Proposed DHHS - MaineCare Emergency Supplemental Budget (LR 2678)

Transcription

1 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Mentl Helth - Community Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding by limiting the vilbility of Testimony questioned fesibility of dult MH 2 7 $0 ($2,084,746) mentl helth crisis intervention to persons determining dignosis of SPMI for person who experience severe nd persistent mentl in crisis. Served 16,117 in FY11. Totl GF illness. $6.8 million. Reduction to contrcted providers of 9.4% to 33%. MOE issue with SMHS community mentl helth block grnt, t risk proportionlly Mentl Helth - Community S Reduces funding by limiting the vilbility of mentl helth crisis intervention to persons who experience severe nd persistent mentl illness. Ditto dult MH Block Grnt Hed Strt S Elimintes funding for the Hed Strt See item 18 lso. Provides Hed Strt nd Erly Hed Strt services to 4714 children in FY11. Cuts ll GF Hed Strt funds. MOE issue Stte-funded Foster Cre/doption ssistnce Stte-funded Foster Cre/doption ssistnce Stte-funded Foster Cre/doption ssistnce S Elimintes funding for the supplementl services for children with complex emotionl nd behviorl needs. S Reduces funding by reducing contrcts in the fmily reunifiction S Reduces funding by reducing contrcts in the lterntive response Provides wrpround services, non-. Served 300 children ge 5 to 18 lst yer, in child welfre, juvenile corrections, children's behviorl helth nd DepEd specil ed, nd children t risk of involvement with those services. Provides intensive reunifiction services to children in stte custody nd in out-of-stte plcements who re within 30 dys of returning home. Children's Children's Children's Testimony indicted of CWS referrls, Children's DHHS screens 53% out nd 47% in for further work. Of those screened in, DHHS continues the work with 74% (5984 fmilies) nd RP begins work with 26% (2135 fmilies). Served 2275 in FY11, through 4 contrctors, disbursement of cuts mong them not determined. DHHS sys verge referrl is 90 cses/mo., would require 11 cseworkers nd 2 supervisors, t cost of $810,000/yr, compred to $2,580,000 for RP. Jon Churchill, Community Concepts, contrctor for RP services sys stff costs for cse mnger in DHHS re $899/mo nd in Community Concepts re $433 per month. Info needed on budgeted cost nd position count to bring work in house, proposl in budget? nd net svings? 92 8 $0 ($91,369) ($800,000) ($2,448,875) 1 54 $0 ($1,999,984) 1 55 $0 ($1,007,112) 1 56 $0 ($1,290,000) HHS Doc. 12/30/11 Pge 1 of 20

2 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Mentl Helth - Children Developmentl - Community Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding by reducing contrcts for Provides services to 650 children with Children's 7 13 $0 ($1,250,000) residentil services. mentl helth/emotionl disorders, DD nd utism spectrum disorders in residentil cre through 14 contrcted providers in 84 progrm sites. Cuts reimbursement rte for room nd bord costs to fcilities. Does not cut tretment. Note: On broder topic of behviorl helth services, "dministrtive Inititives" in 12/20 DHHS pcket includes "Trnsition clinicl services to Section 65 FY12 $.94 million nd FY13$4.71 million." lso "Trnsition Section 65 to CPT s FY12 $.33 million nd FY13 $1.68 million." Informtion needed on these proposls. S Reduces funding for reimbursement in rentl Developmen $0 ($1,200,000) ssistnce to United Sttes Deprtment of tl Housing nd Urbn Development levels. Served 1538 persons lst yer.. pplies to n gency operted group home. Reduces rte 11.9%. Testimony rised issue of potentil D violtion, by reducing ccess to community bsed services Developmentl Wiver Medicl Cre - S Reduces funding to reflect svings from pyment reform in the Developmentl Wiver - S Reduces funding to reflect svings from pyment reform in the Developmentl Wiver Deprtmentwide S Reduces funding from slry svings. Notwithstnding ny other provision of lw, the Stte Budget Officer shll clculte the mount of svings in this tht pplies to ech ccount in the Deprtment of Helth nd Humn nd shll trnsfer the mounts by finncil order upon the pprovl of the Governor. These trnsfers re considered djustments to ppropritions in fiscl yer Currently serve 2825 in Sec. 21 nd 131 in Sec. 29. Replces ggregte cp with individul cp of $161,000, reduces gency home support by 10%, removes medicl ddon for home support, community support, work support nd employment specilist services. Ditto Developmen tl Developmen tl DHHS Mngement $0 ($3,000,000) $0 ($5,053,691) ($5,000,000) ($3,000,000) HHS Doc. 12/30/11 Pge 2 of 20

