40000500 - MassHealth Managed Care

Account Description FY2013
Spending
FY2014
GAA
4000-0500 MassHealth Managed Care
For health care services provided to medical assistance recipients under the executive office's primary care clinician, mental health and substance abuse plan or through a health maintenance organization under contract with the executive office 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 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 expenditures from this item shall be made only for the purposes expressly stated in this item; provided further, that the executive office shall maximize federal reimbursements for state expenditures made to these providers; provided further, that funds may be expended from this item for health care services provided to recipients in prior fiscal years; provided further, that MassHealth shall provide not less than $1,000,000 in the fiscal year 14 capitated rate for the PCC mental health and substance abuse plan for inpatient behavioral health providers; provided further, that the office of Medicaid shall work with the managed care organizations that are under contract with the commonwealth to deliver managed care services to MassHealth enrollees and other relevant stakeholders to develop changes to Medicaid payment policies, quality improvement programs and any other programmatic changes that promote provider efficiencies; provided further, that the office of Medicaid shall work with its actuary to ensure that the development of capitation rates for contracting managed care organizations appropriately account for changes in MassHealth provider rates,that take effect during state fiscal year 2014; provided further, that MassHealth shall report to the house and senate committees on ways and means not later than October 1, 2013 on proposed provider efficiencies and the methodology used to develop actuarially sound capitation rates for managed care organizations, which account for changes to provider rates and develop actuarially sound rates; and provided further, that if MassHealth fails to produce the report and develop actuarially sound capitation rates that account for changes in provider rates that take effect during state fiscal year 2014 then, to the extent permissible under federal law and regulations and subject to the availability of federal financial participation, MassHealth shall adjust each Medicaid managed care organization's base capitation rate to reflect increases in hospital payments paid by Medicaid managed care organizations to their network acute hospitals as a result of state fiscal year 2014 base hospital rate increases
4,222,539,409 4,500,411,804