One Care Program Extended Through 2018

MassHealth announced that the One Care Program for individuals dually eligible for Medicare and MassHealth and between the ages of 21 and 64 has been extended through 2018.

Part of this new agreement with the Centers for Medicare and Medicaid Services (CMS) is that MassHealth will be accepting letters of intent (LOI) from entities interested in becoming One Care Plans effective January 1, 2018.

Beginning in 2013, the One Care program included several plans that were whittled down to what is now Commonwealth Care Alliance and Tufts Health Plan, which began participation in the initiative as Network Health. Funding issues were at the center of why other plans could not sustain covering One Care enrollees, although adjustments have been worked out that are intended to help plans better predict costs and assess financial risk. Fallon Total Care was the latest to drop their participation in June 2015.

Out of 103,041 eligible individuals, MassHealth reports that 13,038 are covered by the two One Care Plans. Commonwealth Care Alliance covers the bulk of that total with 10,050 enrollees as of June 1, 2016. According to the latest enrollment report, more than 30,000 individuals have “opted out” of the One Care Program.

Return to

MassHealth Hosting One Care Outreach Events

This Spring, MassHealth is hosting several One Care outreach events to let individuals who may be eligible for One Care know about the benefits of the program.

One Care Presentations as well as Drop-In Events will be held throughout Suffolk and Worcester County between the dates of March 25th and April 13th. This is a great opportunity to learn more about One Care, particularly for clients who may have received notices indicating that they are being automatically assigned to a One Care plan. More information about One Care can also be found at:

Please share this with individuals you serve who may be eligible for One Care and feel free to forward to colleagues and other providers.

Return to

Fallon Total Care Dropping Out of ‘One Care’ Program

The state’s Executive Office of Health and Human Services (EOHHS) announced that one of the three health plans managing health care for dually eligible ages 21 to 64 through the One Care Demonstration Program will be dropping out.

As of September 30, 2015, Fallon Total Care will be parting ways with the capitated financial alignment program, which will leave Commonwealth Care Alliance and Network Health as the remaining plans. Fallon Total Care provides One Care coverage in Hampden, Hampshire, and Worcester counties to approximately 5,475 individuals and represented the second largest enrollment of the three plans. Commonwealth Care Alliance, as of the May 2015 enrollment report, was handling 10,305 dually eligible individuals.

“MassHealth assures members who are currently enrolled with Fallon Total Care (FTC) that we will work hard to ensure as smooth a transition as possible, working with current members, FTC, the other One Care plans, our partners at CMS, advocates, and the One Care Implementation Council,” stated MassHealth in a brief statement. “One Care members will not lose their MassHealth or Medicare, and all members will have continuous access to health care services, supportive services, and medications.”

MassHealth also promised further updates on the transition and did not share any reasoning for Fallon Total Care departing the One Care Program.

Return to

Advocacy Alert: Email your Senator to Support Home Care in the Senate Budget

The Alliance has worked with home care champions in the Senate to file amendments to the Ways & Means budget to improve home health care services. The HCA now needs home care agencies and advocates to send a message to gain support these proposals TODAY by clicking here!

Below is a list of the items the Alliance will be leading on and supporting in the FY16 Senate budget process.

Restoring Home Nursing Rates: Senator Jennifer Flanagan

•    Purpose: This budget language seeks to restore the MassHealth rate for home health nursing visits past 60 calendar days of care to the payment level prior to the rate cut of December 1, 2008. This amendment creates a consistent rate for as long as an individual on MassHealth requires home health care.

Improved MassHealth Rates for Home Health Aide Services: Senator Barbara L’Italien

•    Purpose: Since 2007, home health aide rates to agencies from MassHealth have remained at $24.40 per hour, which is meant to cover aide salary, benefits, travel, supervision and administrative costs for the employing home health agency. This amendment seeks to raise the rate MassHealth reimburses home health agencies for home health aide services by 12% at a cost to MassHealth of $1.75 million.

Study of MassHealth Third Party Liability: Senator Anne Gobi

•    Purpose: A study is necessary because correct reimbursement coverage determinations for Medicare/Medicaid dual eligibles are far more complex in home health care than in other medical services as the services and program coverage rules are very similar. The process of submitting all or most MassHealth home health claims for review and re-review to Medicare is highly costly to both agencies and the state. The rate of Medicare coverage has also been steadily declining.

