On May 6, MHA submitted a letter to EOHHS Assistant Secretary Daniel Tsai highlighting comments and recommendations related to the development of the MassHealth Accountable Care Organization (ACO) program and 1115 Medicaid Waiver amendment proposal. MHA addressed issues surrounding the ACO program and risk options; delivery system reform incentive payments and the requirement for formal relationships between ACOs and certified community partners. MHA also discussed the need to clarify how ACOs would interact with both MassHealth Managed Care Organizations and the MassHealth Primary Care Clinician (PCC) program.
“MHA and its members support the development of alternative payment arrangements in the MassHealth program and we want an ACO program to be successfully implemented,” MHA Executive Vice President Tim Gens wrote. However, MHA also raised concerns about the risk options, given the underpayment and complexity of the MassHealth program. “MassHealth currently pays below the cost of care for many providers, especially hospital, physician, and behavioral health services,” wrote Gens. “Factoring in downside risk on services that are underpaid certainly increases the risk for their being further underpaid…[and]we hope that MassHealth is considering other options related to risk for those providers that would like to participate in these models.”
The MassHealth ACO program is expected to begin in October 2017 with the application process for ACOs starting this year. A Medicaid waiver amendment proposal is expected this month.