Consolidated Amendment "J" to H3400
Health and Human Services
Fiscal Note: $20,636,000
Amendment 20 has been re-categorized to the Public Health category.
Amendments from the Health and Human Services: 14, 15, 16, 17, 19, 21, 22, 27, 28, 29, 30, 31, 32, 33, 52, 77, 80, 107, 110, 118, 120, 131, 141, 142, 192, 202, 203, 204, 210, 217, 222, 227, 241, 248, 261, 268, 283, 286, 304, 316, 326, 329, 333, 339, 345, 348, 357, 361, 365, 381, 385, 402, 429, 445, 462, 464, 491, 501, 517, 524, 529, 554, 561, 571, 574, 598, 616, 619, 624, 627, 638, 681, 683, 715, 719, 730, 741, 744, 750, 751.
Mr. Dempsey of Haverhill and others move to amend H.3400 in section 2, by striking item 4000-0300 and inserting in place thereof the following item: -
4000-0300For the operation of the executive office of health and human services, including the operation of the managed care oversight board; provided, that the executive office shall provide technical and administrative assistance to agencies under the purview of the secretariat receiving federal funds; provided further, that the Executive Office of Health and Human Services and its agencies, when contracting for services on the islands of Martha’s Vineyard and Nantucket, shall take into consideration the increased costs associated with the provision of goods, services and housing on said islands; provided further, that the executive office shall monitor the expenditures and completion timetables for systems development projects and enhancements undertaken by all agencies under the purview of the secretariat, and shall ensure that all measures are taken to make such systems compatible with one another for enhanced interagency interaction; provided further, that the executive office shall continue to develop and implement the common client identifier; provided further, that the executive office shall ensure that any collaborative assessments for children receiving services from multiple agencies within the secretariat shall be performed within existing resources; provided further, that funds appropriated in this item shall be expended for administrative and contracted services related to the implementation and operation of programs authorized by chapter 118E of the General Laws; provided further, that in consultation with the division of health care finance and policy, no rate increase shall be provided to 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 the rates that 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 funds may be expended for the operation of the office of health equity within the executive office of health and human services; provided further, that expenditures for the purposes of each item appropriated for programs authorized by chapter 118E of the General Laws shall be accounted for in the Massachusetts management accounting and reporting system not more than 10 days after the expenditures have been made by the Medicaid management information system; provided further, that no expenditures shall be made that are not federally reimbursable, including those related to Titles XIX or XXI of the Social Security Act or the MassHealth demonstration waiver approved under section 1115(a) of said Social Security Act or the community first section 1115 demonstration waiver, whether made by the executive office or another commonwealth entity, except as specifically authorized herein, or unless made for cost containment efforts, the purposes and amounts of which have been submitted to the executive office of administration and finance and the house and senate committees on ways and means 30 days prior to making such expenditures; provided further, that the executive office of health and human services may continue to recover provider overpayments made in the current and prior fiscal years through the Medicaid management information system, and that these recoveries shall be considered current fiscal year expenditure refunds; provided further, that the executive office may collect directly from a liable third party any amounts paid to contracted providers under chapter 118E of the General Laws for which the executive office later discovers another third party is liable if no other course of recoupment is possible; provided further, that not less than $250,000 shall be expended on a statewide program of technical assistance to community health centers to be provided by a state primary care association qualified under Section 330(f)(l) of the United States Public Health Service Act at 42 USC 254c(f)(l); provided further, that no funds shall be expended for the purpose of funding interpretive services directly or indirectly related to a settlement or resolution agreement with the office of civil rights or any other office, group or entity; provided further, that interpretive services currently provided shall not give rise to enforceable legal rights for any party or to an enforceable entitlement to interpretive services; provided further, that notwithstanding any general or special law to the contrary, the executive office shall require the commissioner of mental health to approve any prior authorization or other restriction on medication used to treat mental illness in accordance with written policies, procedures and regulations of the department of mental health; provided further, that not later than November 1, 2011, the executive office of health and human services shall submit a report to the house and senate committees on ways and means detailing the methodology used for projecting MassHealth enrollment and utilization in fiscal year 2012 and evaluating the accuracy of the caseload and utilization projection methodologies used to project caseload and utilization in fiscal year 2011 and fiscal year 2012; provided further, that notwithstanding any general or special law to the contrary, the state Medicaid office is hereby authorized to conduct a trial to determine the effectiveness of various fraud management tools to identify potential fraud prior to payment; provided further, any such trial may test innovative technologies to improve medical fraud detection and evaluate the efficacy of, among things, a real time, pro-active model to identify specific suspicious provider billing patterns, document the results of any potential fraud findings and estimated savings to benefit the commonwealth associated with such a fraud detection system; and provided further, that any projection of deficiency in items 4000-0430, 4000-0500, 4000-0600, 4000-0700, 4000-0870, 4000-0875, 4000-0880, 4000-0890, 4000-0895, 4000-0950, 4000-0990, 4000-1400 or 4000-1405 shall be reported to the house and senate committees on ways and means not less than 90 days before the projected exhaustion of funding; and provided further, that any unexpended balance in these accounts shall revert to the General Fund on June 30, 2012 $83,734,473
