, urban and geographically-isolated nursing homes; 5) $300,000 for the purposes of an audit of funds distributed under clause (3); provided further, that the division, in consultation with the department of public health and with the assistance of the executive office of health and human services, shall establish penalties sufficient to deter noncompliance to be imposed against any facility that expends any or all monies in violation of clause (3) including, but not limited to, recoupment, assessment of fines or interest; provided further, that the division shall report to the house and senate committees on ways and means not later than October 1, 2008 a preliminary analysis of funds expended under this subsection in fiscal year 2008 and a description and timeline for auditing of these funds; (6) $250,000 to fund expenses of the division related to the implementation and administration of section 25 of chapter 118G of the General Laws; and (7) an amount sufficient to implement section 622 of chapter 151 of the acts of 1996; and provided further, that any additional funds that may become available through this item due to decreased Medicaid utilization shall first fund a per-diem rate add-on for large Medicaid providers as specified in 114.2 CMR 6.06 (10)(a), as in effect on September 1, 2003 and then fund further enhanced rates to nursing homes
 288,200,000
9110-0100 Department of Elder Affairs Administration
For the operation of the executive office and regulation of assisted living facilities; provided, that the secretary shall continue to support community care ombudsman services; and provided further, that the executive office of elder affairs shall report annually to the house and senate committees on ways and means the number of assisted living units certified and the total revenues generated from application and certification fees for such units 		3,604,378
9110-1455 Prescription Advantage
For the costs of the drug insurance program authorized by section 39 of chapter 19A of the General Laws; provided, that amounts received by the executive office of elder affairs' vendor as premium revenue for this program may be retained and expended by the vendor for the purposes of the program; provided further, that not less than $600,000 shall be made available for the operation of the pharmacy outreach program established by section 4C of chapter 19A of the General Laws; provided further, that notwithstanding any general or special law to the contrary, unless otherwise prohibited by state or federal law, prescription drug coverage or benefits payable by the executive office of elder affairs and the entities with which it has contracted for administration of the subsidized catastrophic drug insurance program pursuant to said section 39 of said chapter 19A, shall be the payer of last resort for this program for eligible persons with regard to any other third-party prescription coverage or benefits available to such eligible persons; provided further, that the executive office shall notify the house and senate committees on ways and means not less than 90 days in advance of any action to limit or cap the number of enrollees in the program; provided further, that this program is subject to appropriation and, in fiscal year 2009, expenditures shall not be more than the amount authorized in this item; provided further, that no action shall be taken to expand the benefits of the program, extend benefits to additional populations or reduce cost sharing in the program without approval of the general court; provided further, that the department shall file all legislation required to implement such actions for review and analysis by the general court; provided further, that the executive office shall take steps for the coordination of benefits with the Medicare prescription drug benefit created pursuant to the federal Medicare Prescription Drug Improvement and Modernization Act of 2003, to ensure that Massachusetts residents take advantage of said benefit; provided further, that the department shall provide assistance for prescription drug costs to enrollees who qualify for Medicare Part D as well as assistance for premiums, deductibles, payments, and co-payments required by the Part D or Medicare Advantage plans; or by other plans which provide creditable prescription drug coverage as defined by section 104 of said Medicare Modernization Act, and which provide coverage of the cost of prescription drugs actuarially equal to or better than that provided by Medicare Part D; provided further, that a person shall also be eligible to enroll in the program at any time within a year after reaching age 65; and provided further, that the department shall allow those who meet the program eligibility criteria to enroll in the program at any time during the year; and provided further, that the secretary of elder affairs shall not implement cost sharing increases during fiscal year 2009 unless such cost sharing increases have been approved by law a vote of the general court 		50,231,990
9110-1500 Elder Enhanced Home Care Services Program
For the provision of enhanced home care services, including case management to elders who meet the eligibility requirements of the home care program and who need services above the level customarily provided under the program to remain safely at home, including elders previously enrolled in the managed care in housing, enhanced community options, and chronic care enhanced services programs; provided, that the secretary shall actively seek to obtain federal financial participation for all services provided to seniors who qualify for Medicaid benefits pursuant to the section 2176 waiver; provided further, that the executive office shall collect income data on persons receiving services provided in this item; provided further, that the executive office shall submit a report to the house and senate committees on ways and means detailing the population served by this item delineated by both 2008 federal poverty income levels and 2008 social security income standards; provided further, that the report shall be submitted not later than February 2, 2009; and provided further, that the executive office shall submit a report not later than October 15, 2008, to the house and senate committees on ways and means which shall include the number of individuals on a waiting list for these services on October 1, 2008, compared to the number of individuals on a waiting list on July 1, 2008 		48,199,305
9110-1604 Supportive Senior Housing Program
For the operation of the supportive senior housing program at state or federally-assisted housing sites; provided, that the funds shall be expended to fully fund existing sites 		4,153,243
9110-1630 Elder Home Care Purchased Services
