Executive Office of Health and Human Services
Division of Medical Assistance
=============================================================================================
Projected Recommended
FY95 FY96
Budgetary Direct Appropriations
DIVISION OF MEDICAL ASSISTANCE ADMINISTRATION
4000-0300 For the administration of the division of medical 33,588,091 33,419,710
assistance; provided, that certain functions, including
support costs for division personnel located in area
offices of the department of transitional assistance,
may continue to be paid by said department pursuant to
an interagency agreement with the division; provided
further, that in consultation with the rate setting
commission, the division 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 on the
Massachusetts management, accounting and reporting
system not more than thirty days after such
expenditures have been made by the medicaid management
information system; provided further, that the division
shall not make expenditures which are not federally
reimbursable, except as specifically authorized herein,
or unless made for cost-containment efforts for
purposes and amounts which have been submitted to the
house and senate committees on ways and means thirty
days prior to the making of such expenditures; provided
further, that the division can continue to recover
current-year and prior-year provider overpayments via
the medicaid management information system and such
recoveries shall be deemed expenditure refunds; and
provided further, that, unless otherwise expressly
authorized by law, the division shall deposit all
federal funds received in the General Fund
DIVISION OF MEDICAL ASSISTANCE CONTRACTED SERVICES
4000-0310 For administrative, support and related services 59,376,000 63,301,023
purchased contractually by the division, including, but
not limited to, contracts for a central automated
vendor payment system, an automated eligibility
verification system, pre-admission screening,
utilization review, medical consultants, disability
determination reviews, health benefit managers and
interagency service agreements; provided, that a
summary description of interagency agreements for which
funds are allocated by the division to other agencies
shall be submitted to the house and senate committees
on ways and means not more than ten days after making
such allocations
.
Executive Office of Health and Human Services
Division of Medical Assistance
=============================================================================================
Projected Recommended
FY95 FY96
MA-21 DATA MANAGEMENT PROJECT DEVELOPMENT
4000-0350 For development costs of the MA-21 project, so-called, 4,317,416 6,306,123
to replace the medicaid management information system
and the recipient eligibility verification system with
a unified, state-of-the-art claims and data management
system or systems, including the costs of personnel,
contractors, hardware, software and administrative
support; provided, that the division shall maximize
federal reimbursements for said project; provided
further, that all federal reimbursements for said
project shall be deposited in the General Fund and
shall not be retained by the division; provided
further, that in developing and designing said project,
the division shall insure that it (1) shall operate
using a readily accessible database, (2) shall utilize
flexible and readily programmable software, (3) shall
have the ability to provide expenditure and utilization
data and provider and recipient information on a
routine and ad hoc basis, (4) shall offer budget and
revenue forecasting support capabilities, (5) shall be
capable of reformatting historical spending and
utilization data consistent with provider and recipient
categories to be used by the new system or systems, (6)
shall be capable of completing an electronic interface
with the Massachusetts management accounting and
reporting system so-called, (7) shall be capable of
responding to changing demands on the commonwealth for
the provision of health care benefits and insurance,
and (8) shall have the capability to interface
electronically with the BEACON system, so-called; and
provided further, that costs for certain division
personnel or contracted personnel working part-time on
said project may be funded from items 4000-0300 and
4000-0310 in this section.
COMMONHEALTH ADMINISTRATION
4000-0430 For the commonhealth program to provide medical care 19,141,119 19,715,353
and assistance to disabled adults and children pursuant
to sections sixteen and sixteen A of chapter one
hundred and eighteen E of the General Laws; provided,
that no funds shall be expended from this item for
expenses incurred in the prior fiscal year; provided
further, that the division shall maximize federal
reimbursement for state expenditures made on behalf of
said adults and children; and provided further, that
the division shall close enrollments or promulgate
regulations that adjust eligibility, benefits, and
other requirements to limit expenditures to the amount
appropriated herein
MANAGED CARE
4000-0500 For medical services for non-institutionalized 903,467,300 961,000,000
recipients who are not otherwise insured and are
required to enroll in the primary care clinician
program, health maintenance organizations, or the
mental health and substance abuse network; provided,
that said program shall be implemented consistent with .