And further amend the bill in section 2, by striking item 4000-0500 and inserting in place thereof the following item: -
4000-0500For health care services provided to medical assistance recipients under the executive office’s primary care clinician/mental health and substance abuse plan or through a health maintenance organization under contract with the executive office and for MassHealth benefits provided to children, adolescents and adults under clauses (a) to (d), inclusive, and clause (h) of subsection (2) of section 9A of chapter 118E of the General Laws and section 16C of said chapter 118E; provided, 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 the executive office shall maintain the fiscal year 2011 overall reimbursement rate for the commonwealth’s only medical respite program for the homeless; provided further, that expenditures from this item shall be made only for the purposes expressly stated herein; provided further, that the executive office shall maximize federal reimbursements for state expenditures made to these providers; and provided further, that funds may be expended from this item for health care services provided to the recipients in prior fiscal years …$3,875,835,669
And further amend the bill in section 2, by striking item 4000-0600 and inserting in place thereof the following item: -
4000-0600For health care services provided to MassHealth members who are seniors, and for the operation of the senior care options program under section 9D of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to these recipients in prior fiscal years; provided further, that funds shall be expended for the community choices initiative; 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 benefits for this demonstration project shall not be reduced below the services provided in fiscal year 2011; provided further, that the eligibility requirements for this demonstration project shall not be more restrictive than those established in fiscal year 2011; provided further, that the executive office of health and human services shall submit a report to the house and senate committees on ways and means detailing the projected costs and the number of individuals served by the community choices initiative in fiscal year 2012 delineated by the federal poverty level; provided further, that notwithstanding any general or special law to the contrary, funds shall be expended from this item for the purpose of maintaining a personal needs allowance of $72.80 per month for individuals residing in nursing homes and rest homes who are eligible for MassHealth, Emergency Aid to the Elderly Disabled and Children program or Supplemental Security Income; provided further that effective July 1, 2011 for the fiscal year ending June 30, 2012, the division of health care finance and policy shall establish nursing facility MassHealth rates that are $12 million in payments above the payments made to nursing facilities for the fiscal year ended 2011 for the purpose of recognizing the Medicaid share of the nursing home assessment established by section 25 of Chapter 118G of the General Laws; provided further, that funds shall be expended from this item to implement the provisions of section 2 of chapter 211 of the acts of 2006, the pre-admission counseling and assessment program, which shall be implemented on a statewide basis through aging and disability resource consortia; provided further, that notwithstanding any general or special law to the contrary, for any nursing home or non-acute chronic disease hospital that provides kosher food to its residents, the executive office of elder affairs, in consultation with the division of health care finance and policy, in recognition of the unique special innovative program status granted by the executive office of health and human services, shall continue to make the standard payment rates established in fiscal year 2006 to reflect the high dietary costs incurred in providing kosher food; provided further, that not less than $2,800,000 shall be expended as fiscal year 2012 incentive payments to nursing facilities meeting the criteria determined by the MassHealth Nursing Facility Pay for Performance Program in 114.2 CMR 6.07 and that have established and participated in a cooperative effort in each qualifying nursing facility between representatives of employees and management, that is focused on implementing that criteria and improving the quality of services available to MassHealth members; provided further that the MassHealth agency shall adopt regulations and procedures necessary to carry out section; and provided further, that notwithstanding any general or special law to the contrary, nursing facility rates effective July 1, 2011 may be developed using the costs of calendar year 2005 .$2,520,402,264
And further amend the bill in section 2, in item 4100-0060, by inserting after “behavior” the following: “; provided further, that funds shall be expended for the operation of the Health Care Quality and Cost Council established per section 16K of chapter 6A of the General Laws to promote high-quality, cost-effective, patient-centered care;”.