For the operation of the elder home care program, including contracts with aging service access points or other qualified entities for the home care program, home care, health aides, home health and respite services, geriatric mental health services, and other services provided to the elderly; provided, that a sliding fee shall be charged to qualified elders; provided further, that the secretary of elder affairs may waive collection of sliding fees in cases of extreme financial hardship; provided further, that not more than $8,000,000 in revenues accrued from sliding fees shall be retained by the individual home care corporations without re-allocation by the executive office of elder affairs, and shall be expended for the purposes of the home care program, consistent with guidelines to be issued by the executive office; provided further, that the executive office shall report quarterly to the house and senate committees on ways and means on the receipt and expenditure of revenues accrued from the sliding fees; provided further, that the executive office shall report monthly to the house and senate committees on ways and means and the executive office for administration and finance on the amount expended from this item for purchase of service expenditures by category of service as set forth in 651 C.M.R. 3.01 and 651 C.M.R. 3.06; provided further, that no rate increase shall be awarded in fiscal year 2009 which would cause a reduction in client services or the number of clients served; provided further, that no funds shall be expended from this item to pay for salary increases for direct service workers who provide state-funded homemaker and home health aid services which would cause a reduction in client services; and provided further, that the secretary of elder affairs may transfer an amount not to exceed 3 per cent of the funds appropriated in this item to item 9110-1633 for case management services and the administration of the home care program 		102,521,281
9110-1633 Elder Home Care Case Management and Administration
For the operation of the elder home care case management program, including contracts with aging service access points, or other qualified entities for home care case management services and the administration of the home care corporations funded through item 9110-1630 and item 9110-1500; provided, that such contracts shall include the costs of administrative personnel, home care case managers, travel, rent and other costs deemed appropriate by the executive office of elder affairs; provided further that no funds appropriated in this item shall be expended for the enhancement of management information systems; and provided further, that the secretary of elder affairs may transfer an amount not to exceed 3 per cent of the funds appropriated herein to item 9110-1630 		37,568,041
9110-1636 Elder Protective Services
For the elder protective services program, including protective services case management, guardianship services, the statewide elder abuse hotline, and the elder-at-risk program; provided, that not less than $800,000 shall be expended for money management services 		16,100,703
9110-1640 Geriatric Mental Health Services Program
For the Geriatric Mental Health Services program, including residential care, case management, and day treatment services, to deinstitutionalize or divert elders with serious and persistent mental illness from institutionalized settings 		120,000
9110-1650 Family Caregivers Program
For the family caregivers program 		0
9110-1660 Congregate Housing Program
For congregate and shared housing services for the elderly; provided, that $375,000 shall be expended for an aging-in-place project operated by the Jewish Family & Children's Service of Greater Boston in Brookline and Malden, and by Jewish Family Service of Metrowest in Framingham; provided further, that not less than $216,000 shall be allocated to the Helping Elders at Risk Through Homes program; provided further, that not less than $75,000 shall be expended for the Jewish Family Services of Western Massachusetts to implement the Aging-Well at Home Program in Springfield; provided further, that not less than $75,000 shall be expended to fund the NORC, Aging-In-Place program operated by the Jewish Family Service of the North Shore in Swampscott; provided further, that no less than $75,000 shall be expended for the Multicultural Alzheimer's Service Project in Springfield; provided further, provided further that not less than $50,000 be expended for the Tuttle House facility in Dorchester; provided further, that not less than $150,000 shall be used to fully fund a supportive housing program at Edward F. Doolan Apartments in the city of Fall River; provided further, provided further, that $90,000 shall be expended for the AgeWell Boston program operated by Ethos; and provided further that not less than $50,000 shall be expended for the Kit Clark Homeless/Housing Program to provide support for homeless and recently housed older adults 		2,123,255
9110-1700 Residential Placement for Homeless Elders
For residential assessment and placement programs for homeless elders; provided, that $50,000 shall be expended for Living Waters Ministry of Hope for homeless outreach programs 		153,000
9110-1900 Elder Nutrition Program
For the elder lunch program; provided, that not less than $50,000 shall be expended for the Senior FarmShare program; provided further, that not less than $15,000 shall be expended for the Grandparents as Parents Initiative; provided further that $40,000 shall be obligated for youth/elder outreach position at the Roche Family Community Center in West Roxbury; and provided further, that $300,000 shall be expended for Community Physicians Associates for the purposes of administering a geriatrics program which shall include, but not be limited to inpatient care, outpatient care, rehabilitation and post-acute care, long-term care and assisted living counseling, and education of caregivers 		6,479,866
9110-9002 Grants to Councils on Aging
For the local services program for grants to the councils on aging and for grants to or contracts with non-public entities which are consortia or associations of councils on aging; provided, that notwithstanding the foregoing, all monies appropriated in this item shall be expended in accordance with the distribution schedules for formula and incentive grants established by the secretary; provided further, that not less than $80,000 shall be provided to the LGBT Aging Project; and provided further, that such distribution schedules shall be submitted to the house and senate committees on ways and means 		7,543,424

account description amount
Federal Grant Spending 34,032,959
9110-1074 Older Americans Act - Title III and Title VII
For the purposes of a federally funded grant entitled, Older Americans Assistance, Title III and Title VII 		9,122,198
9110-1077 National Family Caregiver Support Program
For the purposes of a federally funded grant entitled, Older Americans Act, Title III-E, National Family Caregiver Support Program 		3,673,479
9110-1095 Health Information Counseling and Assistance
For the purposes of a federally funded grant entitled, Health Information Counseling and Assistance 		676,386
9110-1150 Empowering Older People
For the purposes of a federally funded grant entitled, Empowering Older People 		300,000
9110-1173 Older Americans Act - Title III Nutrition Program
For the purposes of a federally funded grant entitled, Older Americans Act - Title III Nutritional Program 		13,936,717
9110-1174 Nutrition Services Incentive Program
For the purposes of a federally funded grant entitled, Nutrition Services Incentive Program 		4,056,178
9110-1178 Community Service Employment Program
For the purposes of a federally funded grant entitled, Community Service Employment Program 		1,881,501
9110-1179 Performance Outcome Measures Project
For the purposes of a federally funded grant entitled, Performance Outcome Measures Project 		30,000
9110-2760 New England Massachusetts Aging and Disability Resource Center
For the purposes of a federally funded grant entitled, New England Massachusetts Aging and Disability Resource Center 		350,000
9110-2761 Aging and Disability Resource Center - Center for Medicaid and Medicare Services
For the purposes of a federally funded grant entitled, Aging and Disability Resource Center- Center for Medicaid and Medicare Services 		6,500