Slide 1: One Care Implementation Council Meeting
Executive Office of Health & Human Services
MassHealth Demonstration to Integrate Care for Dual Eligibles
July 13, 2021, 10:00 AM – 12:00 PM
Virtual Meeting via Zoom
Slide 2: One Care Procurement Implementation – Contracting Updates
•	The procurement for One Care plans is on track for implementation for January 2022*
•	Below are the contract actions MassHealth and CMS are working through for the rest of 2021:
1) Extension Amendment to extend current Demo through 12/31/22
•	Effective August 1, 2021
•	Parties: EOHHS and CMS with CCA and Tufts
2) New Three-way Contract to implement procurement under the current demo terms (expected August 2021)
•	Effective for 1/1/22, effectively replaces current Contract
•	Expected parties: EOHHS and CMS with CCA*, Tufts*, and United*
•	Expect April 2019 Fully Amended and Restated Contract plus subsequent Amendments
3) Amendment to New Contract to incorporate certain items/RFR requirements (Late Fall 2021)
•	Effective for 1/1/22
•	Expected parties: EOHHS and CMS with CCA*, Tufts*, and United*

*Contingent upon successful completion of Contract Negotiations, Readiness Review, and Federal Approval
Slide 3: Duals Demonstration 2.0 Steps
•	Duals Demo 2.0 MOU to authorize new Demo (TBD)
o	Expect to be effective 1/1/23
o	Expected parties: EOHHS and CMS
•	Amendment to New Contract to implement Demo (TBD)
o	Expect to be effective 1/1/23
o	Expected parties: EOHHS and CMS with CCA*, Tufts*, and United*
*Contingent upon successful completion of Contract Negotiations, Readiness Review, and Federal Approval
Slide 4: Three-way Contract Extension Amendment Summary
•	Extends both the federal demonstration authority for One Care and contracts with the current plans through December 31, 2022
•	Financial terms for CY 2022 (details on slide 5)
•	Requires plans to support members to connect to MassHealth Customer Service Center (CSC) for eligibility/enrollment issues beyond what the plan can address
•	Allows plans to outreach passive enrollees up to 60 days prior to enrollment effective date
•	Requires plans to have live representatives available in call centers on New Year’s Day (January 1) each year
•	Electronic Visit Verification (EVV) reporting and provider contract language requirements
•	COVID-19 related retainer/directed payments
•	COVID-19 vaccine incentive payments
•	MLR updates
Slide 5: Three-way Contract Extension Amendment – Financial Terms

The following financial terms will apply for Calendar Year 2022 (Demonstration Year 9):
■	Savings Percentages (same as current year): 
■	Medicare A/B: 0.75%*
-	Reduce to 0.5% if a COVID-19 state of emergency is in effect at any point from September 1, 2021 through December 31, 2021
■	MassHealth: 0.5%
■	Quality Withhold: 
■	2.5% in CY 2022; (currently 1.75% in CY 2021)
■	Expect to update measure slate in Fall 2021 Amendment
■	Risk Corridors (same as current year): 
■	50/50 sharing between plan and CMS/EOHHS for gains or losses between 2.1% and 8.0% 
■	Plan is fully at risk for gains or losses from 0-2.0% and over 8.0%
Slide 6: One Care
MassHealth + Medicare
Bringing your care together

VISIT US ONLINE
www.mass.gov/one-care

EMAIL US 
OneCare@mass.gov