Governor Charles D. Baker's Budget Recommendation - House 2 Fiscal Year 2017

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MassHealth Delivery System Reform and SANE Trust Funds

SECTION 7.   Chapter 29 of the General Laws is hereby amended by inserting after section 2RRRR, inserted by section 48 of chapter 46 of the acts of 2015, the following 2 sections:
Section 2SSSS. There shall be established and set up on the books of the commonwealth a separate fund to be known as the MassHealth Delivery System Reform Trust Fund, referred to herein as the fund. The secretary of health and human services shall be the trustee of the fund and shall expend money in the fund for the purposes described herein. There shall be credited to the fund (a) any transfers from the Health Safety Net Trust Fund established by section 66 of chapter 118E, (b) an amount equal to any federal financial participation revenues claimed and received by the Commonwealth for eligible expenditures made from the fund, and (c) any revenue from appropriations or other monies authorized by the general court and specifically designated to be credited to the fund. Amounts credited to the fund shall be expended without further appropriation.
The fund's resources may be expended for Medicaid payments, including enhanced service payments, and incentive payments to qualifying providers or care organizations under an approved state plan or federal waiver; provided that, all payments from the MassHealth Delivery System Reform Trust Fund shall be: (i) subject to the availability of federal financial participation; (ii) made only under federally-approved payment methods; (iii) consistent with federal funding requirements and all federal payment limits as determined by the secretary of health and human services; and (iv) subject to the terms and conditions of an agreement with the executive office of health and human services; and provided further that, effective October 1 of each provider or care organization rate year, the secretary of health and human services shall expend from the funds credited to this trust, for MassHealth services provided by qualifying acute care hospital providers under contract with the executive office of health and human services or under subcontracts with managed care organizations that contract with said executive office in connection with the MassHealth program, no less than the amount necessary to satisfy the non-federal share of $250,000,000 in payments to said hospitals directly or to said managed care organizations for their payments to hospitals participating in their respective provider networks; provided further, that the sum of all projected payments to said hospitals or managed care organizations shall not exceed $250,000,000 annually and such $250,000,000 in payments shall be in addition to the sum of (a) the amount of reimbursement otherwise provided for and payable in each contract year to said hospitals under contracts executed pursuant to the request for applications issued periodically by the executive office of health and human services for the procurement of acute care hospital services under the MassHealth program; and (b) the portion, as determined by the secretary, of payments made under the contracts executed between managed care organizations and the executive office of health and human services which are projected to be needed by said managed care organizations for payments to hospitals contracted to participate in the provider networks of said managed care organizations. The funds credited and deposited into the fund, which are not expended for the $250,000,000 in additional payments directed by the preceding sentence, may be expended for incentive payments to care organizations or providers under contract with the executive office of health and human services to provide MassHealth services, provided that all such incentive payments shall be consistent with the relevant provisions of the commonwealth's Medicaid state plan under Title XIX of the federal social security act, or any waiver of said Title XIX provisions granted by the federal centers for Medicare and Medicaid services.
To accommodate timing discrepancies between the receipt of revenue and related expenditures, the comptroller may certify for payment amounts not to exceed the most recent estimate of revenues as certified by the secretary of health and human services to be transferred, credited or deposited under this section. Monies remaining in the fund at the end of a fiscal year shall not revert to the General Fund; provided, however, that the comptroller shall report the amount remaining in the fund at the end of each fiscal year to the house and senate committees on ways and means.
Section 2TTTT. There shall be a Massachusetts Sexual Assault Nurse Examiner (SANE) Trust Fund to be administered by the commissioner of public health or a designee for the purpose of supporting the SANE program. There shall be credited to the trust fund all monies received from public or private sources for the SANE program, including, but not limited to, gifts, grants, donations, bequests, contributions of cash or securities, contributions of services or property in kind from persons or other governmental, non-governmental, quasi-governmental or local governmental entities. Expenditures from the trust fund shall be made to support the SANE program, including, but not limited to: (i) costs of the SANE program, including coordination and oversight of SANE services; (ii) wrap-around services for sexual assault patients of all ages that may include medical follow-up, behavioral health intervention, or crisis intervention; (iii) training that supports certification and recertification of sexual assault nurse examiners, including expenditures for training consultants, materials and venues, continuing education, and professional development opportunities; (iv) educational, outreach, and technical assistance efforts for professional and public audiences that may include training and outreach material development and production; (v) costs associated with SANE and sexual assault programs, grants and initiatives of the director; and (vi) other services needed by the SANE program to support program operations and development. The department of public health may incur expenses, and the comptroller may certify amounts for payment, in anticipation of expected receipts; provided, however, that no expenditure shall be made from the fund which shall cause the fund to be in deficit at the close of the fiscal year. Amounts credited to the fund shall not be subject to further appropriation and monies remaining in the fund at the end of a fiscal year shall not revert to the General Fund and shall be available for expenditure in the subsequent fiscal year.
 
 

Summary:
This section establishes two new health-related trust funds. New section 2SSSS establishes the MassHealth Delivery System Reform Trust Fund to support MassHealth delivery system reform payments under an approved 1115 Demonstration Waiver and increased Medicaid reimbursements to acute care hospitals. Funding sources for the fund include a portion of the acute hospital assessment and federal financial participation revenues for expenditures made from the fund. New section 2TTTT establishes a statutory trust fund for the purpose of receiving funds from public or private sources, including philanthropic gifts and contributions, to support the Sexual Assault Nurse Examiner (SANE) Program.



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