Budgetary Direct Appropriations

DIVISION OF MEDICAL ASSISTANCE ADMINISTRATION
4000-0300	For the administration of the division of medical assistance, hereinafter referred to as the division, including costs related to the implementation and operation of programs authorized by sections 9A, 9B, 9C,16B, and 16C of chapter 118E of the General Laws; provided, that in consultation with the division of health care finance and policy, the division of medical assistance shall not approve any increase in 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 such rates as 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 to the division by this act shall be accounted for according to such purpose in the Massachusetts management, accounting and reporting system not more than ten days after such expenditures have been made by the Medicaid management information system; provided further, that the division shall not make expenditures that are not federally reimbursable, except as specifically authorized herein, or unless made for cost containment efforts the purposes and amounts of which have been submitted to the house and senate committees on ways and means 30 days prior to making such expenditures; provided further, that the division may continue to recover provider overpayments made in the current and prior fiscal years through the Medicaid management information system, and such recoveries shall be deemed current fiscal year expenditure refunds, so called; and provided further, that unless otherwise expressly authorized by law including the provisions of this item, the division shall deposit federal reimbursements received in the General Fund	46,200,450
	General Fund 85.84% Children`s and Seniors` Health Care Assistance Fund 14.16%

DIVISION OF MEDICAL ASSISTANCE CONTRACTED SERVICES
4000-0310	For administrative support and related services purchased contractually by the division of medical assistance, including contracted services necessary for the implementation and operation of programs authorized by sections 9A, 9B, 9C, 16B, and 16C of chapter 118E of the General Laws; provided, that no funds appropriated herein shall be scheduled in or expended from the AA subsidiary, so called; provided further, that the division may expend an amount not to exceed $3,000,000 for the purpose of enhancing outreach efforts to uninsured families and children as provided under the federal Personal Responsibility and Work Opportunity Act of 1996, by entering into contracts with the Massachusetts Hospital Association and the League of Community Health Centers, or their members, for the purpose of providing such outreach, and may retain and expend for purposes of this item all federal revenues received as a result of expenditures under such contracts; provided further, that the division may retain and expend for purposes of this item any hospital or community health center donations, in a total amount not to exceed $300,000, received as contributions to offset the division`s costs associated with out-stationed eligibility workers; provided further, that the federal financial participation received from claims filed by the division, pursuant to an agreement specifically referencing this line item language, for the costs of outreach and eligibility activities performed by certain hospitals or by community health centers which are funded in part or in whole by federally permissible in-kind services or provider donations from said hospitals or health centers, shall be credited to this item and may be expended without further appropriation, in an amount specified in said agreement between the division and each donating provider hospital or health center; and provided further, that the federal financial participation received from claims filed by the division based on in-kind administrative services related to outreach and eligibility activities performed by certain community organizations, under the auspices of the so-called "covering kids initiative" and in accordance with the federal revenue criteria set forth 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 between the division and the organizations participating in said initiative	46,167,393
	General Fund 85.84% Children`s and Seniors` Health Care Assistance Fund 14.16%

DIVISION OF MEDICAL ASSISTANCE SYSTEMS
4000-0325	For the non-personnel systems costs of the division of medical assistance, including such costs incurred to implement and operate programs authorized by sections 9A, 9B, 9C, 16B, and 16C of chapter 118E of the General Laws; provided, that 50 per cent of the cost of provider point of service eligibility verification devices purchased by the division shall be assumed by the providers utilizing said devices	25,215,979
	General Fund 85.84% Children`s and Seniors` Health Care Assistance Fund 14.16%

COMMONHEALTH PLAN FOR THE DISABLED
4000-0430	For the commonhealth program to provide primary and supplemental medical care and assistance to disabled adults and children pursuant to sections 9A, 16, and 16A of chapter 118E of the General Laws; provided, that funds may be expended for health care services provided to said disabled adults and children in prior fiscal years; provided further, that the division of medical assistance shall maximize federal reimbursement for expenditures from this item; provided further, that children shall be determined eligible for said medical care and assistance if they meet the disability standards as defined by the division, and that said disability standards shall be no more restrictive than the standards in effect on July 1, 1996; and provided further, that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated herein to items 4000-0500, 4000-0600, and 4000-0700	30,560,000

PHARMACY PROGRAM FOR SENIORS AND THE DISABLED
4000-0450	For a pharmacy assistance program for eligible residents of the commonwealth, pursuant to the provisions of section 16B of chapter 118E of the General Laws, as amended by sections 122 to 127, inclusive, of chapter 127 of the acts of 1999; provided, that in addition to the amount appropriated for the interdepartmental service agreement with the executive office of elder affairs in item 4000-0310, not less than $700,000 shall be provided from this item for an interdepartmental service agreement with said executive office for the costs of promulgating and administering enrollment in said program; and provided further, that notwithstanding the provisions of any general or special law to the contrary, any portion of the sum appropriated herein determined by the commissioner of medical assistance to be unneeded for the purposes set forth herein above may be used for the purposes of items 4000-0451 and 4000-1450	51,700,000
	Children`s and Seniors` Health Care Assistance Fund 58.03% Tobacco Settlement Fund 41.97%

PRESCRIPTION DRUG INSURANCE RESERVE
4000-0451	For a reserve to be spent, pursuant to approval by the secretary of administration and finance, in accordance with the recommendations made by the special commission to study and develop an actuarially sound subsidized prescription drug insurance program, as directed by section 351 of chapter 127 of the acts 1999; provided, that such a program shall be implemented on the condition that there is no new federal program of expanded prescription drug insurance coverage for seniors and the disabled	10,000,000
	Tobacco Settlement Fund 100%

ELDER HOME CARE SERVICES
4000-0460	For an interdepartmental service agreement with the executive office of elder affairs to provide home care services to eligible recipients through the enhanced community options program, so called, the home health substitution initiative, so called, and the nursing home light care initiative, so called; provided, that said executive office shall ensure that the aging services access points, so called, or other entities that receive funds from this item shall comply with any performance measures, outcome goals, and cost-effectiveness standards established by the division of medical assistance and said executive office pursuant to the terms of said interdepartmental service agreement	7,793,000

MANAGED CARE PLANS
4000-0500	For health care services provided to MassHealth members under the division of medical assistance`s primary care clinician/mental health and substance abuse plan or through a health maintenance organization under contract with the division; provided, that not more than $197,660,000 shall be expended from this item for health care services provided to said members in prior fiscal years; 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 expenditures from this item shall be made only for the purposes expressly stated herein; and provided further, that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated herein to items 4000-0430, 4000-0600, and 4000-0700	1,426,070,000

SENIOR CARE PLANS
4000-0600	For health care services provided to MassHealth members under the division of medical assistance`s senior care plan; provided, that not more than $255,710,000 shall be expended from this item for health care services provided to said members in prior fiscal years; 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 not less than $8,600,000 shall be made available from this item for home and community-based health waiver services provided to elderly MassHealth members enrolled in the section 2176 waiver, so called; provided further, that expenditures from this item shall be made only for the purposes expressly stated herein; and provided further, that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated herein to items 4000-0430, 4000-0500, and 4000-0700	1,646,370,000

HEALTH CARE INDEMNITY/THIRD PARTY LIABILITY PLANS
4000-0700	For health care services provided to MassHealth members under the division of medical assistance`s health care indemnity/third party liability plan and MassHealth members not otherwise covered under the division`s commonhealth, managed care, or senior care plans; provided, that not more than $128,840,000 shall be expended from this item for health care services provided to said members in prior fiscal years; 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 expenditures from this item shall be made only for the purposes expressly stated herein; and provided further that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated herein to items 4000-0430, 4000-0500, and 4000-0600	655,630,000

MASSHEALTH EXPANSION - STANDARD COVERAGE
4000-0860	For MassHealth benefits provided to children and adults pursuant to the provisions of clauses (a), (b), (c), (d), and (h) of subsection (2) of section 9A of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to said children and adults in prior fiscal years; provided further, that no funds shall be expended from this item for children and adolescents pursuant to the provisions of said clause (c) of said subsection (2) whose family incomes, as determined by the division of medical assistance, exceed 150 per cent of the federal poverty level; provided further, that all federal reimbursements received for expenditures from this item pursuant to the provisions of Title XIX and Title XXI of the Social Security Act shall be credited to the Children`s and Seniors` Health Care Assistance Fund; and provided further, that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated herein to items 4000-0870, 4000-0880, 4000-0890, and 4000-0891	208,650,000
	Children`s and Seniors` Health Care Assistance Fund 100%

MASSHEALTH EXPANSION FOR UNINSURED INTERMITTENT WORKERS
4000-0865	For the costs resulting from modification of the division of medical assistance`s eligibility criteria for MassHealth Basic benefits to reduce utilization of the uncompensated care pool and provide such benefits to a greater portion of low-income intermittent workers and the homeless, subject to federal approval of an amendment to the Medicaid state plan and Section 1115 waiver, so called	5,000,000
	Tobacco Settlement Fund 100%

MASSHEALTH EXPANSION - BASIC COVERAGE
4000-0870	For health care services provided to MassHealth members pursuant to clause (g) of subsection (2) of section 9A of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to said members in prior fiscal years; and provided further, that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated herein to items 4000-0860, 4000-0880, 4000-0890, and 4000-0891	179,880,000
	Children`s and Seniors` Health Care Assistance Fund 100%

FAMILY ASSISTANCE - DIRECT COVERAGE AND PREMIUM ASSISTANCE
4000-0880	For MassHealth benefits pursuant to the provisions of clause (c) of subsection (2) of section 9A and section 16C of chapter 118E of the General Laws for children and adolescents whose family incomes, as determined by the division of medical assistance, exceed 150 per cent of the federal poverty level; provided, that funds may be expended from this item for health care services provided to said children and adolescents in prior fiscal years; and provided further, that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated in this item herein to items 4000-0860, 4000-0870, 4000-0890, and 4000-0891	43,000,000
	Children`s and Seniors` Health Care Assistance Fund 100%

INSURANCE PARTNERSHIP FOR EMPLOYEES OF SMALL EMPLOYERS AND THE SELF EMPLOYED
4000-0890	For the cost of health insurance premium subsidies paid to employees of small businesses participating in the insurance reimbursement program pursuant to the provisions of section 9C of chapter 118E of the General Laws; provided, that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated herein to items 4000-0860, 4000-0870, 4000-0880, and 4000-0891	33,910,000
	Children`s and Seniors` Health Care Assistance Fund 100%

INSURANCE PARTNERSHIP FOR SMALL EMPLOYERS
4000-0891	For the cost of health insurance subsidies paid to employers participating in the employer insurance partnership program pursuant to the provisions of section 9C of chapter 118E of the General Laws; provided, that the division of medical assistance shall seek federal reimbursement for said payments to employers; and provided further, that the commissioner of medical assistance may, with the approval of the secretary of administration and finance, transfer a total amount not to exceed 10 per cent of the sum appropriated herein to items 4000-0860, 4000-0870, 4000-0880, and 4000-0890	9,500,000
	Children`s and Seniors` Health Care Assistance Fund 100%

ALTERNATIVE COMMUNITY OPTIONS PROGRAM
4000-1001	For the costs resulting from modifications to delivery systems and payment methodologies to improve the community-based service options available to certain disabled individuals and seniors	5,000,000
	Tobacco Settlement Fund 100%

HOSPITAL RATE ADD-ON FOR COMPLEX/LONG-TERM PATIENTS
4000-1002	For the costs resulting from modifications to the rate methodology used by the division of medical assistance to reimburse acute care hospitals for care provided during so-called "outlier" days, that is, days in excess of 20 days after an acute inpatient hospital admission	6,000,000
	Tobacco Settlement Fund 100%

PEDIATRIC GRADUATE MEDICAL EDUCATION PAYMENT
4000-1003	For the costs resulting from modifications to the division`s payment methodology to acute care pediatric specialty hospitals in a manner which shall treat graduate medical education costs for pediatric residents at said hospitals as primary care medical education costs and shall recognize the intensity of certain outpatient services	1,500,000
	Tobacco Settlement Fund 100%

COMMUNITY HEALTH CENTER PRIMARY CARE PHYSICIAN RATE ADD-ON
4000-1004	For an adjustment to the enhanced fees paid under the division of medical assistance`s primary care clinician plan contracts; provided, that an adjustment shall also be made to such fees paid to community health centers in a manner which would make them comparable to fees paid to other entities with primary care clinician plan contracts with the division	3,500,000
	Tobacco Settlement Fund 100%

NURSING HOME RATE ADD-ON FOR LABOR/QUALITY
4000-1005	For funding increases in wages and other staffing costs related to direct care services at nursing facilities; provided, that the division of medical assistance, together with the division of health care finance and policy, shall establish criteria for the distribution of funds from this item; and provided further, that said divisions may conduct an audit and, where appropriate, recoup any portion of these increases which are found not to have been spent on direct care wages or staffing costs	10,000,000
	Tobacco Settlement Fund 100%

MASSHEALTH EXPANSION FOR INDIVIDUALS WITH HIV
4000-1400	For the purposes of expanding MassHealth benefits to persons with a diagnosis of human immuno-deficiency virus, so called, and whose incomes are up to 200 per cent of the federal poverty level, subject to federal approval of an amendment to the Medicaid state plan and Section 1115 waiver, so called	10,000,000
	Tobacco Settlement Fund 100%

PHARMACY PROGRAM PLUS FOR SENIORS AND THE DISABLED
4000-1450	For an interim catastrophic pharmacy assistance program for eligible residents of the commonwealth who are 65 years of age or older, or who are disabled; provided, that the division of medical assistance may expend not more than $500,000 for the administration of said program; provided further, that pursuant to the provisions of section 313 of chapter 127 of the acts of 1999, said program shall be in effect only until December 31, 2000; and provided further, that notwithstanding the provisions of any general or special law to the contrary, any portion of the sum appropriated herein determined by the commissioner of medical assistance to be unneeded for the purposes set forth herein above may be used for the purposes of items 4000-0450 and 4000-0451	10,000,000
	Children`s and Seniors` Health Care Assistance Fund 50.00% Tobacco Settlement Fund 50.00%

MASSHEALTH DENTAL REFORM
4000-1504	For the purpose of enhancing MassHealth members` access to, and quality of, dental services; provided, that funds from this item shall be used to increase the rates of payment for services delivered to MassHealth members by participating MassHealth dental providers, the amount of such rate increases and the specific services to which they apply to be determined by the division of health care finance and policy in cooperation with the division of medical assistance; provided further, that such rate increases shall constitute a component of a multi-year, multi-component MassHealth dental reform initiative by the division of medical assistance; provided further, that said initiative shall be directed toward increasing the participation in MassHealth of dental providers and of addressing the difficulty that MassHealth members currently face in obtaining necessary dental care; and provided further, that said dental reform initiative shall include administrative improvements, to be determined by the division of medical assistance	29,400,000
	Tobacco Settlement Fund 100%

SENIOR CARE OPTIONS PROGRAM
4000-1505	For the costs incurred by the division of medical assistance for the implementation, administration, and operation of the senior care options program, so called, authorized in section 125	10,300,000
	Tobacco Settlement Fund 100%

Budgetary Retained Revenues

PRIOR-YEAR SPENDING RECOVERIES AND COLLECTIONS RETAINED REVENUE
4000-0320	The division of medical assistance is hereby authorized to expend solely for the provision of medical care and assistance rendered in the current fiscal year an amount not to exceed $70,000,000 from the monies received from recoveries of any prior fiscal year expenditures, and collections from liens, estate recoveries, third party recoveries, drug rebates, accident and trauma recoveries, case mix recoveries, computer audits, insurance recoveries, provider overpayment recoveries, bankruptcy settlements, Masspro and Healthpro refunds, Medicaid fraud returns, data match returns, Medicare appeals, and program and utilization review audits; provided, that any revenues collected by the division that are not attributable to the aforementioned categories shall be deposited in the General Fund and shall be tracked separately therein; provided further, that additional categories of recoveries and collections, including the balance of any personal needs accounts collected from nursing and other medical institutions after a recipient`s death and held by the division for more than three years, may, notwithstanding the provisions of any general or special law to the contrary, be credited to this item after providing written notice to the house and senate committees on ways and means, and the secretary of administration and finance; and provided further, that no funds from this item shall be used for the purposes of items 4000-0300, 4000-0310, or 4000-0325	70,000,000

REVENUE MAXIMIZATION UNIT ADMINISTRATION
4000-0321	Notwithstanding the provisions of any general or special law to the contrary, the division of medical assistance is hereby authorized to expend for the purpose of ongoing administrative support for revenue enhancement projects of agencies within the executive office of health and human services an amount not to exceed $525,000 from federal reimbursement received under Title XIX of the Social Security Act	525,000

Federal Grant Spending

WELFARE REFORM ADMINISTRATION
4000-0314	For the purposes of a federally funded grant entitled, Welfare Reform Administration	3,918,143

Trust and Other Spending

4000-0313

MENTAL HEALTH SERVICES FOR YOUTH

6,323