40000700 - MassHealth Fee-for-Service Payments

Account Description FY2009
GAA
FY2009  
Total  
Spending
  
4000-0700 MassHealth Fee-for-Service Payments
For health care services provided to medical assistance recipients under the executive office's health care indemnity/third party liability plan and medical assistance recipients not otherwise covered under the executive office's managed care or senior care plans, and for MassHealth benefits provided to children, adolescents and adults under clauses (a) to (d), inclusive and clause (h) of subsection (2) of section 9A and section 16C of chapter 118E of the General Laws; provided, that no payments 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 no funds shall be expended from this item for children and adolescents under clause (c) of said subsection (2) of said section 9A of said chapter 118E whose family incomes, as determined by the executive office, exceeds 150 per cent of the federal poverty level; provided further, that children who have aged out of the custody of the department of social services shall be eligible for benefits until they reach age 21; provided further, that funds may be expended from this item for health care services provided to the recipients in prior fiscal years; provided further, that notwithstanding the foregoing, funds may be expended from this item for the purchase of third party insurance including, but not limited to, Medicare for any medical assistance recipient including, but not limited to, seniors; provided further, that the executive office may reduce MassHealth premiums or copayments or offer other incentives to encourage enrollees to comply with wellness goals; provided further, the executive office shall report annually to the joint committee on health care financing and the house and senate committees on ways and means on the number of enrollees who met at least 1 wellness goal, any reduction of copayments or premiums, and any other incentives provided because enrollees met wellness goals; provided further, that the executive office shall not, in fiscal year 2009, fund programs relating to case management with the intention of reducing length of stay for neonatal intensive care unit cases; provided further, that funds may be expended from this item for activities relating to disability determinations or utilization management and review, including patient screenings and evaluations, regardless of whether such activities are performed by a state agency, contractor, agent or provider; provided further, that the executive office shall submit a report to the executive office of administration and finance and the house and senate committees on ways and means not later than March 1, 2009 detailing the activities described in the preceding proviso to be expended from this item during fiscal year 2009; provided further, that not less that $10,000,000 $4,200,000 shall be expended to pay for an increase in Medicaid rates for community health centers, as defined in section 1 of chapter 118G of the General Laws; and provided further, that not less than $5,000,000 shall be expended for a medical home demonstration program that shall provide targeted, accessible, continuous and coordinated family-centered care to high need populations including, but not limited to, those with multiple chronic illnessed that require regular monitoring, advising or treatment

1,535,816,000 1,607,116,495  

Veto Explanation: I am striking language which earmarks funding for Community Health Centers not recommended, and I am reducing this item to the amount projected to be necessary.

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

FY2006
Expended

FY2007
Expended

FY2008
Expended

FY2009
GAA
FY2009
Budget
Reductions
Wages & Salaries 5,424 7,871 7,825 9,146 7,135 0
Employee Benefits 4 0 0 0 0 0
Operating Expenses 0 3,620 8,757 9,382 9,233 0
Public Assistance 1,041,455 1,400,779 1,457,095 1,604,696 1,519,447 -63,201
TOTAL 1,046,883 1,412,269 1,473,677 1,623,224 1,535,816 -63,201

 

FY2009 Spending Category Chart

Pie Chart: Wages & Salaries=0%, Operating Expenses=1%, Public Assistance=99%



 
Earmarks

EARMARK DESCRIPTION

City / Town
FY2009
GAA
  FY2009    
  9C Cuts    
Medical Home Demonstration Waiver  5,000,000 0  
Rate Earmark: Community Health Centers Statewide4,200,000 -4,200,000