Courtesy, Mass Home Care

The FY 2013 budget was released from Conference Committee last night. According to the State House News, “the Speaker returned to the chamber at 6:42 p.m. He said although we have one remaining piece of legislation it appears we have an agreement to the fiscal 2013 budget. Tomorrow it is our intention to have a Democratic caucus at 1 p.m. With session at 2 p.m. to accept the conference committee report.”

Today the House and Senate will vote on the final budget. The agreement reached last night is not subject to amendment.

Gov. Deval Patrick now has 10 days to review the budget bill, and either sign or return sections of the bill for amendment.

Although we will see small increases in the Enhanced Home Care budget, and the protective services program, the basic home care and care management line items are level funded compared to 2012. The fact is, unless we begin the budget debate next January with a stronger budget from the Governor, we can expect another year in 2014 of waiting lists. As it stands now, more than 1,000 people are waiting to get into home care, and an even higher number cannot get the enhanced home care they need to live at home. Especially in recessionary times, it is important to keep seeking less restrictive, less costly settings for care, because we save significant money every day we keep someone out of a nursing facility.

While we may be pleased that the Conference committee generally chose higher numbers for some of our key accounts, in the larger context, these numbers were not that far apart and are all inadequate. Appropriation is not keeping up with demand, and people are getting waiting lists in a “Community First” state which is transparently inconsistent and wrong. Despite the fact that community services have helped to drive down nursing facility use by 30% over the past decade, many community based programs — with the exception of a few MassHealth line items — are not reaping the dividends of falling institutional use.

So, yes, there is a human services salary reserve, a $1 M increase in protective funds, a $1.68 M increase in ECOP — but from a high level view, these gains are minor compared to the need and the justification for truly investing in community care as a first resort.

This fiscal year, the Governor’s budget out of the box became the benchmark for the next five months of budget debate, and the Governor’s numbers were pallid and insufficient to prevent waiting lists for the next 12 months.

To see the full budget, go to http://www.mass.gov/legis/journal/desktop/Current%20Agenda%202011/H4200.pdf. 

Analysis:

FY 2013 Final Budget

                   Here are the numbers for the key line items Mass Home Care supports:

Quick Analysis: Mass Home Care gained $1.5 M last night in ECOP and home care, but overall when you compare our numbers to last year, the “rebalancing” effort to move more money into the commmuity is going nowhere—with the notable exception of Medicaid community funding.

• 4000-0600 the major MassHealth senior care plan account  goes with the lower Senate version, $500,000 less than the House. It includes language authorizing the Options Counseling program.
• 1599-6901 the human services salary reserve for workers making less than $40K per year is funded at $20 Million, as proposed by the Senate
• 9110-1500 ECOP is a compromise figure: $1 M higher than the Senate, but $327,853 lower than the House version. The 2013 ECOP figure is $1.672 M higher than 2012.
• 9110-1630 home care uses higher House version adding $527,837 above the Senate level. But this account is level funded at $97.78 M compared to 2012.
• 9110-1633 care management is the same as in both versions. This account is level funded to 2012.
• 9110-1636 protective services is the same as in both version. This account at $17.25 M is $1 M higher than 2012.
• 9110-1660 congregate goes with the higher Senate version, $107,000 higher than House.
• 9110-1900 meals uses a new, higher number $50,000 higher than either version
• 9110-9002 COAs have a new higher funding level of $9.433 million
• OUTSIDE SECTIONS: Mass Home Care has been named to sit on two new study commissions: one on rural access to services (see section 203 below) and one to study the protective services/elder abuse system (see section 204 below).