3 Proposed DHHS - Emergency Supplementl Budget (LR 2678) FHM - Bureu of Helth Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding to reflect redistribution of 07 - Community School Grnts; 06 - Home FHM for $0 ($600,000) funding in the for Helthy. Visits; 01- Orl Helth. Of the cut $350,000 pys for dentl services subsidies for Helthy persons without dentl insurnce nd below 200% FPL, t 19 loctions in 2011, 37,000 dentl services to 19,259 persons. Remining $250,000 of cut is to school orl helth which in 2011 in 77 school districts, 230 schools, serving 23,248 lowincome children with mouth rinse, clssroom eduction nd dentl selnts. Priority given to roostook nd Wshington Counties. Lst yer Portlnd served 2100 children through this Cuts ll FHM-Orl Helth funds FHM - Bureu of Helth S Reduces funding to reflect redistribution of funding in the for Helthy Community School Grnts; 06 - Home FHM Visits; 01- Orl Helth. This cut is to home visiting, cutting 26.9% of totl funding, plcing t risk $3 million federl expnsion grnt tht includes nonsupplnttion lnguge. Totl fmilies served by progrm is 2500 per yer, eligibility from pregnncy to child's 3rd birthdy, priority to fmilies in t risk communities, vulnerble fmilies with teen prents, substnce buse, domestic violence, mentl helth, helth nd developmentl issues. Cuts ll FHM-Home Visiting funding. MOE issue. for Helthy $0 ($2,653,383) FHM - Bureu of Helth S Reduces funding to reflect redistribution of funding in the for Helthy Community School Grnts; 06 - Home Visits; 01- Orl Helth. This cut is to community nd school grnts which fund efforts to reduce tobcco use, tobccorelted chronic disese, ssocited risk fctors, nd substnce buse, school bsed helth centers, obesity nd helthy nerships. Portlnd testified ginst cuts to public helth prevention progrms supported by FHM funds. Cuts most of FHM-Community/school funds, leving $249,032 in FY13. FHM for Helthy $0 ($7,529,890) FHM - Donted Dentl S Reduces funding to reflect redistribution of funding in the for Helthy. This cut is to donted dentl, which by FHM contrct coordintes dentl services to elderly nd disbled persons, in 12 yers hs served 873 persons. Cuts ll FHM-Donted Dentl funds. for Helthy $0 ($36,463) HHS Doc. 12/30/11 Pge 3 of 20

4 Proposed DHHS - Emergency Supplementl Budget (LR 2678) 16 Z015 FHM - Drugs for the Elderly nd Disbled Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding to reflect redistribution of This cut is prt of cuts tht eliminte 100% FHM for $0 ($10,332,353) funding in the for Helthy. the DEL progrm, which provides discounted drug benefits persons who re Helthy elderly nd disbled, who re underinsured nd uninsured. For D enrollees pys for drugs in the donut hole, pys premiums, deductibles nd copyments. Pys 100% for certin drugs not covered by Medicre. Pys for enrollment in D plns, ppels process. Pys for B premiums for MSP members. DHHS sys cut will impct 45,380 low-income seniors nd dults with disbilities, sys DHHS pys D premiums for 50,319 this month nd pys s nd B for 87,144 persons. DHHS sys verge D premium is $ Cuts ll FHM-DEL funds. See items 120, 122, 128, 129. See Lnguge G nd J FHM - Fmily Plnning FHM - Hed Strt 19 Z048 FHM - Immuniztion FHM - Purchsed Socil FHM - Medicl Cre S Reduces funding to reflect redistribution of funding in the for Helthy. S Reduces funding to reflect redistribution of funding in the for Helthy. S Reduces funding to reflect redistribution of funding in the for Helthy. S Reduces funding to reflect redistribution of funding in the for Helthy. S Notwithstnding ny provision of lw, djusts funding by incresing funding in the Medicl Cre - progrm nd reducing funding in the FHM - Medicl Cre progrm to reflect redistribution of funding within the for Helthy. s teen pregnnt prevention, helth nd FHM sex eduction, reproductive helth services, through schools nd community bsed orgniztions. Cut is 22% to 26% of funds. Will cut 16 jobs, reduce clinic hours, close 7 centers, cut services to 2500 students. Cuts ll FHM-Fmily Plnning funds. MOE issue. See item 4 lso. Cuts ll FHM-Hed Strt FHM funds. MOE issue. Vccine progrm purchses 90,000 vccine FHM doses for dministrtion to employees nd residents of helth fcilities, pregnnt women, uninsured nd underinsured dults. 6% of funding. Provides child cre subsidies to 925 FHM children nd fter school progrms for yer olds. Cuts ll FHM-Purchsed Socil funds. lloctes FHM funding to MP ccount. FHM Depproprition from GF in sme mount is in item 22. for Helthy for Helthy for Helthy for Helthy for Helthy $0 ($401,430) ($700,000) ($1,354,580) $0 ($1,078,884) $0 ($3,942,236) $1,003,844 $25,031,096 HHS Doc. 12/30/11 Pge 4 of 20

5 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre Bureu of Medicl O Developmentl Wiver - 25 Z006 Developmentl Wiver - Supports Low-cost Drugs To 's Elderly Medicid - Developmentl Medicl Cre Medicl Cre Mentl Helth - Child Medicid 31 Z009 MR/Elderly PNMI Room nd Bord Nursing Fcilities Nursing Fcilities Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Notwithstnding ny provision of lw, djusts See item 21. FHM ($1,003,844) ($25,031,096) funding by incresing funding in the Medicl Cre - progrm nd reducing funding in the FHM - Medicl Cre progrm to reflect redistribution of funding within the for Helthy. Lpses $5,000,000 from the Bureu of Medicl Lpses $5 million t yer end to GF. 1 ($5,000,000) $0 ccount within the Deprtment of dmin Helth nd Humn to the unpproprited surplus of the t the end of fiscl yer S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the S Provides funding in the nd -relted ccounts necessry to mke cycle pyments through the reminder of the Cycle Pyments Cycle Pyments Cycle Pyments Cycle Pyments Cycle Pyments Cycle Pyments Cycle Pyments Cycle Pyments Cycle Pyments Cycle Pyments $5,808,535 $6,299, $1,967,371 $5,658, $1,401,437 $ $0 $1,201, $91,805,960 $38,142, $207,077,368 $124,626, $5,290,051 $4,709, $0 $8,210, $0 $7,036, $0 $11,852,830 HHS Doc. 12/30/11 Pge 5 of 20