Homemaker Salary Reserve: Senator Michael Barrett

•    Purpose: Appropriate $3 million from the Community First Trust Fund for a FY16 Homemaker Salary Reserve.  This request will continue a campaign to support essential workers by providing an annualized wage and benefit increase of approximately 32 cents an hour to over 26,000 homemakers and personal care homemakers.

Community-Based Safety Net Adjustment: Senator Kathleen O’Connor Ives

•    Purpose: Treat non-profit home health agencies that provide a significant number of home health visits to MassHealth patients as safety-net providers eligible for upward rate adjustments.

FMAP Trust Fund: Senator Michael Rodrigues

•    Purpose: On January 1, 2014, Massachusetts began receiving an enhanced Federal Medical Assistance Percentage (FMAP) for certain Medicaid expansion populations through the ACA.  This amendment creates a trust fund to house this funding and dedicate it to Medicaid and low-income health programs.

Expand Elder Service Home Care Income Eligibility: Senator Barbara L’Italien

•    Purpose: Raise the income eligibility standard for State Home Care Program services funded by Elder Affairs to those below 300% of the Federal Poverty Level.

For more information on what was included in the Senate Ways & Means budget, visit this previous blog post.

Return to

One Care Initiative Hosting Webinar on Independent LTS Coordinators

The One Care demonstration project that coordinates and combines services for dually eligible individuals in Massachusetts hosts periodic webinars to educate the One Care Plans as well as service providers to help the program be successful.

The latest in that series is a free webinar on the role of the Long Term Services and Supports Coordinator, which will take place on Thursday, September 18th from noon to 1:00pm. During this webinar, the One Care Learning Team will discuss making referrals to Independent Living and Long-Term Services (LTS) and Supports Coordinators, ways to explain this role to One Care enrollees, and the benefits of engaging LTS Coordinators on Interdisciplinary Care Teams. An overview of the vision of MassHealth for the role of LTS Coordinator will be outlined and highlighted with examples of how LTS Coordinators are working with enrollees and interdisciplinary care teams.

Check out this video for an overview of the Independent Living LTSS Coordinator role and meet two of the webinar presenters.

Previous webinars have been recorded and can be viewed here.

Return to

Upcoming One Care Shared Learning Conference

MassHealth and UMass Medical School are hosting a One Care Shared Learning Conference at three different locations across the state in early June.

June 3, 2014 June 10, 2014 June 18, 2014
7:30 A.M. – 1:00 P.M.
Springfield Marriott
2 Boland Way,
Springfield, MA 01103Register for the
Springfield Conference
Before May 23, 2014
7:30 A.M. – 1:00 P.M.
Best Western Royal
Plaza – Marlborough
181 Boston Post Rd. W,
Marlborough, MA 01752Register for the
Marlborough Conference
Before May 27, 2014
7:30 A.M. – 1:00 P.M.
Four Points by
Sheraton – Norwood
1125 Boston Providence Turnpike,
Norwood, MA 02062Register for the
Norwood Conference
Before June 4, 2014

This conference will focus on “Integration of Primary Care, Behavioral Health and Community Supports in Real Life Cases: Developing and Implementing Person-Centered Care for People with Complex Health Care Needs.”

Who should attend?

This conference is primarily for primary care providers (PCPs), behavioral health clinicians, long term services and supports (LTSS) providers – including home care agencies – and other community based organizations involved in One Care.

This conference will focus on the collaboration among the members of an integrated care team, focusing on each of their roles in developing and implementing person-centered care for people with complex health care needs. There are a limited number of spots available, and One Care plan staff and their contracted providers will be given priority.

To register for one of these conferences or for more information, visit

Download the Conference Agenda(

Return to

Neighborhood Health Plan Drops Out of Dual Eligible Demonstration

Neighborhood Health Plan announced to partnering providers and organizations that they are withdrawing from the Dual Eligible Demonstration Project as an ICO, or Integrated Care Organization.

NHP was one of six groups that were working to become an ICO, but dropped out due to concern about payment rates conveyed from the state’s Executive Office of Health and Human Services (EOHHS) and the federal Centers for Medicare and Medicaid Services (CMS).

“EOHHS and CMS have acted in good faith to mitigate many of the factors involved in the rate discussions and unfortunately, for NHP, the final proposed rate structure, as projected, would result in substantial losses for NHP,” stated the emailed announcement.  “We feel that it is in our best interest at this time not to pursue the Duals demonstration further.”

The Home Care Alliance  spoke with NHP and met with other potential ICO’s with most expressing concern about the rates of payment. For months, stakeholders have been told that providers will receive no less than Medicare payments for Medicare services and no less than Medicaid payments for Medicaid services, but it is unclear if that is the case.

