Division of Medical Assistance

Division of Medical Assistance.

State Appropriation

4000-0300

For the operation of the division; provided, that the same standards and regulations in place for personal care attendants, nursing home bed holds, so-called, and score III, so-called, in fiscal year 1997 shall be retained in fiscal year 1998; provided, that in consultation with the division of health care finance and policy, the division shall not approve any increase in existing medicaid provider rates without taking all measures possible under Title XIX of the Social Security Act to ensure that rates of payment to providers do not exceed such rates as are necessary to meet only those costs which must be incurred by efficiently and economically operated providers in order to provide services of adequate quality; provided further, that expenditures for the purposes of each item appropriated to the division by this act shall be accounted for according to such purpose on the Massachusetts management, accounting and reporting system not more than ten days after such expenditures have been made by the medicaid management information system; provided further, that the division shall not make expenditures that are not federally reimbursable, except as specifically authorized herein, or unless made for cost containment efforts the purposes and amounts of which have been submitted to the house and senate committees on ways and means 30 days prior to making such expenditures; provided further, that the division may continue to recover provider overpayments made in the current and prior fiscal years through the medicaid management information system, and that such recoveries shall be deemed current fiscal year expenditure refunds, so-called; provided further, that the division shall report quarterly to the house and senate committees on ways and means the amounts of said expenditure refunds credited to each item of appropriation; provided further, that, unless otherwise expressly authorized by law, the division shall deposit all federal funds received in the General Fund; provided further, that $50,000 shall be made available for the funding of a head injury treatment program on Cape Cod, being the head injured program also known as the "CHIP" house, serving the treatment needs of individuals with brain injuries; provided further, that the division shall report quarterly to the house and senate committees on ways and means the amount of hand generated payments, so-called, to providers by item of appropriation from which said payments were made; provided further, that the definitions for the personal care attendant program as set forth in 130 C.M.R. 422.402 and the operating procedures as set forth in 130 C.M.R. 422-421 shall not be changed from those in effect on January 1, 1996 until July 1, 1998, or until agreement is reached between the division of medical assistance and designees of the governor's advisory commission on disability policy, the Massachusetts office on disability, and the statewide independent living council regarding the legal and fiscal responsibilities associated with the employment of personal care attendants; provided further, that not less than $107,000 shall be provided to compensate Morgan Memorial Goodwill Industries, Inc., of Boston for services provided to division of medical assistance recipients from March 1993 to June, 1993, inclusive; and provided further, that such reimbursement shall be for services rendered during said period, yet currently outstanding due to technical changes to the Submission Recap Reports Rule, so-called

......................................................$34,875,614

4000-0302

The division of medical assistance may retain and expend for the administrative expenses of the division an amount not to exceed two million dollars pursuant to a project to claim new revenue from retroactive costs under family planning, from a project to claim hospital payments under disproportionate share from the medical security plan, from projects to increase the collection of prior year expenditures above sixty-five million dollars; provided, however, that no funds shall be credited to this item until the division first deposits five million seven hundred fifty thousand dollars into the General Fund

......................................................$2,000,000

4000-0307

For the administrative costs related to the implementation and operation of programs authorized by chapter 203 of the acts of 1996

......................................................$2,746,100

Children's and Seniors' Health Care Assistance Fund .................. 100.0%

4000-0310

For administrative support and related services purchased contractually by the division, including, but not limited to, pre-admission screening, utilization review, medical consultants, disability determination reviews, health benefit managers and interagency service agreements; provided, that a summary description of interagency service agreements for which funds are allocated by the division to other agencies shall be submitted to the house and senate committees on ways and means not more than ten days after making such allocations; provided further, that no funds shall be expended from this item for the contracted services funded in item 4000-0325; provided further, that no funds shall be expended by the division for the purpose of funding interpretive services directly or indirectly related to a settlement or resolution agreement, so-called, with the office of civil rights or any other office, group, or entity; and provided further, that interpretive services currently provided by the division shall not give rise to enforceable legal rights for any party or to an enforceable entitlement to interpretive services

......................................................$31,160,000

4000-0315

For administrative support and related services purchased contractually by the division for the implementation and operation of programs authorized by chapter 203 of the acts of 1996, including, but not limited to, pre-admission screening, utilization review, medical consultants, disability determination reviews, health benefit managers, and interagency service agreements; provided, that not less than $1,641,150 shall be provided for an interagency service agreement with the executive office of elder affairs that provides for the transfer of funds from this item for the costs of administering enrollment in the senior pharmacy assistance program established pursuant to the provisions of section 16B of chapter 118E of the General Laws; and provided further, that not less than $500,000 shall be distributed to home care corporations for the purposes of said interagency service agreement

