Governor Deval Patrick's Budget Recommendation - House 2 Fiscal Year 2009

Governor's Budget Recommendation FY 2009

Health and Human Services


Online Advertising of State Procurements

SECTION 4.   Chapter 7 of the General Laws is hereby amended by inserting after section 22 the following section:-
Section 22 1/2. Notwithstanding any general or special law to the contrary, whenever a law requires a state agency, department, office, commission or authority to publish in a newspaper a notice of a public procurement or solicitation, it shall be sufficient instead to post that notice on a public government internet website, including the commonwealth's electronic bidding website.

 

Quality in Health Professions Trust Fund

SECTION 6.   (A) Section 35X of chapter 10 of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out, in lines 22 to 24, the words "and that total not more than 20 percent of the department's expenditures related to health board licensing for the previous fiscal year".

(B) Said section 35X of said chapter 10, as so appearing, is hereby further amended by adding the following subsection:-
(d) Notwithstanding any general or special law to the contrary, all of any new fee and any increase in the fee in effect after the fee increases authorized pursuant to subsection (c) for obtaining or renewing a license, certificate, registration, permit or authority issued by a board within the department of public health, excluding the board of registration in medicine, adopted by the secretary of administration and finance, following a public hearing, shall be deposited in the Quality in Health Professions Trust Fund.

 

Medicare Part D and Prescription Advantage

SECTION 8.   (A) Subsection (k) of section 39 of chapter 19A of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out the first sentence and inserting in place thereof the following sentence:- In order to maintain the fiscal viability of the program, the department shall adjust cost sharing required of enrollees in the form of copayments, premiums, and deductibles, or any combination of these forms, to reflect price trends for outpatient prescription drugs, as determined by the secretary.

(B) Said section 39 of said chapter 19A, as so appearing, is hereby amended by adding the following 3 subsections:-
          (t) In addition to the eligibility requirements set forth in this section, to be considered eligible for the program, individuals who receive Medicare and are applying for, or are then enrolled in, the program shall also be enrolled in a Medicare prescription drug plan, a Medicare Advantage prescription drug plan, or in a plan which provides creditable prescription drug coverage as defined by section 104 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, in this section called MMA, and which provides coverage of the cost of prescription drugs actuarially equal to or better than that provided by Medicare Part D, in this section called a creditable coverage plan.
          (u) In addition to the eligibility requirements set forth in this section, to be considered eligible for the program, individuals who receive Medicare and are applying for, or are then enrolled in, the program, who may qualify for the low-income subsidy provided under MMA Subpart P - Premiums and cost-sharing subsidies for low-income individuals, shall apply for those subsidies. To the extent permitted by MMA and regulations adopted under it, and all other applicable federal law, the program may apply on behalf of a member for enrollment into a Medicare prescription drug plan or for the low-income subsidy provided under MMA and may receive information about the member's eligibility and enrollment status necessary for the operation of the program.
          (v) For enrollees who qualify for enrollment in a Medicare Part D plan, the program shall provide a supplemental source of financial assistance for prescription drug costs, in this section called supplemental assistance, in lieu of the catastrophic prescription drug coverage provided under this section. The program shall provide supplemental assistance for premiums, deductibles, payments, and co-payments required by a Medicare prescription drug plan or Medicare Advantage prescription drug plan, and shall provide supplemental assistance for deductibles, payments and co-payments required by a creditable coverage plan. The department may take steps for the coordination of these benefits. The department shall establish the amount of the supplemental assistance it will provide enrollees based on a sliding income scale and the coverage provided by the enrollees' Medicare prescription drug plan, Medicare Advantage prescription drug plan, or creditable coverage plan. In addition to the eligibility requirements set forth in this section, to be considered eligible for the program, an individual must have a household income of less than 500 per cent of the poverty guidelines updated periodically in the Federal Register by the United States Department of Health and Human Services under 42 U.S.C. section 9902(2). Residents of the commonwealth who are not eligible for Medicare shall continue to be eligible for the program under this section.

 

Deposit of Tobacco Litigation Proceeds

SECTION 11.   (A) Section 24 of chapter 32A of the General Laws, as inserted by section 8 of chapter 61 of the acts of 2007, is hereby amended by inserting after subsection (b) the following subsection:-
(b 1/2) Ninety per cent of the monies received in any fiscal year as a result of any claim or action undertaken by the attorney general against a manufacturer of cigarettes to recover the amount of medical assistance provided pursuant to chapter 118E or any other claim or action undertaken by the attorney general against a manufacturer of cigarettes including, but not limited to, the action known as Commonwealth of Massachusetts v. Philip Morris, Inc., et al., Middlesex Superior Court, No. 95-7378, shall be deposited in the fund. The remaining 10 per cent of these monies shall be deposited in the General Fund, to be used subject to appropriation for tobacco control and other health care programs.

