MassHealth to Improve Management of Long-Term Services and Supports
Contract with Optum Government Solutions, Inc. to support care for 300,000
BOSTON — MassHealth signed a three-year contract with Optum Government Solutions, Inc. to support its management and oversight of fee-for-service Long-Term Services and Supports (LTSS) programs provided by more than 2,100 health care entities at an annual of cost of $3.5 billion. The LTSS Program provides crucial care to 300,000 of MassHealth’s most vulnerable members, including those with disabilities, allowing them to maintain their independence in the community.
“The Baker-Polito Administration is committed to a sustainable, robust MassHealth program and partnering with Optum to manage one of our fastest growing service areas is an additional step in fulfilling that goal,” said Marylou Sudders, Secretary of the Executive Office of Health and Human Services. “Optum has significant local and national experience in managing long-term services and support programs and have proven to be an effective partner to the Commonwealth on other significant projects.”
The LTSS program provides services such as home health care services, adult day health and durable medical equipment for individuals with physical, intellectual or developmental disabilities, or who need support with activities of daily living. Optum, a leading technology-enabled health services company, will serve as the LTSS program’s Third-Party Administrator (TPA) and will provide MassHealth with clinical, administrative, operations and systems support to:
- Strengthen program integrity;
- Conduct analyses on utilization and quality patterns;
- Perform prior authorization and utilization management as directed by MassHealth;
- Credential, enroll and train providers;
- Process and adjudication claims and provide electronic visit verification.
“We are deeply committed to ensuring MassHealth members receive the important supports they need to live with independence and resilience in the community and are grateful to the many providers that care for our members,” said Dan Tsai, Assistant Secretary of the Executive Office of Health and Human Services who oversees the state’s Medicaid program. “The complexity, scope and cost of the LTSS program require a strong third-party administrator to augment our management of this crucial program.”
The contract, which begins April 15th, is provider focused only and will be seamless to MassHealth members who use LTSS services. Optum, with a flagship Boston-based office at 1325 Boylston St., employs over 1,200 Massachusetts residents. Under this contract, Optum will employ approximately 90 full-time employees.
"Optum is honored to serve the State and committed to leveraging the expertise we've developed over 30 years of working in long-term services and supports to provide MassHealth and its LTSS providers high quality service," said Lisa Tseng, MD, Executive Vice President of Optum.
MassHealth is the Commonwealth’s Medicaid program and covers 1.9 million (1 in 4) residents. MassHealth has grown unsustainably and represents 40 percent of the Commonwealth’s budget and is currently over $15 billion.
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