Governor Deval Patrick's Budget Recommendation - House 1 Fiscal Year 2010

Governor's Budget Recommendation FY 2010

Office of the Secretary of Health and Human Services




Fiscal Year 2010 Resource Summary ($000)
DEPARTMENT FY2010
Budgetary
Recommendations
FY2010
Federal, Trust,
and ISF
FY2010
Total
Spending
FY2010
Budgetary
Non-Tax Revenue
Office of the Secretary of Health and Human Services 9,163,000 457,004 9,620,004 5,084,903

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account description amount
OFFICE OF THE SECRETARY OF HEALTH AND HUMAN SERVICES 9,620,003,592
Budgetary Direct Appropriations 9,162,999,755
Direct Appropriations
4000-0050 Personal Care Attendant Council
For the personal care attendant quality home care workforce council established under section 29 of chapter 118G of the General Laws
206,285
4000-0300 Executive Office of Health and Human Services and Medicaid Administration
For the operation of the office of the secretary of health and human services, including the operation of the managed care oversight board; provided, that the executive office shall provide technical and administrative assistance to agencies under the purview of the secretariat receiving federal funds; provided further, that the executive office shall continue to develop and implement the common client identifier; provided further, that funds appropriated in this item shall be expended for administrative and contracted services related to the implementation and operation of programs authorized by chapter 118E of the General Laws; provided further, that in consultation with the division of health care finance and policy, no rate increase shall be provided to existing Medicaid provider rates without taking all measures possible under Title XIX of the Social Security Act to ensure that rates of payment to providers do not exceed the rates that are necessary to meet only those costs which must be incurred by efficiently and economically operated providers in order to provide services of adequate quality; provided further, that expenditures for the purposes of each item appropriated for programs authorized by chapter 118E shall be accounted for in the Massachusetts management accounting and reporting system not more than 10 days after the expenditures have been made by the Medicaid management information system; provided further, that no expenditures shall be made that are not federally reimbursable, including those related to Titles XIX or XXI of the Social Security Act or the MassHealth demonstration waiver approved under section 1115(a) of the act or the community first section 1115 demonstration waiver, whether made by the executive office or another commonwealth entity, except as explicitly authorized, or unless made for cost containment efforts the purposes and amounts of which have been submitted to the executive office for administration and finance and the house and senate committees on ways and means 30 days prior to making these expenditures; provided further, that the executive office may continue to recover provider overpayments made in the current and prior fiscal years through the Medicaid management information system, and that these recoveries shall be considered current fiscal year expenditure refunds; provided further, that the executive office may collect directly from a liable third party any amounts paid to contracted providers under chapter 118E for which the executive office later discovers another third party is liable if no other course of recoupment is possible; provided further, that no funds shall be expended for the purpose of funding interpretive services directly or indirectly related to a settlement or resolution agreement with the office of civil rights or any other office, group or entity; provided further, that interpretive services currently provided shall not give rise to enforceable legal rights for any party or to an enforceable entitlement to interpretive services; provided further, that the federal financial participation received from claims filed based on in-kind administrative services related to outreach and eligibility activities performed by certain community organizations, under the "covering kids initiative", and in accordance with the federal revenue criteria in 45 CFR 74.23 or any other federal regulation which provides a basis for federal financial participation, shall be credited to this item and may be expended, without further appropriation, on administrative services including those covered under an agreement with the organizations participating in the initiative; provided further, that notwithstanding any general or special law to the contrary, the executive office shall require the commissioner of mental health to approve any prior authorization or other restriction on medication used to treat mental illness in accordance with written policies, procedures and regulations of the department of mental health; and provided further, that any unexpended balance in items 4000-0320, 4000-0500, 4000-0700, 4000-0740, and 4000-0835 on June 30, 2009 shall revert to the General Fund
96,948,844
4000-0301 MassHealth Auditing and Utilization Reviews
For the costs of MassHealth provider and member audit and utilization review activities including eligibility verification, disability evaluations, provider financial and clinical audits and other initiatives intended to enhance program integrity
1,948,560
4000-0355 Health Care Quality and Cost Council
For the operation of a health care quality and cost council to promote high-quality, cost-effective patient-centered care
1,115,952
4000-0500 MassHealth Managed Care
For all health care services provided to medical assistance members who are enrolled in a managed care organization under contract with the executive office, including both Masshealth managed care organization covered services and MassHealth covered services not provided by the managed care organization; provided, that funds shall be expended from this item for the senior care option program and the program for all-inclusive elderly; provided further, that funds may be expended from this item for the children's behavioral health initiative (Rosie D. et al v. Romney, civil action No. 01-30199-MAP) implementation costs and services; provided further, that funds may be expended from this item for health care services provided to members in prior fiscal years; provided further, 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, family assistance for persons under age 65 who are HIV positive, and MassHealth standard for women with breast or cervical cancer; provided further, that the secretary may limit or close enrollment to individuals made eligible solely through the MassHealth section 1115 demonstration waiver, consistent with the terms and conditions of the demonstration, if necessary in order to ensure that expenditures from this item do not exceed the amount appropriated; and provided further, that no such limitation shall be implemented unless the secretary has given 90 days notice to the house and senate committees on ways and means and the joint committee on health care financing
2,489,337,036
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
3,361,041,116
4000-0740 MassHealth Primary Care Plan
For all health care services provided to medical assistance members who are enrolled in the primary care clinician plan or the managed behavioral health contract, including managed behavioral health contract services and all other MassHealth covered services; provided, that funds may be expended from this item for the children's behavioral health initiative (Rosie D. et al v. Romney, civil action No. 01-30199-MAP) implementation costs and 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, family assistance for persons under age 65 who are HIV positive, and MassHealth standard for women with breast or cervical cancer; provided further, that the secretary may limit or close enrollment to individuals made eligible solely through the MassHealth section 1115 demonstration waiver, consistent with the terms and conditions of the demonstration, if necessary in order to ensure that expenditures from this item do not exceed the amount appropriated herein; and provided further, that no such limitation shall be implemented unless the secretary has given 90 days notice to the house and senate committees on ways and means and the joint committee on health care financing
2,197,718,795
4000-0835 MassHealth Premium and Subsidy Payments
For the cost of health insurance subsidies paid under section 9C of chapter 118E of the General Laws, including health insurance premium subsidies paid to employees of participating small businesses and health insurance subsidies paid to participating employers; provided, that notwithstanding the foregoing, funds may be expended from this item for health insurance premiums including, but not limited to, Medicare for any medical assistance recipient; provided further, that funds may be expended from this item for health care services provided to recipients in prior fiscal years; and provided further, that funds may be expended from this item for the purposes of making payment to the federal Centers for Medicare and Medicaid Services in compliance with Title XIX of the Social Security Act, as amended by the Medicare Prescription Drug Improvement and Modernization Act of 2003
695,190,011
4000-1700 Health and Human Services Information Technology Costs
For the provision of information technology services within the executive office of health and human services
94,393,156

