Consolidated Amendment #F to H.3600

Consolidated Amendment "F" to H3600

Health and Human Services and Elder Affairs

Fiscal Note: $7,562,000

Amendment 1091 has been re-categorized to Public Health.

Amendments from the Health and Human Services: 15, 25, 31, 100, 126, 191, 203, 226, 281, 316, 341, 349, 378, 419, 439, 476, 486, 517, 525, 553, 586, 609, 637, 695, 740, 769, 804, 807, 813, 817, 818, 835, 876, 878, 880, 909, 914, 951, 959, 969, 1013, 1050, 1077, 1080, 1088, 1092, 1114, 1157, 1208.

Amendments from Elder Affairs: 27, 77, 148, 181, 217, 222, 293, 303, 446, 448, 449, 461, 478, 501, 556, 560, 571, 633, 672, 687, 696, 737, 778, 816, 893, 908, 1027, 1029, 1090.

Mr. Dempsey of Haverhill and others move to amend H 3600 in section 2, in item 4000-0005, by inserting after the words “as selected in fiscal year 2017;” the following:- provided further, that not less than $25,000 shall be expended to Springfield Partners, Inc. for the AWAKE program in Springfield, to provide comprehensive youth development and violence prevention services to at-risk youth;

And further amend said item by striking the figure “$6,000,000” and inserting in place thereof the following figure:- 6,025,000;

And further amend said section 2, by inserting after item 4000-0005 the following item:-

4000-0007For housing and supportive services for unaccompanied youth pursuant to section 16X of chapter 6A of the General Laws; provided that not less than $40,000 shall be expended for the Y2Y homeless shelter in Cambridge; and provided further, that the secretary of health and human services shall report to the house and senate committees on ways and means not later than March 1, 2018 on: (a) the number of youths served through this item; (b) the types of services received by participating youths; (c) the number of youths who transition into stabilized housing and the zip code of the stabilized housing; (d) the number of youths who remain in stabilized housing after 90 days, when applicable; (e) other quantifiable data related to client outcomes as determined by the secretary; (f) the number of youths turned away from the program; and (g) the amount of funding awarded to vendors for the delivery of services and the names of each vendor. $540,000

And further amend said section 2, by striking out item 4000-0300 and inserting in place thereof the follow 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 under chapter 118E of the General Laws; provided further, that all applications, application information, service information and guidelines, in electronic form, paper form and on the website, for MassHealth and MassHealth related programs shall be made available in both classical and traditional Chinese translations; 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 not less than $25,000 shall be expended to contract with Martha’s Vineyard Community Services, Inc. for the purpose of increasing access to health and human services on Martha’s Vineyard and Nantucket; 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 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 no expenditures, whether made by the executive office or another commonwealth entity, 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, the MassHealth demonstration waiver under section 1115(a) of the Social Security Act, as codified at 42 U.S.C. section 1315(a), or the community first demonstration waiver under section 1115 of the Social Security Act, as codified at 42 U.S.C. section 1315, except as required for: (a) the equivalent of MassHealth standard benefits for children under 21 years of age 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 21 years of age or over; (c) for managed care capitation payments for any MassHealth members who are residents of Institutions for Mental Disease for more than 15 days in any calendar month, and otherwise as explicitly authorized; or (d) 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 before making these expenditures; 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 not less than $250,000 shall be expended for the Brookline Community Mental Health Center, Inc. to expand the healthy lives program; 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 under 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, 2018 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 the executive office shall submit a report not later than December 1, 2017 to the house and senate committees on ways and means and the joint committee on health care financing detailing utilization in fiscal year 2017 of the Health Safety Net Trust Fund established in section 66 of said chapter 118E; provided further, that the report shall include: (a) the number of persons whose medical expenses were billed to the Health Safety Net Trust Fund; (b) the total dollar amount billed to the Health Safety Net Trust Fund; (c) the age, income level, and insurance status of recipients using the Health Safety Net Trust Fund; (d) the types of services paid for out of the Health Safety Net Trust Fund; and (e) the amount disbursed from the Health Safety Net Trust Fund to each hospital and community health center; provided further, that the office of Medicaid shall coordinate with the health policy commission in the development of care delivery and payment models in the MassHealth program, including patient-centered medical homes and accountable care organizations, in order to ensure alignment of such models with the commission’s certification programs under sections 14 and 15 of chapter 6D of the General Laws; provided further, that any unexpended balance in these accounts shall revert to the General Fund on June 30, 2018; provided further, that not later than January 18, 2018, 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 2017 and fiscal year 2018; provided further, that the executive office of health and human services, in consultation with the department of transitional assistance, shall report to the joint committee on ways and means, the joint committee on health care financing, and the joint committee on children, families and persons with disabilities, no later than January 1, 2018, 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; and provided further, that MassHealth shall establish a direct phone number for court employees who serve participants of specialty courts to use in contacting MassHealth regarding enrollment and other benefits’ issues for participants and MassHealth shall notify the specialty courts administrator with the direct contact number and other pertinent information within 30 days after the effective date of this item $103,777,734

