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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