6 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Office of Substnce buse - Medicid Seed Bureu of Medicl Medicl Cre Medicl Cre Mentl Helth - Children Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Provides funding in the nd 1 35 $983,953 $869,928 -relted ccounts necessry to mke Cycle cycle pyments through the reminder of the Pyments S djusts funding for the biennium only Depproprites GF, to be offset by 1 50 ($44,413) ($241,124) for the Cub Cre progrm for fmilies with lloction from Dirigo Helth. No Eligibility/ income greter or equl to 150% but less thn chnge in enrollment, eligibility. 200% of the nonfrm income officil poverty line s the result of contributions from the Dirigo Helth to provide seed for the S djusts funding for the biennium only for the Cub Cre progrm for fmilies with income greter or equl to 150% but less thn 200% of the nonfrm income officil poverty line s the result of contributions from the Dirigo Helth to provide seed for the S djusts funding for the biennium only for the Cub Cre progrm for fmilies with income greter or equl to 150% but less thn 200% of the nonfrm income officil poverty line s the result of contributions from the Dirigo Helth to provide seed for the S djusts funding for the biennium only for the Cub Cre progrm for fmilies with income greter or equl to 150% but less thn 200% of the nonfrm income officil poverty line s the result of contributions from the Dirigo Helth to provide seed for the Dirigo Helth inititive needed. Dirigo Helth inititive needed. Dirigo Helth inititive needed. Eligibility/ Eligibility/ Eligibility/ Other Specil Revenue s 1 58 ($410,995) ($2,231,331) 3 59 $472,800 $2,556, ($17,392) ($94,426) HHS Doc. 12/30/11 Pge 6 of 20

7 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre - Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding by eliminting optionl DHHS sys serves 21,156 members, 1 60 ($2,184,239) ($8,533,575) coverge under the progrm for enrollment chrt from 12/20 DHHS info Eligibility/ fmilies who re covered bove mndtory shows 22,000 members t 101% to 150% federl levels. FPL nd 7,700 members t 151% to 200% FPL..? prents will lose coverge. Dirigo Helth hs pid GF cost for prents % FPL since FY12. See Title 24-, sec Beginning 1/1/12 Dirigo will py for prents % FPL. This proposl would eliminte Dirigo's responsibility to py for prent coverge. Svings for prents 200% to 133% would ccrue to Dirigo. Svings from 133% down to 100% would ccrue to GF. How mny persons lose coverge, how much svings? MOE issue. Wiver needed to 100% to implement proposl or to nother level below 200%. Portlnd testified tht eliminting nonct progrm might force closure of their 2 FQHCs, which provide cre for over 2200 persons/yr, ccess to needed prescription drugs to tretble conditions. Lnguge F Medicl Cre Medicl Cre - S Reduces funding by eliminting optionl coverge under the progrm for fmilies who re covered bove mndtory federl levels. S Reduces funding by eliminting optionl coverge under the progrm for fmilies who re covered bove mndtory federl levels. Eligibility/ Eligibility/ Other Specil Revenue s 1 61 ($5,791,515) ($30,571,405) 3 62 ($1,159,127) ($9,614,390) HHS Doc. 12/30/11 Pge 7 of 20

8 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre Medicl Cre Mentl Helth - Child Medicid Mentl Helth - Community Medicid 46 Z009 MR/Elderly PNMI Room nd Bord S Reduces funding by eliminting optionl coverge under the progrm for persons 19 nd 20 yers of ge with income less thn or equl to 150% of the nonfrm income officil poverty line. Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 Serves 8700 members, under Stte Pln 1 63 ($993,649) ($5,393,575) mendment not wiver. MOE issues Eligibility/ regrding whether wiver to cut eligibility is possible nd whether cn secure wiver nd eliminte eligibility completely or only down to 133% FPL. Note: my not be ble to wive s to this popultion s elected to cover 19 nd 20 yer olds s children under the Stte Pln, mking them 1902(gg)(2) popultion. Wiver process under federl lw, Socil Security ct, section 1902(gg)(3) sttes tht wivers re possible for 1902(gg)(1) certin dult popultions only. Clrifiction needed on vilbility of wiver for to eliminte coverge for 19 nd 20 yer olds or to reduce eligibility to 133% FPL or whether wiver is not pplicble under section 1902(gg)(3). If eligibility is to end informtion needed on trnsition plnning, timefrme for terminting coverge, stffing needs. S Reduces funding by eliminting optionl coverge under the progrm for persons 19 nd 20 yers of ge with income less thn or equl to 150% of the nonfrm income officil poverty line. S Reduces funding by eliminting optionl coverge under the progrm for persons 19 nd 20 yers of ge with income less thn or equl to 150% of the nonfrm income officil poverty line. S Reduces funding by eliminting optionl coverge under the progrm for persons 19 nd 20 yers of ge with income less thn or equl to 150% of the nonfrm income officil poverty line. S Reduces funding by eliminting optionl coverge under the progrm for individuls in the mediclly needy ctegory. Eligibility/ Eligibility/ Eligibility/ Serves 2100 people, who re over 100% FPL nd under sset limit of $2000, in Eligibility/ spend down ctegory who cnnot fford privte py rtes, who re residents of ppendix C nd F residentil cre fcilities. DHHS sys tht coverge is 100% from GF, no MOE issue ($1,898,564) ($10,021,863) ($64,775) ($351,600) ($37,593) ($204,059) ($2,533,359) ($13,511,247) HHS Doc. 12/30/11 Pge 8 of 20