 Line Item Narratives

 1599-6901 For a reserve to adjust the wages, compensation or salary and associated employee-related costs to personnel earning less than $40,000 in annual compensation who are employed by private human service providers that deliver human and social services under contracts with departments within the executive office of health and human services and the executive office of elder affairs; provided, that home care workers shall be eligible for funding from this appropriation; provided further, that workers from shelters and programs that serve homeless individuals and families that were previously contracted through the department of transitional assistance and the department of public health currently contracted with the department of housing and community development and direct care workers that serve homeless veterans through the department of veterans affairs shall be eligible for funding from this item; provided further, that the secretary of administration and finance may allocate the funds appropriated in this item to the departments in order to implement this initiative; provided further, that the executive office of health and human services shall condition the expenditure of funds from this item upon assurances that the funds shall be used solely for the purposes of equal percentage adjustments to wages, compensation or salary; provided further, that not later than January 15, 2013, the executive office of health and human services shall submit to the house and senate committees on ways and means a report delineating the number of employees, by job title and average salary, receiving the adjustment in fiscal year 2013 and the average percentage adjustment funded herein; provided further, that the report shall also include, for each contract scheduled to receive an allocation from this item in each such department, the total payroll expenditures in each contract for the categories of personnel scheduled to receive the adjustments; provided further, that no funds from this item shall be allocated to special education programs under chapter 71B of the General Laws, contracts for early education and care services or programs for which payment rates are negotiated and paid as class rates as established by the division of health care finance and policy; provided further, that no funds shall be allocated from this item to contracts funded exclusively by federal grants as delineated in section 2D; provided further, that all raises provided from this salary reserve shall be above and beyond any previously negotiated or agreed upon pay raise; provided further, that the total fiscal year 2013 costs of salary adjustments and any other associated employee costs authorized hereunder shall not exceed $20,000,000; provided further, that the executive office of health and human services shall submit an allocation schedule to the house and senate committees on ways and means not less than 30 days after disbursement of funds; and provided further, that the annualized cost of the adjustments in fiscal year 2014 shall not exceed the amount appropriated in this item ……………………………………………………………………………………………. $20,000,000

4000-0600 For health care services provided to MassHealth members who are seniors and for the operation of the senior care options program under section 9D of chapter 118E of the General Laws; provided, that funds may be expended from this item for health care services provided to these recipients in prior fiscal years; provided further, that funds shall be expended for the community choices initiative; provided further, that no payment 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 benefits of the community choices initiative shall not be reduced below the services provided in fiscal year 2012; provided further, that the eligibility requirements for this demonstration project shall not be more restrictive than those established in fiscal year 2012; provided further, that the executive office of health and human services shall submit a report to the house and senate committees on ways and means, not later than December 5, 2012, detailing the projected costs and the number of individuals served by the community choices initiative in fiscal year 2013 delineated by the federal poverty level; provided further, that funds shall be expended from this item to implement the pre-admission counseling and assessment program under the third paragraph of section 9 of chapter 118E of the General Laws, which shall be implemented on a statewide basis through aging and disability resource consortia; provided further, that notwithstanding any general or special law to the contrary, funds shall be expended from this item for the purpose of maintaining a personal needs allowance of $72.80 per month for individuals residing in nursing homes and rest homes who are eligible for MassHealth, Emergency Aid to the Elderly, Disabled and Children program or Supplemental Security Income; provided further, that notwithstanding any general or special law to the contrary, for any nursing home or non-acute chronic disease hospital that provides kosher food to its residents, the executive office of elder affairs, in consultation with the division of health care finance and policy, in recognition of the special innovative program status granted by the executive office of health and human services, shall continue to make the standard payment rates established in fiscal year 2006 to reflect the high dietary costs incurred in providing kosher food; provided further, that notwithstanding any general or special law to the contrary, nursing facility rates effective July 1, 2012 may be developed using the costs of calendar year 2005; provided further, that MassHealth shall continue to provide the same number of nursing home leave of absence days to clients as were provided in the fiscal year beginning July 1, 2010; provided further, that no nursing home shall be permitted to reassign a patient‘s bed during a leave of absence eligible for reimbursement under this clause; and provided further, that MassHealth shall reimburse nursing home leave of absence days at a rate of not less than $30 per day ……………………………………….. $2,756,130,662

