This is not the official budget document.

Budget Summary FY2009

40000640 - MassHealth Nursing Home Supplemental Rates
Data Current as of:  6/22/2009





Account Description FY2009
GAA
FY2009  
Total  
Spending
  
4000-0640 MassHealth Nursing Home Supplemental Rates
For nursing facility Medicaid rates; provided, that notwithstanding any general or special law to the contrary, in fiscal year 2009 the division of health care finance and policy shall establish nursing facility Medicaid rates 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; provided further, that the division shall adjust per diem rates to reflect any reductions in Medicaid utilization; provided further, that $287,950,000 shall be expended 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 2009; provided further, that the payments made pursuant to this item shall be allocated in the following manner in fiscal year 2009: (1) effective July 1, 2008, an annual amount of $99,000,000 in the aggregate to fund the use of 2000 base year cost information for rate determination purposes; provided, that not more than $9,000,000 of this amount shall be expended for purposes of reimbursing nursing facilities for up to 10 bed hold days for patients of the facility on medical and non-medical leaves of absence; (2) effective July 1, 2008, an annual amount of $122,500,000 for enhanced payment rates to nursing homes; (3) effective July 1, 2008, an annual amount of $50,000,000 to fund a rate add-on for wages, hours and benefits and related employee costs of direct care staff of nursing homes; provided further, that as a condition for such rate add-on, the division shall require that each nursing home document to the division that 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; provided further, that a facility's direct care staff shall include 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; provided further, that the division shall credit wage increases that are over any previously collectively-bargained wage increases; provided further, that in monitoring compliance for this rate add-on, 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; provided further, that 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; provided further, that in implementing this section, the division shall consult with the Nursing Home Advisory Council; (4) effective July 1, 2008, an annual amount of $16,450,000: (a) to fund rate adjustments for reasonable capital expenditures by nursing homes, giving priority to nursing homes located or constructed in under-bedded areas as determined by said executive office, in consultation with the division, that meet quality standards established by the executive office of health and human services in conjunction with the department of public health and the division for the purposes of encouraging the upgrading and maintenance of quality of care in nursing homes; and (b) to fund rate adjustments to eligible nursing homes that meet utilization standards established by the executive office of health and human services in conjunction with the division for the purpose of reducing unnecessary nursing home admissions and facilitating the return of nursing homes residents of non-institutional settings; provided further, that to the extent that the annual amount of $16,450,000 in this clause is not fully allocated, the division shall first provide operating or capital rate adjustments for publicly operated, urban and geographically-isolated nursing homes; 5) $300,000 for the purposes of an audit of funds distributed under clause (3); provided further, that the division, 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 clause (3) including, but not limited to, recoupment, assessment of fines or interest; provided further, that the division shall report to the house and senate committees on ways and means not later than October 1, 2008 a preliminary analysis of funds expended under this subsection in fiscal year 2008 and a description and timeline for auditing of these funds; (6) $250,000 to fund expenses of the division related to the implementation and administration of section 25 of chapter 118G of the General Laws; and (7) an amount sufficient to implement section 622 of chapter 151 of the acts of 1996; and provided further, that any additional funds that may become available through this item due to decreased Medicaid utilization shall first fund a per-diem rate add-on for large Medicaid providers as specified in 114.2 CMR 6.06 (10)(a), as in effect on September 1, 2003 and then fund further enhanced rates to nursing homes

288,500,000 288,200,000  

Veto Explanation: I am striking language which requires rate adjustments for nursing facility utilization that is not recommended.

 
 
HISTORICAL SPENDING CATEGORIES ($000)
column definitions
SPENDING CATEGORY
FY2005
Expended

FY2006
Expended

FY2007
Expended

FY2008
Expended

FY2009
GAA
FY2009
Budget
Reductions
Wages & Salaries 0 0 0 296 0 -258
Employee Benefits 0 0 0 4 0 -5
Operating Expenses 0 0 0 148 0 -38
Public Assistance 0 0 0 287,950 288,500 0
TOTAL 0 0 0 288,398 288,500 -300

 

FY2009 Spending Category Chart

Pie Chart: Public Assistance=100%



 
Earmarks

EARMARK DESCRIPTION

City / Town
FY2009
GAA
  FY2009    
  9C Cuts    
Rate Earmark: Nursing Facility Per Diem Add On Statewide1,400,000 0  
Rate Earmark: Nursing Facility Direct Care Staff Benefits and Wages Statewide50,000,000 0  
Rate Earmark: Nursing Facility Capital Expenditures Statewide16,450,000 0  
Rate Earmark: Nursing Facility Bed Hold Statewide9,000,000 0  
Rate Earmark: Nursing Facility Base Year Statewide90,000,000 0  
Audit of Nursing Facility User Fee Payments Statewide300,000 0  
Costs Associated with Implementing the Nursing Home User Fee Statewide250,000 0  
Rate Earmark: Nursing Facilities Statewide122,500,000 0