This is not the official budget document.

Budget Summary FY2017

40000700 - MassHealth Fee for Service Payments
Data Current as of:  8/9/2016





Account Description FY2016
Spending
FY2017
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 section 9 of chapter 118E of the General Laws and clauses (a) to (d), inclusive, and clause (h) of subsection (2) of section 9A of said chapter 118E 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 through the age limit specified in MassHealth's approved state plan; provided further, that not less than $1,000,000 shall be made available to establish a 1-year pilot program to increase efficiencies and align system-wide goals within a regional hospital system located in Western Massachusetts to improve the overall sustainability of the system and to create a comprehensive approach to system-wide needs and a transition into the structure of the new 1115 Medicaid Waiver; provided further, that the pilot program will include measurable milestones that shall demonstrate progress in at least 1 of the following areas: (a) care coordination, integration and delivery transformations; (b) electronic health records and information exchange advancements; (c) increasing alternative payment methods and accountable care organizations; (d) enhancing patient safety; (e) increasing access to behavioral health services; (f) increasing coordination between system hospitals and community-based providers and organizations; and (g) preparing the system to undertake risk as a potentially designated ACO; 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 recipients in prior fiscal years; provided further, that the funds appropriated in item 4000-0265 of section 2A of chapter 142 of the acts of 2011 shall again be appropriated for the same dollar amount as in said item 4000-0265 and shall be distributed in and managed in the same manner as designated in section 60 of chapter 118 of the acts of 2012; provided further, that $500,000 shall be distributed in and managed in the same manner as designated in section 60 of chapter 118 of the acts of 2012; provided further, that in fiscal year 2017 MassHealth shall maintain the same level of federally-optional chiropractic services that were in effect in fiscal year 2016 that were included in its state plan or demonstration program in effect on January 1, 2002 for members enrolled in the primary care clinician (PCC) program; provided further, that the executive office shall not, in fiscal year 2017, fund programs relating to case management with the intention of reducing length of stay for neonatal intensive care unit cases; provided further, that notwithstanding this item, 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 not later than March 1, 2017 the executive office shall report to the house and senate committees on ways and means on: (a) dental coverage available to MassHealth recipients as of January 1, 2017 as it compares to dental coverage available to MassHealth recipients on January 1, 2010; (b) utilization of dental services in fiscal year 2016 and fiscal year 2017; (c) the actual and projected costs and revenue associated with dental coverage in fiscal year 2016 and fiscal year 2017; and (d) the estimated cost effectiveness of dental coverage as a contributor to MassHealth total cost of care; and provided further, that the executive office shall maintain full-year coverage for adult dental fillings and adult denture coverage

2,530,834,668 2,377,838,433

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