account description amount
Retained Revenues
4000-0320 MassHealth Recoveries from Current and Prior Fiscal Years Retained Revenue
The executive office of health and human services may expend for medical care and assistance rendered in the current year an amount not to exceed $225,000,000 from the monies received from recoveries and collections of any current or prior year expenditures; provided, that notwithstanding any general or special law to the contrary, the balance of any personal needs accounts collected from nursing and other medical institutions upon a medical assistance member's death and held by the executive office for more than 3 years may be credited to this item
225,000,000
4000-0360 Health Information Analysis Retained Revenue
The health care quality and cost council may expend for operation of the council an amount not to exceed $100,000 from the monies received from the sale of data reports
100,000

account description amount
Intragovernmental Service Spending 59,801,819
4000-0102 Chargeback for Human Services Transportation
For the cost of transportation services for health and human services clients and the operation of the health and human services transportation office
                Intragovernmental Service Fund ............... 100%
7,272,275
4000-0103 Chargeback for Human Services Administration
For the costs of core administrative functions performed within the executive office of health and human services; provided, that the secretary of health and human services may, notwithstanding any general or special law to the contrary, identify administrative activities and functions common to the separate agencies, departments, offices, divisions and commissions within the executive office and designate them "core administrative functions" in order to improve administrative efficiency and preserve fiscal resources; provided further, that common functions that may be designated core administrative functions include, without limitation, human resources, financial management and leasing and facility management; provided further, that all employees performing functions so designated may be employed by the executive office and the executive office shall charge the agencies, departments, offices, divisions and commissions for these services; provided further, that upon the designation of a function as a core administrative function, the employees of each agency, department, office or commission who perform these core administrative functions may be transferred to the executive office of health and human services; provided further, that the reorganization shall not impair the civil service status of any transferred employee who immediately before the effective date of this act either holds a permanent appointment in a position classified under chapter 31 of the General Laws or has tenure in a position by reason of section 9A of chapter 30 of the General Laws; and provided further, that nothing in this section shall be construed to impair or change an employee's status, rights, or benefits under chapter 150E of the General Laws
                Intragovernmental Service Fund ............... 100%
19,824,955
4000-1701 Chargeback for Health and Human Services Information Technology Costs
For the cost of information technology services provided to agencies of the executive office of health and human services
                Intragovernmental Service Fund ............... 100%
32,704,589

account description amount
Federal Grant Spending 8,202,018
4000-7560 Medicaid Emergency Diversion Grant
For the purposes of a federally funded grant entitled, Medicaid Emergency Diversion Grant
143,034
4000-9401 Community Mental Health Services
For the purposes of a federally funded grant entitled, Community Mental Health Services
8,058,984
account description amount
Trust and Other Spending 389,000,000
4000-0330 Connector Administration Expendable Trust 5,000,000
4000-1068 Medical Assistance Trust Fund 379,000,000
4000-4000 Health Insurance Portability and Accountability Act Fund 5,000,000


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