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4000-0700 - MassHealth Fee-for-Service Payments
Account | Description | FY2009 GAA |
FY2010 House 1 |
---|---|---|---|
4000-0700 | MassHealth Fee-for-Service Payments For all health care services provided to medical assistance members who are not enrolled in managed care organizations, the primary care clinician plan or MassHealth's managed behavioral health contract or senior care option or program for all-inclusive elderly; provided, that funds may be expended from this item for children's behavioral health initiative (Rosie D. et al v. Romney, civil action No. 01-30199-MAP) services; provided further, that funds may be expended from this item for health care services provided to members in prior fiscal years; provided, that these members shall meet the applicable eligibility requirements of the MassHealth program established in chapter 118E of the General Laws, including, but not limited to, CommonHealth, the healthy start program and the children's medical security plan; provided further, notwithstanding the provision of any general or special law to the contrary, that nursing facility rates effective July 1, 2009 may be developed using the costs of any year the secretary of health and human services determines is appropriate; 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 notwithstanding the foregoing, funds may be expended from this item to pay for the purchase of third party commercial insurance premiums excluding payments under section 9C of chapter 118E of the General Laws; provided further, that up to $35,000,000, but no more than $17,500,000 in federally unmatched state 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 those expenditures may also be made for these purposes with respect to members enrolled in managed care organizations, the primary care clinician plan, MassHealth's managed behavioral health contract, the senior care option or the program for all-inclusive elderly; provided further, that funds may be expended from this item for medical deductible and co-pays for commercial insurance and Medicare; provided further, that funds may be expended from this item for activities relating to disability determinations, utilization management, and member clinical assessment and evaluations, regardless of whether these activities are performed by a state agency, contractor, agent or provider; provided further that funds from this item may be expended for the MassHealth community choices program; and provided further that funds from this item may be expended for the community first initiative |
1,535,816,000 | 3,361,041,116 |
Consolidated with 1599-7050, 4000-0430, 4000-0600, 4000-0640, 4000-0650, 4000-0880, 4000-0895, 4000-0990, 4513-1010 and 4513-1020
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