During the fourth quarter of state fiscal year 2020, due to COVID-19, providers experienced an unanticipated and significant reduction in service utilization. As a result of this reduction in utilization, MassHealth and EOEA project that there will be a surplus in the appropriation after all service units have been paid at the current add-on rates from April – June 2020. Distribution of Appropriated Funds from the FY19 Supplemental Budget MassHealth will take special action to distribute the final surplus after the implementation period has completed. Based on the final service utilization from April – June 2020, MassHealth will recalculate the add-on rate amount and will promulgate emergency regulations that adjust the addon rate for June 2020. After doing so, MassHealth will process billable units incurred during June 2020, at the higher add-on rates to account for the surplus. Please note the following elements of this change.
- Distribution to direct care workers – All providers are reminded that this funding is required to be passed down to direct care workers in the form of increased wages, compensation, or other salary-related costs as described in the legislation and previous guidance documents. The funding cannot be used to offset lost revenue or pay for other expenses incurred as a result of COVID-19.
- Payment based on service utilization – Final payments to providers will continue to be based on actual service utilization.
- Spending Plan requirement – Providers are required to review their original Spending Plan submission and determine if changes are necessary based on the surplus distribution and the COVID-19 pandemic in order to meet the legislative requirements for this funding. If changes are necessary, providers are required to document the changes to their Spending Plan and retain the documentation internally. Providers will be required to provide an updated Spending Plan upon request to EOEA or MassHealth.
- Timing – Timely submission of units from April – June 2020 will be essential to the efficient and effective distribution of the surplus funding. Providers should note the following milestone.
MassHealth providers are expected to submit all units from April – June 2020 by July 15, 2020.
MassHealth will use the units submitted as of the above dates to recalculate the add-on rates. Payment will be distributed through standard MassHealth processes.