Consolidated Amendment #G to H.4200

Consolidated Amendment "G" to H4200

Health and Human Services and Elder Affairs

Fiscal Note: $3,137,000

Amendment 479 and 753 has been re-categorized to Public Health

Amendment 742 has been re-categorized to Veterans Services and Soldiers Homes

Amendments from the Health and Human Services:101, 105, 185,191, 210, 250, 263, 273, 287, 342, 423, 430, 472, 491, 520, 535, 552, 556, 602, 659, 679, 773, 785, 793, 794, 808, 810, 834, 865, 900, 914, 956, 963, 1022, 1026, 1041, 1050, 1106, 1118, 1119, 1144, 1192, 1196, 1273, 1278, 1281.

Amendments from Elder Affairs:51, 63, 90, 112, 167, 180, 240, 365, 382, 403, 482, 494, 699, 775, 778, 820, 887, 925, 1001, 1002, 1007, 1017, 1052, 1071, 1087, 1097, 1138, 1178, 1219, 1252.

Mr. Dempsey of Haverhill and others move to amend H 4200 in section 2, by striking out item 4000-0300 and inserting in place 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 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 $100,000 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 to ensure that rates of payment to providers shall not exceed the rates that are necessary to meet only those costs which shall 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 said chapter 118E 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, not less than $25,000 shall be provided to Baystate Noble Hopsital, a federal and state disproportionate share hospital that is geographically isolated, to make extensive improvements to the existing entranceway access for all patients, especially those challenged with disabilities, provided that such funds are matched by an equal or greater amount by Baystate Noble Hospitall; provided further, that no expenditures shall be made that are not federally reimbursable, including those related to Titles XIX or XXI of said Social Security Act or the MassHealth demonstration waiver pursuant to section 1115(a) of said Social Security Act or the community first demonstration waiver pursuant to section 1115 of said Social Security Act, 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 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 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 said chapter 118E, the executive office shall make a supplemental payment not less than $14,800,000 to any acute care pediatric hospital and pediatric specialty unit in the commonwealth, above base rates, to compensate for high-complexity pediatric care; 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 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 said chapter 118E 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 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 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 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, 2017 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; provided further, that any unexpended balance in these accounts shall revert to the General Fund on June 30, 2017; and provided further, that not later than January 18, 2017, 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 2016 and fiscal year 2017 $100,213,866

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 4000-0700 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 section 9 of chapter 118E of the General Laws and clauses (a) to (d), inclusive, and clause (h) of subsection (2) of section 9A of said chapter 118E 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 through the age limit specified in MassHealth’s approved state plan; provided further, that not less than $1,000,000 shall be made available to establish a 1-year pilot program to increase efficiencies and align system-wide goals within a 1 regional hospital system located in Western Massachusetts to improve the overall sustainability of the system and to create a comprehensive approach to system-wide needs and a transition into the structure of the new 1115 Medicaid Waiver; provided further, the pilot program wilinclude measurable milestones that shall demonstrate progress in at least 1 of the following areas: (i) care coordination, integration and delivery transformations; (ii) electronic health record and information exchange advancements; (iii) increasing alternative payment methods and accountable care organizations; (iv) enhancing patient safety; (v) increasing access to behavioral health services; (vi) increasing coordination between system hospitals and community-based providers and organizations; and (vii) preparing the system to undertake risk as a potentially designated ACO; provided further, that funds shall be expended from this item for members who qualify for early intervention services; 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 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 in fiscal year 2017 MassHealth shall maintain the same level of federally-optional chiropractic services that were in effect in fiscal year 2016 that were included in its state plan or demonstration program in effect on January 1, 2002 for members enrolled in the primary care clinician (PCC) program; provided further, that the executive office shall not, in fiscal year 2017, fund programs relating to case management with the intention of reducing length of stay for neonatal intensive care unit cases; provided further, that notwithstanding this item, 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 $2,435,238,433

And further amend said section 2, in item 4100-0060, in line 4, by inserting after the words “section 7 of said chapter 12C” the following: “and provided further, that up to $1,563,617 of this appropriation may be expended for the operation of the Betsy Lehman Center for Patient Safety.”;

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 2016 at proportions of total available funding equal to those provided in fiscal year 2016;

And further amend said item by striking the figure “$1,417,798” and inserting in place thereof the following figure:- “$2,059,798”;

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 “$6,506,375” and inserting in place thereof the following figure:- $7,256,375”;

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

9110-9002For 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 no less than $25,000 shall be allocated for the operation of the South Boston Neighborhood House and its Senior Programs; provided further, that the distribution schedules shall be submitted to the house and senate committees on ways and means; provided further, that no less than $50,000 shall expended for the maintenance of the heating system at the Gladys L. Hurrell Senior Center in Rehoboth; provided further, that $200,000 shall be expended for the construction, design, improvement, and addition of a council on aging facility at Dedham town hall; provided further, that not less than $50,000 shall be expended for hiring a full time director for the Council on Aging in Wareham; provided further, that not less than $75,000 shall be expended for the cost associated with care and services provided at Whipple Senior Center in Weymouth; provided further, that no less than $50,000 shall be expected for ABCD North End/West End elderly program; provided further, that not less than $50,000 shall be expended to the towns of Maynard and Acton for the senior van program; provided further, that no less than $100,000 shall be expended to provide furnishings and equipment for a Senior Community Center in Greenfield; and provided further, that not less than $20,000 shall be granted to Quincy’s Council on Aging to enable the agency to create a dementia-capable system of home and community-based services and supports ……………….$14,650,000

