Budget Amendment ID: FY2014-S3-625-R1

Redraft EHS 625

Equitable Rates for Medicaid Managed Care Organizations

Messrs. Welch, Knapik and Moore and Ms. Lovely and Ms. Candaras and Mr. DiDomenico and Ms. Clark and Ms. Chandler and Messrs. Petruccelli, Downing, Donnelly and Tarr moved that the proposed new text be amended in section 2, in item 4000-0500, by adding the following words:-

“; provided further, that the office of Medicaid shall work with the managed care organizations that are under contract with the commonwealth to deliver managed care services to MassHealth enrollees and other relevant stakeholders to develop changes to Medicaid payment policies, quality improvement programs and any other programmatic changes that promote provider efficiencies; provided further, that the office of Medicaid shall work with its actuary to ensure that the development of capitation rates for contracting managed care organizations appropriately account for changes in MassHealth provider rates, that take effect during state fiscal year 2014; provided further, that MassHealth shall report to the house and senate committees on ways and means not later than October 1, 2013 on proposed provider efficiencies and the methodology used to develop actuarially sound capitation rates for managed care organizations, which account for changes to provider rates and develop actuarially sound rates; and provided further, that if MassHealth fails to produce the report and develop actuarially sound capitation rates that account for changes in provider rates that take effect during state fiscal year 2014, then, to the extent permissible under federal law and regulations and subject to the availability of federal financial participation, MassHealth shall adjust each Medicaid managed care organization’s base capitation rate to reflect increases in hospital payments paid by Medicaid managed care organizations to their network acute hospitals as a result of state fiscal year 2014 base hospital rate increases”.