As filed on November 4, 2016
The Massachusetts Executive Office of Health and Human Services (EOHHS) received approval on November 4, 2016 from the Centers for Medicare and Medicaid Services (CMS) to amend and extend its MassHealth Section 1115 Demonstration. The waiver supports the restructuring of the MassHealth program to provide integrated, outcomes-based care to 1.9 million Massachusetts residents. It will allow Massachusetts to move from its current fee-based model to a system of Accountable Care Organization models (ACO) who work in close partnership with community-based organizations to better integrate care for behavioral health, long-term services and supports and health-related social needs. The new waiver, which is effective July 2017, authorizes $1.8 billion over five years of new Delivery System Reform Incentive Program (DSRIP) funding to support the move to ACOs, invests in Community Partners for behavioral health and long-term services and supports, and allows for innovative ways of addressing the social determinants of health. It also authorizes and sustains nearly $6 billion of additional safety net care payments over 5 years to hospitals and the health safety net for the uninsured and underinsured, and for subsidies to assist consumers in obtaining coverage on the Massachusetts Health Connector.
The waiver also authorizes more than $52.4 billion to the MassHealth program over the next five years, expands substance use benefits to address the opioid epidemic, and secures important investments for strengthening the community-based health care system for behavioral health services and long-term supports.
EOHHS appreciates all of the support and engagement received from the health care community and is committed to continue to engage stakeholders as it begins to implement these reforms.
More detailed information regarding the approved 1115 Waiver, including an overview factsheet, can be found below:
- MA 1115 Press Release
- MA 1115 Waiver Factsheet
- MA 1115 Waiver Summary
- MA 1115 Waiver FAQs
- MA 1115 Waiver Approval Letter
- MA 1115 Waiver Amendment Approved file size 2MB file size 3MB
- MA 1115 Waiver Extension Approved file size 1MB file size 1MB
DSRIP Protocol Approved
- DSRIP Protocol Approval Letter
Efforts are currently underway to convert this PDF document shortly into an alternative accessible format. The Massachusetts Executive Office of Health and Human Services is committed to achieving meaningful accessibility to this online environment for all users, including users with disabilities. We recognize that this document may not work for all users. If you are a user with visual impairments who needs alternative access to the presentations, please contact Monique Bertic at 617-573-1831 or by email: MassHealth.Innovations@MassMail.State.MA.US.
- DSRIP Protocol file size 1MB
1115 Waiver Proposal Information
As filed on July 22, 2016
The Massachusetts Executive Office of Health and Human Services (EOHHS) has submitted its request to amend and extend the MassHealth Section 1115 Demonstration to the Centers for Medicare and Medicaid Services (CMS).
MassHealth has proposed a five-year extension of its 1115 Demonstration, starting July 1, 2017, in order to advance alternative payment methodologies and delivery system reform through Accountable Care Organizations and certified Community Partners for behavioral health and long term services and supports. A significant focus will be placed on improving integration and delivery of care for members with behavioral health needs and those with dual diagnoses of substance abuse disorder; as well as integration of long term services (LTSS) and supports and health-related social services. In addition, MassHealth plans to expand treatment for individuals affected by substance use disorder, including opioid addiction.
EOHHS appreciates everyone that submitted comments on the draft proposal. Every comment was reviewed and considered while finalizing the proposal for CMS. Many commenters were enthusiastic about the proposal overall. In particular, multiple commenters applauded the goals of payment and delivery reform and key parts of the proposal, including:
- the shift to payment and care delivery models focused on the quality, coordination and total costs of care;
- integration of physical health with behavioral health and LTSS;
- acknowledgment of the importance of community-based services and social supports; and
- expansion of services for members with substance use disorders.
Commenters also expressed appreciation for the extensive stakeholder engagement process that informed the development of this proposal and recommended that MassHealth continue a robust stakeholder engagement process through the further planning and implementation of MassHealth’s ACO initiative. MassHealth is committed to continued transparency and stakeholder input throughout the implementation of these reforms.
Commenters offered a range of suggestions and viewpoints. A synopsis of the major themes from the public comments, and MassHealth’s responses, are included in the final proposal. The final proposal, along with copies of all written comments received during the public comment period, is available on the MassHealth Innovations website: www.mass.gov/hhs/masshealth-innovations.
