Consolidated Amendment #G to H.3400

Consolidated Amendment "G" to H3400

Health and Human Services and Elder Affairs

Fiscal Note: $18,867,000

Amendment 771 has been re-categorized to Elder Affairs

Amendment 958 has been re-categorized to Elder Affairs

Amendments from the Health and Human Services: 16, 85, 92, 127, 158,173, 203, 209, 222, 270, 285, 296, 298, 404, 433, 435, 436, 487, 490, 512, 534, 539, 580, 598, 614, 691, 729, 730, 807, 819, 875, 925, 955, 975, 1033, 1038, 1049, 1062, 1070, 1078, 1088, and 1092.

Amendments from Elder Affairs: 123, 271, 368, 511, 531, 610, 703, 737, 738, 771, 772, 843, 876, 958, 1008, and 1009.

Mr. Dempsey of Haverhill and others move to amend H.3400 in section 2, by inserting after item 1599-1979 the following item:-

1599-2004For a reserve to be administered by the health policy commission to develop a pilot program to implement a model of field triage of behavioral health patients under medical control by specially-trained emergency medical services providers, care for appropriate patients at home by such providers in coordination with behavioral health care providers, and transport of appropriate, non-medically complex patients to a behavioral health site of care for most effective treatment rather than to an acute hospital emergency department; provided further, that the commission shall implement this pilot to triage behavioral health patients in the greater Quincy area affected by the recent hospital closure; provided further, that in developing the program, the commission shall consider evidence-based practices from successful programs implemented locally, nationally, or internationally; provided further, that the commission shall report to the joint committee on mental health and substance abuse and the house and senate committees on ways and means not later than 12 months following completion of the pilot program on its results, including its effectiveness, efficiency, and sustainability; and provided further, that funds appropriated in this item shall not revert and shall be available for expenditure through June 30, 2017……………..$500,000

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 continue to develop and implement the common client identifier; 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 the executive office 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 contract with Martha’s Vineyard Community Services, Inc. for no less than $75,000 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 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 on or before December 31, 2015, not less than $150,000 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 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 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 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 initiative; 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 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 fifty percent of the amount appropriated in this item in Chapter 165 of the acts of 2014; 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, $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 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 18, 2016, 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 2015 and fiscal year 2016; 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, 2016 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, 2016 $91,865,452

And further amend said section 2, in item 4000-0600, in line 20, by striking out the following “up to” and inserting in place therof the following “of”

And further amend said section 2, by striking out item 4000-0640 and inserting in place thereof the following item:-

4000-0640For nursing facility Medicaid rates; provided, that notwithstanding any general or special law to the contrary, in fiscal year 2016 the executive office of health and human services, in consultation with the center for health information and analysis, shall establish nursing facility Medicaid rates that cumulatively total $291,600,000 more than the annual payment rates established under the rates in effect as of June 30, 2002; provided further, that the MassHealth agency shall adopt all additional regulations and procedures necessary to carry out this item; provided further that effective July 1, 2015 the executive office of health and human services shall establish nursing facility MassHealth rates that fully recognize the Medicaid share of the nursing home assessment established by section 63 of chapter 118E of the General Laws; provided further, that an amount for expenses related to the collection and administration of section 63 of chapter 118E of the General Laws shall be transferred to the executive office of health and human services; provided further, that not less than $2,800,000 shall be expended as incentive payments to nursing facilities meeting the criteria determined under the MassHealth Nursing Facility Pay-for-Performance Program 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 and that shall decide jointly how to expend such incentive payments; provided further, that the MassHealth agency shall adopt all additional regulations and procedures necessary to carry out this section; and provided further, that the payments made under this item shall be allocated in an amount sufficient to implement section 622 of chapter 151 of the acts of 1996 $300,400,000

And further amend said section 2, in item 4000-0700, by striking out the figure “$2,491,392,092” and inserting in place thereof the following figure:- $2,498,792,092

And further amend said section 2, in item 9110-1500, by inserting after the words “section 1396n(c);” the following:- provided further, that the executive office shall submit a report, not later than October 7, 2015, to the house and senate committees on ways and means which shall include the number of individuals receiving services from the intensive care management program on July 1, 2015 and a subsequent report, not later than March 15, 2016 on the number of individuals receiving services from the intensive care management program on March 1, 2016;

And further amend said section 2, in item 9110-1636, by inserting after the words “elder-at-risk program” the following:- ; provided, that not less than $50,000 shall be expended for the establishment of and administrative support of regional Financial Abuse Specialist Teams to improve the ability of elder protective services programs to investigate and respond to reports of financial exploitation as recommended by the Elder Protective Service Commission established by section 204 of Chapter 139 of the Acts of 2012; and 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, 2016;

