Slide 1: One Care: Implementation Council Meeting
MassHealth Demonstration to
Integrate Care for Dual Eligibles
December 10, 2024 10:00AM – 12:00PM
Virtual Meeting via Zoom

Note: an image of the One Care motto appears in the upper right corner of this slide. It includes the following text:
One Care
MassHealth+Medicare
Bringing your care together
Slide 2: MassHealth Agenda
•	One Care Three-way Contract Covered Services & Continuity of Care Provisions 
•	Definitions of Transportation Grievances
•	One Care Grievance Methodology
•	Share of One Care Plan Grievances
•	Breakdown of Clinical vs. Admin – Transportation only

Slide 3: One Care Transportation Covered Services
•	Transportation Services included in Appendix B – Covered Services, 
Exhibit 1: General Service and Exhibit 4: Additional Community Based Services of the One Care Three-way Contract:
o	Ambulance ‑ the provision of transportation in an ambulance for medical reasons
o	Medically Necessary non‑Emergency Transportation ‑ the provision of transportation on a non‑emergency basis where medically necessary for the Enrollee.
o	Non‑Medical Transportation services within the community to enable the Enrollee to access community services, activities and resources in order to foster the Enrollee’s independence and support integration and full participation in their community.
o	Transportation requirements are also incorporated into a many covered services which include but are not limited to: Adult Day Health, Adult Foster Care, Self-directed PCA services, etc.

•	Transportation Continuity of Care Provisions:
o	Section 2.6.4.4. of the One Care Three-way Contract outlines The Contractor must offer to contract with all current EOHHS–contracted transportation broker(s) in the Contractor’s Service Area(s) to provide medically necessary non‑emergency transportation services (as defined in Appendix B, Exhibit 1)  authorized by EOHHS for Enrollees as of each Enrollee’s Effective Enrollment Date during the continuity of care period, provided that such transportation broker(s) accept the payment for direct transportation services as established through the payment methodology set forth in such transportation broker(s) contract(s) with EOHHS.
Slide 4: Definitions of Transportation Grievances – Self Reported by Plans
•	Transportation – Admin: Appendix B of the Three-Way Contract. For example- Issues surrounding but not limited to scheduling, availability, length of ride.
•	Transportation – Clinical: Appendix B of the Three-Way Contract. For example- Issues surrounding but not limited to missed medical appointments, appropriate level of care while being transported.
Slide 5: One Care Grievances – Methodology
By Plan, January 2023-June 2024
•	To calculate a total grievances per 1000 members over a given period, monthly grievances were divided by plan monthly enrollment (in thousands).
o	Then, these per member month values were summed across months in the period (2023 or the first half of 2024), to provide a period total.
o	The first half of 2024 data were not multiplied by 2 to estimate an annualized grievances number for H1 2024, as there may be substantial seasonal variation making such a calculation inaccurate.

•	Grievance totals shown are calculated from data on monthly total grievances supplied by the plans.
o	“Non-transportation” grievances include grievances categorized by the plans as:
•	“Access to Care”, “Billing”, “Behavioral Health”, “Benefits”, “Care Coordination”, “Dental”, “Enrollment/Disenrollment”, “LTSS”, “Member Services”, “Part D”, “Quality of Care”, and “Other”
o	Transportation grievances include grievances categorized by the plans as:
•	“Transportation – Admin”, “Transportation – Clinical”
Slide 6: Share of One Care Grievances Which are Related to Transportation
By plan, January 2023-June 2024
Note: the following data is shown in a bar chart on this slide.

One Care Transportation vs. Non-Transportation Grievances
January 2023–June 2024

•	CCA
o	2023
•	Transportation=40%
•	Non-Transportation=60%

o	H1 2024**
•	Transportation=32%
•	Non-Transportation=68%

•	THP
o	2023
•	Transportation=13%
•	Non-Transportation=87%

o	H1 2024**
•	Transportation=8%
•	Non-Transportation =92%

•	UHC
o	2023
•	Transportation=71%
•	Non-Transportation=29%

o	H1 2024**
•	Transportation=78%
•	Non-Transportation	=22%
Notes:
*” Transportation Grievances” refers to grievances categorized by the plans as related to “Transportation – Admin” and “Transportation – Clinical”.
**H1 2024 refers to the first half of 2024, January 2024 to June 2024.
Slide 7: One Care Transportation Grievances - Clinical vs. Admin
By Plan, January 2023-June 2024
Note: the following data is shown in a table. The information in the table is also illustrated in a bar graph.

One Care Clinical vs. Non-Clinical Transportation
Grievances per 1,000 Members

•	CCA
•	2023
•	Transportation - Clinical	=0.00
•	Transportation - Admin	=70.77
•	Total=70.77

•	Jan-Jun 2024
•	Transportation - Clinical	=1.70
•	Transportation - Admin	=25.61
•	Total=27.31

•	THP
•	2023
•	Transportation – Clinical= 6.88
•	Transportation – Admin=	2.95
•	Total=9.83

•	Jan-Jun 2024
•	Transportation – Clinical =0.00
•	Transportation – Admin=	3.23
•	Total=3.23

•	UHC
•	2023
•	Transportation - Clinical	=6.94
•	Transportation – Admin =	29.54
•	Total=36.48

•	Jan-Jun 2024
•	Transportation - Clinical	=2.69
•	Transportation - Admin	=13.96
•	Total=16.65

*H1 2024 refers to the first half (January-June) of 2024. Because there are only 6 months of data and these are cumulative totals, the 2024 totals are substantially less than the full year of 2023 data.