Division of Medical Assistance

Division of Medical Assistance.

4000-0300

For the operation of the division, including the administrative costs related to the implementation and operation of programs authorized by sections 9A to 9C, inclusive, and sections 16B and 16C of chapter 118E of the General Laws; provided, that the same standards and regulations in place for personal care attendants and score III, so-called, in fiscal year 1998 shall be retained in fiscal year 1999; provided further, 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 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, 1999, 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; and provided further, that the division shall, subject to the availability of federal financial participation, authorize durable medical equipment that is prescribed for preventative services

...............................................................$39,001,776

General Fund............................................................. 85.84%

Children's and Seniors' Health Care Assistance Fund............................................................. 14.16%

4000-0308

For a reserve for the operation of the division; provided, that no expenditures shall be made from this item prior to the submission by the division to the house and senate committees on ways and means and the executive office of administration and finance data for fiscal year 1998 and the first two quarters of fiscal year 1999 consisting of: (1) monthly expenditure data for items 4000-0430, 4000-0460, 4000-0500, 4000-0600, and 4000-0700 of this act, including monthly member-month caseload, date-of-service and date-of-payment expenditure data by provider type and health benefit plan; (2) monthly expenditure data for items 4000-0860, 4000-0870, 4000-0880, and 4000-0890 of this act which, pursuant to the budget neutrality analysis dated February 24, 1998, shall identify, by item of appropriation, total caseload and member-months for participants in the standard, basic, and family assistance plans, delineated by age, disability status and direct coverage or premium assistance type of coverage and respective per member per month rates for each such category of eligibility; and (3) monthly expenditure data for item 4000-0450, including monthly member-month caseload and expenditure data required pursuant to the provisions of section 16B of chapter 118E of the General Laws; and provided further, that all expenditures from this item shall be made for the purposes of item 4000-0300

...............................................................$1,000,000

General Fund............................................................. 85.84%

Children's and Seniors' Health Care Assistance Fund............................................................. 14.16%

4000-0309

For administrative expenses of the division made pursuant to the EE subsidiary, so-called, as classified by the comptroller; provided, that all funds appropriated herein shall be scheduled in the EE subsidiary, so-called; and provided further, that no funds from any other item of state appropriation available to the division shall be used for said expenses except as specifically authorized in any such item

...............................................................$3,977,868

General Fund............................................................. 85.84%

Children's and Seniors' Health Care Assistance Fund............................................................. 14.16%

4000-0310

For administrative support and related services purchased contractually by the division, including contracted services necessary for the implementation and operation of programs authorized by sections 9A to 9C, inclusive, and sections 16B and 16C of chapter 118E of the General Laws; provided, that said services shall include but shall not be limited to, pre-admission screening, utilization review, medical consultants, disability determination reviews, health benefit managers and interagency service agreements; provided further, that not less than $1,602,342 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 said section 16B; provided further, that not less than $500,000 shall be distributed to home care corporations for the purposes of said interagency service agreement; provided further, 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

...............................................................$36,341,082

General Fund............................................................. 85.84%

Children's and Seniors' Health Care Assistance Fund............................................................. 14.16%

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, provider overpayment recoveries, bankruptcy settlements, 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, 4000-0308, 4000-0309, 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; and 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

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

4000-0325

For the non-personnel systems costs of the division, including such costs incurred as a result of the implementation and operation of programs authorized by sections 9A to 9C, inclusive, and sections 16B and 16C of chapter 118E of the General Laws; provided, that such systems costs may include contracts for the management and operation of the central automated vendor payment system, including the recipient eligibility verification system, vendor contracts to upgrade and enhance the division's central automated vendor payment system, the medicaid management information system, so-called and the recipient eligibility verification system, MA21, so-called, the EE subsidiary costs, so-called, related to information technology division chargebacks, contracted staff whose main duties are systems related, and personal computers and other systems equipment used by division staff; 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

...............................................................$31,547,461

General Fund............................................................. 85.84%

Children's and Seniors' Health Care Assistance Fund............................................................. 14.16%