And further amend said item by striking out the figure “$23,123,254” and inserting in place thereof the following figure:- $23,173,254;

And further amend said section 2, in item 9110-1660, by inserting after the words “elderly” the following:- ; provided, that not less than $642,000 shall be expended for providers of naturally occurring retirement communities with whom the department of elder affairs entered into service agreements within fiscal year 2015 at proportions of total available funding equal to those provided in fiscal year 2015;

And further amend said item by striking out the figure “$1,512,626” and inserting in place thereof the following figure:- $2,154,626;

And further amend said section 2, in item 9110-1900, by inserting after the words “share program” the following:- ; and provided further, that not less than $750,000 shall be expended for home delivered meals;

And further amend said item by striking out the figure “$6,381,427” and inserting in place thereof the following figure:- $7,131,427;

And further amend said section 2, by striking out item 9110-9002 and inserting in place thereof the following item:-

9110-9002 For grants to the councils on aging and for grants to or contracts with non-public entities which are consortia or associations of councils on aging; provided, that notwithstanding the foregoing, all monies appropriated in this item shall be expended in accordance with the distribution schedules for formula and incentive grants established by the secretary of elder affairs; provided further, that the distribution schedules shall be submitted to the house and senate committees on ways and means; provided further, that not less than $150,000 shall be expended for the Rossetti-Cowan Senior Center in Revere; provided further, that not less than $50,000 shall be expended for the costs associated with care and services provided at Whipple Senior Center in the Town of Weymouth; provided further, that not less than $65,000 shall be expended for the Sterling Senior Center; provided further, that not less than $75,000 shall be expended as a grant to the town of Easton for the Easton Council on Aging; provided further, that not less than $60,000 be provided to the Worcester Regional Transit Authority for the establishment of a Senior Van and Paratransit Service in the Town of Boylston; provided further, that not less than $50,000 shall be expended as a grant to the town of Braintree for the Braintree Council on Aging; and provided further, that not less than $50,000 shall be expended for the Winchendon Senior Center……………….$13,415,000;

And further amend the bill by inserting after section 7 the following section:

SECTION 7A: Chapter 6A of the General Laws is hereby amended by inserting after section 16X the following section:-

16Y. (a) There shall be a commission within the executive office of health and human services for the purpose of studying and making recommendations relative to state policies and regulations on LGBT older adults to ensure equality of access, treatment, care and benefits; examine strategies to increase provider awareness of the needs of LGBT older adults and their caregivers and to improve the competence of and access to treatment, services and on-going care, including preventive care; assess the funding and programming needed to enhance services to the growing population of LGBT older adults; examine best practices for increasing access, reducing isolation, preventing abuse and exploitation, promoting independence and self-determination, strengthening caregiving, eliminating disparities and improving quality of life; examine whether certain policies and practices, or the absence thereof, promote the premature admission of LGBT older adults to institutional care; recommend, as appropriate and necessary, lower cost and culturally appropriate home and community-based alternatives to institutional care; examine the feasibility of developing statewide training curricula to improve provider competency in the delivery of health, housing and long-term support services to older LGBT adults and their caregivers; and examine outreach protocols to reduce apprehension among LGBT elders and caregivers of utilizing mainstream providers.

(b) The commission shall consist of the house and senate chairs of the joint committee on elder affairs or their designees, who shall serve as co-chairs; the secretary of elder affairs or a designee; the director of housing and community development or a designee; the commissioner of public health or a designee; the director of the LGBT Aging Project or a designee; the president of Fenway Health or a designee; the executive director of the Gay & Lesbian Advocates & Defenders or a designee; a representative of the National Association on HIV Over Fifty, Inc.; the executive director of MassEquality or a designee; the executive director of the Mass Home Care or a designee; the director of AARP Massachusetts or a designee; the executive director of the Massachusetts Association of Councils on Aging, Inc. or a designee; the director of the Massachusetts Senior Care Association or a designee; the director of the Massachusetts Council for Home Care Aides Services, Inc. or a designee; and 5 members appointed by the governor, 1 of whom shall be a member of the Massachusetts bar who practices elder law, 1 of whom shall be an expert in LGBT public policy or research and 3 LGBT elders, at least 1 of whom shall be transgender. The governor’s appointees shall ensure that the commission has at least 1 representative from each of the following areas: Cape Cod, western Massachusetts and central Massachusetts.

(c) The commission may hold regular public meetings, fact-finding hearings and other public forums as it considers necessary and shall submit an annual report by December 31 to the governor, the clerks of the house of representatives and the senate, and the joint committee elder affairs. The report shall include, but not be limited to, the commission’s findings and any recommendations for regulatory or legislative action, with a timeline for implementation, cost estimates and finance mechanisms, any other efforts to address the needs of this population.

