Consolidated Amendment #H to H.4000

Consolidated Amendment "H", as changed to H4000

Health and Human Services and Elder Affairs

Fiscal Note: $43,675,000

Amendment 1015 has been re-categorized to the Labor and Economic Development category

Amendments from the Health and Human Services: 2, 18, 25, 39, 92, 98, 101, 128, 135, 161, 188, 224, 246, 251, 274, 304, 327, 361, 386, 400, 425, 431, 447, 458, 491, 492, 505, 557, 560, 565, 578, 589, 590, 593, 598, 599, 604, 613, 616, 652, 656, 658, 667, 668, 699, 733, 743, 816, 820, 822, 846, 863, 868, 884, 896, 936, 952, 968, 975, 977, 978, 981, 989, 1001, 1022, 1024, 1026, 1063, and 1088.

Amendments from Elder Affairs: 89, 264, 270, 287, 288, 308, 317, 430, 477, 530, 540, 584, 642, 694, 775, 776, 800, 810, 830, 911, and 930.

Mr. Dempsey of Haverhill and others move to amend H.4000 in section 2, in item 4000-0005, by inserting after the words “cover all youths in the target population” the following words:- ; provided further, that not less than $100,000 shall be expended on the Martin Luther King, Jr. Family Services, Inc. to provide youth development and violence prevention services to at-risk youth; and further move to amend said item by striking out the figure “$4,000,000” and inserting in place thereof the following figure:- “$4,100,000”;

And further move to amend said section 2, by striking out 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 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 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 on or before December 31, 2014, not less than $100,000 shall be provided to Noble Hospital, a federal and state disproportionate share hospital that is geographically isolated, to improve the access entry way for all patients, especially those challenged with disabilities, provided that such funds are matched by an equal or greater amount by Noble Hospital; provided further, that in consultation with the center for health information and analysis, no rate increase shall be provided to existing Medicaid provider rates without taking all measures possible under Title XIX of the Social Security Act, as codified at 42 U.S.C. chapter 7, subchapter XIX, 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 the executive office shall contract with Martha’s Vineyard Community Services, Inc. for no less than $60,000 to increase access to health and human services on Martha’s Vineyard and Nantucket, and such funds shall be used to cover feasible travel costs associated with arranging access to health and human services; 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, as codified at 42 U.S.C. chapter 7, subchapters XIX or XXI or the MassHealth demonstration waiver pursuant to section 1115(a) of said Social Security Act, as codified at 42 U.S.C. section 1315(a) or the community first demonstration waiver pursuant to section 1115 of the Social Security Act, as codified at 42 U.S.C. section 1315, whether made by the executive office or another commonwealth entity, except as required for: (a) the equivalent of MassHealth Standard benefits for children under age 21 who are in the care or custody of the department of youth services or the department of children and families; (b) dental benefits provided to clients of the department of developmental services who are age 21 or over; or (c) cost containment efforts the purposes and amounts of which have been submitted to the executive office for administration and finance and the house and senate committees on ways and means 30 days prior to making these expenditures; provided further, that the office of Medicaid shall apply an add-on to reimburse the managed care organizations and senior care organizations under contract with the commonwealth for the full costs associated with the Affordable Care Act’s annual insurer fee, as specified in section 9010(a) of the Affordable Care Act, Public Law 111-148; provided, that said add-on shall be exclusive of any additional rate increase currently being proposed for the fiscal year 2015; provided further, that not later than September 15, 2014, MassHealth shall provide a report of the total amount of reimbursement of the Affordable Care Act’s insurer fee to managed care organizations and senior care organizations to the house and senate committees on ways and means and the joint committee on health care financing; 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 funds shall be provided in an amount not less than the total appropriated in item 1599-2009 in section 2 of chapter 182 of the acts of 2008; provided further, that of the amount allocated in this line item, the office of Medicaid shall provide a two percent rate increase for Medicaid managed care organizations that are under contract with the commonwealth to deliver managed care services to Masshealth and care plus enrollees; 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 no funds shall be expended for 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 the federal financial participation received from claims filed based on in-kind administrative services related to outreach and eligibility activities performed by certain community organizations, under the "covering kids initiative," and in accordance with the federal revenue criteria in 45 CFR 74.23 or any other federal regulation which provides a basis for federal financial participation, shall be credited to this item and may be expended, without further appropriation, on administrative services including those covered under an agreement with the organizations participating in the program; provided further, $150,000 shall be expended for the work of the Massachusetts unaccompanied homeless youth commission to determine the scope of need among unaccompanied youth and young adults ages 24 and younger who are experiencing homelessness, and to identify and implement potential models for appropriate service delivery to unaccompanied homeless youth in urban, suburban, and rural areas of the commonwealth; provided further, that in calculating rates of payment for children enrolled in MassHealth receiving inpatient and outpatient services at acute care pediatric hospitals and pediatric specialty units as defined in section 8A of Chapter 118E of the General Laws, the executive office shall make a supplemental payment to any acute care pediatric hospital and pediatric specialty unit in the Commonwealth, above base rates, to compensate for high-complexity pediatric care in an amount not less than the amount appropriated in this item in Chapter 38 of the Acts of 2013; provided further, that notwithstanding any general or special law to the contrary, the commissioner of mental health shall 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 January 16, 2015, 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 to project caseload and utilization in fiscal year 2014 and fiscal year 2015; provided further, that the executive office of health and human services shall report to the house and senate committees on ways and means not later than January 13, 2015 on the number of members served in the dual eligible initiative, the average expenditure per member, the average expenditure per member prior to the demonstration project and the number of clients that receive care at skilled nursing facilities; provided further, that any projection of deficiency in item 4000-0430, 4000-0500, 4000-0600, 4000-0640, 4000-0700, 4000-0875, 4000-0880, 4000-0885, 4000-0940, 4000-0950, 4000-0990, 4000-1400, 4000-1420 or 4000-1425 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, 2015………………$90,557,569