9 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre Medicl Cre Medicl Cre Medicl Cre Medicl Cre Mentl Helth - Child Medicid Developmentl Wiver - Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S djusts funding in fiscl yer s result Dirigo Helth inititive needed ($10,000,000) $0 of contributions from the Dirigo Helth to Provides funding for nonct wiver Eligibility/ provide seed for the childless dult popultion in FY12 only (coverge is wiver. terminted in FY13). Served 18,800 persons in Oct 11. DHHS sys no MOE issue. Others disgree. Note tht "dministrtive Inititive" list from DHHS 12/20 shows freeze in nonct progrm nd svings due to freeze in FY12 of $1.8 million. MOE issue clrifiction needed. Lnguge F. S djusts funding in fiscl yer s result Dirigo Helth inititive Other 3 91 $10,000,000 $0 of contributions from the Dirigo Helth to needed. Eligibility/ Specil provide seed for the childless dult Revenue wiver. s S Reduces funding from the elimintion of the childless dult wiver S Reduces funding from the elimintion of the childless dult wiver S Reduces funding by reducing optionl coverge for children who re behviorlly chllenged nd who re in residentil setting. S Reduces funding by reducing optionl coverge for children who re behviorlly chllenged nd who re in residentil setting. S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. Elimintes eligibility 7/1/12. Nonct wiver serves 18,800 persons. MOE issue? Would Eligibility/ wiver be needed to cut eligibility to 133$ FPL or to eliminte eligibility? CMS requires trnsition pln tht review ll members for eligibility under other ctegories. Info needed on time nd stff needed to review, time for ppels, when members would move off coverge, incresed enrollment in other ctegories of eligibility, net svings? See item 48. Eligibility/ See below. Eligibility/ Serves 195 children with serious mentl nd emotionl helth disorders, DD, utism Eligibility/ spectrum disorders who will not hve ccess to the service. MOE issues with C nd mtch issues with federl mentl helth block grnt. Informtion needed on how services will be provided to this popultion. FMP $0 ($22,000,000) $0 ($37,060,403) $0 ($842,282) $0 ($500,000) $0 $1,190, Z006 Developmentl Wiver - Supports S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. FMP 1 45 $0 $91,346 HHS Doc. 12/30/11 Pge 9 of 20

10 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Disproportiont e Shre - Dorothe Dix Psychitric Center Disproportiont e Shre - Riverview Psychitric Center Dorothe Dix Psychitric Center FHM - Medicl Cre FHM - Substnce buse IV-E Foster Cre/doption ssistnce Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S djusts funding for Medicid services s result $0 $73,700 of the decrese of the Medicl FMP ssistnce Percentge. S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. S djusts funding for Medicid services s result of the decrese in the Medicl ssistnce Percentge. S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. S djusts funding for Medicid services s result of the decrese in the Medicl ssistnce Percentge. FMP FMP FMP FMP FMP Other Specil Revenue s for Helthy for Helthy $0 $151, $0 ($73,700) $0 $113, $0 $17, $0 $13, Medicid - Developmentl Medicl Cre - S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. S djusts funding for Medicid services s result of the decrese in the Medicl ssistnce Percentge. FMP FMP $0 $592, $0 $6,997, Medicl Cre Mentl Helth - Child Medicid S djusts funding for Medicid services s result of the decrese in the Medicl ssistnce Percentge. S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. FMP FMP $0 ($10,382,324) $0 $470, Mentl Helth - Community Medicid Nursing Fcilities S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. S djusts funding for Medicid services s result of the decrese in the Medicl ssistnce Percentge. FMP FMP $0 $614, $0 $1,538,014 HHS Doc. 12/30/11 Pge 10 of 20