And moves to further amend the bill by inserting after section 20 the following section:-

SECTION 20A. Chapter 10 of the General Laws is hereby amended by inserting after section 35UU the following section:-

35UU 1/2. There shall be established and set up on the books of the commonwealth a separate fund to be known as the Acute Care Hospital Trust Fund which shall be administered by the secretary of health and human services. Subject to appropriation, monies from the trust fund may be expended for payments to acute care hospitals.

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

SECTION 66A. Notwithstanding section 53 of chapter 118E of the General Laws, for fiscal year 2016, the executive office of health and human services may determine the extent to which to include within its covered services for adults the federally-optional dental services that were included in its state plan or demonstration program in effect on January 1, 2002; provided that dental services shall be covered for adults at least to the extent covered as of June 30, 2015.

SECTION 66B. Notwithstanding the provision of section 2GGGG of chapter 29 of the General Laws or any other general or special law or regulation to the contrary, on January 1, 2016, the Health Policy Commission shall transfer from the Distressed Hospital Trust Fund the following amounts:

(a) $8,227,865 to the Delivery System Transformation Initiatives Trust Fund established by section 35UU of chapter 10 of the General Laws; provided, that these funds shall be expended under the delivery system transformation initiative master plan and hospital-specific plans approved in the MassHealth section 1115 demonstration for state or federal fiscal year 2015; provided further, that all payments from the Delivery System Transformation Initiatives Trust Fund shall be subject to the availability of federal financial participation, shall be made only in accordance with 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;

(b) $17,153,885 to the Acute Care Hospital Fund, provided, that of these funds, $11,000,000 shall provide an additional 5 per cent of the office of Medicaid’s 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 $6,153,885 shall be provided for supplemental payments to inpatient and outpatient behavioral and mental health services provided by 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 such behavioral and mental health supplemental payments shall be subject to all required federal approvals and the availability of federal financial participation and shall be prioritized for services provided to children and adolescents.

SECTION 66C. (a) There shall be a special commission relative to ovarian cancer in the Commonwealth. The commission shall consist of the following members: the secretary of the executive office of health and human services, or a designee; the commissioner of public health, or a designee; the commissioner of insurance, or a designee; and 8 members who shall be appointed as follows: 2 members appointed by the senate president, 1 of whom shall be a person with or survivor of ovarian cancer and 1 of whom is a medical specialist in ovarian cancer; 2 members appointed by the speaker of the house of representatives, 1 of whom shall be a person with or survivor of ovarian cancer and 1 of whom is a medical specialist in ovarian cancer; and 4 members appointed by the governor, 1 of whom shall be a person with or survivor of ovarian cancer, 1 of whom is a medical specialist in ovarian cancer, and 2 members of the public with demonstrated expertise in issues relating to the work of the commission.

(b) The commission shall study and report on the following: (i) establish a mechanism in order to ascertain the prevalence of ovarian cancer in Massachusetts and, to the extent possible, collect statistics relative to the timing of diagnosis and risk factors associated with ovarian cancer; (ii) determine how to best effectuate an early diagnosis and treatment for ovarian cancer patients; (iii) determine any unmet needs of persons with ovarian cancer and those of their families; and (iv) provide recommendations for additional legislation, support programs and resources necessary to meet the unmet needs of persons with ovarian cancer and their families.

(c) The commission shall file its report and recommendations with the clerks of the senate and house of representatives and the chairs of the joint committee on public health by December 31, 2015.

SECTION 66D. Notwithstanding any general or special law to the contrary, the office of Medicaid shall establish a prospective, global payment pilot program under which Medicaid contracts with risk-bearing provider organizations for the provision and coordination of health care services for their attributed members beginning not later than September 1, 2016; provided, that such risk-bearing provider organizations shall be able to provide coordinated care through the provider’s network of primary care providers; provided further, that such providers shall have experience and demonstrated capabilities to provide behavioral health services including psychiatric and substance abuse beds; provided further, that Medicaid shall reimburse such providers on a prospective monthly basis; provided further, that such risk-bearing provider organizations that have obtained a risk certificate or a waiver from the Division of Insurance pursuant to section 3 of chapter 176T shall not be required to obtain additional insurance licensure under chapters 175, 176A, 176B, 176G, 176I or 176J of the General Laws; provided further, that the program shall not go into effect until the division of insurance, in conjunction with other health policy agencies, has promulgated regulations providing for risk certificates or procedures for waivers for such risk-bearing provider organizations.