And further amend the bill in section 2D by inserting after “EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES.” the following:

Executive Office of Elder Affairs

OLDER AMERICANS ACT

For the purposes of a federally funded grant entitled, Older Americans Act

9110-1074.......$109,606

TITLE VII OMBUDSMAN

For the purposes of a federally funded grant entitled, Title VII Ombudsman

9110-1075.......$336,169

TITLE IIIB SUPPORTIVE SERVICE

For the purposes of a federally funded grant entitled, Title IIIB Supportive Service

9110-1076.......$10,182,633

NATIONAL FAMILY CAREGIVER SUPPORT PROGRAM

For the purposes of a federally funded grant entitled, National Family Caregiver Support Program

9110-1077.........$3,700,000

IIID PREVENTATIVE HEALTH

For the purposes of a federally funded grant entitled, IIID Preventative Health

9110-1079.........$436,823

STATE HEALTH INSURANCE ASSISTANCE PROGRAM

For the purposes of a federally funded grant entitled, State Health Insurance Assistance Program

9110-1094........$1,097,000

OLDER AMERICANS ACT

For the purposes of a federally funded grant entitled, Older Americans Act

9110-1173.........$13,383,620

NUTRITION SERVICES INCENTIVE PROGRAM

For the purposes of a federally funded grant entitled, Nutrition Services Incentive Program

9110-1174..........$ 4,885,300

COMMUNITY SERVICE EMPLOYMENT PROGRAM

For the purposes of a federally funded grant entitled, Community Service Employment Program

9110-1178..........$ 1,881,340

MA CHRONIC DISEASE SELF-MANAGEMENT EDUCATION PROGRAM

For the purposes of a federally funded grant entitled, MA Chronic Disease Self-Management Education Program

9110-1190...........$100,714

ENHANCED ALCOHOL AND DRUG RECOVERY OPTIONS COUNSELING PROGRAM

For the purposes of a federally funded grant entitled, Enhanced Alcohol and Drug Recovery Options Counseling Program

9110-1191.............$198,706

2013 MIPPA ADRC

For the purposes of a federally funded grant entitled, 2013 MIPPA ADRC

9110-1194.............$79,154

ALZHEIMER'S DISEASE SUPPORTIVE SERVICE PROGRAM

For the purposes of a federally funded grant entitled, Alzheimer's Disease Supportive Service Program

9110-1197.............$200,000

Moves to further amend the bill by inserting after section 24 the following section:-

Section 24A Item 9110-1630 of chapter 46 of the acts of 2015 is hereby amended by adding the following words:- ; provided further, that the executive office of elder affairs shall report, not later than January 1, 2017, to the house and senate committees on ways and means on: (i) enrollment data and any other information relevant to caseload forecasting for items 9110-1630 and 9110-1500 at current levels; (ii) projected utilization of services provided by said items 9110-1630 and 9110-1500 with eligibility expanded to include the individuals whose income does not exceed 275 per cent of the federal poverty level and with eligibility expanded to include the individuals whose income does not exceed 300 per cent of the federal poverty level; (iii) the projected fiscal impact of expanding eligibility to include the individuals whose income does not exceed 275 per cent of the federal poverty level and the individuals whose income does not exceed 300 per cent of the federal poverty level; (iv) program design considerations regarding the application of cost-sharing revenues to best support individuals in an expansion population of up to 300 per cent of the federal poverty level; provided further that the executive office of health and human services may file a state plan amendment for section 1915(i) of the federal Social Security Act to maximize the opportunity for federal financial participation for any future expansion of eligibility for individuals whose incomes exceed current limits.

And moves to further amend the bill by inserting after section 42 the following sections:-

SECTION 42A. The office of Medicaid within the executive office of health and human services, in consultation with the department of transitional assistance, shall study and report on the feasibility of offering MassHealth applicants or recipients the opportunity to complete a common application for MassHealth and for programs administered by the department of transitional assistance, including the federal Supplemental Nutrition Assistance Program, the Program for Emergency Aid to Elders, Disabled and Children pursuant to chapter 117A and the Program for Transitional Assistance to Families with Dependent Children pursuant to chapter 118. The report shall be filed with the clerks of the house of representatives and senate, who shall forward the same to the joint committee on health care financing, and the joint committee on children, families and persons with disabilities no later than January 1, 2017.

SECTION 42B: The health policy commission, in consultation with the state’s community hospitals, shall develop a marketing campaign to show the high value of community hospitals and the cost and quality benefits to patients and employers of seeking care in local settings. The commission shall direct not more than $500,000 from the distressed hospital trust fund, established under section 2GGGG of chapter 29 of the General Laws, to fund the development and implementation of the marketing campaign.