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News & Press: Clinical Alerts

MassHealth's Continuity of Care Promise

Monday, February 26, 2018   (0 Comments)
Posted by: Jamie Klufts
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In advance of the launch of MassHealth's new Accountable Care Organizations and Managed Care Organizations on March 1, 2018, the MassHealth Office of Behavioral Health held "office hours" on Friday, February 23, 2018, to inform licensed mental and behavioral health clinicians on the upcoming changes. The following are notes from that meeting. 

 

For the hundreds of you who joined the MassHealth Behavioral Health Office Hours phone call earlier this afternoon (2/23), we apologize for not sending out the Continuity of Care document referenced during the call in advance. This 9-page document is a helpful guide for understanding the transitions happening at MassHealth. Our notes from the call are below. Please note that MassHealth did take several questions during the call and will be crafting responses to those questions, which will pass along to you as soon as they are available.
 
Reminder: all of these changes go into effect as of March 1, 2018.
 

Acronyms you need to know:

 
  • ACO = Accountable Care Organization (The new ACO health plans are groups of doctors, hospitals, and other health care providers who come together to give coordinated, high-quality care to MassHealth members). This is not to be confused with the Affordable Care Act (ACA).
  • MCO = Managed Care Organization (The MCOs provide care through their own provider network that includes primary care providers or PCPs, specialists, behavioral health providers, and hospitals. Care coordinator staff will be available through the MCO).
  • PCC = The Primary Care Clinician plan is a managed care health plan for MassHealth members. In the PCC plan, primary care providers are called primary care clinicians (PCCs). Members select or are assigned a PCC from a network of MassHealth providers. Members can use the MassHealth network of hospitals and specialists to receive care as coordinated with their PCC and can use the Massachusetts Behavioral Health Partnership (MBHP) behavioral health provider network for behavioral health services. * PCPs who are part of an ACO will not be available as PCCs in the PCC Plan.
  • EVS = Eligibility Verification System for MassHealth members. This is the system you can use as a provider to look up a client and see which ACO they are a part of for authorization and billing purposes.
 

Highlights:

 
  • Secretary Marylou Sudders was in attendance and assured us that their goal is a smooth transition for MassHealth members. They are committed to continuity of care. One of the major expected outcomes of this new model is improved care, with an emphasis on the integration of behavioral health services.
  • These changes apply only to MassHealth managed care members; meaning those who are under age 65, do not have another primary insurer and are not in a long-term facility. This also does not affect youth who have MassHealth (MBHP) as a secondary insurer for behavioral health services.
  • All members have a minimum 90-day continuity of care period for outpatient behavioral health services and non-24-hour diversionary services (CBHI, ABA, etc). The bulletin states 30 days, but behavioral health services is 90 days.
  • Pregnant women can stay with their OB/GYN until the end of pregnancy and up to 6 weeks post-partum.
  • All existing prior authorizations for services and for provider referrals will be honored by the member’s new plan.
  • During this 90-day continuity of care period, it is recommended that you continue to see the member, contact their new plan to either join their panel OR negotiate a single-case agreement. Providers will be able to see the new plan information of the member (if they have lost their notification letter) in the MassHealth Elibility Verification System (EVS) starting March 1st.
  • Should you have any troubles with the new plan, please see page 8 of the Continuity of Care document for a list of phone numbers to contact them directly. It was recommend on the call that you pay special attention to page 8 of this document, hanging it on your wall or displaying prominently in another location. To contact MassHealth Customer Service try 1-800-841-2900 ormasshealth.innovations@state.ma.us.
 

Logistics:

 
  • There are three behavioral health contractors among all of the accountable care organizations / managed care plans:
  • Beacon Health Options for all ACOs affiliated with BMC HealthNet, Fallon, and Neighborhood Health Plan, as well as the BMC Health Net MCO.
  • Tufts Health Plan has formed 4 ACO partnerships and also have an MCO contract with the state. The 4 ACOs are Beth Israel Deaconess, Cambridge Health Alliance, Children's Hospital, and Atrius. They are an MCO option for MassHealth members who reside in the state except for the Southeast region. They will continue to have behavioral health providers in that area but are not an MCO option in that area.
  • MBHP provides services for all Primary Care ACOs, the PCC plan, and the Health New England/Be Healthy Partnership Plan.
 
Please refer back to the continuity of care document for an in-depth look at all we’ve discussed above. Thank you for your patience as we too learn more about this changeover every day and work to communicate it you, our valued members!

 


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