Section 21 Behavioral Health Trust Fund and Hospital Assessment 4

Said chapter 29 is hereby further amended by inserting after section 2QQQQQ, as inserted by section 17 of chapter 24 of the acts of 2021, the following 3 sections:-

2RRRRR. There shall be a Behavioral Health Access and Crisis Intervention Trust Fund to be administered by the secretary of health and human services. The secretary may expend money from the fund, without further appropriation, to support a statewide, payor-agnostic community behavioral health crisis system, including, but not limited to, all necessary costs to support (i) a Behavioral Health Access Line to connect individuals to behavioral health services, including clinical assessment and triage and (ii) a statewide system to deliver behavioral health crisis intervention services 24 hours per day and 7 days per week in mobile and community-based settings, available to all residents without regard to insurance.

There shall be credited to the fund all monies paid to the commonwealth under section 69A of chapter 118E and any other federal reimbursements, grants, premiums, gifts, interest or other contributions from any source received that are specifically designated to be credited to the fund. At the option of the secretary of administration and finance in consultation with the secretary of health and human services, revenues equal to the amount of federal financial participation received by the commonwealth's General Fund for expenditures for the Behavioral Health Access Line may also be credited to the fund.

The fund may incur expenses, and the comptroller shall certify for payment, amounts in anticipation of the most recent estimate of expected receipts, as certified by the secretary of health and human services. Any balance in the fund at the close of a fiscal year shall be available for expenditure in subsequent fiscal years and shall not be transferred to any other fund or revert to the General Fund. The secretary shall report annually, on or before August 1, to the house and senate committees on ways and means and the senate and house chairs of the joint committee on mental health, substance use and recovery on the revenue and expenditure activity within the fund.

Section 2SSSSS. (a) There shall be a Hospital Investment and Performance Trust Fund. The secretary of health and human services shall be the trustee of the fund and shall expend money in the fund to make payments to acute hospitals or to care organizations under contract with the executive office of health and human services to provide MassHealth services pursuant to an approved state plan or federal waiver, provided that such care organizations shall use all such payments to make payments to qualifying acute hospitals. There shall be credited to the fund: (1) any transfers from the Health Safety Net Trust Fund established in section 66 of chapter 118E; (2) an amount equal to any federal financial participation revenues claimed and received by the commonwealth for eligible expenditures made from the fund; (3) any revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; and (4) interest earned on any money in the fund. Amounts credited to the fund shall be expended without further appropriation.

(b) Money in the fund shall be expended for Medicaid payments under an approved state plan or federal waiver; provided, however, that all payments from the fund shall be: (i) subject to the availability of federal financial participation; (ii) made only under federally-approved payment methods; (iii) consistent with federal funding requirements and all applicable federal payment limits as determined by the secretary; and (iv) subject to the terms and conditions of applicable agreements between acute hospitals or care organizations and the executive office of health and human services. To accommodate timing discrepancies between the receipt of revenue and related expenditures, the comptroller may certify for payment amounts not to exceed the most recent revenue estimates as certified by the secretary to be transferred, credited or deposited under this section. The secretary shall to the maximum extent possible, and in compliance with all laws and regulations, administer the fund to obtain federal financial participation for the expenditures of non-federal monies from the fund. Money remaining in the fund at the end of a fiscal year shall not revert to the general fund. The payments from the fund shall supplement and not supplant Medicaid payments that would be made to providers in the absence of such payments.

(c)(1) The secretary shall expend money in the fund, including all amounts credited to the fund, for payments to qualifying acute hospital providers under contract with the executive office of health and human services or under subcontracts with care organizations that contract with the executive office in connection with the MassHealth program, as further provided in paragraph (2) of this subsection.

(2) The secretary shall annually expend amounts from the fund averaging, over a period of five years, not less than $1,210,000,000 per year, provided that all such payments shall fall into one of the following four categories: (i) health equity incentive payments; (ii) clinical quality incentive payments; (iii) rate payments for services provided to MassHealth members; or (iv) targeted payments to (A) freestanding pediatric acute hospitals; (B) the acute hospital with a pediatric specialty unit, as defined in section 64 of chapter 118E; and (C) non-profit teaching acute hospitals that provide medical, surgery, emergency, and obstetrical services and are affiliated with a state-owned medical school. The secretary may determine funding allocations among and within each such category within a given year, provided that such allocations shall be consistent with all approved federal waivers and state plan provisions, and provided further that the secretary shall allocate an average of not less than $550,000,000 per year over a period of five years for the rate payments described in clause (iii) of this paragraph.