- 1115 Waiver Summary
- Section 1115 Demonstration Extension Request Submitted to CMS file size 1MB file size 1MB
- Appendix A: Public Notices file size 3MB file size 8MB
- Appendix B: Tribal Consultation Documents
- Appendix C: Public Comments file size 6MB file size 8MB
- Appendix D: Budget Neutrality Worksheets
The Massachusetts Executive Office of Health and Human Services is committed to achieving meaningful accessibility to this online environment for all users, including users with disabilities. We recognize that the budget neutrality document may not work for all users. If you are a user with visual impairments who needs alternative access to this document, please contact Monique Bertic at 617-573-1831 or by email: MassHealth.Innovations@MassMail.State.MA.US.
- Appendix E: Interim Evaluation
1115 Waiver Proposal Information
As posted for public comment on June 15, 2016
The Massachusetts Executive Office of Health and Human Services (EOHHS) announces its intent to submit a request to amend and extend the MassHealth Section 1115 Demonstration (“Request”) to the Centers for Medicare and Medicaid Services.
The MassHealth 1115 Demonstration provides federal authority for Massachusetts to expand eligibility to individuals who are not otherwise Medicaid or CHIP eligible, offer services that are not typically covered by Medicaid, and use innovative service delivery systems that improve care, increase efficiency, and reduce costs as a part of MassHealth restructuring. Federal authorization and funding for key aspects of the current 1115 Demonstration are only approved through June 30, 2017.
MassHealth plans to advance alternative payment methodologies and delivery system reform through accountable care organizations and community partners for behavioral health and long term services and supports. A significant focus will be placed on improving integration and delivery of care for members with behavioral health needs and those with dual diagnoses of substance abuse disorder; as well as integration of long term services and supports and health-related social services. In addition, MassHealth plans to expand treatment for individuals affected by substance use disorder and opioid addiction.
The Request does not affect eligibility for MassHealth. A more detailed public notice can be found at MassHealth’s home page: MassHealth , and the Request documents can be found below.
Public Comment Period
EOHHS will host two public listening sessions in order to hear public comments on the Request. Stakeholders are invited to review the Request in advance and share with program staff at the listening sessions any input and feedback, or questions for future clarification. The listening sessions are scheduled as follows:
Listening session #1, in conjunction with a meeting of the MassHealth Medical Care Advisory Committee and the MassHealth Payment Policy Advisory Board
Date: Friday, June 24, 2016
Time: 2:30 PM – 4:00 PM
Location: 1 Ashburton Place, 21st Floor, Boston MA
Conference Line: 1-866-565-6580, Passcode: 9593452
Listening session #2
Date: Monday, June 27, 2016
Time: 2:00 PM – 3:30 PM
Location: Auditorium, Fitchburg Public Library, 610 Main Street, Fitchburg, MA
Conference Line: 1-720-279-0026, Passcode: 975296
Communication Access Realtime Translation (CART) services and American Sign Language (ASL) interpretation will be available at both meetings. Please contact Donna Kymalainen at Donna.Kymalainen@state.ma.us or 617-886-8247 to request additional accommodations.
EOHHS will accept comments on the proposed Request through July 17, 2016. Written comments may be delivered by email or mail. By email, please send comments to MassHealth.Innovations@state.ma.us and include “Comments on Demonstration Extension Request” in the subject line. By mail, please send comments to: EOHHS Office of Medicaid, Attn: 1115 Demonstration Comments, One Ashburton Place, 11th Floor, Boston, MA 02108. Comments must be received by July 17, 2016 in order to be considered. Paper copies of submitted comments may be obtained in person by request from 9 AM to 5 PM at EOHHS, One Ashburton Place, 11th Floor, Boston, MA 02108.
Comments will be posted on the MassHealth 1115 Demonstration website: MassHealth and State Health Care Reform
UPDATE: The public comment period is now open and will close on Sunday, July 17, 2016.
- 1115 Waiver Summary
- Full 1115 Waiver Proposal file size 1MB
- Appendix: Budget Neutrality Worksheets
- 1115 Waiver Proposal – Slides for Public Listening Sessions
This information is provided by the Executive Office of Health and Human Services.