11 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Nursing Fcilities Office of Substnce buse - Medicid Seed Riverview Psychitric Center 70 Z042 Trumtic Brin Injury Seed Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S djusts funding for Medicid services s result $0 ($1,538,014) of the decrese in the Medicl FMP ssistnce Percentge. S djusts funding for Medicid services s result 1 36 $0 $53,748 of the decrese of the Medicl FMP ssistnce Percentge. S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. S djusts funding for Medicid services s result of the decrese of the Medicl ssistnce Percentge. FMP FMP Other Specil Revenue s 20 3 $0 ($151,512) 1 47 $0 $1, Medicl Cre Medicl Cre Medicl Cre Medicl Cre Medicl Cre - S Reduces funding by reducing reimbursement for criticl ccess hospitls from 109% to 105%. S Reduces funding by reducing reimbursement for criticl ccess hospitls from 109% to 105%. S Reduces funding by limiting reimbursement to 15 outptient hospitl visits per yer. S Reduces funding by limiting reimbursement to 15 outptient hospitl visits per yer. Will pply to clims nd settlements. In ddition "dministrtive Inititive" list from Hospitls DHHS 12/20 lists expnsion of nonpyment for redmission for sme dignosis from 3 dys to 14 dys sving $.62 million in FY12 nd $2.48 million in FY13. Lnguge M. Hospitls 3342 members exceeded 15 OP visits/yr. Not pplicble to visits to physicin with office in hospitl or to emergency deprtment services. Note from testimony: uncler how will be enforced, uncler how ptients with serious illness will be served, i.e. dilysis nd chemotherpy. Hospitls Hospitls S Reduces funding by limiting reimbursement for Note from testimony: uncler how will be hospitl dmissions to 5 per member per yer. enforced, uncler how ptients with serious Hospitls illness will be served. Note: With regrd to the lrger issue of reimbursement of hospitls, "dministrtive Inititives" info from DHHS 12/20 includes "Emergency room FY12 $.5 million." Informtion needed on this inititive ($290,834) ($1,179,804) 1 93 ($503,794) ($1,987,455) 1 96 ($277,540) ($1,480,214) 1 97 ($480,766) ($2,493,515) 1 98 ($91,890) ($490,081) Medicl Cre - S Reduces funding by limiting reimbursement for hospitl dmissions to 5 per member per yer. Hospitls 1 99 ($159,176) ($825,573) HHS Doc. 12/30/11 Pge 11 of 20

12 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre - Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding for outptient services t Is in ddition to proposed stremlining 5% $0 ($3,180,269) cute cre hospitls by 5%, effective July 1, OP cut nd 5% OP cut from lst yer's Hospitls budget Medicl Cre Medicl Cre Medicl Cre Medicl Cre Medicl Cre - 83 Z009 MR/Elderly PNMI Room nd Bord S Reduces funding for outptient services t cute cre hospitls by 5%, effective July 1, S Reduces funding by reducing reimbursement for hospitl inptient services by 10%. S Reduces funding by reducing reimbursement for hospitl inptient services by 10%. S Reduces funding by eliminting dult fmily cre s n optionl service in the S Reduces funding by eliminting dult fmily cre s n optionl service in the S Reduces funding by eliminting dult fmily cre s n optionl service in the "dministrtive Inititive" list from DHHS 12/20 lists Redmission Policy to 14 dys FY12 $.62 million nd FY13 $2.48 million." Current rule does not reimburse for redmission within 3 dys for sme dignosis. Informtion needed on this proposl. Testimony: rte cuts nd usge cuts will lose hospitl $50 million/yr, will shift costs to insurers, employers, privte py nd other pyors. Hospitls Hospitls Hospitls Served 88 members who hve medicl necessity, need ssistnce with or cueing for t lest 2 ctivities of dily living. Informtion needed on plns for services for this popultion $0 ($5,357,366) ($768,208) ($3,127,406) ($2,098,929) ($5,268,314) 1 65 ($40,810) ($220,068) 1 66 ($68,641) ($362,332) ($22,609) ($121,918) Medicl Cre Medicl Cre - S Reduces funding by eliminting mbultory Served 800 persons who received surgicl surgicl center services s n optionl service in proced requiring less thn 24 hour the hospitliztion. Informtion needed for plns for services for these medicl proced. S Reduces funding by eliminting mbultory surgicl center services s n optionl service in the 1 67 ($17,200) ($93,274) 1 68 ($28,155) ($148,619) HHS Doc. 12/30/11 Pge 12 of 20

13 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre Medicl Cre Medicid - Developmentl Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding by eliminting consumerdirected Served 1700 persons, eligible, 1 69 ($449,605) ($2,440,130) ttendnt services s n optionl dults with permnent or chronic disbilities service in the tht impir bility to provide self-cre, providing members with cre coordintion, skills development nd personl cre services. lph One testified tht consumer directed ttendnt services re the lowest cost of ny long-term cre services, costing $11.67/hr, next closest rte being gency bsed personl cre t $14.98/hr. Simply shifting the 430 consumers on this progrm to gency bsed personl cre will increse GF costs $444,000/yr. Informtion needed on plns for services for this popultion. S Reduces funding by eliminting consumerdirected 1 70 ($772,450) ($4,077,499) ttendnt services s n optionl service in the S Reduces funding by eliminting trgeted cse mngement services s n optionl service in the Served 4767 members, dults with DD, S, nd HIV/IDS dignoses nd homeless persons. Provides intke/ssessment, pln of cre development, coordintion/dvoccy, monitoring nd evlution. Testimony: provides ll cre mngement t Portlnd's homeless shelters nd refugee services centers, serving 240 fmilies lst yer, necessry prt of mngement of services nd shifting services to less expensive more pproprite loction nd coverge ($389,340) ($1,772,320) Medicl Cre - S Reduces funding by eliminting trgeted cse mngement services s n optionl service in the 1 71 ($94,312) ($429,320) Medicl Cre Medicl Cre - S Reduces funding by eliminting trgeted cse mngement services s n optionl service in the S Reduces funding by eliminting dentl services s n optionl service in the Served 14,416 members, dults, providing mediclly necessry services to llevite pin, infection or prevent imminent tooth loss nd surgicl cre fter n ccident. Dent only when mediclly necessry to tret n underlying medicl condition. Informtion needed on possible deteriortion of helth nd shift of cost. See Lnguge E nd K ($908,725) ($4,846,533) 1 73 ($410,611) ($2,225,611) HHS Doc. 12/30/11 Pge 13 of 20

