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Budget Summary FY2012

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Outside Section 203
Data Current as of:  7/11/2011

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Adult Day Health Reimbursement, Eligibility, and Provider Moratorium

SECTION 203.   Notwithstanding the provisions of any general or special law to the contrary, the division of medical assistance and the division of health care finance and policy shall make no changes prior to December 31, 2011 in the clinical eligibility or level of reimbursement paid to providers of adult day health services for basic and complex levels of care.

Contingent upon receiving any applicable approval from the Federal Centers for Medicare and Medicaid Services, the executive office of health and human services is further directed to implement a temporary moratorium effective with the passage of this legislation on the acceptance and approval of applications for (i) enrollment of new adult day health providers and (ii) expansion of the certified capacity of already approved adult day health providers as provided in 130 C.M.R. 404.400 et seq. This moratorium shall not apply to Programs of All-Inclusive Care for the Elderly (PACE) as established in 42 US Code Section 1894.

Such moratorium shall remain in effect until such time as the Secretary of Health and Human Services and the Secretary of Elder Affairs jointly complete a comprehensive study in consultation with representatives of House and Senate Ways and Means Committee, the Joint Committee on Elder Affairs and the Joint Committee on Health Care Financing as well as the Massachusetts Adult Day Services Association and other interested parties. The study shall make recommendations regarding licensure and other means to ensure an appropriate level of high quality adult day health care. In addition the study shall make recommendations updating the basis for the current rate structure by developing a model for imputing actual costs into the rate structure and the overall financing structure of Adult Day Services. In addition the study shall asses the current manner of categorizing clients as basic or complex. The study shall also assess the commonwealth's current and future adult day health services needs and recommend needed changes these needs require.

The final study and recommendations shall be reported to the House and Senate committees on ways and means, the joint committee on elder affairs and the joint committee on health care financing no later than December 31, 2011. If that date is not met, the moratorium shall stay in effect until 90 days after the report is submitted.

The division of medical assistance and the division of health care finance and policy shall take immediate steps, on the enactment of this legislation, to terminate reimbursement for the Health Promotion and Prevention level of care pursuant to a transition plan developed by the division of medical assistance for affected members.

Notwithstanding the provision of any general or special law to the contrary, the division of health care financing and policy and the division of medical assistance shall collect any outstanding cost reports from adult day health programs and shall review said cost reports and take any action as required or allowed by 114 C.M.R. 10.04.