......................................................$4,783,810

Children's and Seniors' Health Care Assistance Fund.................. 100.0%

4000-0318

For the nonpersonnel systems costs of the division incurred as a result of the implementation and operation of programs authorized by chapter 203 of the acts of 1996, including vendor contracts to upgrade and enhance the division's central automated vendor payment system, the medicaid management information system, so-called; provided, that not less than $300,000 shall be provided for said systems enhancements to process claims for the senior pharmacy assistance program established pursuant to the provisions of section 16B of chapter 118E of the General Laws

......................................................$1,366,221

Children's and Seniors' Health Care Assistance Fund.................. 100.0%

4000-0320

The division of medical assistance may expend an amount not to exceed $65,000,000 from the monies received from recoveries of any prior year expenditures and collections from liens, estate recoveries, third party recoveries, drug rebates, accident and trauma recoveries, case mix recoveries, computer audits, insurance recoveries, masspro and healthpro refunds, medicaid fraud returns, data match returns, medicare appeals, and program and utilization review audits; provided, that any revenues collected by the division that are not attributable to the aforementioned categories shall be deposited in the General Fund and shall be tracked separately therein; provided further, that additional categories of recoveries and collections may be credited to this item after providing written notice to the house and senate committees on ways and means; provided further, that no funds from this item shall be used for the purposes of items 4000-0300, 4000-0310, or 4000-0325; provided further, that expenditures from this item shall be limited solely to payments for the provision of medical care and assistance rendered in the current fiscal year; provided further, that the division shall file quarterly, with the house and senate committees on ways and means, a report delineating the amount of current year rebates from pharmaceutical companies or other current year collections which are being used to supplement current year expenditures; and provided further, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to noncitizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called

......................................................$65,000,000

4000-0325

For the nonpersonnel systems costs of the division, including contracts for the management and operation of the central automated vendor payment system, including the recipient eligibility verification system, contracts for the operation and enhancement of the client eligibility systems, contracted staff whose main duties are systems related, and personal computers and other systems equipment used by division staff; provided, that all federal reimbursements for said contracts shall be deposited in the General Fund; and provided further, that 50 per cent of the cost of provider point of service eligibility verification devices purchased by the division shall be assumed by the providers utilizing said devices

......................................................$28,773,922

4000-0430

For the commonhealth program to provide primary and supplemental medical care and assistance to disabled adults and children pursuant to sections 9A, 16 and 16A of chapter 118E of the General Laws; provided, that no funds shall be expended from this item for expenses incurred in the prior fiscal year; provided further, that the division shall maximize federal reimbursement for state expenditures made on behalf of said adults and children; provided further, that the division shall close enrollments or promulgate regulations that adjust eligibility, benefits and other requirements to limit expenditures to the amount appropriated herein; provided further, that the division shall adhere to the same time standards for processing of a commonhealth application as govern applications under Title XIX, namely within 45 days of receipt of a completed application, or within 90 days if a determination of disability is required; provided further, that children will be eligible for said medical care and assistance if said children meet the disability standards as defined by the division of medical assistance; provided further, that said disability standards shall be no more restrictive than the standards in effect on July 1, 1996; and provided further, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to non-citizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called

......................................................$24,560,012

4000-0450

For a pharmacy assistance program for eligible residents of the commonwealth aged 65 or older, pursuant to the provisions of chapter 203 of the acts of 1996; provided, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to noncitizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called

......................................................$30,000,000

Children's and Seniors' Health Care Assistance Fund.................. 100.0%

4000-0460

For an interagency service agreement with the executive office of elder affairs to provide home care services to eligible recipients through the enhanced community options program, so-called, the home health substitution initiative, so-called, and the nursing home light care initiative, so-called; provided that, the executive office of elder affairs shall ensure that the home care corporations or other entities that receive funds from this item shall comply with any performance measures, outcome goals and cost-effectiveness standards established by the division and the executive office of elder affairs pursuant to the terms of said interagency service agreement

......................................................$7,793,000

4000-0500

For health care services provided to medical assistance recipients under the division's primary care clinician/mental health and substance abuse plan or through a health maintenance organization under contract with the division; provided, that not more than $227,100,000 shall be expended from this item for health care services provided to said recipients in prior fiscal years; provided further, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to non-citizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called; provided further, that no payment 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 expenditures from this item shall be made only for the purposes expressly stated herein; and provided further, that the commissioners of the division of medical assistance and the department of mental health shall report quarterly to the house and senate committees on ways and means relative to the performance of the managed care organization under contract with the division to administer the mental health and substance abuse benefit; such quarterly reports shall include, but not be limited to, analyses of utilization trends, quality of care and costs across all service categories and modalities of care purchased from providers through the mental health and substance abuse program, including those services provided to clients of the department of mental health