4000-0640 For nursing facility Medicaid rates; provided, that notwithstanding any general or special law to the contrary, in fiscal year 2013 the division of health care finance and policy shall establish nursing facility Medicaid rates that cumulatively total $288,500,000 more than the annual payment rates established by the division under the rates in effect as of June 30, 2002; provided further, that an amount for expenses related to the collection and administration of section 25 of chapter 118G of the General Laws shall be transferred to the division of health care finance and policy; provided further, that effective July 1, 2012 for the fiscal year ending June 30, 2013, not less than $27,400,000 above the amount expended in fiscal year 2011 shall be expended for the purpose of recognizing the Medicaid share of the nursing home assessment established by section 25 of chapter 118G of the General Laws; provided further, that not less than $2,800,000 shall be expended as incentive payments to nursing facilities meeting the criteria determined under the MassHealth Nursing Facility Pay-for-Performance Program and that have established and participated in a cooperative effort in each qualifying nursing facility between representatives of employees and management that is focused on implementing that criteria and improving the quality of services available to MassHealth members; provided further, that the MassHealth agency shall adopt regulations and procedures necessary to carry out the purposes of the foregoing incentive payment program; and provided further, that the payments made under this item shall be allocated in an amount sufficient to implement section 622 of chapter 151 of the acts of 1996 ………………………….. $318,700,000

4000-1604 For MassHealth costs associated with the implementation of the Patient Protection and Affordable Care Act and payment reform; provided, that no expenditures shall be made from this item that are not federally reimbursable; and provided further, that MassHealth shall submit a report to the house and senate committees on ways and means not later than April 24, 2013 on the implementation of the Affordable Care Act and payment reform initiatives …………………………………………………………………………………. $750,000

DEPARTMENT OF ELDER AFFAIRS.

9110-0100 For the operation of the executive office of elder affairs and regulation of assisted living facilities; provided, that the executive office of elder affairs shall report to the house and senate committees on ways and means the number of assisted living units certified and the total revenues generated from application and certification fees for such units ………………………………………………………………………………….. $1,990,1089110-1455 9110-1455 For the costs of the drug insurance program authorized in section 39 of chapter 19A of the General Laws; provided, that amounts received by the executive office of elder affairs‘ vendor as premium revenue for this program may be retained and expended by the vendor for the purposes of the program; provided further, that funds shall be expended for the operation of the pharmacy outreach program established in section 4C of said chapter 19A; provided further, that notwithstanding any general or special law to the contrary, unless otherwise prohibited by federal law, prescription drug coverage or benefits payable by the executive office of elder affairs and the entities with which it has contracted for administration of the subsidized catastrophic drug insurance program pursuant to said section 39 of said chapter 19A, shall be the payer of last resort for this program for eligible persons with regard to any other third-party prescription coverage or benefits available to such eligible persons; provided further, that the executive office shall notify the house and senate committees on ways and means not less than 90 days in advance of any action to limit or cap the number of enrollees in the program; provided further, that notification shall be given to the house and senate committees on ways and means at least 30 days prior to any coverage or benefits expansions; provided further, that the executive office shall seek to obtain maximum federal funding for discounts on prescription drugs available to the executive office and to prescription advantage enrollees; provided further, that the executive office shall take steps for the coordination of benefits with the Medicare prescription drug benefit created pursuant to the federal Medicare Prescription Drug Improvement and Modernization Act of 2003, Public Law 108-173, to ensure that residents of the commonwealth take advantage of this benefit; provided further, that a person shall also be eligible to enroll in the program at any time within a year after reaching age 65; and provided further, that the executive office shall allow those who meet the program eligibility criteria to enroll in the program at any time during the year …………………………………………… $18,500,869

9110-1500 For enhanced home care services, including case management to elders who meet the eligibility requirements of the home care program and need services above the level customarily provided under the program to remain safely at home, including elders previously enrolled in the managed care in housing, enhanced community options and chronic care enhanced services programs; provided, that the secretary shall seek to obtain federal financial participation for all services provided to seniors who qualify for Medicaid benefits under the section 1915(c) waiver; provided further, that the executive office shall collect income data on persons receiving services provided in this item; provided further, that the executive office shall submit a report to the house and senate committees on ways and means detailing the population served by this item delineated by both 2012 federal poverty income levels and 2012 social security income standards; provided further, that the report shall be submitted not later than February 8, 2013; and provided further, that the executive office shall submit a report not later than October 8, 2012, to the house and senate committees on ways and means which shall include the number of individuals on a waiting list for these services on October 1, 2012, compared to the number of individuals on a waiting list on July 1, 2012 ………………………………………………………………… $47,461,487

9110-1604 For the operation of the supportive senior housing program at state or federally-assisted housing sites; provided, that funds shall be expended to fund existing sites ……………. $4,014,802

9110-1630 For the operation of the elder home care program, including contracts with aging service access points or other qualified entities for the home care program, home care, health aides, home health and respite services, geriatric mental health services, and other services provided to the elderly; provided, that sliding-scale fees shall be charged to qualified elders; provided further, that the secretary of elder affairs may waive collection of sliding-scale fees in cases of extreme financial hardship; provided further, that not more than $11,500,000 in revenues accrued from sliding-scale fees shall be retained by the individual home care corporations without re-allocation by the executive office of elder affairs and shall be expended for the purposes of the home care program, consistent with guidelines to be issued by the executive office; provided further, that no rate increase shall be awarded in fiscal year 2013 which would cause a reduction in client services or the number of clients served; provided further, that no funds shall be expended from this item to pay for salary increases for direct service workers who provide state-funded homemaker and home health aide services which would cause a reduction in client services; provided further, that funding shall be expended for provider training and outreach to lesbian, gay, bisexual and transgender elders and caregivers; and provided further, that the secretary of elder affairs may transfer an amount not to exceed 3 per cent of the funds appropriated in this item to item 9110-1633 for case management services and the administration of the home care program ……………………………………………………………….. $97,780,898

9110-1633 For the operation of the elder home care case management program, including contracts with aging service access points or other qualified entities for home care case management services and the administration of the home care corporations funded through items 9110-1630 and 9110-1500; provided, that such contracts shall include the costs of administrative personnel, home care case managers, travel, rent and other costs deemed appropriate by the executive office of elder affairs; provided further, that no funds appropriated in this item shall be expended for the enhancement of management information systems; and provided further, that the secretary of elder affairs may transfer an amount not to exceed 3 per cent of the funds appropriated herein to item 9110-1630 ……………………………………………………………….. $35,738,377

9110-1636 For the elder protective services program including, but not limited to, protective services case management, guardianship services, the statewide elder abuse hotline, money management services and the elder-at-risk program ……………………………………………. $17,250,554

9110-1660 For congregate and shared housing services and naturally occurring retirement communities for the elderly; provided, that not less than $214,000 shall be expended from this item for providers of naturally occurring retirement communities with whom the department of elder affairs entered into service agreements with in fiscal year 2012 at not less than the amount expended to those providers in fiscal year 2012 ………… $1,824,616

9110-1700 For residential assessment and placement programs for homeless elders ……………………………… $186,000

9110-1900 For the elder nutrition program; provided, that funds shall be expended for the senior farm share program …………………………………………………………………………………………………….. $6,375,328

9110-2500 For the department of elder affairs which may expend not more than $750,000 from revenues from federal reimbursements received for the operation of the Veterans Independence Plus Initiative, a joint initiative of the United States Department of Veterans Affairs and the United States Administration on Aging; provided, that for the purpose of accommodating timing discrepancies between the receipt of retained revenues and related expenditures, the department may incur expenses and the comptroller may certify for payment amounts not to exceed the lower of this authorization or the most recent revenue estimate as reported in the state accounting system ……………………………………………………………………………………………………………………….. $750,000

9110-9002 For grants to the councils on aging and for grants to or contracts with non-public entities which are consortia or associations of councils on aging; provided, that notwithstanding the foregoing, all monies appropriated in this item shall be expended in accordance with the distribution schedules for formula and incentive grants established by the secretary of elder affairs; provided further, that not less than $100,000 shall be spent for the Needham Senior Center located in the town of Needham; and provided further, that such distribution schedules shall be submitted to the house and senate committees on ways and means ………………………………………………….. $9,433,748

Federal funding:

 EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES.

Office of the Secretary.

4000-0033 For the purposes of a federally funded grant entitled, State Demonstration to Integrate Care for Dual Eligible Individuals ……………………………………………………………………… $167,667

 4000-0826 For the purposes of a federally funded grant entitled,

EXECUTIVE OFFICE OF ELDER AFFAIRS.

Office of the Secretary.

9110-1074 For the purposes of a federally funded grant entitled, Older Americans Assistance – Title III and Title VII ………………………………………………………………………………………………….. $7,509,748

9110-1077 For the purposes of a federally funded grant entitled, National Family Caregiver Support Program ………………………………………………………………………………………………………… $4,983,746

9110-1095 For the purposes of a federally funded grant entitled, Health Information Counseling and Assistance ……………………………………………………………………………………………………………… $802,000

9110-1173 For the purposes of a federally funded grant entitled, Older Americans Act – Title III Nutritional Program ………………………………………………………………………………………………….. $12,366,039

9110-1174 For the purposes of a federally funded grant entitled, Nutrition Services Incentive Program ………………………………………………………………………………………………………………….. $5,525,088

9110-1178 For the purposes of a federally funded grant entitled, Community Service Employment Program …………………………………………………………………………………………………. $1,831,035

9110-1183 For the purposes of a federally funded grant entitled, Massachusetts Options Counseling Standards Initiative ………………………………………………………………………………………. $450,000

9110-1184 For the purposes of a federally funded grant entitled, Standards Care for People with Alzheimer‘s in Home Care Program ……………………………………………………………………………….. $350,000

9110-3031 For the purposes of a federally funded grant entitled, ADRC Strategic Planning …………………… $267,058

9110-3037 For the purposes of a federally funded grant entitled, Massachusetts Community Living Program …………………………………………………………………………………………………………….. $250,000

9110-3100 For the purposes of a federally funded grant entitled, Nursing Home Diversion Modernization ………………………………………………………………………………………………………………. $361,093

                                             OUTSIDE SECTIONS

SECTION 145. Section 178 of chapter 131 of the acts of 2010 is hereby amended by striking out 1542 the second paragraph, as amended by section 41 of chapter 9 of the acts of 2011, and inserting in 1543 place thereof the following 2 paragraphs:- 1544

The advisory committee shall utilize any previously collected data, where relevant, to 1545 compare the current and projected impact of the managed care program, the primary care 1546 clinician plan, accountable care organizations and patient-centered medical homes on the 1547 following: (1) the quality and continuity of care provided to MassHealth members; (2) access to 1548 primary care or other specialty care providers; (3) access to behavioral health or long-term care 1549 support services; (4) the availability of care coordination programs, excluding any proposed 1550 demonstration projects involving dual-eligible populations; (5) the overall quality of care for all 1551 MassHealth members, with particular emphasis on quality of care for disabled members; (6) 1552 accountability through the reporting of quality data; (7) the potential to address racial and ethnic 1553 disparities; and (8) appropriations to the Medicaid program, including, but not limited to, an 1554 estimate of the potential increase or decrease in programmatic costs of transitioning from 1 care 1555 delivery system to another and the impact of the different delivery systems on the financial risk 1556 borne by the commonwealth. 1557

The secretary of health and human services shall make any data requested by the advisory 1558 committee available in a timely manner. For the purpose of conducting this analysis, the 1559 secretary of administration and finance, in consultation with the advisory committee and subject 1560 to appropriation, shall contract with a private or not-for-profit organization with expertise in 1561 fiscal analysis of the Medicaid program and the managed care model within state Medicaid 1562 programs. The advisory committee shall file a report of its findings with the clerks of the senate 1563 and house of representatives, the house and senate committees on ways and means and the joint 1564 committee on health care financing on or before October 1, 2012.

SECTION 177. Notwithstanding any general or special law to the contrary, the executive office 1993 of health and human services, acting in its capacity as the single state agency under Title XIX of 1994 the Social Security Act and as the principal agency for all of the agencies within the executive 1995 office and other federally-assisted programs administered by the executive office, may enter into 1996 interdepartmental services agreements with the University of Massachusetts medical school to 1997 perform activities that the secretary of health and human services, in consultation with the 1998 comptroller, determines appropriate and within the scope of the proper administration of said 1999 Title XIX and other federal funding provisions to support the programs and activities of the 2000 executive office. The activities may include: (1) providing administrative services including, but 2001 not limited to, providing the medical expertise to support or administer utilization management 2002 activities, determining eligibility based on disability, supporting case management activities and 2003 similar initiatives; (2) providing consulting services related to quality assurance, program 2004 evaluation and development, integrity and soundness and project management; and (3) providing 2005 activities and services for the purpose of pursuing federal reimbursement or avoiding costs, third-2006 party liability and recouping payments to third parties. Federal reimbursement for any 2007 expenditures made by the University of Massachusetts medical school relative to federally-2008 reimbursable services the university provides under these interdepartmental service agreements 2009 or other contracts with the executive office shall be distributed to the university and recorded 2010 distinctly in the state accounting system. The secretary may negotiate contingency fees for 2011 activities and services related to pursuing federal reimbursement or avoiding costs and the 2012 comptroller shall certify these fees and pay them upon the receipt of this revenue, reimbursement 2013 or demonstration of costs avoided. Contracts for contingency fees shall not exceed 3 years and 2014 shall not be renewed without prior review and approval by the executive office for administration 2015 and finance. The secretary shall not pay contingency fees in excess of $40,000,000 for state 2016 fiscal year 2013; provided, however, that contingency fees paid to the University of 2017 Massachusetts medical school under an interagency service agreement for recoveries related to 2018 the special disability workload projects shall be excluded from that $40,000,000 limit for fiscal 2019 year 2013. The secretary of health and human services shall submit to the secretary of 2020 administration and finance and the senate and house committees on ways and means a quarterly 2021 report detailing the amounts of the agreements, the ongoing and new projects undertaken by the 2022 university, the amounts expended on personnel and the amount of federal reimbursement and 2023 recoupment payments that the university collected.

SECTION 185. Notwithstanding any general or special law to the contrary, MassHealth shall, 2081 not later than August 1, 2012, file a report with the executive office for administration and 2082 finance and the house and senate committees on ways and means identifying savings initiatives 2083 and cash management strategies that the executive office will pursue in fiscal year 2013 in order 2084 to operate the MassHealth program within the amounts appropriated in items 4000-0430, 4000-2085 0500, 4000-0600, 4000-0700, 4000-0870, 4000-0875, 4000-0880, 4000-0890, 4000-0895, 4000-2086 0950, 4000-0990, 4000-1400 and 4000-1405 of this act; provided that MassHealth shall notify 2087 the executive office for administration and finance and the house and senate committees on ways 2088 and means not less than 15 days in advance of any deviation from the planned implementation of 2089 savings initiatives and cash management strategies included in this initial report; and provided 2090 further, that MassHealth shall notify the executive office for administration and finance and the 2091 house and senate committees on ways and means not less than 90 days in advance of 2092 implementing any proposed rate cuts to providers or service cuts to members.

SECTION 186. There is hereby established an advisory committee for the purpose of arranging 2094 for and evaluating an independent analysis of the public and private behavioral health care 2095 services available to the residents of the commonwealth. 2096

The advisory committee shall consist of the chairs of the house and senate committees on 2097 ways and means, the joint committee on health care financing, the joint committee on mental 2098 health and substance abuse, or their designees, 1 member of the minority party to be appointed 2099 by the minority leader of the house of representatives, 1 member of the minority party to be 2100 appointed by the minority leader of the senate; and the secretary of health and human services, 2101 the commissioner of mental health, the commissioner of public health, the commissioner of 2102 insurance, and the director of Medicaid, or their designees; and 1 representative from each of the 2103 following organizations: the Association for Behavioral Healthcare; the Massachusetts 2104 Association of Behavioral Health Systems; the Massachusetts College of Emergency Physicians; 2105 the Massachusetts Hospital Association; the Massachusetts League of Community Health 2106 Centers; the Massachusetts Medical Society; the Massachusetts Psychiatric Society; the 2107 Massachusetts Nurses Association; the Service Employees International Union; AFSCME 2108 Council 93; Blue Cross Blue Shield of Massachusetts; the Massachusetts Association of Health 2109 Plans; Health Law Advocates; the National Alliance on Mental Illness of Massachusetts; and the 2110 Massachusetts Society for the Prevention of Cruelty to Children. The advisory committee shall 2111 be co-chaired by 1 advisory committee senate member designated by the senate president and 1 2112 advisory committee house member designated by the speaker of the house of representatives. 2113

Subject to appropriation and upon the appointment of the co-chairs, the advisory 2114 committee shall: (1) convene upon the call of the co-chairs to commission an independent 2115 consultant to evaluate and analyze the public and private behavioral health care services 2116 available to the residents of the commonwealth. The advisory committee shall advise, direct and 2117 consult with the independent consultant on the execution and completion of the analysis. The 2118 analysis shall include, but not be limited to, an account of the following: (a) the availability of 2119 inpatient and outpatient behavioral health care services, including community based supports; (b) 2120 the inpatient capacity of acute and continuing care beds at public and private psychiatric 2121 facilities, including overall bed availability and bed availability for co-morbid and difficult to 2122 place patients, average length of stay and geographic location; (c) the connection between public 2123 and private behavioral health care services; (d) the payment and reimbursement of behavioral 2124 health care services; (e) the implementation of state and federal mental health parity laws; (f) the 2125 prior authorization and adverse determination requirements related to the coverage of behavioral 2126 health care services; (g) the boarding of behavioral health patients in hospital emergency 2127 departments; (h) the use of direct admissions to inpatient behavioral health care services from a 2128 community-based setting; and (i) a review of the Massachusetts Emergency Services Program; 2129 and (2) convene upon the call of the co-chairs to: (a) advise and consult with the independent 2130 consultant on the completion and implementation of the analysis; and (b) review and make 2131 recommendations to the independent consultant on the preliminary findings of the analysis. 2132

Not later than December 28, 2012, the consultant shall provide to the legislature a report 2133 containing: (i) an assessment of the state’s inpatient services provided through the department of 2134 mental health; (ii) an estimate of the appropriate number of inpatient mental health beds given 2135 the current number of community placements; and (iii) the anticipated impact of the closure of 2136 Taunton State Hospital on the mental health needs of the southeastern region of the 2137 commonwealth. Until this report is provided, the department of mental health shall not reduce 2138 the number of inpatient beds at Taunton State Hospital. The independent consultant shall report 2139 to the general court the preliminary results of its analysis by filing the same with the clerk of the 2140 house of representatives and the clerk of the senate on or before April 30, 2013. The independent 2141 consultant shall report to the general court the final results of its analysis by filing the same with 2142 the clerk of the house of representatives and the clerk of the senate on or before November 15, 2143 2013. The advisory committee shall file its recommendations based on the final report of the 2144 independent consultant with the clerk of the house of representatives and the clerk of the senate 2145 on or before December 31, 2013.

SECTION 203. There shall be a special commission to study access to public assistance and 2549 state-sponsored services in rural areas. The commission shall consist of 13 members including: 2550 the secretary of health and human services or a designee, who shall serve as the chair; the 2551 commissioner of transitional assistance or a designee; the child advocate or a designee; the 2552 secretary of elder affairs or a designee; the undersecretary of housing and community 2553 development or a designee; the commissioner of early education and care or a designee; a 2554 representative from the Massachusetts League of Community Health Centers; a representative 2555 from Children’s Trust Fund; a representative from the Massachusetts Association of Community 2556 Action Centers; a representative from the Massachusetts Model of Community Coalitions; a 2557 representative of Mass Home Care; a representative from a food bank or food pantry located in 2558 the commonwealth, appointed by the governor; and a representative of the Citizens’ Housing and 2559 Planning Association. The commission shall examine the barriers faced by low-to moderate-income individuals 2561 living in rural areas to obtain public assistance and state-sponsored services including, but not 2562 limited to, fuel assistance, child care subsidies, direct cash assistance, emergency housing 2563 services and health and human service programs which provide services to children, families, 2564 persons with disabilities and elders. The commission’s analysis shall include, but not be limited 2565 to, the cost of traveling to and from regional offices, the cost of delivering services in rural areas 2566 and the success of outreach efforts in rural communities. The commission shall investigate the 2567 feasibility of coordinating delivery of services between local and state agencies, expanding the 2568 use of technology to increase access to services and eliminating application requirements for in-2569 person visits to state agencies. The commission shall file the results of its study, together with 2570 drafts of legislation, if any, necessary to carry its recommendations into effect, with the house 2571 and senate committees on ways and means, the joint committee on children, families and persons 2572 with disabilities and the joint committee on elder affairs not later than April 1, 2013.

SECTION 204. There shall be a special commission to make an investigation and study of elder 2574 protective services and to make recommendations to enhance said services where appropriate 2575 and necessary. The special commission shall consist of the house and senate chairs of the 2576 committee on elder affairs, or their designees, who shall serve as co-chairs; the secretary of elder 2577 affairs, or a designee; the commissioner of public health, or a designee; the attorney general, or a 2578 designee; a district attorney as designated by the Massachusetts District Attorneys Association; 2579 the president of the Massachusetts Chiefs of Police Association, or a designee; the executive 2580 director of the Massachusetts Association of Home Care Programs, or a designee; the head of the 2581 elder, health and disability unit of Greater Boston Legal Services, Inc., or a designee; the state 2582 director of AARP Massachusetts, or a designee; the executive director of the Massachusetts 2583 Association of Councils on Aging Inc., or a designee; the executive director of Jane Doe, Inc., or 2584 a designee; the executive director of the Massachusetts office of victim assistance, or a designee; 2585 the president of the Alzheimer’s Association, or a designee; and 3 members appointed by the 2586 governor, 1 of whom shall be a member of the Massachusetts bar who practices in the area of 2587 elder law, 1 of whom shall be an expert in financial services, 1 of whom shall be a representative 2588 of a visiting nurse association and 1 of whom shall be an expert in geriatric mental health. The commission shall examine strategies to increase public awareness of elder abuse and 2590 mechanisms for reporting said abuse. The commission shall assess the funding and programming 2591 needed to enhance elder protective services to the growing elder population and examine best 2592 practices for the prevention and detection of elder abuse. The commission shall also examine 2593 methods for addressing the high cost of financial exploitation investigations and expanding the 2594 availability of affordable legal services and financial advisory services for elders. The 2595 commission shall also examine the development of elder abuse multidisciplinary teams to 2596 provide consultation on protective services cases and perform critical incident case reviews. 2597  The commission, in formulating its recommendations, shall take into account the best 2598 policies and practices in other states and jurisdictions, including, but not limited to, those relating 2599 to elder abuse prevention strategies. The commission shall be empowered to hold regular public 2600 meetings, fact-finding hearings and other public forums as it considers necessary. The commission shall file its recommendations, together with recommendations for 2602 legislation, if any, with the clerks of the house of representatives and senate on or before June 30, 2603 2013.

 SECTION 206. Notwithstanding any general or special law to the contrary there is hereby 2617 established a special commission for the purpose of conducting an investigation and study of 2618 strategies to promote public awareness and increase knowledge of the causes of chronic 2619 obstructive pulmonary disease, or COPD, the importance of early diagnosis, effective prevention 2620 strategies, and disease management. Said special commission shall determine what existing 2621 resources are currently being utilized, if there exists a solid scientific base of knowledge 2622 concerning COPD through surveillance, epidemiology and research, and whether there is a need 2623 for improving the quality and accessibility of existing community-based COPD services. The 2624 special commission shall consist of the chairs of the joint committee on public health, or their 2625 designees; the commissioner of public health, or a designee; the secretary of elder affairs, or a 2626 designee; a representative of the American Lung Association; and 4 members to be appointed by 2627 the governor, from the following populations: a patient representative; a pulmonologist; a 2628 respiratory therapist; and a representative of the health insurance industry. The special 2629 commission shall report, in writing the results of said study together with its recommendations, if 2630 any, not later than December 31, 2013.

SECTION 207. Notwithstanding any general or special law to the contrary, the department of 2632 revenue, in conjunction with the executive office of health and human services, shall investigate 2633 and report on the feasibility and costs of implementing a sales tax exemption for any medical 2634 equipment deemed medically necessary and prescribed by a physician. The department of 2635 revenue shall report its findings and recommendations, together with drafts of legislation 2636 necessary to carry those recommendations into effect, by filing the same with the clerks of the 2637 house of representatives and senate, the joint committee on revenue and the house and senate 2638 committees on ways and means not later than December 31, 2012.