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 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 recipients in prior fiscal years; provided further, that 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 MassHealth shall expend not less than an additional $13,000,000 in the aggregate for acute care hospitals that have greater than 63 percent of their gross patient service revenue from governmental payers and free care as determined by the executive office of health and human services; provided further, that in fiscal year 2018 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 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 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, that the pilot program will include measurable milestones that shall demonstrate progress in at least 1 of the following areas: (a) care coordination, integration and delivery transformations; (b) electronic health records and information exchange advancements; (c) increasing alternative payment methods and accountable care organizations; (d) enhancing patient safety; (e) increasing access to behavioral health services; (f) increasing coordination between system hospitals and community-based providers and organizations; and (g) preparing the system to undertake risk as a potentially designated ACO; provided further, that the executive office shall not, in fiscal year 2018, 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; 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; provided further, that not later than March 1, 2018 the executive office shall report to the house and senate committees on ways and means on: (a) dental coverage available to MassHealth recipients as of January 1, 2018 as it compares to dental coverage available to MassHealth recipients on January 1, 2010; (b) utilization of dental services in fiscal year 2017 and fiscal year 2018; (c) the actual and projected costs and revenue associated with dental coverage in fiscal year 2017 and fiscal year 2018; (d) the estimated cost effectiveness of dental coverage as a contributor to MassHealth total cost of care; and (e) a schedule to include within its covered services for adults at least those federally optional services for dental care and dentures which were included in its state plan in effect on January 1, 2010 and the accompanying cost of implementation; and provided further, that the executive office shall maintain full-year coverage for adult dental fillings and adult denture coverage $2,664,848,930

And further amend said section 2, in item 4000-1700, by striking out the figure “$125,223,292” and inserting in place thereof the following figure:- “$127,723,292”;

And further amend said section 2, in item 9110-1636, by striking out the figure “$29,207,918” and inserting in place thereof the following figure:- $29,457,918

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 2017 at proportions of total available funding equal to those provided in fiscal year 2017;

And further amend said item by striking the figure “$1,427,880” and inserting in place thereof the following figure:- “$2,069,880”;

And further amend said section 2, in by striking out item 9110-1700, and inserting in place thereof the following item:-

9110-1700 For assessment, placement and homelessness prevention services for homeless and at-risk elders………………………………………………………………………… “$261,000”;

And further amend said section 2, in item 9110-1900, by inserting after the word “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 “$6,507,795” and inserting in place thereof the following figure:- $7,257,795”;

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 expended on a grant for the Quincy department of elder affairs; provided further, that no less than $25,000 shall be expended on the West Brookfield Senior Center; provided further, that no less than $25,000 shall be expended on the Norwell Council on Aging; provided further, that not less than $50,000 shall be expended on the Seekonk Senior Center; provided further, that not less than $75,000 shall be expended on the Whipple senior center of Weymouth; provided further, that $25,000 shall be expended on the South Boston Neighborhood House; provided further, that no less than $100,000 shall be expended on the Dedham Council on Aging; provided further, that no less than $150,000 shall be expended on the Arlington senior center; provided further, that not less than $25,000 shall be expended on the West Brookfield senior center; provided further, that not less than $15,000 shall be expended on the Carver council on aging; provided further that not less than $15,000 shall be expended on the Billerica Friends of the council on aging; and provided further, that the distribution schedules shall be submitted to the house and senate committees on ways and means not later than February 15, 2018 ….$14,555,000

And moves to further amend the bill by inserting, after section 40, the following section:-

SECTION 40A. Said chapter 111 is hereby amended by inserting after section 51J, the following new section:-

Section 51L. For the purposes of this section, the following terms shall have the following meanings:-

"Home Care Worker" means any person employed by a home care aide agency to provide home health, homemaker, personal care, companion, or chore services.

