This is not the official budget document.

Budget Summary FY2012

41000060 - Division of Health Care Finance and Policy
Data Current as of:  7/11/2011





Account Description FY2011
Spending
FY2012
GAA
4100-0060 Division of Health Care Finance and Policy
For the operation of the division of health care finance and policy and the administration of the Health Safety Net Trust Fund established in section 36 of chapter 118G of the General Laws between July 1, 2011 and December 31, 2011; provided, that notwithstanding any general or special law to the contrary, the assessment to acute hospitals authorized pursuant to section 5 of said chapter 118G for the estimated expenses of the division shall include in fiscal year 2012 the estimated expenses, including indirect costs, of the division and shall be equal to the amount appropriated in this item less one-half of amounts projected to be collected in fiscal year 2012 from: (1) filing fees; (2) fees and charges generated by the division's publication or dissemination of reports and information; and (3) federal financial participation received as reimbursement for the division's administrative costs; provided further, that the assessed amount shall not be less than 55 per cent of the total expenses appropriated for the division and the health safety net office; provided further, for the purposes of supporting the division's expanded role in developing health care policies that benefit government entities, providers, purchasers, and consumers, the division shall assess surcharge payors as defined in section 34 of said chapter 118G, not less than 10 per cent of the total estimated expenses appropriated for the division and the health safety net office, including indirect costs, in fiscal year 2012, less one-half of amounts projected to be collected in fiscal year 2012 from: (1) filing fees; (2) fees and charges generated by the division's publication or dissemination of reports and information; and (3) federal financial participation received as reimbursement for the division's administrative costs; provided further, that the assessment on surcharge payors shall be calculated in a manner similar to the assessment authorized under section 38 of said chapter 118G, and shall be collected in a manner consistent with the provisions of said chapter 118G and deposited in the General Fund; provided further, that the division shall promulgate regulations requiring all hospitals receiving payments from the Health Safety Net Trust Fund to report to the division the following utilization information: the number of inpatient admissions and outpatient visits by age category, income category, diagnostic category, and average charge per admission; provided further, that the division shall submit quarterly reports to the house and senate committees on ways and means compiling this data; provided further, that the division, in consultation with the executive office of health and human services, shall not promulgate any increase in Medicaid provider rates without taking all measures possible under Title XIX of the Social Security Act or any successor federal statute to ensure that rates of payment to providers do not exceed such rates as are necessary to meet only those costs incurred by efficiently and economically operated providers in order to provide services of adequate quality; provided further, that the division shall meet the reporting requirements of section 25 of chapter 203 of the acts of 1996; provided further, that funds may be expended for the purposes of a survey and study of the uninsured and underinsured in the commonwealth, including the health insurance needs of the residents of the commonwealth; provided further, that this study shall examine the overall impact of programs administered by the executive office of health and human services on the uninsured, the underinsured, and the role of employers in assisting their employees in affording health insurance pursuant to section 23 of chapter 118G of the General Laws; provided further, that the division shall publish annual reports on the financial condition of hospitals and other health care providers through the Health Benchmarks project website, in collaboration with the executive office of health and human services, the office of the attorney general, and the University of Massachusetts; provided further, that the division shall submit to the house and senate committees on ways and means and the joint committee on health care financing not later than December 8, 2011 a report detailing utilization of the Health Safety Net Trust Fund; provided further, that the report shall include: (1) the number of persons in the commonwealth whose medical expenses were billed to the Health Safety Net Trust Fund in fiscal year 2011; (2) the total dollar amount billed to the Health Safety Net Trust Fund in fiscal year 2011; (3) the demographics of the population using the Health Safety Net Trust Fund; and (4) the types of services paid for out of the Health Safety Net Trust Fund in fiscal year 2011; provided further, that the division shall include in the report an analysis on hospitals' responsiveness to enrolling eligible individuals into the MassHealth program upon the date of service rather than charging those individuals to the Health Safety Net Trust Fund; provided further, that the division shall include in the report possible disincentives the state could provide to hospitals to discourage such behavior; provided further, that funds shall be expended for the operation of the Health Care Quality and Cost Council established per section 16K of chapter 6A of the General Laws to promote high-quality, cost-effective, patient-centered care; provided further, that in fiscal year 2012, the division of health care finance and policy shall allocate $2,000,000 for the Catastrophic Illness in Children Relief Fund, established in section 2ZZ of chapter 29 of the General Laws, from funds previously allocated for a demonstration project under section 22 of chapter 47 of the acts of 1997; provided further, that within 60 days after the effective date of this act, the division shall enter into an interagency agreement with the executive office of health and human services to perform health safety net claims adjudication with a full range of claims editing including edits to capture duplicate claims, medically unnecessary services, medically unlikely services and incorporating correct coding initiative edits through its MMIS system as soon as feasible but not later than June 30, 2012; provided further, that the division and the executive office may consult with hospitals regarding such transition; and provided further, that the division and the executive office of health and human services shall file a report no later than October 1, 2011 with the house and senate committees on ways and means on the plan to transition health safety net claims processing to the MMIS system
20,957,507 10,578,754