And further amend the bill in section 2, in item 9110-1630, by inserting after the word “services” the following: “; and provided further, that funding shall be expended for provider training and outreach for LGBT elders and caregivers”.
And further amend the bill in section 2, in item 9110-1636, by striking out the figures “$15,250,554” and inserting in place thereof the figures: “$16,250,554”.
And further amend the bill in section 2 by inserting after item 9110-1660 the following item:-
9110-1700For residential assessment and placement programs for homeless elders$136,000
And further amend the bill in section 2, in item 9110-9002, by striking out the figures “$7,904,327” and inserting in place thereof the figures: “$8,254,327”.
And further amend the bill in section 2E, in item 1595-5819, by striking out the figures “$50,000,000” and inserting in place thereof the figures: “$15,000,000”
And further amend the bill in section 2E, in item 1595-5819, by striking out the figures “$361,005,911” and inserting in place thereof the figures: “$363,505,911”
And further amend the bill in section 2E, in item 1595-5820, by striking out the figures “$50,000,000” and inserting in place thereof the figures: “$15,000,000”
And further amend the bill in section 2E, in item 1595-5819, by striking out the figures “$361,005,911” and inserting in place thereof the figures: “$363,505,911”
And further amend the bill by adding the following sections:
SECTION XX. Notwithstanding the division of health care finance and policy shall, within eight months of the passage of this act, develop regulations to ensure the following: i) that Medicare-like claims editing is fully and effectively implemented and used to determine reimbursements from the Health Safety Net Trust Fund; and ii) that claims editing is effectively used to reduce the occurrence of payments for medically unnecessary services, medically unlikely events, and duplicate services.
SECTION XX. Notwithstanding the office of Medicaid shall, within eight months of the passage of this act, develop regulations to ensure that incentives or regulations are implemented to increase competition among MassHealth managed care organizations, reduce the size of some provider networks offered by managed care organizations, and/or to reduce cost of managed care organizations.
SECTION XX. Notwithstanding any general or special law to the contrary, in hospital fiscal year 2012, the office of the inspector general may expend funds from the Health Safety Net Trust Fund, established by section 36 of chapter 118G of the General Laws, for the costs associated with conducting an audit of the Commonwealth’s Medicaid program. The inspector general may examine the practices utilized in all hospitals including, but not limited to, the care of the insured receiving health care services reimbursed pursuant to the Commonwealth’s Medicaid system. The inspector general shall submit a report to the house and senate committees on ways and means containing the findings of any audits so conducted and any other completed analyses not later than April 1, 2012. For the purposes of such audits, health care services shall be defined pursuant to said chapter 118G and any regulations adopted there under
SECTION XX. Section 3 of chapter 175H of the General Laws, as appearing in the 2008 Official Edition, is hereby amended by inserting at the end thereof the following two paragraphs:-
This section shall not apply to a discount, rebate, free product voucher or other reduction in out of pocket expenses, including but not limited to co-payments and deductibles on a prescription drug, biologic or vaccine provided by a pharmaceutical manufacturing company, as defined in section 1 of chapter 111N, that is made available to an individual, if such is provided directly or electronically to the individual or through a so-called “point of sale” or “mail-in” rebate, or through similar means; provided however, that a pharmaceutical manufacturing company shall neither exclude nor favor any individual pharmacy or restricted network of pharmacies in the design of such discount, rebate, free product voucher or other expense reduction offer to an individual; provided further, that this section does not negate the need for a written prescription as otherwise required by law, nor is it intended to constrain a carrier or a health maintenance organization, as defined in chapter 118G, with regard to how its plan design will treat such discounts, rebates, free product voucher or other reduction in out of pocket expenses, including but not limited to co-payments and deductibles.
