A New Era in State Health Care - Update


A New Era in State Health Care Update

You Still Have Time

April 2018

By Tom Walsh, COO

MassHealth recently sent out an update to assist in the recent health care insurance transition. See excerpts below:

On March 1, 2018, MassHealth launched its restructured delivery system through 17 Accountable Care Organizations (ACOs) across the state, with the goals of increasing members’ engagement in their health care, better integrating and coordinating care to meet our members’ diverse needs, and paying providers based on quality and outcomes. In addition to ACOs, members can also choose from two Managed Care Organizations (MCOs) and the MassHealth Primary Care Clinician (PCC) Plan. As a reminder, these changes apply to members under age 65 who have MassHealth as their primary insurance.

MassHealth remains committed to ensuring that all members make a successful transition and is taking the following additional steps:

Continuity of Care Extended for Medical Care Through May 31, 2018
To help members and providers who need additional time to complete the transition process, all plans will be taking additional steps through May 31, 2018, to ensure uninterrupted care for members, including continued coverage for members’ existing providers, scheduled appointments and ongoing treatment.

Fixed Enrollment will Now Begin July 1, 2018
MassHealth members now have until July 1, 2018, to change their health plan for any reason. Fixed Enrollment was originally scheduled to begin in June 2018 for members who enrolled in a new plan in March. The extension until July 1st allows for a greater period of transition. For general information about the Plan Selection Period, please go to www.mass.gov/service-details/plan-selection-period and for details about the Fixed Enrollment Period, go to www.mass.gov/service-details/fixed-enrollment-period.

New Service Area Exceptions Process
Effective April 9, 2018, MassHealth is implementing a process to allow members, under certain specific circumstances, to join an Accountable Care Partnership Plan that does not cover the service area in which the member lives. MassHealth will allow current and future members to request a service area exception to enroll in an out-of-area Accountable Care Partnership Plan by contacting the MassHealth Customer Service Center.

Service area exceptions may be granted for the following reasons:

• The member has an established relationship with a PCP who participates in an Accountable Care Partnership Plan that does not cover the service area in which the member resides;

• The member is homeless and a specific Accountable Care Partnership Plan can better accommodate the member’s support needs; or

• The member’s enrollment in the Accountable Care Partnership Plan significantly supports language, communication, or cultural needs; specialized health care needs; or other accessibility needs.

MassHealth will respond to all service area exception requests no later than 30 days after receipt. Members whose requests are approved will receive a confirmation letter of enrollment in the requested plan. Denial notices will include information on how to appeal the decision. MassHealth is aware that some members were previously unable to join an ACO in which their PCP participates because they live outside the ACO’s service area. Given the new exceptions process, MassHealth will send letters about the new process to members who, prior to March 1, 2018, had a PCP on record that joined an Accountable Care Partnership Plan and who live outside the service areas that such Accountable Care Partnership Plan covers. MassHealth Customer Service will have a list of these members in order to expedite approval for service area exceptions based on the established PCP relationship. Requests to change plans may be made by phone call (below) or by emailing an enrollment form. If emailing, we urge members to provide the best contact information possible so that enrollment confirmation happens as quickly as possible. The link to electronic enrollment form is https://masshealth.ehs.state.ma.us/StateForms/.

Customer Service and Other Assistance for Members
Members with questions or needing help enrolling in a new plan are encouraged to:

• Visit https://www.masshealthchoices.com to learn about their options and to enroll in a different plan.

• Call MassHealth Customer Service at 1-800-841-2900, TTY: 1-800-497-464. MassHealth has over 200 specially trained customer service staff to address questions related to the ACO transition. As a result of the reduction in call volume, MassHealth Customer Service is returning to its regular office hours, 8:00 a.m. through 5:00 p.m. Monday through Friday.

• Call their health plan. Contact information on ACOs, MCOs and the MassHealth PCC Plan can be found here and is attached to this letter.

• Attend an in-person enrollment event, where they can receive assistance with understanding their health plan options. Information about upcoming events is available at https://www.masshealthchoices.com/person-help.

Thank you. We encourage all members to utilize the website and or call us directly and we will do our best to advise you of all the changes and how to best navigate through these changes for your family.