"Home Care Aide Agency" means an entity providing designated and approved home care program services under contract with an Aging Services Access Point as defined in section 4B of chapter 19A as appearing in the 2014 Official Edition.

"Home Care Worker Registry" means the registry established under this section.

The department, subject to appropriation and in consultation with the executive office of elder affairs, shall establish a home care worker registry of all individuals currently employed by a home care aide agency. A home care aide agency shall only hire or employ on a paid, unpaid, temporary or permanent basis, a home care worker who is listed in said registry as having completed all required certifications and trainings.

The registry shall also contain specific documented findings, in accordance with this section, by any department within the executive office of health and human services of patient or resident abuse, mistreatment, neglect or misappropriation of patient or resident property involving an individual listed on the registry. All home care aide agencies shall contact the registry prior to hiring an employee to ascertain if there is a finding of patient or resident abuse, mistreatment, neglect or misappropriation of patient or resident property. In the case of inquiries to the registry, any information disclosed concerning a finding of patient or resident abuse, mistreatment, neglect or misappropriation of patient or resident property shall also include a disclosure of any statement in the registry relating to the finding or a clear and accurate summary of any such statement. No home care aide agency shall hire an individual whose name appears in the registry with an adjudicated finding of patient or resident abuse, mistreatment, neglect or misappropriation of patient or resident property if that individual is under a suspension or termination imposed by the department under the terms of this section.

The department shall make a finding as to the accuracy of allegations of patient or resident abuse, mistreatment, neglect or misappropriation of patient or resident property after providing notice to the home care worker of the allegation and a reasonable opportunity for a hearing for the individual to rebut such allegations. If the department finds that a home care worker abused, mistreated or neglected a patient or resident or misappropriated patient or resident property, the department shall notify the home care worker and the home care aide agency of that finding. The department shall not make a finding that an individual has neglected a patient or resident if the individual demonstrates that such neglect was caused by factors beyond the control of the individual. Upon making a finding of patient or resident abuse, mistreatment, neglect or misappropriation of patient or resident property, the department may suspend the right of such individual to work as a home care worker. The department shall include the terms of any such suspension in the registry and no home care aide agency shall hire that individual until the suspension has been served to its completion.

If the individual is charged with and convicted of a crime arising out of a report of abuse, the department shall terminate the individual’s ability to work as a home care worker; provided, however, that if an individual’s finding of guilt is overturned on appeal, the individual may appeal to the department to overturn the termination. If a case is continued without a finding, the department may suspend an individual’s ability to work as a home care worker and shall make such a finding on the record to that effect after notice to that individual and an opportunity to appeal; provided, however, that a case continued without a finding shall appear in the registry as part of the registrant’s record for not less than the length of probation or sanction imposed on the individual by the court.

A home care worker who is subject to a suspension or termination shall not offer services, whether publicly or privately funded, as a caregiver or in another direct service capacity to persons with a physical, intellectual or developmental disability, a mental illness or to children or elderly persons. An individual in violation of this paragraph shall be subject to a fine, as determined by the department.”

The home care worker registry shall include, but not be limited to, the following information concerning each home care worker: (i) full legal name; (ii) current home address; (iii) date of birth; (iv) employers full legal name; (v) job title; and (vi) an updated list of home care trainings and/or certifications completed by the home care worker.

The department shall require the registry information for each employed home care worker to be submitted and regularly updated by each home care aide agency subject to the provisions of this subsection. A home care aide agency shall collect and maintain the required information for each employed home care worker and shall promptly submit updated information whenever such information changes. No charges shall be imposed on any person or entity for any costs related to the registry.

Persons employed as a home care worker by a home care aide agency on the effective date of this section shall be registered not later than 12 months after the effective date of this statute. The registry shall be updated at least quarterly.

The registry shall be sufficiently and promptly accessible to meet the needs of the public. Upon request, information in the home care worker registry shall be made available to home care workers and home care aide agencies. The department shall include security mechanisms in the registry to implement and maintain a record of accessing or obtaining information from the registry.

The department shall make any such additional rules and regulations as are reasonably necessary to implement the provisions of this subsection.