This is not the official budget document.

Budget Summary FY2011

40000700 - MassHealth Fee-for-Service Payments
Data Current as of:  8/6/2010





Account Description FY2010
Spending
FY2011
GAA
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 of chapter 118E of the General Laws and section 16C of said chapter 118E; 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, exceed 150 per cent of the federal poverty level; provided further, that children who have aged out of the custody of the department of children and families shall be eligible for benefits until they reach age 21; provided further, that funds shall be expended from this item for members who qualify for early intervention services; 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 $10,000,000 shall be expended from this item, or item 4000-0500, if necessary to achieve maximum federal financial participation, to enhance the ability of hospitals, community health centers and primary care clinicians to serve populations in need more efficiently and effectively; provided further, that upon receipt of a written certification by the secretary of administration and finance, addressed to the chairs of the house and senate committees on ways and means and the comptroller of the commonwealth, that legislation extending the commonwealth's eligibility for an enhanced federal medical assistance percentage pursuant to the American Recovery and Reinvestment Act of 2009, Pub. L. No. 111-5, not in effect as of June 1, 2010, has been duly enacted and signed into law by the President of the United States or that the federal government has otherwise obligated itself to release additional funding not available as of June 1, 2010, to the commonwealth during state fiscal year 2011, an additional $10,000,000 shall be expended from this item, or item 4000-0500, if necessary to achieve maximum federal financial participation, to enhance the ability of hospitals, community health centers and primary care clinicians to serve populations in need more efficiently and effectively; provided further, that the executive office shall maximize federal reimbursements for state expenditures made to these providers; provided further, that unless prohibited by federal or state law or regulations, the executive office of health and human services may transfer the coverage of pharmacy services for members enrolled in a Medicaid managed care organization to this item, but shall make all reasonable efforts to retain coverage of said services within the Medicaid managed care organizations; provided further, that rebates shall be collected in a manner and form authorized by the federal Centers for Medicare and Medicaid Services for prescription drugs dispensed to individuals enrolled in a Medicaid managed care organization as permitted by the Patient Protection and Affordable Care Act of 2010, Public Law 111-148 and the Health Care and Education Reconciliation Act of 2010, Public Law 111-152; provided further, that the executive office shall not, in fiscal year 2011, fund programs relating to case management with the intention of reducing length of stay for neonatal intensive care unit cases; 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; provided further, that the executive office may reduce MassHealth premiums or copayments or offer other incentives to encourage enrollees to comply with wellness goals; and 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



General Fund 97.433%

FMAP Budget Relief Fund 2.567%


1,719,349,286 1,667,529,464

Veto Explanation:   I am vetoing this language and reducing this amount because none of the enhanced FMAP funds have been received from or committed by the federal government.