The state is proposing changes to the MassHealth Managed Care Organization (MCO). About 850,000 MassHealth members today have their coverage through one of six MassHealth MCOs. The Executive Office of Health and Human Services (EOHHS) has requested responses from MCOs that seek to serve in a revised program that will take effect in December 2017.
One of the changes introduces competitive bidding for MCOs seeking to participate in the program, where MCOs will now bid the administrative component of the per-member-per-month capitation rate that MassHealth pays the MCOs. EOHHS also intends to only contract with no more than three MCOs in each of the state’s five MassHealth regions, whereas today four to six MCOs operate in each region. Preference will go to bidders that operate statewide, that serve members in a larger number of regions, and that propose competitive rates related to the administrative component of the capitated payment. And the state will require that a minimum proportion of enrollees receiving care through an MCO to have that care paid through an alternative payment methodology (that is, one that include risk sharing or bundle payments, for example.)
Responses to the MassHealth RFR are due March 15.