(B) Notwithstanding subsection (b 1/2) of section 24 of chapter 32A of the General Laws, inserted by subsection (A), for fiscal years 2009 to 2012, inclusive, of the 90 per cent of the monies received in that fiscal year as a result of any claim or action undertaken by the attorney general against a manufacturer of cigarettes to recover the amount of medical assistance provided pursuant to chapter 118E or any other claim or action undertaken by the attorney general against a manufacturer of cigarettes including, but not limited to, the action known as Commonwealth of Massachusetts v. Philip Morris, Inc., et al., Middlesex Superior Court, No. 95-7378, the following portions shall not be deposited in the State Retiree Benefits Trust Fund but rather shall be deposited in the General Fund:
(a) for fiscal year 2009, all of the 90 per cent of those monies;
(b) for fiscal year 2010, 3/4 of the 90 per cent of those monies;
(c) for fiscal year 2011, half of the 90 per cent of those monies;
(d) for fiscal year 2012, 1/4 of the 90 per cent of those monies.
In each such fiscal year, the remainder of the 90 per cent of those monies shall be deposited in the State Retiree Benefits Trust Fund.

 

EOHHS Debt Recovery By Tax Refund Intercept

SECTION 15.   (A) Section 1 of chapter 62D of the General Laws is hereby amended by inserting after the word "assistance", in line 4, as appearing in the 2006 Official Edition, the following words: - , the executive office of health and human services.

(B) Said section 1 of said chapter 62D is hereby further amended by inserting after the word "assistance", in line 17, as so appearing, the following words: - or the executive office of health and human services.

(C) Said section 1 of said chapter 62D is hereby further amended by striking out , in lines 39 to 43, as so appearing, the words "for costs incurred as a result of noncompliance by that individual with an order to provide coverage for the cost of health services to a child eligible for assistance under Title XIX of the Social Security Act, as further described in section 23 of chapter 118E" and inserting in place thereof the following words:- or the executive office of health and human services.

 

Medicaid Clawback Pharmacy Recovery

SECTION 19.   (A) Subsection (b) of section 31 of chapter 118E of the General Laws, as appearing in the 2006 Official Edition, is hereby amended by striking out the last paragraph and inserting in place thereof the following paragraph:-
Any recovery under subsections (a), (b), or (b 1/2) may be made only after the death of the surviving spouse, if any, and only at a time when the surviving spouse has no surviving child who is under age 21 or is blind or permanently and totally disabled. The division shall waive recovery if that recovery would work an undue hardship, as defined by the division in its regulations. If insufficient estate assets are available to repay the full amount due, any amounts recovered shall first be applied to the amount due under subsection (b 1/2).

(B) Said section 31 of said chapter 118E, as so appearing, is hereby further amended by inserting after said subsection (b) the following subsection:-
(b 1/2) This subsection shall apply to estates of individuals dying on or after July 1, 2008. An estate of an individual who was a "full benefit dual eligible", as defined under 42 U.S.C. section 1396u-5, shall be responsible for repaying the state Medicaid program contributions that the state made to the secretary of the federal Department of Health and Human Services for the federal assumption of prescription costs for the dual eligible under 42 U.S.C. section 1396u-5(c).

(C) The first paragraph of subsection (d) of said section 31 of said chapter 118E , as so appearing, is hereby amended by striking out the second sentence and inserting in place thereof the following 2 sentences:- If the individual at any time on or after July 1, 2008, was a "full benefit dual eligible", as defined by 42 U.S.C. section 1396u-5, the amount due shall also include contributions the state Medicaid program made to the secretary of the federal Department of Health and Human Services for the federal assumption of prescription costs for the dual eligible under 42 U.S.C. section 1396u-5(c). If insufficient assets exist from the proceeds from the sale to repay both the amount of assistance provided and payments for the federal assumption of prescription costs, any amounts recovered shall first be applied to payments for the federal assumption of prescription costs.

 

Hospital Assessments for DHCFP/HSNO Administrative Funding

SECTION 20.   Section 5 of chapter 118G of the General Laws, as amended by section 21 of chapter 205 of the acts of 2007, is hereby further amended by inserting after the second sentence the following sentence:- The assessed amount shall not be less than 65 percent of the total expenses appropriated for the division and the health safety net office.