(3) Of the targeted payments described in clause (iv) of paragraph (2) of this subsection, the secretary shall expend annually from the fund (i) $25,000,000 to freestanding pediatric acute hospitals, of which 90 per cent shall be paid to the freestanding pediatric hospital with the largest volume of inpatient discharges in fiscal year 2019, (ii) $10,000,000 to the acute hospital with a pediatric specialty unit, as defined in said section 64 of said chapter 118E, and (iii) $25,000,000 to non-profit teaching acute hospitals that provide medical, surgery, emergency, and obstetrical services and are affiliated with a state-owned medical school.

(4) Of the health equity incentive payments and clinical quality incentive payments described in clauses (i) and (ii) of paragraph (2) of this subsection, the secretary shall make interim payments to qualifying hospitals based on the secretary's estimate of each such hospital's final payment for the measurement period, with each such estimate as determined by the secretary in the secretary's sole discretion. As quickly as practicable after the close of the measurement period, the secretary shall determine, in the secretary's sole discretion, the final amount of each qualifying hospital's health equity incentive payment and clinical quality incentive payment, and shall reconcile each hospital's interim payment with its final payment.

(d) In the event that any portion of the final annual amount allocated by the secretary to health equity incentive payments or clinical quality incentive payments is unearned during the relevant measurement period for such payment, as determined by the secretary in the secretary's sole discretion, the secretary shall transfer the state share of that unearned amount to the Health Safety Net Trust Fund established in section 66 of chapter 118E.

Section 2TTTTT. (a) There shall be a Population Health Investment Trust Fund. The secretary of health and human services shall be the trustee of the fund and shall expend money in the fund to make payments to providers or care organizations under contract to provide MassHealth services pursuant to an approved state plan or federal waiver. There shall be credited to the fund: (i) any transfers from the Health Safety Net Trust Fund established in section 66 of chapter 118E; (ii) an amount equal to any federal financial participation revenues claimed and received by the commonwealth for eligible expenditures made from the fund; (iii) any revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; and (iv) interest earned on any money in the fund. Amounts credited to the fund shall be expended without further appropriation.

(b) Money in the fund may be expended for Medicaid payments under an approved state plan or federal waiver; provided, however, that all payments from the fund shall be: (i) subject to the availability of federal financial participation; (ii) made only under federally-approved payment methods; (iii) consistent with federal funding requirements and all applicable federal payment limits as determined by the secretary; and (iv) subject to the terms and conditions of applicable agreements between providers or care organizations and the executive office of health and human services. To accommodate timing discrepancies between the receipt of revenue and related expenditures, the comptroller may certify for payment amounts not to exceed the most recent revenue estimates as certified by the secretary to be transferred, credited or deposited under this section. The secretary shall to the maximum extent possible, and in compliance with all laws and regulations, administer the fund to obtain federal financial participation for the expenditures of non-federal monies from the fund. Money remaining in the fund at the end of a fiscal year shall not revert to the general fund. The payments from the fund shall supplement and not supplant Medicaid payments that would be made to hospitals in the absence of such payments.

(c)(1) The secretary shall annually expend money in the fund for payments to qualifying providers or care organizations under contract with the executive office, as further provided in paragraph (2) of this subsection.

(2) The secretary shall annually expend amounts from the fund averaging, over a period of five years, not less than $290,000,000 per year, provided that such payments shall promote the continued implementation of certain federally-approved delivery system reform activities, including to support primary care and complex care management, and to address health-related social needs.

This section establishes the Behavioral Health Access and Crisis Intervention Trust Fund to receive and expend certain revenue from behavioral health surcharge payments. This section also establishes the Hospital Investment and Performance Trust Fund and the Population Health Investment Trust Fund to receive and expend certain revenue from the restructured hospital assessment.