And further amend the bill in section 2, in item 4000-0500, after the words “federal poverty level”, by inserting the following words: “provided further, that of the amount allocated in this line item, that $8,000,000 shall be allocated for providers in the PCC mental health and substance abuse plan” .

And further move to amend said in section 2, by striking out 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 MassHealth senior care options initiative 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 of the community choices initiative shall not be reduced below the services provided in fiscal year 2014; provided further, that the eligibility requirements for this demonstration project shall not be more restrictive than those established in fiscal year 2014; provided further, that funds shall be expended from this item to implement the pre-admission counseling and assessment program under the fourth paragraph of section 9 of chapter 118E of the General Laws, 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, funds shall be expended from this item to maintain 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 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 center for health information and analysis, in recognition of the 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 effective October 1, 2014, for the fiscal year ending June 30, 2015, the executive office of health and human services shall establish nursing facility Medicaid rates that are up to $47,476,982 in payments above the payments made to nursing facilities for fiscal year 2014, for the purpose of establishing the base year at calendar year 2007 costs; provided further, that the $47,476,982 in payments shall be subject to the availability of federal financial participation; provided further, that the executive office of health and human services shall notify the secretary of administration and finance and the chairs of the house and senate committee on ways and means prior to October 1, 2014, on the ability to obtain federal financial participation; and, provided further, that if federal financial participation is not available for said payments, the executive office of health and human services shall maintain the rates at the 2005 base year and shall make a one-time supplemental payment for nursing facility Medicaid rates for an amount not less than $23,738,491……………………………………………………$3,197,069,129

And further move to amend said section 2, by striking out item 4000-0700 and inserting in place thereof the following item:

4000-0700For health care services provided to medical assistance recipients under the executive office’s health care indemnity or third party liability plan, to medical assistance recipients not otherwise covered under the executive office’s managed care or senior care plans 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 payments 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 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 children who have aged out of the custody of the department of children and families shall be eligible for benefits until they reach age 21; provided further, that funds shall be expended from this item for members who qualify for early intervention services; provided further, that in calculating rates of inpatient and outpatient services for neonatal intensive care units, also known as (NICU), with at least 55 licensed beds with-in an acute hospital that has at least 109 pediatric intensive NICU beds, the executive office shall make a supplemental payment of not less than $200,000; provided further, that funds may be expended from this item for health care services provided to the recipients in prior fiscal years; provided further, the funds appropriated in item 4000-0265 of section 2A of chapter 142 of the acts of 2011 shall again be appropriated for the same dollar amount as in said line item 4000-0265 and shall be distributed in and managed in the same manner as designated in section 60 of chapter 118 of the acts of 2012; provided further, that MassHealth shall provide an additional 5 per cent of its standard payment amount per discharge, or SPAD, above rate year 2013, or of reimbursement provided under any subsequent inpatient payment methodologies and to provide an additional 5 per cent of its outpatient payment amount per episode or PAPE above rate year 2013, or of reimbursement provided under any subsequent outpatient payment methodologies to any acute care hospital that has greater than 63 per cent of its gross patient service revenue from governmental payers and free care as determined by the executive office of health and human services; provided further, that the executive office shall not, in fiscal year 2015, fund programs relating to case management with the intention of reducing length of stay for neonatal intensive care unit cases; provided further, that notwithstanding the foregoing, funds may be expended from this item for the purchase of third party insurance including, but not limited to, Medicare for any medical assistance recipient; provided further, that the executive office may reduce MassHealth premiums or copayments or offer other incentives to encourage enrollees to comply with wellness goals; and provided further, that funds may be expended from this item for activities relating to disability determinations or utilization management and review, including patient screenings and evaluations, regardless of whether such activities are performed by a state agency, contractor, agent, or provider…………………..$2,367,151,217