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 prior fiscal years; 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 of the federal Social Security Act namely within 45 days of receipt of a completed application, or within 90 days if a determination of disability is required; and provided further, that children shall be determined eligible for said medical care and assistance if said children meet the disability standards as defined by the division of medical assistance and that said disability standards shall be no more restrictive than the standards in effect on July 1, 1996

...............................................................$25,051,212

4000-0450

For a pharmacy assistance program for eligible residents of the commonwealth aged 65 or older, pursuant to the provisions of section 16B of chapter 118E of the General Laws

...............................................................$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 $203,290,000 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 expenditures from this item shall be made only for the purposes expressly stated herein; 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; and provided further, that such quarterly reports shall include, but shall 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

...............................................................$1,371,400,000

4000-0600

For health care services provided to medical assistance recipients under the division's senior care plan; provided, that not more than $217,770,000 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 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

...............................................................$1,506,037,000

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 $118,420,000 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 not less than $900,000 shall be made available from this item to pay for the cost of a program of outreach and follow-up services conducted by agencies certified as comprehensive family planning agencies to increase the utilization of comprehensive family planning services known as the Keep Teens Healthy Project, so-called; and provided further, that expenditures from this item shall be made only for the purposes expressly stated herein

...............................................................$590,620,000

4000-0860

For MassHealth benefits provided to children and adults pursuant to the provisions of clauses (a), (b), (c), (d) and (h) of subsection 2 of section 9A of chapter 118E of the General Laws; provided, that no funds shall be expended from this item for children and adolescents pursuant to the provisions of clause (c) of said subsection 2 whose family incomes, as determined by the division, exceed 150 per cent of the federal poverty level; provided further, that not more than $19,654,000 shall be expended from this item for health care services provided to said children and adults in prior fiscal years; and provided further, that all federal reimbursements received for expenditures from this item pursuant the provisions of Title XIX and Title XXI of the federal Social Security Act shall be credited to the Children's and Seniors' Health Care Assistance Fund

...............................................................$160,050,381

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 not more than $11,220,000 shall be expended from this item for health care services provided to said recipients in prior fiscal years; 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

...............................................................$91,677,911

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

4000-0880

For MassHealth benefits pursuant to the provisions of clause (c) of subsection 2 of section 9A and section 16C of chapter 118E of the General Laws for children and adolescents whose family incomes as determined by the division are above 150 per cent of the federal poverty level; provided, that funds may be expended from this item for health care services provided to said children and adolescents in prior fiscal years; and provided further, that all federal reimbursements received for expenditures from this item pursuant the provisions of Title XXI of the federal Social Security Act shall be credited to the Children's and Seniors' Health Care Assistance Fund

...............................................................$13,039,747

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

4000-0890

For the cost of health insurance premium subsidies paid to employees of small businesses participating in the insurance reimbursement program pursuant to the provisions of section 9C of chapter 118E of the General Laws; provided, that all federal reimbursements received for expenditures from this item pursuant the provisions of Title XIX and Title XXI of the federal Social Security Act shall be credited to the Children's and Seniors' Health Care Assistance Fund

...............................................................$32,209,639

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

4000-0891

For the cost of health insurance subsidies paid to employers participating in the insurance reimbursement program pursuant to the provisions of section 9C of chapter 118E of the General Laws; provided, that the division shall directly market said program to private human service providers that deliver human and social services under contract with departments within the executive office of health and human services and the executive office of elder affairs for the purpose of mitigating health insurance costs to said employers and their employees; provided further, that on or before May 1, 1999 the division shall report to the house and senate committees on ways and means and the executive office of administration and finance on the specific measures taken to promote said participation, the number of said employers and their employees electing to participate in said program, and the monthly costs of subsidies paid by the division on their behalf; provided further, that the division shall report monthly to the house and senate committees on ways and means and the executive office of administration and finance monthly expenditure data for said program, including the total number of employers participating in said program, the percentage of said employers who purchased health insurance for employees prior to participating in said program, and total monthly expenditures delineated by payments to small employers and self-employed persons for individual, two-person, and family subsidies; and provided further, that the division shall seek federal reimbursement for said payments to employers

...............................................................$8,949,540

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