 

Pay for Performance Payments

SECTION 23.   Chapter 58 of the acts of 2006 is hereby amended by striking out section 128, as amended by section 40 of chapter 61 of the acts of 2007, and inserting in place thereof the following section:-
Section 128. Notwithstanding any general or special law to the contrary and in accordance with section 13B of chapter 118E of the General Laws, in fiscal year 2007, $90,000,000 shall be made available from the Commonwealth Care Trust Fund, established pursuant to section 2OOO of chapter 29 of the General Laws, to pay for an increase in the Medicaid rates paid to acute hospitals and physicians; but not less than 15 per cent of the increase shall be allocated to rate increases for physicians. For fiscal year 2008, an additional $90,000,000, for a total of $180,000,000, shall be made available from the Commonwealth Care Trust Fund in accordance with this section, to pay for an increase in the Medicaid rates paid to acute hospitals and physicians; but not less than 15 per cent of the increase shall be allocated to rate increases for physicians. In fiscal year 2009, an additional $90,000,000, for a total of $270,000,000, shall be made available to pay for an increase in the Medicaid rates paid to acute hospitals, as defined in section 1 of chapter 118G of the General Laws, and physicians; but not less than 15 per cent of the increase shall be allocated to rate increases for physicians. In fiscal year 2008, not more than $20,000,000 of the amounts to be made available to acute hospitals under this section shall be contingent on hospital adherence to quality standards and achievement of performance benchmarks, including the reduction of racial and ethnic disparities in the provision of health care, in accordance with said section 13B of said chapter 118E, and may be paid in fiscal year 2009. In fiscal year 2009, not more than $58,000,000 of the amounts to be made available to acute hospitals under this section shall be contingent on hospital adherence to quality standards and achievement of performance benchmarks, including the reduction of racial and ethnic disparities in the provision of health care, in accordance with section said 13B of said chapter 118E, and may be paid in fiscal year 2010. For fiscal years 2008 and 2009, any such performance benchmarks shall be determined by the secretary of health and human services without any limitation but in consultation with hospitals, the MassHealth payment policy advisory board and the health care quality and cost council, and may include measures to be reported by hospitals to the federal Centers for Medicare and Medicaid Services for Reporting Hospital Quality Data for Annual Payment Update, to the Joint Commission on Accreditation of Healthcare Organizations for core measures, or to the MassHealth Program pursuant to Appendix G of the contract between MassHealth and acute hospitals for Rate Year 2007 or other nationally-recognized measures that are drawn on those approved by the National Quality Forum and adopted by the Hospitals Quality Alliance Performance benchmarks and quality measures related to racial and ethnic disparities in the provision of health care. The secretary of health and human services shall, after consultation required by said section 13B of said chapter 118E, issue final quality standards and performance benchmarks for use in the hospital fiscal year beginning October 1, 2008. For purposes of payments to hospitals pursuant to this section, fiscal year shall mean the hospitals fiscal year and, for purposes of any payments to physicians pursuant to this section, fiscal year shall mean the state fiscal year.

 

Transfers Between Operating and Capital Funds

SECTION 28.   (a) Whenever the commonwealth has borrowed funds as authorized by law to fund the acquisition of equipment that would have otherwise been funded under an item of appropriation in section 2, the secretary of administration and finance may authorize the transfer of funds from the item of appropriation in section 2 from which the equipment acquisition would have been funded to any other item of appropriation for the purpose of funding personnel or other operating-related expenses that would have otherwise been funded in the fiscal year 2009 capital budget from the proceeds of bonds. The secretary may establish an appropriation account to receive this transfer if none exists under section 2. Any amount transferred under this section shall not exceed the cost of the related equipment acquisition, and the aggregate amount of all such transfers shall not exceed $50,000,000.
          (b) Before making any transfer authorized by this section, the secretary of administration and finance shall submit a transfer report and certification to the house and senate committees on ways and means. The report and certification shall include the following: (1) a schedule showing the cost of equipment acquisition that would have been funded from an item of appropriation in section 2, the item of appropriation from which the equipment would have been funded and the bond authorization against which bonds may be issued to fund the acquisition of the equipment; (2) a schedule showing the cost of all personnel and other operating expenses that would have been funded from the fiscal year 2009 capital budget, identification of each of the agencies that pay the related expenses, the item in the capital budget and the bond authorization from which the personnel or operating expenses would have been funded, and the item of appropriation in section 2 from which the personnel or operating expenses will be funded; (3) a schedule of each amount that will be transferred from one item of appropriation in section 2 to another under subsection (a) in order to effectuate the transactions described in clauses (1) and (2); and (4) a certification of the secretary confirming that the equipment will be acquired in fiscal year 2009 with bond proceeds pursuant to the fiscal year 2009 capital budget and the bond authorization identified in clause (1).

