1. What are MCO Plan Selection and Fixed Enrollment Periods?

    Currently, MassHealth members who enroll in a managed care plan (MCO) may change plans at any time for any reason. Effective October 1st, 2016, MassHealth will implement Plan Selection Periods and Fixed Enrollment Periods for members enrolled in MCOs.  Members enrolled with an MCO will only be able to change MCOs during their annual 90-day Plan Selection Period.  Once their annual Plan Selection Period has ended, members will be in a Fixed Enrollment Period and, except in limited circumstances, members will be unable to change MCOs until their next annual Plan Selection Period.

    Information about exceptions to the Fixed Enrollment Period can be found in the MassHealth regulations (130 CMR 508.004).

  2. What are the MassHealth MCO health plans?

    The MassHealth MCO health plans are:
    • Boston Medical Center HealthNet Plan;
    • Neighborhood Health Plan;
    • Health New England;
    • Fallon Community Health Plan;
    • Tufts Health Plan, and
    • CeltiCare Health

If a member is enrolled in one of those plans through MassHealth, the new Plan Selection and Fixed Enrollment Periods applies.
 

  1. Will the MCO Plan Selection Period apply to MassHealth member who are children in the care and custody of the Department of Children and Families (DCF) or Department of Youth Services (DYS)?

    No, these members will not have a Plan Selection Period or Fixed Enrollment Period. 

  2. Does this impact member’s ability to change their primary care physicians?

    No, members enrolled in an MCO can change to a different primary care physician in their MCO plan at any time.

  3. When will changes made during the Plan Selection Period take effect?

    As is the case today, Care Plus member’s plan changes are effective on the first day of the month following the change.  All other MCO members will see their requested plan changes take effect typically in 1-2 days, depending upon which health plan the member chooses.

  4. Will the Plan Selection Period Apply to the Primary Care Clinician Plan (PCC Plan)?

    No, members enrolled in the PCC Plan will not have a Plan Selection Period. PCC Plan members can choose a different PCC in the PCC Plan or can choose to enroll in an MCO Plan at any time. However, members that select to enroll in an MCO will have a Plan Selection Period followed by a Fixed Enrollment Period. 

Additional MCO Plan Selection Period and Fixed Enrollment Period FAQs  pdf format of Provider MCO Plan Selection & Fixed Enrollment FAQs
doc format of                             Provider MCO Plan Selection & Fixed Enrollment FAQs

Attend An Upcoming Webinar Or Training

  • MassHealth is sponsoring 24 webinars between September 6, 2016 and October 13, 2016 to go over the new changes.  To register for one of the webinar sessions, go to www.masshealthtraining.com and select “Payment Reform” Course.

 

 


This information is provided by MassHealth.