And further amend in the bill in section 2, in item 9110-1636, by inserting after the words “elder-at-risk program” the following words: “; provided, that not less than $50,000 shall be expended for the establishment of and administrative support of regional financial abuse specialist teams as recommended by the elder protective service commission established by section 204 of chapter 139 of the acts of 2012; provided further, that the executive office of elder affairs shall provide a report to the house and senate chairs of the joint committee on elder affairs on the implementation of FAST teams on or before June 30, 2015; and provided further, that no less than $50,000 shall be allocated for the Stanley Street Treatment and Resource Center in the city of Fall River” and in said item by striking out the figures “$22,710,663” and inserting in place thereof the figures: “$22,810,663”.

And further amend the bill in section 2, in item 9110-1660, by striking out the following: “provided, that providers of naturally occurring retirement communities shall not receive less than the amount appropriated in item 9110-1660 of section 2 of chapter 139 of the acts of 2012” and inserting in place thereof the following: “provided, that not less than $464,000 shall be expended for providers of naturally occurring retirement communities” and in said item by striking out the figures “$2,086,626” and inserting in place thereof the figures: “$2,336,626”.

And further amend the bill in section 2, in item 9110-1900, by inserting after the words “farm share program” the following words: “; and provided further, that not less than $750,000 shall be expended for home delivered meals” and in said item by striking out the figures “$6,378,317” and inserting in place thereof the figures: “$7,128,317”.

And further amend the bill in section 2, in item 9110-9002, by inserting after the words “secretary of elder affairs;” the following words: “provided further, that not less than $65,000 shall be expended for a one time grant to the city of Everett; provided further, that not less than $50,000 shall be expended for a one time grant to the city of Westfield;” and in said item by striking out the figures “$11,500,000” and inserting in place thereof the figures: “$11,615,000”.

And further move to amend the bill by striking out section 91;

And further move to amend the bill by striking out section 92.

And further moves to amend the bill by inserting after section 45 the following section:-

SECTION 45A. Section 57D of chapter 111 of the Generals Laws, as appearing in 2012 Official Edition, is hereby amended by striking out the third paragraph and inserting in place thereof the following paragraph:-

The department shall issue for a term of 2 years and renew for a like term a license to maintain a hospice program to any organization it considers responsible and suitable to maintain such a program. The department may issue not more than 8 licenses under this section to maintain an inpatient hospice program and shall promulgate regulations to govern the issuance of licenses to such programs. Hospice program licensees shall be subject to suspension, revocation or refusal to renew for cause. The department shall determine the fee and renewal of the license. Prior to issuing a new license, and every 4 years thereafter, the department, in consultation with the Hospice and Palliative Care Federation of Massachusetts, shall review the number of inpatient hospice facilities operating under this section, as well as the demand for such facilities, and make recommendations on the appropriate number of inpatient hospice facility licenses that should be available in the commonwealth. The department shall report its recommendations to the executive office of health and human services and the joint committee on public health.

And further move to amend the bill by inserting after section 53 the following section:-

SECTION 53B. The third paragraph of section 9 of chapter 118E of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by adding the following 3 sentences:- Enrollees with a household income that does not exceed 100 per cent of the federal poverty guidelines shall only be responsible for copayments equal to those required of enrollees in the MassHealth program. No other deductible or cost sharing shall apply to these enrollees. Enrollees with income that does not exceed 150 per cent of said guidelines shall have available to them at least one plan with no premium contribution.

And further move to amend the bill by inserting after section 62 the following section:-

SECTION 62E. Section 3 of chapter 176Q of the General Laws, as appearing in the 2012 Official Edition, is hereby amended by striking out clause (b) and inserting in place thereof the following clause:– (b) to determine each applicant's eligibility for purchasing insurance offered by the connector, and to establish eligibility criteria and determine eligibility for premium assistance payments or point of service cost-sharing subsidies for applicants at or below 300 per cent of the federal poverty guidelines, provided that individuals receiving premium assistance payments or point-of-service cost-sharing subsidies whose household income does not exceed 100 per cent of the federal poverty guidelines shall only be responsible for copayments equal to those required of enrollees in the MassHealth program, and no other deductible or cost sharing shall apply to these enrollees; provided further that individuals receiving premium assistance or point-of-service cost-sharing subsidies with income that does not exceed 150 per cent of said guidelines shall have available to them at least one plan with no premium contribution.