 

Commission on Maintenance of State Facilities

SECTION 30.   (a) There shall be a special commission to investigate and study the maintenance of state facilities.
(b) The commission shall consist of the secretary of administration and finance, or her designee, who shall chair the commission; the commissioner of capital asset management and maintenance, or his designee; the chairs of the house and senate committees on ways and means, or their designees; the house and senate chairs of the joint committee on bonding, capital expenditures and state assets, or their designees; the minority leaders of the senate and house of representatives, or their designees; a representative of the International Facility Management Association; and 3 other persons appointed by the governor. The division of capital asset management and maintenance shall provide staff assistance to the commission and shall conduct a facilities maintenance review to assist in the commission's study.
(c) The commission shall study opportunities to improve maintenance of state facilities, including, but not limited to, more efficiently allocating resources and responsibility for facility maintenance, implementing best practices in assessing and addressing facility maintenance needs, and more effectively funding facility maintenance needs.
(d) The commission shall report its findings and recommendations, including any proposed legislation, to the clerks of the senate and house of representatives on or before March 31, 2009.

 

Transfers Among Health Care Funds

SECTION 33.   (a) Notwithstanding any general or special law to the contrary, on or before October 1, 2008 and without further appropriation, the comptroller shall transfer from the General Fund to the Health Safety Net Trust Fund, established pursuant to section 35 of chapter 118G of the General Laws and in this subsection called the fund, the greater of $45,000,000 or one-twelfth of the total expenditures to hospitals and community health centers required pursuant to subsection (b), for the purpose of making initial gross payments to qualifying acute care hospitals for the hospital fiscal year beginning October 1, 2008. These payments shall be made to hospitals before, and in anticipation of, the payment by hospitals of their gross liability to the fund. The comptroller shall transfer from the fund to the General Fund not later than June 30, 2009, the amount of the transfer authorized by this subsection and any allocation thereof as certified by the director of the health safety net office.
          (b) Notwithstanding any general or special law to the contrary, the comptroller shall, in consultation with the state treasurer, the secretary of administration and finance and the secretary of health and human services, develop a schedule for transferring funds among the General Fund, the Commonwealth Care Trust Fund, established by section 2OOO of chapter 29 of the General Laws and the Health Safety Net Trust Fund, established by section 36 of chapter 118G of the General Laws. Not less than $1,292,561,456 shall be transferred from the General Fund to the Commonwealth Care Trust Fund and not less than $62,996,382 shall be transferred from the Commonwealth Care Trust Fund to the Health Safety Net Trust Fund. The hospital fiscal year 2009 payment amount to each hospital shall be funded by the Health Safety Net Trust Fund. Payments may be made either as safety net care payments under the Commonwealth's 1115 waiver, or as an adjustment to Title XIX service rate payments, or a combination thereof;. The executive office of health and human services and the health safety net office may use other federally permissible funding mechanisms available for public service hospitals, as defined in 114.1 CMR 36.02, to reimburse up to $70,000,000 of uncompensated care at the hospitals using sources distinct from the funding made available to the Health Safety Net Trust Fund. The executive office of health and human services shall make expenditures required for fiscal year 2008 under section 122 of chapter 58 of the acts of 2006. The schedule shall provide for transfers in increments considered appropriate to meet the cash flow needs of these funds. The transfers shall not begin before July 1, 2008 and shall be completed on or before June 30, 2009. The secretary of administration and finance, in consultation with the secretary of health and human services and the executive director of the commonwealth health insurance connector, shall on a quarterly basis evaluate the revenue needs of the health safety net program funded by the Health Safety Net Trust Fund and the Commonwealth Care subsidized health insurance program funded from the Commonwealth Care Trust Fund, and if necessary, transfer monies between these funds for the purpose of ensuring that sufficient revenues are available to support projected program expenditures.
          (c) Notwithstanding any general or special law to the contrary, the comptroller shall, in consultation with the office of the state treasurer, the executive office of administration and finance and the executive office of health and human services, develop a schedule and make a series of transfers not to exceed $251,000,000 from the General Fund to the MassHealth provider payment account in the Medical Assistance Trust Fund, established by section 2QQQ of chapter 29 of the General Laws, if the comptroller has determined that General Fund revenues are sufficient to accommodate the schedule of transfers. These funds may be expended only for services provided during state or federal fiscal year 2009, and no amounts previously or subsequently transferred into the Medical Assistance Trust Fund may be expended on payments described in the 1115 demonstration waiver for services provided during state fiscal year 2009 or payments described in the state plan for services provided during federal fiscal year 2009. All payments from the Medical Assistance Trust Fund shall be subject to the availability of federal financial participation, shall be made only in accordance with federally-approved payment methods, shall be consistent with federal funding requirements and all federal payment limits as determined by the secretary of health and human services, and shall be subject to the terms and conditions of an agreement with the executive office of health and human services. The secretary of the executive office of health and human services shall make a payment of up to $148,000,000 from the Medical Assistance Trust Fund to the Cambridge public health commission's hospital network for dates of service in state and federal fiscal year 2009 only after the Cambridge public health commission transfers up to $74,000,000 of its funds to the Medical Assistance Trust Fund, using a federally permissible source of funds which shall fully satisfy the non-federal share of such payment.
          (d) Notwithstanding any general or special law to the contrary, the comptroller, in consultation with the secretary of health and human services, shall develop a schedule for transferring not less than $28,000,000 from the General Fund to the Essential Community Provider Trust Fund, established in section 2PPP of chapter 29 of the General Laws, for the purpose of making expenditures as described in this section in fiscal year 2009. The secretary shall authorize expenditures by the division of health care finance and policy from the fund without further appropriation for the purpose of (1) grants to financially distressed MassHealth providers that provide emergency care, behavioral health, and routine care for MassHealth and Commonwealth Care members; (2) grants to financially viable MassHealth providers that are essential providers to MassHealth and Commonwealth Care members; (3) a program, which may be based on the Medicare Management Performance Demonstration or similar models, to provide financial incentives to small group practices with MassHealth Primary Care Clinician Plan enrollment of between 100 and 1,000 members, which must (a) report specified clinical data, (b) achieve specified clinical benchmarks in service delivery and care management, and (c) implement an electronic medical record system within specified timeframes and with specified data sharing capacity; (4) a program to provide financial incentives to encourage the establishment of systems of care in communities with high concentrations of MassHealth, Commonwealth Care, and Group Insurance Commission membership to engage hospitals, community health centers, community mental health centers, physicians, and other providers, and to reward such providers based upon their ability to timely deliver expected health outcomes in a lower cost setting; and (5) a program to review and address, as needed, payments for behavioral health care to MassHealth members in community hospital settings, and coordination of inpatient and outpatient care in such settings. The secretary, in consultation with the division, shall determine which entities meet the purposes and criteria described in this section. The executive office shall structure expenditures under this section to maximize allowable federal reimbursement under Title XIX. All federal financial participation received for expenditures from the Essential Community Provider Trust Fund shall be deposited in the General Fund, and shall be available for further appropriation for purposes specified in this subsection.

