MassHealth Adjusting Payment System, Investing in One Care Program
BOSTON – Today MassHealth announced payment changes to provide financial stability to One Care program health plans that better reflect the cost of care for the complex population served by the demonstration project.
Participating One Care Plans - Commonwealth Care Alliance and Tufts Health Plan – were notified of the adjustments, approved by the federal government’s Center for Medicare and Medicaid Services (CMS). These changes will be made to provide more accurate rates for the complex care management and service needs of low-income adults with disabilities.
“We appreciate the strong support from our federal partners and the participating health plans,” said the Secretary of the Executive Office of Health and Human Services, Marylou Sudders. “One Care is pioneering the way care for high-risk populations can be delivered. It is a model that integrates behavioral and physical health care, acute and long-term supports for adults with significant disabilities.”
Massachusetts is one of 12 states across the country participating in a federal demonstration project to provide integrated care to approximately 17,000 working-age residents with disabilities who are eligible for both Medicare and Medicaid, commonly known as “duals.” The joint efforts of the state and federal government to invest in this demonstration reflect the belief and commitment that this type of integrated care model is the right way to provide medical, behavioral health and long-term services and supports to this vulnerable and complex population.
“We are pleased that we were able to stabilize the One Care program through a more sustainable and adequate set of payments that better reflect the needs of this complex population,” said Dan Tsai, assistant secretary of MassHealth. “We believe integrated care models are the way to improve quality of care the population served by the program.”
The state will invest $6 to $8 million in 2015 per year over the next two years as part of the revised payment methodology. The exact amounts will vary by plan depending on member mix, enrollment and plan performance. Over the two years, a total of $29.8 million will come from Medicaid funding and another $17.8 million from Medicare funding.
The change was welcomed by the largest plan in One Care, Commonwealth Care Alliance.
“This is really good news. We believe the steps CMS and MassHealth are taking to strengthen the financial framework of the One Care plan will enable the plans to successfully provide the array of services members need, including intensive case management for many” said Lois Simon, president and co-founder of Commonwealth Care Alliance. “We have always believed—and continue to believe—that this demonstration will ultimately prove to be a highly successful model of integrated care that makes an appreciable difference in the lives of the population it serves.”
The Commonwealth has also requested that the demonstration project be extended beyond 2016 until 2018. The extension would provide sufficient time for MassHealth and CMS to fully measure and understand the impact of the demonstration.