For purposes of the Federal Health Insurance Portability and Accountability Act of 1996 and regulations issued there under, nothing in this section shall be deemed to require or allow the use or disclosure of health information in any manner that does not otherwise comply with such Act or such regulations.
SECTION XX. Subsection (d) of section 6 of chapter 176J of the General Laws, as inserted by section 29 of chapter 288 of the acts of 2010 is hereby amended by adding the following sentence: The commissioner shall have discretion to apply waivers to the presumptive disapproval process requirements under section 6 to carriers who receive 80% or more of its income from government programs.
SECTION XX. Subsection (a) of section 11 of chapter 176J of the General Laws, as inserted by section 32 of chapter 288 of the acts of 2010 is hereby amended by adding the following sentence: The commissioner shall have discretion to apply waivers to the 12% requirement under section 11 to carriers who receive 80% or more of its income from government programs
SECTION XX. Subsection (a) of section 33 of chapter 288 of the acts of 2010is hereby amended by adding the following sentence: The commissioner shall have discretion to apply waivers to the 12% requirement under section 33 to carriers who receive 80% or more of its income from government programs.
Section XX. SECTION __________. Subsection (e)(3) of section 9D of Chapter 118E of the General Laws is hereby amended by inserting after said subsection the following paragraph:- Notwithstanding any provision of law to the contrary, the executive office of health and human services shall direct MassHealth to provide each beneficiary age 65 and over with an annual notice of the options for enrolling in voluntary programs including Program of All Inclusive Care for the Elderly (PACE) plans, Senior Care Options (SCO) plans, Frail Elder Home and Community Based Waiver Program or any other voluntary elected benefit to which they are entitled to supplement or replace their MassHealth benefits. Provided that MassHealth receives approval from the Centers for Medicare and Medicaid Services, MassHealth shall arrange that such annual notice include the names and contact information for the program providers, general contact information for MassHealth and a general description of the benefits of joining particular programs in clear and simple language and method to request for the same information in a language other than English. Such notice shall include a method for the beneficiary to indicate interest in receiving additional information for any programs identified as of interest to them. A draft of the proposed language and format for providing information to beneficiaries will be circulated to the providers contracted to provide each of these programs for review and comment prior to finalization. In addition, the division will work with the program providers and other appropriate stakeholders to assess whether and to what extent barriers to program enrollment shall be alleviated through modifications to the program and or the enrollment process. The executive office of health and human services shall establish rules and regulations on or before December 31, 2011
Section XX. Notwithstanding the provisions of any general or special law to the contrary, the division of medical assistance and the division of health care finance and policy shall make no changes prior to December 31, 2011 in the clinical eligibility or level of reimbursement paid to providers of adult day health services for basic and complex levels of care.
The executive office of health and human services is further directed to implement a temporary moratorium effective with the passage of this legislation on the acceptance and approval of applications for (i) enrollment of new adult day health providers and (ii) expansion of the certified capacity of already approved adult day health providers as provided in 130 C.M.R. 404.400 et seq. This moratorium shall not apply to Programs of All-Inclusive Care for the Elderly (PACE) as established in 42 US Code Section 1894.
Such moratorium shall remain in effect until such time as the Secretary of Health and Human Services and the Secretary of Elder Affairs jointly complete a comprehensive study in consultation with representatives of House and Senate Ways and Means Committee, the Joint Committee on Elder Affairs and the Joint Committee on Health Care Financing as well as the Massachusetts Adult Day Services Association and other interested parties. The study shall make recommendations regarding licensure and other means to ensure an appropriate level of high quality adult day health care. In addition the study shall make recommendations updating the basis for the current rate structure by developing a model for imputing actual costs into the rate structure and the overall financing structure of Adult Day Services. In addition the study shall asses the current manner of categorizing clients as basic or complex. The study shall also assess the commonwealth’s current and future adult day health services needs and recommend needed changes these needs require.
