This is not the official budget document.

Budget Summary FY2018

40000700 - MassHealth Fee for Service Payments
Data Current as of:  7/20/2017





Account Description FY2017
Spending
FY2018
GAA
4000-0700 MassHealth Fee for Service Payments
For health care services provided to medical assistance recipients under the executive office of health and human services' 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 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 MassHealth may expend an additional $13,000,000 in the aggregate for acute care hospitals that have greater than 63 percent of their gross patient service revenue from governmental payers and free care as determined by the executive office; provided further, that not less than $1,000,000 shall be made available to establish a one-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 one of the following areas: (i) care coordination, integration and delivery transformations; (ii) electronic health records and information exchange advancements; (iii) increasing alternative payment methods and accountable care organizations; (iv) enhancing patient safety; (v) increasing access to behavioral health services; (vi) increasing coordination between system hospitals and community-based providers and organizations; and (vii) preparing the system to undertake risk as a potentially designated ACO; provided further, that 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 program; provided further, that the executive office shall not, in fiscal year 2018, fund programs relating to case management with the intention of reducing length of stay for neonatal intensive care unit cases; provided further, that $500,000 shall be equally distributed to the teaching community health centers with family medicine residency programs in the city of Worcester and in the South Boston section of the city of Boston not later than June 30, 2018, and the secretary of health and human services shall designate an agency to administer the funds and shall retain 5 per cent of the total funds: (a) to report to the house and senate committees on ways and means and the executive office on the use of the funds by teaching community health centers; and (b) to audit such centers in order to confirm the use of the funds by each center for training purposes; 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 customer service, disability determinations or utilization management and review, including patient screenings and evaluations, regardless of whether the activities are performed by a state agency, contractor, agent or provider; provided further, that not later than March 1, 2018 the executive office shall report to the house and senate committees on ways and means on: (1) dental coverage available to MassHealth recipients as of January 1, 2018 as it compares to dental coverage available to MassHealth recipients on January 1, 2010; (2) utilization of dental services in fiscal year 2017 and fiscal year 2018; (3) the actual and projected costs and revenue associated with dental coverage in fiscal year 2017 and fiscal year 2018; (4) the estimated cost effectiveness of dental coverage as a contributor to MassHealth total cost of care; and (5) a schedule to include within its covered services for adults at least those federally optional services for dental care and dentures which were included in its state plan in effect on January 1, 2010 and the accompanying cost of implementation; provided further, that the executive office shall maintain full-year coverage for adult dental fillings and adult denture coverage; provided further, that not less than $1,000,000 shall be expended in a one-time payment to a western Massachusetts regional academic health system to address regional physician shortages and enhance access to rural and urban preventive care by recruiting, training and retaining residents of the commonwealth into careers in medicine and to conduct projects on population and community health through collaboration with a medical school in the commonwealth; provided further, that for items 4000-0320, 4000-0430, 4000-0500, 4000-0601, 4000-0641, 4000-0700, 4000-0875, 4000-0880, 4000-0885, 4000-0940, 4000-0950, 4000-0990, 4000-1400, 4000-1420 and 4000-1425, the executive office shall provide to the senate and house committees on ways and means quarterly reports on implemented or anticipated administrative and programmatic changes that generate savings, gross and net, in fiscal year 2018; provided further, that reports shall delineate each change's impact on members, member cost-sharing and membership levels and the action taken to implement the change; provided further, that reports shall delineate savings generated by caseload, program integrity or other administrative or programmatic changes and whether those savings were included in the governor's proposed fiscal year 2018 general appropriations act; and provided further, that the first report shall be filed no later than August 1, 2017, and subsequent reports shall be filed at the start of each quarter and note any deviation from the planned changes included in the first report and updates to saving estimates or realizations

2,440,109,902 2,187,898,930

Veto Explanation:   I am reducing this item to the amount projected to be necessary and striking language which earmarks funding for programs not recommended. The reduction in the item incorporates the amount of the stricken earmarked funds.