Submission of a Request to Amend and Extend the Massachusetts 1115 Demonstration: Summary and Public Comment Period (Updated date for submitting comments below)

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. The Request documents can be found at the MassHealth Innovations web site: www.mass.gov/hhs/masshealth-innovations. Paper copies of the documents may be obtained in person from 9 am-5 pm at EOHHS, One Ashburton Place, 11th Floor, Boston, MA 02108.

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 – 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 and State Health Care Reform web page.

 

Background

MassHealth provides health insurance and access to health care for over 1.8 million residents of Massachusetts, more than one-quarter of the Commonwealth’s population. It is an essential safety net for 40 percent of children and more than half of people with disabilities. However, MassHealth’s spending has grown unsustainably and, at more than $15 billion, is now almost 40 percent of Massachusetts’ budget. Massachusetts also faces a burgeoning opioid addiction epidemic, and continued fragmentation between primary and behavioral health care for MassHealth members. Over the past year, MassHealth has undertaken an extensive public stakeholder engagement and policy development process to devise strategies to address these challenges and put MassHealth on a path to sustainability.

MassHealth’s 1115 demonstration provides an opportunity to restructure MassHealth to emphasize value in care delivery, and better meet members’ needs through more integrated and coordinated care, while moderating the cost trend. Massachusetts seeks to amend and extend the MassHealth 1115 demonstration for five years in order to advance these goals. This proposal seeks to amend the current demonstration through June 30, 2017 and begin a new five-year extension effective July 1, 2017.

MassHealth plans to implement 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, including opioid addiction.

 

Summary of Requested Changes to the Demonstration

Advancing Accountable Care. MassHealth is transitioning from fee-for-service, siloed care and into integrated accountable care, as providers form accountable care organizations (ACOs). ACOs are provider-led organizations that are held contractually responsible for the quality, coordination and total cost of members’ care. MassHealth’s ACO approach places a significant focus 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 (LTSS) and health-related social services. Therefore, ACOs will be required to maintain formal relationships with community-based behavioral health and LTSS providers certified by MassHealth as Community Partners, furthering the integration of care. This shift from fee-for-service to accountable, total cost of care models at the provider level is central to the demonstration extension request, and to the Commonwealth’s goals of a sustainable MassHealth program. Massachusetts seeks new waiver and expenditure authority necessary to authorize ACOs.

Delivery System Reform Incentive Program (DSRIP). Massachusetts’ goal is to achieve meaningful delivery system reform through provider partnerships across the care continuum and the implementation of broad participation in alternative payment models. Massachusetts is committed to concrete targets for cost, quality and member experience to measure progress toward this vision. To fund the changes to the delivery system, Massachusetts proposes partnering with the federal government in a DSRIP program. This five-year federal investment will catalyze change, after which our reform should be self-sustaining and supported by projected savings. MassHealth proposes a $1.8 billion DSRIP investment over five years to support the transition toward ACO models, including direct funding for community-based providers of behavioral health LTSS, in addition to ACOs.

Enhanced Benefits to Treat Substance Use Disorders. A key feature of the proposed demonstration extension is to address the growing crisis related to opioid addiction. Massachusetts proposes enhanced MassHealth substance use disorder (SUD) services to promote treatment and recovery, specifically by increasing treatment services and expanding access to various services, such as 24-hour community based services, Medication Assisted Treatment, care management and other recovery support. Additionally, Massachusetts will engage in SUD workforce development across the health care system.

Safety Net Care Pool Redesign. MassHealth proposes to restructure its payments to providers under the SNCP, as required in the October 2014 waiver extension agreement with CMS. DSRIP will replace existing programs focused on delivery system reform, including Infrastructure and Capacity Building grants and the Delivery System Transformation Initiatives (DSTI) program. MassHealth will continue to provide necessary and ongoing funding support to safety net providers through a new funding stream available to an expanded group of providers. The combination of DSRIP and restructured safety net provider payments through the SNCP will provide a glide path to a more sustainable funding level for current DSTI hospitals over the five-year demonstration term. MassHealth requests to continue currently authorized funding for uncompensated care, including the Health Safety Net, and to continue the current Public Hospital Transformation and Incentive Initiatives. In addition, MassHealth proposes to more fully recognize the Commonwealth’s commitment to reimburse providers for otherwise uncompensated care by creating a new Uncompensated Care Pool. Finally, MassHealth proposes to expand federal financial participation for ConnectorCare by including state cost sharing subsidies in addition to state premium subsidies for lower income Health Connector enrollees.

Additional Changes. MassHealth proposes additional changes, including the following:

  • MassHealth proposes to extend CommonHealth coverage for working adults age 65 and older.
  • MassHealth requests authority to provide premium assistance through the Student Health Insurance Program (SHIP), combined with cost sharing assistance and a benefit wrap, for students with access to student individual health plans, to the extent that MassHealth determines that this is cost-effective.
  • As part of its continuing ACA implementation work, MassHealth plans to update the out-of-pocket cost sharing schedule, which includes premiums and copayments, in 2018. These updates will encourage members to enroll in integrated and coordinated systems of care.
  • In order to encourage eligible MassHealth members to enroll in an MCO or ACO rather than the PCC Plan, MassHealth also proposes to provide selected fewer covered benefits to members who choose the PCC Plan, such as chiropractic services, eye glasses and hearing aids. Members who select the Primary Care Clinician (PCC) Plan as their managed care option can choose to disenroll from the PCC Plan and enroll in an MCO or ACO at any time.

Impact on MassHealth Enrollment and Expenditures. In SFY 2015, MassHealth enrollment included 16.6 million waiver member months. This figure is expected to increase by approximately 2.8% per year. Actual waiver expenditures were $6.6 billion in SFY 2015 and are expected to increase by approximately 5.4% per year. The changes to the demonstration in total are expected to add $581 million per year, due to the impacts of the Substance Use Disorder request, inclusion of LTSS and expanding the CommonHealth population.

Hypothesis and Evaluation Parameters. MassHealth has engaged the University of Massachusetts Medical School’s Center for Health Policy and Research (UMass) to evaluate the current Demonstration extension. The evaluation will examine MassHealth initiatives against the Demonstration’s goals of coverage, movement away from uncompensated care, delivery system reform, and payment reform.

 


This information is provided by MassHealth.