SECTION 2SSSS. MassHealth Delivery System Reform Trust Fund

(a) There shall be a MassHealth Delivery System Reform Trust Fund. The secretary of health and human services shall be the trustee of the fund and shall expend money in the fund to: (i) provide reimbursement for services delivered to MassHealth beneficiaries by acute hospitals participating in the MassHealth program; (ii) make enhanced service payments and incentive payments to acute hospitals and other providers or care organizations under contract to provide MassHealth services pursuant to an approved state plan or federal waiver; and (iii) provide for other federally-approved delivery system reform incentive program purposes. There shall be credited to the fund: (1) any transfers from the Health Safety Net Trust Fund established in section 66 of chapter 118E; (2) an amount equal to any federal financial participation revenues claimed and received by the commonwealth for eligible expenditures made from the fund; (3) any revenue from appropriations or other money authorized by the general court and specifically designated to be credited to the fund; and (4) interest earned on any money in the fund. Amounts credited to the fund shall be expended without further appropriation.

(b) Money in the fund may be expended for Medicaid payments under an approved state plan or federal waiver; provided, however, that all payments from the fund shall be: (i) subject to the availability of federal financial participation; (ii) made only under federally-approved payment methods; (iii) consistent with federal funding requirements and all federal payment limits as determined by the secretary of health and human services; and (iv) subject to the terms and conditions of an agreement between acute hospitals, other providers or care organizations and the executive office of health and human services. To accommodate timing discrepancies between the receipt of revenue and related expenditures, the comptroller may certify for payment amounts not to exceed the most recent revenue estimates as certified by the secretary of health and human services to be transferred, credited or deposited under this section. Money remaining in the fund at the end of a fiscal year shall not revert to the General Fund.

[Subsection (c) effective until October 1, 2022. Deleted by 2016, 115, Sec. 5. See 2016, 115, Sec. 13.]

(c)(1) Effective October 1 of each provider or care organization rate year, the secretary of health and human services shall expend money in the fund for MassHealth services provided by qualifying acute hospital providers under contract with the executive office of health and human services or under subcontracts with care organizations that contract with the office in connection with the MassHealth program.

(2)(A) The secretary of health and human services shall expend $250,000,000 in payments to qualifying acute hospital providers or to care organizations for their payments to hospitals participating in their respective provider networks, subject to the terms and conditions of a payment agreement with the executive office of health and human services; provided, however, that the payments shall be in addition to the sum of: (i) the amount of reimbursement otherwise provided for and payable in each contract year to those hospitals under contracts executed pursuant to the request for applications issued periodically by the executive office of health and human services for the procurement of acute hospital services under the MassHealth program; and (ii) the portion, as determined by the secretary, of payments made under the contracts executed between care organizations and the executive office of health and human services which are projected to be needed by the care organizations for payments to hospitals contracted to participate in the provider networks of the care organizations.

(B) Money credited to and deposited in the fund that is not expended under subparagraph (A) may be expended for incentive payments to care organizations or other providers under contract with the executive office of health and human services to provide MassHealth services; provided, however, that all such incentive payments shall be consistent with the relevant provisions of the Medicaid state plan under Title XIX of the federal Social Security Act or any waiver of Title XIX provisions granted by the federal Centers for Medicare and Medicaid Services.

(3)(A) In addition, to the payments set forth above, the secretary of health and human services shall expend up to $15,000,000, subject to the availability of federal financial participation of not less than $7,500,000, in payments to qualifying acute hospital providers or to care organizations for their payments to hospitals participating in their respective provider networks, subject to the terms and conditions of a payment agreement with the executive office of health and human services; provided, however, that the payments shall be in addition to the sum of: (i) the amount of reimbursement otherwise provided for and payable in each contract year to those hospitals under contracts executed pursuant to the request for applications issued periodically by the executive office of health and human services for the procurement of acute hospital services under the MassHealth program; and (ii) the portion, as determined by the secretary, of payments made under the contracts executed between care organizations and the executive office of health and human services which are projected to be needed by the care organizations for payments to hospitals contracted to participate in the provider networks of the care organizations.

(B) Money credited to and deposited in the fund that is not expended under subparagraph (A) may be expended for incentive payments to care organizations or other providers under contract with the executive office of health and human services to provide MassHealth services; provided, however, that all such incentive payments shall be consistent with the relevant provisions of the Medicaid state plan under Title XIX of the federal social security act or any waiver of Title XIX provisions granted by the federal Centers for Medicare and Medicaid Services.

(d) Not later than 30 days after the close of each hospital fiscal quarter, the executive office of health and human services shall submit to the house and senate committees on ways and means a detailed accounting of all money transferred, credited or deposited into the fund. The fourth quarter report shall include the amount remaining in the fund at the end of each hospital fiscal year and the reasons for the unspent amount.