New MassHealth ACO Program: Working to Ensure Continuity of Care

As of March 1, 2018, approximately 1.2 million MassHealth managed-care members will have a new set of plan options in which to enroll. These options consist of 13 Accountable Care Partnership Plans; three Primary Care Accountable Care Organizations (ACOs); two Managed Care Organizations (MCOs); and MassHealth’s Primary Care Clinician (PCC) Plan.

MassHealth, ACOs, MCOs, the hospital and provider community, and patient advocates have been working diligently to ensure the people that are affected by the new ACO/MCO rollout can continue to receive the medically necessary services they need during the March transition – even if the services typically require prior authorizations from an MCO or the MassHealth program.  For example, MassHealth led an effort to identify high-risk patients and share existing information about them among the ACOs, MCOs, and MassHealth. Providers have reached out to patients to inform them of the changes and, importantly, MassHealth established a minimum “continuity of care” requirement.
The Executive Office of Health and Human Services held meetings last week to discuss with providers and others those continuity of care policies. To ensure that members transition to their new plans successfully and continue to have access to all the services they need, all members enrolling into a new plan on or after March 1, 2018, will have at a minimum 30-days continuity of care. The 30-day period begins on the first day the member is enrolled with the plan. During the continuity of care period, all existing prior authorizations for services and for provider referrals will be honored by the new plan. Members can continue to see all providers currently providing their care during this period, even if that provider is not in their new plan’s network.  ACOs and MCOs also may offer additional flexibility beyond the 30-day minimum.  Continuity of care requirements will also be effective for new applicants to the MassHealth program post March 1 and for those enrollees who switch plans during their 90-day plan selection period or for some other qualifying event.

For more information, please see this EOHHS continuity of care guidance document that was published last week.