This is not the official budget document.

Budget Summary FY2010

40000500 - MassHealth Managed Care
Data Current as of:  1/26/2010

Account Description FY2009
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 herein; provider further, that funds may be expended from this item to enhance the ability of hospitals, community health centers, and primary care clinicians to serve populations in need more efficiently and effectively; provided further, that the executive office shall maximize federal reimbursements for state expenditures made to these providers; provided further, that in conjunction with the new Medicaid management information system, 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 rates of payment from the Commonwealth Care and the Medicaid managed care plans to acute care hospitals shall be subject to negotiation between those health plans and hospitals; provided further, that the Commonwealth Care and the Medicaid managed care plan rates for acute care hospitals shall not be promulgated by regulation nor stipulated in the MassHealth Request For Applications (RFA); provided further, that the executive office of health and human services, in order to promote continuity of patient care and access to cost-effective health care services, may require an acute care hospital, as a condition of participating in the Medicaid program, to accept Medicaid fee-for-service rates of reimbursement for out-of-network care delivered to MassHealth and Commonwealth Care members enrolled in a Medicaid managed care organization that does not have a contract with said hospital; provided further, that the executive office shall incorporate no greater than $30 million in total savings attributable directly to the implementation of said requirement; and provided further, that notwithstanding any general or special law to the contrary, the secretary of health and human services shall not, without prior written or verbal consent, reassign the behavioral health benefit of any eligible person to a managed care plan under contract with the office of MassHealth if the benefit is already managed by MassHealth's specialty behavioral health managed care contractor
3,355,799,107 3,456,559,882

Veto Explanation:  I am reducing this item by an amount not recommended in light of available revenues.