14 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre Medicl Cre Medicl Cre - 95 Z009 MR/Elderly PNMI Room nd Bord Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding by eliminting dentl services 1 74 ($652,668) ($3,445,208) s n optionl service in the S Reduces funding by eliminting occuptionl therpy s n optionl service in the S Reduces funding by eliminting occuptionl therpy s n optionl service in the S Reduces funding by eliminting occuptionl therpy s n optionl service in the Served 6477 members with rehbilittion potentil nd if mediclly necessry, with gol of improving physicl function, preventing deteriortion in function, tretment following hospitl sty, tretment to improve performnce of DLs. Informtion needed on possible deteriortion of helth nd shift of cost. See Lnguge B ($78,846) ($426,996) 1 76 ($124,966) ($659,650) ($4,088) ($22,141) Nursing Fcilities S Reduces funding by eliminting occuptionl therpy s n optionl service in the ($7,516) ($40,706) Nursing Fcilities Medicl Cre Medicl Cre Medicl Cre - S Reduces funding by eliminting occuptionl therpy s n optionl service in the S Reduces funding by eliminting vision services Served 35,441 dults, providing eye exms, s n optionl service in the tretment, therpies, studies, prosthesis, therpies. Does not provide corrective lenses, except will provide 1 pir per lifetime if power is greter thn diopters. Informtion needed on possible deteriortion of helth nd shift of cost. Lnguge C. S Reduces funding by eliminting vision services s n optionl service in the S Reduces funding by eliminting physicl therpy s n optionl service in the Served 11,067, dults, with potentil for rehbilittion, tretment fter surgicl procedure or to improve performnce of DLs, to prevent deteriortion of function nd for mediclly necessry pllitive cre. Informtion needed on possible deteriortion of helth nd shift of cost. See Lnguge B nd C ($11,088) ($58,532) 1 77 ($151,826) ($823,447) 1 78 ($250,663) ($1,323,161) 1 79 ($97,657) ($529,071) HHS Doc. 12/30/11 Pge 14 of 20

15 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre Z009 MR/Elderly PNMI Room nd Bord Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding by eliminting physicl 1 80 ($158,352) ($835,885) therpy s n optionl service in the S Reduces funding by eliminting physicl ($4,890) ($26,490) therpy s n optionl service in the Nursing Fcilities S Reduces funding by eliminting physicl therpy s n optionl service in the ($9,087) ($49,230) Nursing Fcilities Medicl Cre Medicl Cre Medicl Cre - S Reduces funding by eliminting physicl therpy s n optionl service in the S Reduces funding by eliminting poditry services s n optionl service in the S Reduces funding by eliminting poditry services s n optionl service in the Served 12,374 dult members for whom self-crcre or foot cre by nonprofessionl person would be hzrdous nd pose thret or the person hs n illness, dignosis or condition tht if left untreted my cuse loss of function or risk loss of limb. Informtion needed on possible deteriortion of helth nd shift of cost. Lnguge C. S Reduces funding by eliminting sexully Served 8477, dults, providing screening, trnsmitted disese screening clinic services s testing, mediction, tretment follow-up nd n optionl service in the counseling. Informtion needed on possible deteriortion of helth nd shift of cost ($13,732) ($72,488) 1 81 ($68,407) ($370,903) 1 82 ($110,904) ($585,423) 1 86 ($40,397) ($217,951) Medicl Cre Medicl Cre - S Reduces funding by eliminting sexully trnsmitted disese screening clinic services s n optionl service in the S Reduces funding by eliminting chiroprctic services s n optionl service in the Served 15,514 dults following evlution by physicin nd determintion of rehbilittion potentil. Provides mnul or mechnicl mnipultion nd x-ry services for dignosis of subluxtion. Informtion needed on possible deteriortion of helth nd shift of cost. Lnguge C ($45,771) ($241,610) 1 88 ($69,199) ($375,344) Medicl Cre - S Reduces funding by eliminting chiroprctic services s n optionl service in the 1 89 ($114,901) ($606,525) HHS Doc. 12/30/11 Pge 15 of 20