The final study and recommendations shall be reported to the House and Senate committees on ways & means, the joint committee on elder affairs and the joint committee on health care financing no later than December 31, 2011. If that date is not met, the moratorium shall stay in effect until 90 days after the report is submitted.
The division of medical assistance and the division of health care finance and policy shall take immediate steps, on the enactment of this legislation, to terminate reimbursement for the Health Promotion and Prevention level of care pursuant to a transition plan developed by the division of medical assistance for affected members.
Notwithstanding the provision of any general or special law to the contrary, the division of health care financing and policy and the division of medical assistance shall collect any outstanding cost reports from adult day health programs and shall review said cost reports and take any action as required or allowed by 114 C.M.R. 10.04
SECTION XX. Notwithstanding any general or special law to the contrary, in fiscal years 2012, the division of health care finance and policy shall allocate $1,000,000 from the Health Safety Net Trust Fund for a Fishing Partnership Health Plan Corporation demonstration project under subsection (d) of section 18 of chapter 118G of the General Laws; provided, however, that all current members in the Fishing Partnership Health Plan shall make every effort to enroll in other health insurance programs including but not limited to Commonwealth Care Choice, Commonwealth Care, and MassHealth; and provided further this funding shall be made available to individuals that prove ineligible for all other insurance products available in the Commonwealth.
SECTION XX. (a) Notwithstanding any general or special law to the contrary and except as provided in subsection (b), an eligible individual pursuant to section 3 of chapter 118H of the General Laws shall not include a person who is not eligible to receive federally-funded benefits under sections 401, 402 or 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Pub. L. No. 104-193, as amended, for fiscal year 2012.
(b) Notwithstanding any general or special law to the contrary, the secretary of administration and finance, the secretary of health and human services and the executive director of the health insurance connector authority may, in their discretion and subject only to the terms and conditions in this subsection, establish or designate a health insurance plan in which a person who is not eligible to receive federally-funded benefits under said sections 401, 402 or 403 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, Public Law 104-193, as amended, but who is an eligible individual pursuant to said section 3 of said chapter 118H may enroll for the period including July 1, 2011 to December 31, 2011, inclusive, provided however, that only those persons that enrolled in the health insurance plan established pursuant to section 31 of chapter 65 if the acts of 2009 shall be eligible to enroll in the plan authorized by this section
The plan may be contracted for selectively from the health plans that contracted in fiscal year 2011 to provide insurance coverage to commonwealth care or MassHealth enrollees. Notwithstanding any general or special law to the contrary, the secretary of administration and finance, the secretary of health and human services and the executive director of the commonwealth health insurance connector authority may, in their discretion and subject only to the terms and conditions in this subsection, make payments from the Commonwealth Care Trust Fund established in section 2OOO of chapter 29 of the General Laws to operate the plan using resources in the trust fund, provided these payments from the said fund shall include savings from the procurement of the Commonwealth Care, increased cigarette tax revenue and any surpluses from the Commonwealth Care Trust Fund. Total state expenditures for providing coverage to all such persons, net of enrollee contributions and any federal financial participation, shall not exceed $25,000,000 for the year 2012. Total state expenditures for providing coverage to all such persons, net of enrollee contributions and any federal financial participation, shall not exceed resources available in the trust fund not required to fund coverage of commonwealth care; provided that this shall not result in a reduction of services to commonwealth care enrollees. To the extent that additional federal financial participation becomes available for paying the costs of such coverage, the secretary of administration and finance may direct the comptroller to make such amounts available from the General Fund for the purpose of paying for the costs of such coverage. If the secretary of administration and finance, the secretary of health and human services and the executive director of the commonwealth health insurance connector authority determine that the projected costs of enrolling eligible individuals in such coverage in fiscal year 2012 will exceed funds in the trust fund that are available for this program, they may limit enrollment in such coverage. If the secretary of administration and finance, the secretary of health and human services and the executive director of the commonwealth health insurance connector authority are unable to establish, reauthorize or designate a health insurance plan under this section, the secretary of administration and finance may direct the comptroller to transfer up to $20,000,000 from the Commonwealth Care Trust Fund to the Health Safety Net Trust Fund for the cost of health care services.