The Home Care Alliance will be attending the next “open stakeholder” meeting on April 19th in Shrewsbury to obtain more information.

“We strongly believe in the potential of truly integrated care models to improve care for the dually eligible and all Medicaid populations,” the NHP statement continued. “We wish your organization and the remaining ICOs much success.”

Return to

Timeline Updated for Dual-Eligible Care Demonstration

MassHealth and CMS have agreed to a new implementation timeline for the statewide demonstration to better integrate and coordinate health care services for dually eligible individuals between the ages of 21 and 64.

Obviously, the deadline for selectionselection of ICO’s, or Integrated Care Organizations, has come and gone, but the “readiness review” for those ICO’s has been extended. Previously, the demo was set to begin enrollment on April 1st, but it now appears that the state and CMS have agreed to have the first self-selected enrollments to become effective on July 1st.

See the updated timeline below and visit the state’s demonstration webpage for more info:

ICO Selection Announcement

November 2, 2012

Readiness Review

Nov. 2012 – March/April 2013

3-Way Contracts

March/April 2013

Learning Collaboratives

March 2013 – Ongoing

Implementation Activities


       Stakeholder Workgroups: Quality, Notices, Outreach, Admin. Simplification

Dec. 2012 – Ongoing

     Implementation Council

Feb. 2012 – Ongoing


May 2013 – Ongoing

Public Awareness Campaign

April 2013 – Ongoing

Member Outreach Activities

(Members can begin to select ICOs for effective date July 1, 2013)

May 2013 – Ongoing

Self-Selected Enrollments Begin

July 1, 2013

Auto-assignments Effective

(Members notified at least 60 days prior to the effective date)

Oct. 1, 2013; Jan. 1, 2014

State Reveals ICOs in Dual Eligible Care Demonstration

More than a month passed their anticipated announcement date of September 21st, the state’s Executive Office of Health and Human Services (EOHHS) named the Integrated Care Organizations, or ICO’s, that will be managing and directing both payment and care for the demonstration to integrate services for dual eligibles.

The six organizations are Blue Cross and Blue Shield of Massachusetts HMO Blue Inc. (BCBSMA), Boston Medical Center HealthNet Plan (BMCHP), Commonwealth Care Alliance (CCA), Fallon Total Care, LLC (FTC), Neighborhood Health Plan (NHP), Network Health, LLC. Only Network Health was picked to serve every county in the state and will be the only ICO in Nantucket and Martha’s Vineyard.

Aside from Network Health, all other ICO’s are listed in as few as three counties and as many as eleven.

These organizations were selected for full (F) or partial (P) Massachusetts counties as follows:

Barnstable F F F F
Berkshire F F
Bristol F F F F
Dukes F
Essex F F F F F
Franklin F F F F
Hampden F F F F F
Hampshire F F F F F
Middlesex F F F F F F
Nantucket F
Norfolk F F F F F
Plymouth F F P F F
Suffolk F F F F F F
Worcester F F F F

These organizations will now be engaged in a “readiness review” over the next two months. As part of the review, EOHHS and CMS will require that the organizations demonstrate full readiness and meet operational requirements.  An ICO will not be able to accept enrollments without successfully completing the joint Readiness Review, negotiating and executing a three-way contract, and receiving any necessary state and federal approvals.

Return to

Request for Responses for Consumer Consultants

MassHealth released an RFR to recruit “consumer consultants” that will assist with the review of applications from potential Integrated Care Organizations managing care for dual eligible individuals.

The demonstration project to better integrate and coordinate care for dual eligibles is still set to begin in January 2013 and the state remains on an aggressive pace to get the initiative underway. The RFR for Integrated Care Organizations (ICO’s) is due at the end of the month, and this separate RFR for “consumer consultants” is due July 20th.

These “consumers” must receive medical services, behavioral health services and/or long term services and supports (LTSS) from the state and will form a paid advisory subcommittee that shares its experiences and expertise with MassHealth and the state’s Executive Office of Health and Human Services.

The RFR is available on the state procurement website Comm-PASS as Document Number 13CBEHSCONSUMERCONSULTANTRFR and at this site on the Integrating Medicare and Medicaid for Dual Eligibles website under Related Information.

For those home care agencies that have patients with positive experiences of the care and services that have been delivered to them and that may be interested, please encourage them to apply.

Return to

%d bloggers like this: