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Budget Recommendations
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Health Care Finance and Policy - Related Outside Sections Detail
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| Office of Health Services |
| Division of Health Care Finance and Policy |
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Medicaid - Maximization of Third Party and Federal Revenue
SECTION 4.
Section 16 of chapter 6A of the General Laws, as appearing in the 2004 Official Edition, is hereby amended by adding at the end the following paragraph:-
Notwithstanding any general or special law to the contrary, state agencies and direct and subcontracted providers of health-related services, including purchase-of-service providers financed from appropriation items for any state agency, shall maximize Title XIX and all other federal, state and private health insurance coverage available to offset costs to the commonwealth in compliance with the requirements herein. The agencies or providers shall collect information from clients, or from the parent or guardian of a minor receiving services, necessary to determine the extent to which clients may be eligible for medical assistance benefits under chapter 118E or are beneficiaries of any health insurance policy. The agency or provider shall forward client information collected under this section to the executive office of health and human services and such data shall only be used to match against available databases for the purpose of identifying all sources of potential payment for health services or health insurance coverage. As required or permitted by federal law, the executive office of health and human services shall return the results of any such data matches to the originating agency, which shall take the appropriate action to ensure that costs to the commonwealth are minimized. Such actions shall include, but not be limited to, the agency or provider billing or re-billing all verified third-party sources. The executive office for administration and finance may grant an agency or provider an exemption from this section for good cause. The executive office of health and human services and the operational services division within the executive office for administration and finance shall review regulations, contracting forms, service delivery reports and uniform financial reporting requirements to determine what changes are necessary for the successful implementation of this section.
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Establishment of the Medical Assistance Trust Fund
SECTION 18.
Said chapter 29, as so appearing, is hereby amended by adding the following:-
Section 2OOO. There shall be established on the books of the commonwealth the Medical Assistance Trust Fund, which shall be administered by the secretary of health and human services. Funds from this account may be expended for supplemental Medicaid payments to qualifying providers pursuant to an approved state plan or federal waiver. Amounts credited to the fund shall not be subject to further appropriation.
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MassHealth - Nursing Facility Rate Reviews
SECTION 59.
Section 7 of chapter 118G of the General Laws, as appearing in the 2004 Official Edition, is hereby amended by striking out in line 2, the word "annually" and inserting in place thereof the following:- biennially.
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Nursing Facility Base Rate Adjustment
SECTION 60.
Said section 7 of said chapter 118G, as so appearing, is hereby further amended by striking out in line 27 the word "four" and inserting in place thereof the following:- five.
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MassHealth - Hospital Supplemental Payment #1
SECTION 61.
Section 18 of said chapter 118G, as so appearing, is hereby amended by adding the following subsection:-
(q) Within the Medical Assistance Trust Fund as established in section 2OOO of chapter 29, there is hereby established a MassHealth provider payment account, administered by the secretary of the executive office of health and human services. Subject to the availability of federal financial participation, funds may be expended from this account for supplemental Medicaid payments to qualifying providers pursuant to an approved state plan or federal waiver. All Title XIX federal financial participation revenue generated by hospital payments funded by the Medical Assistance Trust Fund, whether the payments are made by the division of health care finance and policy or the executive office of health and human services, shall be credited to the General Fund.
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MassHealth - Spending Authorization for Nursing Facility Assessment
SECTION 84.
(a) Notwithstanding any general or special law to the contrary, in fiscal year 2007, the division of health care finance and policy, hereinafter referred to as the division, shall establish nursing facility Medicaid rates, payable out of the Health Care Quality Improvement Trust Fund established under section 2EEE of chapter 29, effective July 1, 2006 through June 30, 2007 that cumulatively total $288,500,000 more than the annual payment rates established by the division under the rates in effect as of June 30, 2002, as mandated under section 1 of chapter 42 of the acts of 2003. Payments from the fund shall be allocated in the following manner in fiscal year 2007:
(1) $287,950,000 for the purposes of Medicaid per diem rate payments to nursing homes participating in the MassHealth program for services provided to MassHealth members during fiscal year 2007, provided that as a condition for such funds, the division shall require that each nursing home document to the division that at least $50,000,000 of such funds are spent only on direct care staff by increasing the wages, hours and benefits of direct care staff, increasing the facility's staff-to-patient ratio, or by demonstrably improving the facility's recruitment and retention of nursing staff to provide quality care, which shall include expenditure of funds for nursing facilities which document actual nursing spending that is higher than the median nursing cost per management minute in the base year used to calculate Medicaid nursing facility rates. A facility's direct care staff shall include any and all nursing personnel including registered nurses, licensed practical nurses, and certified nurses' aides hired by the facility from any temporary nursing agency or nursing pool registered with the department of public health. The division shall credit wage increases that are over and above any previously collectively bargained for wage increases. In monitoring compliance under this clause, the division's regulations shall adjust any spending compliance test to reflect any Medicaid nursing facility payment reductions, including, but not limited to, rate reductions imposed on or after October 1, 2002. The expenditure of these funds shall be subject to audit by the division in consultation with the department of public health and the executive office of health and human services;
(2) $300,000 for the purposes of an audit of funds distributed pursuant to subsection (1). The division of health care finance and policy, in consultation with the department of public health and with the assistance of the executive office of health and human services, shall establish penalties sufficient to deter noncompliance to be imposed against any facility that expends any or all monies in violation of subsection (1), including but not limited to recoupment, assessment of fines or interest; and
(3) $250,000 to fund expenses at the division of health care finance and policy related to the implementation and administration of section 25 of chapter 118G of the General Laws.
(b) The comptroller shall transfer from the Health Care Security Trust Fund to the Health Care Quality Improvement Trust Fund on the first business day of each quarter, the amount indicated by the division of health care finance and policy to fund the expenditures described herein.
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MassHealth - Hospital Supplemental Payment #2
SECTION 85.
The Comptroller shall, in consultation with the office of the state treasurer, the executive office for administration and finance, and the executive office of health and human services, develop a schedule and shall make a series of transfers not to exceed $251,000,000 from the General Fund to the MassHealth provider payment account in the Medical Assistance Trust Fund established in section 18 of this act.
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