ATTACHMENT E

July 11, 2011

To the Honorable Senate and House of Representatives:

Pursuant to Article LVI, as amended by Article XC, Section 3 of the Amendments to the Constitution, I am returning to you for amendment Section 203 of House Bill No. 3535, "An Act Making Appropriations for the Fiscal Year 2012 for the Maintenance of the Departments, Boards, Commissions, Institutions and Certain Activities of the Commonwealth, for Interest, Sinking Fund and Serial Bond Requirements and for Certain Permanent Improvements."

Section 203 temporarily prevents certain changes in the adult day health program. I am concerned that this provision sweeps too broadly and will hinder necessary savings initiatives. I propose instead that the Executive Office of Health and Human Services study the need for such a moratorium.

In addition, the Executive Office of Health and Human Services is moving forward to develop a licensure process for adult day health providers. That Office will take steps immediately to develop regulations that will include statewide requirements.

I therefore recommend that Section 203 be amended by striking out the text and inserting in place thereof the following text:-

SECTION 203. The executive office of health and human services shall conduct a feasibility study of implementing a moratorium on (1) clinical eligibility or level of reimbursement paid to providers of adult day health services for basic and complex levels of care, and (2) 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 a PACE program as defined in 42 U.S.C. section 1396u-4(a)(2).

The executive office shall also assess the current manner of categorizing clients as basic or complex, and it shall assess the commonwealth's current and future adult day health services needs and changes to address these needs.

The executive office shall report the results of its study and its recommendations to the house and senate committees on ways and means, the joint committee on elder affairs, and the joint committee on health care financing, not later than December 31, 2011.

Respectfully submitted,

Deval Patrick