Executive Office of Health and Human Services
Division of Medical Assistance
=============================================================================================
Projected Recommended
FY95 FY96
the terms of any waiver of Title XIX requirements
approved by the United States Secretary of Health and
Human Services; provided further, that expenditures
from this item shall be made only for services rendered
to recipients in the current fiscal year; and provided
further, that the division may expend from this account
for the purposes of items 4000-0600 and 4000-0700 in
this section after providing written notice to the
house and senate committees on ways and means
LONG-TERM CARE
4000-0600 For long-term care provided to medical assistance 1,232,607,200 1,257,000,000
recipients by chronic disease and rehabilitation
hospitals, nursing facilities, certain hospitals and
facilities operated by the commonwealth, and services
provided by community-based long-term care providers;
provided, that notwithstanding the provisions of any
general or special law to the contrary and without the
necessity of obtaining approval by the rate setting
commission, the division may establish rates by
contract with such hospitals for services provided to
medicaid-eligible patients; provided further, that
expenditures from this item shall be made only for
services rendered to recipients in the current fiscal
year; provided further, that the division may expend
from this account for the purposes of items 4000-0500
and 4000-0700 in this section after providing written
notice to the house and senate committees on ways and
means; and provided further, that the division may
transfer funds from this item for the purposes of an
interagency service agreement with the executive office
of elder affairs for the home and community-based
waiver, known as a 2176 waiver, for elderly medicaid
recipients enrolled in said waiver program
EXEMPT RECIPIENTS AND SERVICES
4000-0700 For medical services not otherwise funded by items 351,861,500 368,000,000
4000-0500 and 4000-0600 in this section and provided to
medical assistance recipients; provided, that
expenditures from this item shall only be made for
services rendered to recipients in the current fiscal
year; provided futher, that the division may expend
from this account for purposes of said items 4000-0500
and 4000-0600 after providing written notice to the
house and senate committees on ways and means; and
provided further, that not more than two million
dollars shall be expended for early screening and
treatment necessary to reduce hospitalizations and to
avoid future medical assistance costs by delaying the
onset of fully symptomatic AIDS, so-called; and
provided further, that not less than nine hundred
thousand dollars shall be made available from this item
to pay for the cost of outreach and follow-up services
conducted by agencies certified as comprehensive family
planning agencies to increase the utilization of
comprehensive family planning services
.
Executive Office of Health and Human Services
Division of Medical Assistance
=============================================================================================
Projected Recommended
FY95 FY96
PRIOR-YEAR SERVICES
4000-0800 For the payment of claims incurred in the prior fiscal 688,281,000 672,000,000
year, to pay fiscal closure claims incurred in previous
fiscal years and for certain other special provider
costs incurred in such fiscal years; provided, that
payment for special provider costs shall be made from
this item only with the prior written approval of the
secretary for administration and finance; and provided
further, that expenditures from this item shall be made
only for the purposes expressly stated herein
SPRINGFIELD MUNICIPAL HOSPITAL FINAL RATE SETTLEMENT
4000-0813 1,729,707
NURSING HOME FINAL RATE SETTLEMENTS
4000-0814 6,050,000
NURSING HOME FINAL RATE SETTLEMENTS
4000-0816 28,950,000
ACUTE HOSPITAL FINAL RATE SETTLEMENTS
4000-0817 25,500,000
INTERGOVERNMENTAL TRANSFERS
4000-0820 For the intergovernmental transfer component of the 39,600,000 39,600,000
Title XIX payments to municipal acute care hospitals;
provided, that such payments shall be made in
accordance with Title XIX, federal regulations
promulgated thereunder, the medicaid state plan, and
the terms and conditions of agreement reached with the
division for such transfer payments; provided further,
that the costs recognized by these payments shall not
create recurring liabilities to the commonwealth in
future years; provided further, that an accounting of
such payments shall be reported quarterly to the house
and senate committees on ways and means; provided
further, that the General Fund shall be reimbursed by
said municipal acute care hospitals in an amount equal
to one-half of the amount of any payments received by
said hospitals pursuant to this item; and provided
further, that all revenues generated by said program
shall be credited to the General Fund
Local Aid Fund . . . . . . . . . . . . . . . 100.00
UNIVERSITY OF MASSACHUSETTS INTERGOVERNMENTAL TRANSFER
4000-0830 For the intergovernmental transfer component of the 9,000,000 5,000,000
medicaid rate and disproportionate share payments to
the university of Massachusetts medical center for
hospital services as provided pursuant to the terms and
conditions of the contract between the division of
medical assistance and said medical center; provided,
that programs funded pursuant to this item shall not
create recurring liabilities to the commonwealth in .
Executive Office of Health and Human Services
Division of Medical Assistance
=============================================================================================
Projected Recommended
FY95 FY96
future fiscal years; and provided further, that the
General Fund shall be reimbursed two million five
hundred thousand dollars by said medical center for its
share of funds transferred pursuant to this item
Budgetary Retained Revenues
PRIOR-YEAR SPENDING RECOVERIES
4000-0320 The division of medical assistance may expend an amount 65,000,000 65,000,000
not to exceed sixty-five million dollars from the
monies received from collections of any prior-year
expenditures from liens, estate recoveries, third-party
recoveries, pharmaceutical manufacturers’ drug rebates,
or other collections subject to the approval of the
division; provided, that expenditures from this item
shall be limited solely to payments for the provision
of medical care and assistance rendered in the current
fiscal year
Federal Grant Spending
MEDICAID OPPORTUNITIES TO HELP ENTER RECOVERY SERVICES
4000-0534 For the purposes of a federally funded grant entitled, 375,000 375,000
Medicaid Opportunities to Help Enter Recovery Services
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