- Beginning this Friday, March 9, MassHealth will host a weekly meeting for providers on the new Accountable Care Organization (ACO) program. Details are below.
- As a reminder, please check the MassHealth Eligibility Verification (EVS) system to identify which ACO or Managed Care Organization (MCO) a member is in. The EVS system includes contact telephone numbers for the entities responsible for authorizing services and reimbursing providers.
- MassHealth members enrolled in a new ACO or MCO currently receive, at a minimum, 30 days continuity of care coverage.
MassHealth Provider Check-In Meetings
Each Friday in March, MassHealth will host a weekly meeting to update healthcare providers on the ACO rollout that began March 1 and provide an opportunity to ask questions and give feedback. The meetings for medical providers run from 3 to 4 p.m. and will also be available via conference call.
The conference line is limited to 200 participants so MassHealth encourages providers at the same location to dial in together to make sure that every organization can get on the line. In addition, to the extent possible, MassHealth requests providers send their questions or concerns to MassHealth by end of day Tuesday each week email@example.com. You can also e-mail your questions to MHA and we will communicate them to MassHealth.
MassHealth Provider Meetings/Calls
MHA has received questions on how to bill for services for MassHealth members in the new ACOs. As a reminder, Accountable Care Partnership Plans (Model A ACOs) are entities that are joined directly with an MCO, which is responsible for reimbursing providers and managing the provider network, similar to how MassHealthMCOs have operated historically. Providers are reimbursed by the Accountable Care Partnership Plan whether they are affiliated with the ACO or they are not.
For Primary Care ACOs (Model B ACOs), MassHealth manages the medical provider network, authorizes services, and reimburses providers, including those affiliated with the ACO and those that are not. Similar to the PCC plan, the Massachusetts Behavioral Health Partnership (MBHP) manages behavioral health services and reimburses providers for enrollees in Primary Care ACOs. Primary Care ACOs do not reimburse provider claims for MassHealth services. This MassHealth ACO/MCO matrix shows the ACOs and MCOs contact information, including the MCOs that are partnered with ACOs that are Accountable Care Partnership Plans.
It is important to check the MassHealth Eligibility Verification System (EVS) for patients receiving services. EVS shows which ACO or MCO a patient belongs to and includes the contact information for the entities authorizing services and reimbursing claims. This document contains the current EVS screenshots by ACO and MCO, and this document provides a summary of the EVS messages.
MassHealth members also will be issued new member ID cards detailing their ACO and MCO; however, it is important to always verify a MassHealth’s members eligibility status in EVS each day they receive services.
In February, MassHealth released these enrollment estimates of how 1.1 million members were assigned by ACO and MCO. This information is as of February 9 and members have been able to switch plans since then. Members enrolled into a new plan have until May 31, 2018, to change plans.
As highlighted previously, all members enrolling into a new plan on or after March 1, 2018, will have at a minimum 30-days continuity of care. Some plans will be offering additional time in certain cases. During the continuity of care period, the new plan will honor all prior authorizations for services and for provider referrals. Members can continue to see all providers currently providing their care during this period, even if that provider is not in the new plan’s network. This policy applies to new applicants and those switching plans after March 1. MassHealth has issued this guidance document and this FAQ document which explains the details on the continuity of care policy. For future iterations of the FAQ and other related information, please continue to visit the MassHealth Payment & Care Delivery Innovation (PCDI) website.
If you have not done so already, please sign up for the provider education webinars. MassHealth currently is in Phase II of its training and has reviewed the following issues in this recent provider presentation. To register for the webinars as well as in-person trainings, please go to the MassHealth Learning & Productivity Center.
Questions & Comments
With the MassHealth ACO program up and running, please continue to keep MHA aware of any issues your organizations encounter including related to member access, eligibility, continuity of care, and primary care assignments. Here at MHA, please do not hesitate to contact Dan McHale at firstname.lastname@example.org or (781) 262-6044, or Anuj Goel at email@example.com or (781) 262-6034.