16 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre Medicl Cre Medicid - Developmentl S Reduces funding by eliminting the reimbursement for smoking cesstion products. Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 Served 2000 persons. Will mintin benefit ($80,000) ($430,000) for pregnnt women. Informtion needed on possible deteriortion of helth nd shift of cost. S Reduces funding by eliminting the reimbursement for smoking cesstion products. S Reduces funding by eliminting privte nonmedicl institution services s n optionl service in the progrm effective July 1, Served 5542 persons in fcilities: medicl nd remedil (ssisted living, dementi cre, PNMI DD, BI, HIV/IDS, blindness), S, MH fcilities. Clrifiction needed on reimbursement for fcilities, plns for residents' cre, vilble options nd funding for cre, cost shifting, plns for nd non residents. 12/20 info indictes cost of cre s cuse of the shortfll in FY12 nd cost of cre collections. Much testimony ginst proposed elimintion of PNMI services, citing frilty, need, inbility to cre for self, eligibility for NF cre for mny nd shortge of NF beds, short term nd long term needs of elderly, persons with disbilities nd persons in tretment, need for time for trnsition to new home nd community bsed nd fcility bsed cre in n orderly mnner. Informtion needed on options for trnsitioning, timefrme with CMS, vilble resources. Lnguge D. Other Specil Revenue s ($138,580) ($724,363) $0 ($83,408) Medicl Cre Medicl Cre Medicl Cre Mentl Helth - Community Medicid S Reduces funding by eliminting privte nonmedicl institution services s n optionl service in the progrm effective July 1, S Reduces funding by eliminting privte nonmedicl institution services s n optionl service in the progrm effective July 1, S Reduces funding by eliminting privte nonmedicl institution services s n optionl service in the progrm effective July 1, S Reduces funding by eliminting privte nonmedicl institution services s n optionl service in the progrm effective July 1, HHS Doc. 12/30/11 Pge 16 of 20 PNMI PNMI PNMI PNMI Other Specil Revenue s 1 83 $0 ($47,637,039) 1 84 $0 ($104,043,080) 1 85 ($319,609) ($5,113,739) $0 ($12,754,745)

17 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Mentl Helth - Community Medicid Office of Substnce buse - Medicid Seed 120 Z015 FHM - Drugs for the Elderly nd Disbled Low-cost Drugs To 's Elderly 122 Z015 FHM - Drugs for the Elderly nd Disbled Medicl Cre Medicl Cre Medicl Cre - Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding by eliminting privte Other $0 ($341,170) nonmedicl institution services s n optionl PNMI Specil service in the progrm effective July Revenue 1, s S Reduces funding by eliminting privte Other 1 34 $0 ($89,487) nonmedicl institution services s n optionl PNMI Specil service in the progrm effective July Revenue 1, s S Reduces funding by eliminting the coinsurnce deductible nd copy for prescription drugs nd the pyment of Medicre D premiums for certin individuls receiving benefits from the Low-cost Drugs To 's Elderly S Reduces funding by eliminting the coinsurnce deductible nd copy for prescription drugs nd the pyment of Medicre D premiums for certin individuls receiving benefits from the Low-cost Drugs To 's Elderly S Reduces funding by reducing the number of prescriptions for brnd nme drugs for which reimbursement is llowed from 4 to 2 per month unless the prescription is determined to be mediclly necessry. S Reduces funding by reducing the number of prescriptions for brnd nme drugs for which reimbursement is llowed from 4 to 2 per month unless the prescription is determined to be mediclly necessry. S Reduces funding by reducing the number of prescriptions for brnd nme drugs for which reimbursement is llowed from 4 to 2 per month unless the prescription is determined to be mediclly necessry. S Reduces funding by limiting the use of Suboxone for the tretment of opioid dependency to coverge for 2-yer period. See item 16. See Lnguge G nd J. Note: On the lrger issue of Prescription Drugs, "dministrtive Inititives" 12/20 info from DHHS includes "Phrmcy WP-16% FY12 $.14 Million nd FY13 $.7 million. Informtion needed on this inititive. Informtion needed on possible deteriortion of helth nd shift of cost. See item 16 nd 123. Informtion needed on possible deteriortion of helth nd shift of cost. See Lnguge G. Served 10,200 members, will provide prior uthoriztion for more thn 2 brnd nme drugs per month. Testimony rised questions bout persons with complex conditions requiring brnd nme drugs. Title 32, section lredy requires generic unless prescriber designtes brnd, with exception for drugs if DHHS hs determined brnd to be more cost-effective. Served 700 persons beyond the suggested 2- yer limit. This is for FY12 only. Proposed stremlining bill will suggest this for FY13. Testimony opposed s contrry to best medicl prctice in treting chronic conditions. Informtion needed on possible deteriortion of helth nd shift of cost. Prescription Drugs Prescription Drugs Prescription Drugs Prescription Drugs Prescription Drugs Prescription Drugs for Helthy for Helthy ($247,964) ($1,322,475) ($836,743) ($4,462,786) ($55,880) ($279,402) 1 94 ($1,168,120) ($5,840,598) 1 95 ($2,023,465) ($9,838,860) ($147,563) $0 HHS Doc. 12/30/11 Pge 17 of 20

18 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Medicl Cre Budget Stbiliztion for Helthy Q N Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line HHS F FY 12 FY 13 S Reduces funding by limiting the use of ($1,082,650) $0 Suboxone for the tretment of opioid Prescription dependency to coverge for 2-yer period. Drugs Trnsfers $39,500,000 from 1 $0 $39,500,000 unpproprited surplus to the Budget Stbiliztion in order to ensure funds will be vilble to support services through the Deprtment of Helth nd Humn to 's most vulnerble citizens. Elimintes the trnsfer of $4,500,000 of net slot mchine revenue to the for Helthy for the fiscl yer ending June 30, 2013 Cuts remining funding in DEL See items 16, 120, $0 ($4,500,000) for Helthy N Stte Controller -P Office of the Stte Controller -P Office of the Elimintes the trnsfer of $4,500,000 of net slot mchine revenue to the for Helthy for the fiscl yer ending June 30, 2013 Increses the interfund dvnce from Other Specil Revenue s to the unpproprited surplus required for one dy t the end of fiscl yer from $43,000,000 to $102,000,000. Increses the interfund dvnce from Other Specil Revenue s to the unpproprited surplus required for one dy t the end of fiscl yer from $43,000,000 to $102,000,000. for Helthy Other Specil Revenue s 2 $0 $4,500,000 1 ($59,000,000) $59,000,000 1 $59,000,000 ($59,000,000) Lnguge Summry Lnguge Notes 132 B See items on OT nd on PT. This repels the requirement tht cover optionl services under the progrm for dults for physicl nd occuptionl therpy services provided to residents of intermedite cre or skilled nursing fcilities, subject to federl guidelines nd pprovl. 133 C This repels provisions requiring copyments for physicl therpy services, occuptionl therpy services, speech therpy services, poditry services, chiroprctic services, opticl services nd optometric services which re proposed for elimintion subject to federl guidelines nd pprovl. Speech therpy is not proposed for elimintion but is included in this mendment to the co-py lw. Correction needed. See items on OT, on vision, on PT, poditry, on chiroprctic. HHS Doc. 12/30/11 Pge 18 of 20

19 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line Number 134 D This repels the requirement tht the See items on PNMIs. Deprtment of Helth nd Humn dminister the progrm of medicl coverge for persons residing in cost reimbursement bording homes effective July 1, 2012, subject to federl guidelines nd pprovl. 135 E This repels the requirement tht the See items nd Lnguge K. progrm provide coverge for dult dentl services s n optionl service under the 136 F This does the following: 1. It reduces to See items on prent coverge nd 47- the mximum income level for prent nd 50 on childless dult coverge. cretker reltives of child under 18 from 200% FPL to the minimum federl requirement of no less thn Stndrd of Need for FDC in plce in 1996 (pproximtely 51% FPL). 2. It elimintes medicl coverge for childless dults between the ges of 21 nd G This does the following: 1. It repels the elderly low-cost drug 2. It repels the requirement tht the Deprtment of Helth nd Humn provide prescription drug wrp benefits nd py Medicre D premiums for certin individuls receiving benefits from the elderly low-cost drug See items 16, 120, 122 nd Lnguge s J nd N (t item 128, 129) on DEL Note G repels DEL nd portions of lw on eligibility for infnts nd elderly nd disbled persons, resource tests nd uthoriztion of benefits consistent with federl OBR lw. HHS Vote F Vote FY 12 FY H This uthorizes the Deprtment of Helth nd Humn to mke chnges to service provisions if necessry to comply with stte blnced budget provisions. 145 I This repels the Bsic Note: mends 22 section 3174-Q, which refers to Title 5, section 1664, which requires the stte budget document to embrce generl budget summry setting forth the ggregte fig of the budget in such mnner s to show "the blnced reltionship between the totl proposed expendit nd the totl nticipted revenues together with the other mens of finncing the budget..." Note: Bsic in 22 section FF contins limits on speech therpy, rehbilittion services for brin injury, psychologicl counseling services, durble medicl equipment, PT, chiroprctic, privte duty nursing nd personl cre, wivers nd nonctegoricl dults. Some of these services re not being eliminted. HHS Doc. 12/30/11 Pge 19 of 20

20 Proposed DHHS - Emergency Supplementl Budget (LR 2678) Inititive Text Inititive Notes (compiled by OPL) Sort Clss Unit Line Number 146 J This repels the provision uthorizing the Deprtment of Helth nd Humn to provide prescription drug services for members through the Elderly Low-Cost Drug. 147 K This elimintes the requirement tht the See items nd Lnguge E. progrm cover optionl dentl services to dults, subject to federl guidelines nd pprovl. 148 L This gives the Deprtment of Helth nd Humn the uthority to dopt emergency rules to implement ny provisions of the bill over which it hs specific uthority tht hs not been ddressed by some other of the bill. 149 M See items on reimbursement to This does the following: 1. It reduces criticl ccess hospitls. the reimbursement rte for criticl ccess hospitls from 109% to 105% nd strikes the provision tht repeled this method of reimbursement effective pril 1, It repels the provision tht requires the Deprtment of Helth nd Humn to phse in system to reimburse criticl ccess hospitls for inptient services under the progrm bsed on dignosis-relted groupings. 3. It repels the provision tht requires the Deprtment of Helth nd Humn to phse in system to reimburse criticl ccess hospitls for outptient services under the progrm bsed on mbultory pyment clssifictions. 155 O This lpses $5,000,000 from the Bureu of Medicl ccount within the Deprtment of Helth nd Humn to the unpproprited surplus of the t the end of fiscl yer HHS Vote F Vote FY 12 FY 13 HHS Doc. 12/30/11 Pge 20 of 20