MassHealth Initiative will Transform Payment and Care Delivery: Are you Ready?

January 24, 2018

As has been announced by MassHealth in numerous webinars, bulletins and most recently member mailings, effective March 1, 2018 MassHealth will begin enrolling the majority on their non dual,  under 65 years of age eligible members into one of three types of Accountable Care Organizations, or one of two Managed Care Organizations .  As outlined in this provider bulletin, there are  12 different Accountable Care Plan Partnerships, and  three Primary Care ACO Plans.

Member should all have been noticed about which plan they have been assigned  as of November 2017, and their enrollments are all effective March 1, 2018. Members will have between March 1 and May 31 2018 to switch plans.  After June 1 they will remain in a fixed enrollment until Feb 2019.

MassHealth is hosting series of important webinars and live trainings for providers between Jan and March, see dates and sites in the same Provider Bulletin.

It is imperative that agencies serving MassHealth patients attend one of these trainings.  At these training Masshealth we will covering issues around eligibility verification and how to establish if a patient’s insurer has changed, as well as what plans are required to do to ensure continuity of care for patients who may be switching plans.  Most of training information will also be posted to the Delivery Reform Provider resource website.

All patients who are switching to an ACO or an MCO should have received written notice already.  These patients are being directed to www.masshealthchoices.com if they need to verify plan information or want to switch their plans.

The large number of patients facing a change in the management of their care promises to cause confusion especially for home health patients for whom continuity of service is particularly critical.  HCA of MA asks members to keep HCA informed about the transition  process.


MA Legislative/Regulatory Preview for 2018

January 11, 2018
On Wednesday January 3rd , the Massachusetts Legislature returned for the second year of its two-year session. After a seven-week recess, the body is looking at a traditionally busier second half than the first. The nearly 170 bills that passed in 2017 marked the lowest total in twenty years.

Lawmakers have until July 31 to complete all substantial legislative debate. In addition, all 200 members are up for election in 2018, which is expected to be a distraction from normal legislative work as a result of a polarized political landscape. Here’s what the Alliance will be focused on in 2018:

Workforce Issues:

Prior to the Holiday break, the Alliance met with its ‘Enough Pay to Stay’ partners to strategize coordinated efforts to attain wage relief for direct care workers and ASAP case managers. The coalition has pending legislation which would take steps toward this initiative, but we will pursue other legislative vehicles to fight for our workforce.

Worker Registry:

In November, Governor Baker signed into law the Home Care Worker Registry. This law will establish a worker registry that requires agencies contracting with ASAPs to submit workers’ private information to the state. The law is enacted and subject to regulations. The Alliance and its partners are in active communication regarding next steps toward protecting our members and their workers’ rights.

Licensure:

The FY 2018 State Budget included language that will establish a licensure process for home health agencies providing skilled services. It is unclear at this point when the process to promulgate regulations will begin, but the Alliance will be providing input to the Department of Public Health as these parameters are developed. In addition, Alliance-sponsored legislation that would license private care agencies is still making its way through the legislative process. Under procedural rules, the legislature has until February to report legislation out of committee. The Alliance will continue to advocate for passage of this legislation.

Continuous Skilled Nursing:

In late 2017, MassHealth announced two rate increases for the Continuous Skilled Nursing (CSN) program that totaled nearly 11 million. This was welcomed news, but there remains work to be done. The CSN provider/parent coalition will continue to advocate for the CSN Bill of Rights legislation that would mandate bi-annual reviews of the workforce to ensure safeguards against future crises.

MassHealth Rates:

The Alliance has been informed that MassHealth will conduct a long-overdue review of rates for per-visit nursing, therapies, and home health aide services.  The Alliance will be working to gather data to demonstrate that the current low rates are interfering with agencies’ ability to attract and retain enough workers to meet the demand for services.

MassHealth Reorganization:

MassHealth’s initiative to enroll the majority of members into managed care programs this coming spring will dramatically change the way MassHealth members access home health services, and disrupt many existing provider referral relationships.  The Alliance will continue to work to ensure that MassHealth members retain access to needed home health services, and that agencies are adequately reimbursed for those services.

House of Representative Health Care Bill:

Late last year the Senate passed a health care cost containment bill aimed at curbing costs while maintaining access. It has long been rumored that the House will be embarking on similar initiatives. Though the details are scarce, this legislation could be a vehicle for many of the Alliances priorities in 2018 and we will continue to advocate where necessary.

If you have any questions about the year ahead for advocacy or would like to get involved, reach out to Jake Krilovich, the Alliance’s Director of Legislative and Public Affairs.


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