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40000700 - MassHealth Fee for Service Payments
Data Current as of: 8/10/2018
Account | Description | FY2018 Spending |
FY2019 GAA |
---|---|---|---|
4000-0700 | MassHealth Fee for Service Payments For health care services provided to medical assistance recipients under the executive office of health and human services' health care indemnity or third party liability plan, to 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 section 9 of chapter 118E of the General Laws and clauses (a) to (d), inclusive and clause (h) of subsection (2) of section 9A of said chapter 118E and section 16C of said chapter 118E; 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 household incomes as determined by the executive office exceed 150 per cent of the federal poverty level; provided further, that not less than $1,000,000 shall be made available to increase efficiencies and align system-wide goals within a regional hospital system located in Western Massachusetts to improve the overall sustainability of the system and to create a comprehensive approach to system-wide needs and a transition into the structure of the new 1115 Medicaid Waiver; provided further, that children who have aged out of the custody of the department of children and families shall be eligible for benefits through the age limit specified in MassHealth's approved state plan; 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 recipients in prior fiscal years; provided further, that notwithstanding any general or special law to the contrary the executive office shall expend not less than $4,000,000 to begin to align MassHealth fee-for-service payment rates for outpatient and diversionary behavioral health services with payment rates of MassHealth accountable and managed care products; provided further, that funds for said rate add-on shall be expended for MassHealth recipients that receive benefits under items 4000-0430,4000-0500, 4000-0601, 4000-0700, 4000-0880 and 4000-0940; provided further, that $750,000 shall be equally distributed to the teaching community health centers with family medicine residency programs in the cities of Worcester and Lawrence and in the South Boston section of the city of Boston not later than December 1, 2018, and the secretary of health and human services shall designate an agency to administer the funds and shall retain 5 per cent of the total funds; (a) to report to the house and senate committees on ways and means and the executive office of health and human services on the use of the funds by teaching community health centers; and (b) to audit such centers in order to confirm the use of the funds by each center for training purposes; provided further, that MassHealth shall expend $13,000,000 in the aggregate for acute care hospitals that have more than 63 percent of their gross patient service revenue from governmental payers and free care as determined by the executive office; provided further, that in fiscal year 2019 MassHealth shall maintain the same level of federally-optional chiropractic services that were in effect in fiscal year 2016 that were included in its state plan or demonstration program in effect on January 1, 2002 for members enrolled in the primary care clinician (PCC) program; provided further, that the executive office shall not, in fiscal year 2019, fund programs relating to case management with the intention of reducing length of stay for neonatal intensive care unit cases; provided further, that notwithstanding this item, 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; provided further, that funds may be expended from this item for activities relating to customer service, disability determinations or utilization management and review, including patient screenings and evaluations, regardless of whether such activities are performed by a state agency, contractor, agent or provider; provided further, that not later than March 1, 2019 the executive office shall report to the house and senate committees on ways and means on: (a) dental coverage available to MassHealth recipients as of January 1, 2019 as it compares to dental coverage available to MassHealth recipients on January 1, 2010; (b) utilization of dental services in fiscal year 2018 and fiscal year 2019; (c) the actual and projected costs and revenue associated with dental coverage in fiscal year 2018 and fiscal year 2019; and (d) the estimated cost effectiveness of dental coverage as a contributor to MassHealth total cost of care; and provided further, that the executive office shall maintain full-year coverage for adult dental fillings and adult denture coverage and shall begin said coverage for adult periodontic services on June 1, 2019 |
2,952,455,632 | 2,646,228,033 |
Veto Explanation: I am striking earmark language and reducing this item by the earmarked amount for two earmarks. $1 M earmarked for the regional hospital system located in Western Massachusetts is not necessary, because that hospital system is already set to receive $5.6 M in Safety Net Provider payments as well as $9 M to assist with transition into the structure of the new 1115 Medicaid Waiver. $11.8 M earmarked for acute care pediatric hospitals, in item 4000-0300, is duplicative of increases already built into FY19 MassHealth base payment rates.
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