 

UMass/EHS Interagency Service Agreements

SECTION 34.   Notwithstanding any general or special law to the contrary, the executive office of health and human services under section 16 of chapter 6A of the General Laws, acting in its capacity as the single state agency under Title XIX of the Social Security Act and as the principal agency for all of the agencies within the executive office, and other federally assisted programs administered by the executive office, may enter into interdepartmental services agreements with the University of Massachusetts medical school to perform activities that the secretary, in consultation with the comptroller, determines are appropriate and within the scope of the proper administration of Title XIX and other federal funding provisions to support the programs and activities of the executive office. These activities shall include: (1) providing administrative services, including, but not limited to, activities such as providing the medical expertise to support or administer utilization management activities, determining eligibility based on disability, supporting case management activities and similar initiatives; (2) providing consulting services related to quality assurance, program evaluation and development, integrity and soundness and project management; and (3) providing activities and services for the purpose of pursuing federal reimbursement or avoiding costs, third party liability and recouping payments to third parties. Federal reimbursement for any expenditures made by the University of Massachusetts medical school relative to federally reimbursable services the university provides under these interdepartmental service agreements or other contracts with the executive office of health and human services shall be distributed to the university, and recorded distinctly in the state accounting system. The secretary may negotiate contingency fees for activities and services related to the purpose of pursuing federal reimbursement or avoiding costs, and the comptroller shall certify these fees and pay them upon the receipt of this revenue, reimbursement or demonstration of costs avoided. Contracts for contingency fees shall not extend longer than 3 years, and shall not be renewed without prior review and approval from the executive office of administration and finance. The secretary shall not pay contingency fees in excess of $40,000,000 for state fiscal year 2009. The secretary of health and human services shall submit to the secretary of administration and finance and the senate and house committees on ways and means a quarterly report detailing the amounts of the agreements, the ongoing and new projects undertaken by the university, the amounts spent on personnel and the amount of federal reimbursement and recoupment payments that the university collected.

 
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