......................................................$1,259,047,300

4000-0600

For health care services provided to medical assistance recipients under the division's senior care plan; provided, that not more than $255,300,000 shall be expended from this item for health care services provided to said recipients in prior fiscal years; provided further, that no payment 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 notwithstanding the provisions of item 4000-0310 to the contrary, not less than $8,600,000 shall be made available from this item to pay for the cost of home and community-based health waiver services provided to elderly medicaid recipients enrolled in the section 2176 waiver, so-called; provided further, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to non-citizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called; provided further, that the division is hereby authorized to seek any federal waivers necessary to establish a managed care program for dually-eligible seniors, so-called; provided further, that said program shall integrate services covered by medicare and medicaid, including home and community-based support services, for the purpose of providing said seniors with high quality, accessible, cost-effective care which shall enable said seniors to maintain the highest feasible functional level; provided further, that said waiver shall not take effect unless specifically authorized by law; and provided further, that expenditures from this item shall be made only for the purposes expressly stated herein

......................................................$1,542,950,750

4000-0700

For health care services provided to medical assistance recipients under the division's health care indemnity/third party liability plan and medical assistance recipients not otherwise covered under the division's managed care or senior care plans; provided, that not more than $127,000,000 shall be expended from this item for health care services provided to said recipients in prior fiscal years; provided further, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to non-citizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called; provided further, that no payment 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 not less than $900,000 shall be made available from this item to pay for the cost of outreach and follow-up services conducted by agencies certified as comprehensive family planning agencies to increase the utilization of comprehensive family planning services; and provided further, that expenditures from this item shall be made only for the purposes expressly stated herein

......................................................$599,085,940

4000-0820

For the intergovernmental transfer component of the disproportionate share program for certain acute care hospitals established in accordance with Title XIX, or any successor federal statute, any regulations promulgated thereunder, the medicaid state plan and the terms and conditions of agreements reached with the division for such transfer payments; provided, that such funds may only be expended from this item for such payments owed during the current fiscal year; provided further, that an accounting of such payments shall be reported quarterly to the house and senate committees on ways and means; and provided further, that all revenues generated by said program shall be credited to the General Fund

......................................................$32,000,000

Local Aid Fund .................. 100.0%

4000-0830

For the intergovernmental transfer component of the medicaid payments to the University of Massachusetts Medical Center for hospital services as provided pursuant to the terms and conditions of the contract between the division and said medical center; provided, that programs funded pursuant to this item shall not create recurring liabilities to the commonwealth in future fiscal years; provided further, that the General Fund shall be reimbursed $2,500,000 by the medical center for its share of funds transferred pursuant to this item; and provided further, that said hospital shall submit by December 2, 1997, to the house and senate committees on ways and means, a report detailing the programs funded from this item

......................................................$5,000,000

4000-0860

For health care services provided to children and adults participating in the medical assistance program pursuant to clauses (a), (b), (c), (d), (e) and (h) of subsection 2 of section 9A of chapter 118E of the General Laws; provided, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to non-citizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called; and provided further, that all revenues received as a result of expenditures authorized herein shall be credited to the Children's and Seniors' Health Care Assistance Fund

......................................................$48,085,380

Children's and Seniors' Health Care Assistance Fund.................. 100.0%

4000-0870

For health care services provided to adults participating in the medical assistance program pursuant to clause (g) of subsection 2 of section 9A of chapter 118E of the General Laws; provided, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to non-citizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called; provided further, that all revenues received as a result of expenditures authorized herein shall be credited to the Children's and Seniors' Health Care Assistance Fund; and provided further, that the division may enter into an interagency service agreement with the department of transitional assistance for the provision of health benefits for enrollees in the emergency aid to the elderly, disabled, and children program

......................................................$54,443,125

Children's and Seniors' Health Care Assistance Fund.................. 100.0%

4000-0880

For a reserve for health care services provided to children with family incomes between 134 per cent and 200 per cent of the federal poverty level, inclusive, pursuant to clause (b) of subsection 2 of section 9A of chapter 118E of the General Laws; provided, that except as otherwise provided by this act, the division is hereby authorized and directed to make expenditures for services provided to noncitizens in all optional and mandatory coverage groups identified pursuant to sections 401, 402, 403, 411 and 412 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, whether or not federal reimbursement is available and whether or not they are qualified aliens, so-called; provided further, that said division shall apply for an amendment to the MassHealth demonstration project waiver as required by section 26 of chapter 203 of the acts of 1996 no later than October 1, 1997; and provided further, that funds allocated, transferred, or expended from this item shall be expended subject to the availability of federal financial reimbursement for said expenditures

......................................................$14,845,075

Children's and Seniors' Health Care Assistance Fund.................. 100.0%

Federal Appropriation

4000-0314

For the purposes of a federally funded grant entitled, Welfare Reform

......................................................$4,300,000