This is not the official budget document.

Budget Summary FY2014

40000700 - MassHealth Fee-for-Service Payments
Data Current as of:  9/11/2013





Account Description FY2013
Spending
FY2014
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 or third party liability plan, to 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 $23,000,000 shall be expended from this item, or item 4000-0500 if necessary, to achieve maximum federal financial participation, to enhance the ability of hospitals and community health centers 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 the executive office shall not, in fiscal year 2014, 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; 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 MassHealth shall expend not less than $13,683,965 to provide an additional 5 per cent of its standard payment amount per discharge, or SPAD, or of reimbursement provided under any subsequent inpatient payment methodologies and $12,332,013 to provide an additional 5 per cent of its outpatient payment amount per episode or PAPE, or of reimbursement provided under any subsequent outpatient payment methodologies to any acute care hospital that has greater than 63 per cent of its gross patient service revenue from governmental payers and free care as determined by the executive office of health and human services; provided further, that not more than $17,200,000 shall be expended for fillings for all teeth, reducing extractions and loss of teeth for adult MassHealth members; and provided further, that not later than October 1,2013 MassHealth shall report to the house and senate committees on ways and means the date at which full coverage for dental services may be restored given the funding level provided for those services
1,803,049,138 2,196,315,039

Veto Explanation:   I am striking language in 4000-0300 which earmarks funding for a program not recommended. The reduction in this item incorporates the amount of the stricken earmarked funds.