And further moves to amend the bill by inserting after section 66 the following section:-

SECTION 66B. Section 113 of chapter 58 of the acts of 2006 is hereby amended by inserting after the first sentence the following sentence:- Managed care organizations shall be required to file with MassHealth any contracts or subcontracts for the management and delivery of behavioral health services by specialty behavioral health organizations to MassHealth members, and MassHealth shall disclose such contracts upon request.

And further moves to amend the bill by inserting after section 73 the following section:-

SECTION 73C. Section 187 of chapter 38 of the acts of 2013 is hereby amended by striking out the last sentence and inserting in place thereof the following sentence:- The commission shall file its recommendations together with the drafts of legislation necessary to carry those into effect, with the clerks of the senate and the house of representatives, not later than 12 months after the first time the commission is convened.

And further moves to amend the bill by inserting after section 84 the following section:-

SECTION 84A. The executive office of health and human services shall authorize an additional $52,000,000 in item 1595-1068 for an operating transfer to the MassHealth provider payment account in the Medical Assistance Trust Fund established pursuant to section 2QQQ of chapter 29 of the General Laws; provided, that, except as otherwise provided in this section, these funds shall be expended on payment demonstration waivers pursuant to section 42 U.S.C. § 1315 for services provided during fiscal year 2015; provided further, that the additional authorization from the Medical Assistance Trust Fund shall be subject to the availability of federal financial participation, shall be made only under 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.

And further moves to amend the bill by inserting after section 101 the following sections:-

SECTION 101D. Effective July 1,2014, MassHealth and any commercial insurer that insures MassHealth subscribers shall provide breast pumps to expectant and new mothers as specifically prescribed by their attending physician, consistent with the provisions of the Affordable Care Act of 2010.

SECTION 101E. Notwithstanding any general or special law to the contrary, the director of MassHealth, in collaboration with the department of correction, shall study the feasibility of enrolling incarcerated persons eligible for medical assistance under chapter 118E into MassHealth. The director shall submit a report of its findings to the clerks of the house of representatives and senate, the joint committee on health care financing and the house and senate committees on ways and means on or before December 31, 2014.

SECTION 101F. There is hereby established a special commission on aphasia which shall consist of 13 members: 1 of whom shall be the secretary of the executive office of health and human services, or a designee, who shall serve as chair; 1 of whom shall be the commissioner of public health, or a designee; 1 of whom shall be the commissioner of insurance, or a designee; 3 members appointed by the senate president, 1 of whom shall be the senate chairman of the joint committee on public health, or a designee, 1 of whom shall be a person with aphasia and 1 of whom provides services to persons with aphasia; 3 members appointed by the speaker of the house of representatives, 1 of whom shall be the house chairman of the joint committee on public health, or a designee, 1 of whom shall be a person with aphasia and 1 of whom provides services to persons with aphasia; and 4 members appointed by the governor, 1 of whom shall be a person with aphasia, 1 of whom provides services to persons with aphasia, and 2 members of the public with demonstrated expertise in issues relating to the work of the commission.

The commission shall study and make recommendations regarding the need for support programs to meet the needs of persons with aphasia and their families, and which shall include, but not be limited to: (1) establishing a mechanism in order to ascertain the prevalence of aphasia in Massachusetts, and the unmet needs of persons with aphasia and those of their families; (2) studying model aphasia support programs, such as the Aphasia Center at Massachusetts General Hospital’s Institute of Health Professions Department of Communication Sciences and Disorders and the Aphasia Resource Center at Boston University College of Health & Rehabilitation Sciences: Sargent College; and (3) providing recommendations for additional legislation, support programs and resources necessary to meet the unmet needs of persons with aphasia and their families.

The commission shall organize within 120 days following the appointment of a majority of its members. Vacancies in the membership of the commission shall be filled in the same manner provided for the original appointments. Public members shall serve without compensation, but shall be reimbursed for necessary travel expenses incurred in the performance of their duties. The executive office of health and human services may provide staff support to the commission.

The commission shall report to the general court the results of its investigation and study and its recommendations, if any, together with drafts of legislation necessary to carry its recommendations into effect, by filing the same with the clerk of the senate and the clerk of the house of representatives on or before December 31, 2014.

And further move to amend the bill by inserting after section 102 the following section:-

SECTION 102B. Notwithstanding any general or special law to the contrary, the executive office of health and human services shall conduct a review of the financial impact of the failure of the health connector website following the implementation of the federal Patient Protection and Affordable Care Act. The review shall include a cost analysis of state funds expended for temporary coverage, including those funds that would have been reimbursed by the federal government had the Connector website been properly functioning. The executive office of health and human services shall provide a report of their findings to the joint committee on health care financing no later than July 31, 2014.