Slide 1: One Care and SCO Procurement / One Care Transition
Executive Office of Health and Human Services
May 25, 2023
Slide 2: Notice
Material in this presentation is for informational purposes only and is not an official part of EOHHS procurement for One Care or SCO plans. 
All official procurement information will be included in the RFR and its attachments, which will be posted on COMMBUYS.
Potential bidders are encouraged to check COMMBUYS regularly for updates.
Slide 3: Agenda
1.	Recap of Prior Discussions
2.	Enrollment Process
3.	Guiding Principles for Plan Procurement
4.	Consumer Reviewer Procurement
5.	Timeline
Slide 4: Stakeholder Discussion Topics
Prior Discussions
•	October 2022: Transition planning process overview
•	December 2022: Transition Principles, Benefits, Financial considerations
•	March 2023: Duals Demo 2.0, Aligned Procurement, Medicare Contracting Process, Procurement Timeline
Today (05/25/23)
Meeting Focus:
•	Enrollment Process
•	Provider Network
•	Guiding Principles for Plan Procurement
•	Consumer Reviewer Procurement
Future Discussion Topics
Tentative Upcoming Meeting Topics:
•	Summer: Finance Topics Deep Dive
To be Scheduled: 
•	Encounter Data Collection and Monitoring
•	Quality Metrics
Slide 5: Recap of Prior Discussions
MassHealth is committed to active engagement with CMS and stakeholders throughout the One Care 
D-SNP transition and the procurement of the One Care plans and Senior Care Options (SCO) plans
Prior Meeting Topics and Updates:
1.	Aligned Procurement for One Care and SCO; resulting in separate contracts for One Care and SCO
2.	Preserve Expanded Benefits: MassHealth intends to continue offering current One Care and SCO benefits, and is exploring strategies to ensure that Duals Demo benefits in One Care continue.
3.	No Copays: MassHealth expects that One Care and SCO will not have copays (as happens today) 
4.	Leverage Care Model improvements: MassHealth will build on the work of the Care Model Focus Initiative (CMFI) for One Care to ensure effective and engaged person-centered care coordination, to drive plan investments in care coordination, to improve enrollee outcomes, and to achieve high enrollee satisfaction.
5.	Self-Selection Enrollment (No Passive): For 2026 forward, eligible members must request to enroll (self-select) into a One Care Plan. Eligible older adults can continue to enroll in SCO Plans through self-selection (SCO already uses this process)
Slide 6: Enrollment Process Ownership
CMS delegates Enrollment Processing to Medicare Advantage Plans (D-SNPs) 
Current Enrollment Process
Responsible Entity: MassHealth
•	MassHealth coordinates One Care enrollment and disenrollment processes.
Future Enrollment Process
Responsible Entity: Plans
•	Plans will coordinate One Care enrollment and disenrollment processes (as in SCO today)
Current Enrollment Process
Enrollment Processing: MassHealth and CMS
•	MassHealth and CMS align member’s One Care enrollment status for Medicaid and Medicare
Future Enrollment Process
Enrollment Processing: Plans
•	Plans must align member’s One Care enrollment status for Medicare and Medicaid
Current Enrollment Process
Accept Member Requests: MassHealth
•	Members enroll/disenroll through MassHealth’s Customer Service Center
Future Enrollment Process
Accept Member Requests: One Care Plans
•	Members will enroll/disenroll directly through One Care Plans
Please note:
•	Members can also go to 1-800-Medicare. Enrolling in a new plan disenrolls a member from their current plan.
Current Enrollment Process
Manage Enrollment Changes: MassHealth
MassHealth sends enrollment/disenrollment actions:
•	To CMS for Medicare processing
•	To One Care Plans for coverage
Future Enrollment Process
Manage Enrollment Changes: Plans
Plans will send enrollment/disenrollment actions:
•	To MassHealth for Medicaid confirmation and processing
•	To CMS for Medicare confirmation and processing
Current Enrollment Process
Member Notices: MassHealth
MassHealth sends enrollment/disenrollment notices. 
•	e.g., MassHealth member enrolled in XYZ One Care Plan
Future Enrollment Process
Plans will send enrollment/disenrollment notices.
•	e.g., MassHealth member enrolled in our XYZ Plan
Please Note:
MassHealth and CMS send eligibility notices.
•	e.g., Individual is eligible for MassHealth Standard, Medicare Part A/B
Slide 7: Enrollment Process Protections
Proposed Protections for Eligible Members
1.	Permit only One Care and SCO Plan employees (Employed Agents) to market and enroll members in One Care and SCO plans.
•	No third-party Captive Agents or Independent Agents/Brokers will be permitted to enroll members in One Care or SCO
•	No referral fees, contingency basis, or other volume-based payment for enrollments into One Care or SCO
2.	Training requirements for Plan Employed Agents 
In addition to Department of Insurance (DOI) required training, additional training in key areas, including: 
•	MassHealth, Medicare coverage options, and integrated care program: One Care, PACE, and SCO
•	Eligible populations, including relative to other Medicare or MassHealth populations
•	Disability, Independent Living, Recovery, Accessibility, and Aging Topics
•	Social Determinants of Health, health disparities, health equity
3.	Improve MassHealth and Plan reporting and enrollment data monitoring to identify enrollment and market trends.
Examples include: 
•	How many dual eligible individuals are choosing to enroll in other types of Medicare Advantage and Part D plans
•	Short-term enrollments, both in other Medicare Advantage plans, and in One Care and SCO plans
•	Which Medicare Advantage plans enroll One Care and SCO eligible members.
4.	Additional MassHealth review and contract requirements for marketing, education, and enrollment activities
•	Leverage integrated templates for member materials (Summary of Benefits, Member Handbook, etc.)
•	Clarify rules for when member eligibility or other circumstances change (e.g., turning 65, support need changes, etc.)
•	Monitor plan enrollment and marketing activities, including in coordination with CMS.
Slide 8: Guiding Principles for Plan Procurement – Service Areas
Geographic Coverage and Choice:
•	Provide members with choices between plans
o	In all or most counties, choice of at least 2 One Care or SCO plans; and 
o	Encourage bids that maximize statewide coverage for One Care and SCO
•	Potential bidding requirements such as:
o	Allowing bidding on full counties only (no partial counties)
o	Requiring bids to include at least 6 counties in plan Service Areas
•	Continuity when members move or have an address change.
Slide 9: Guiding Principles for Plan Procurement – Provider Networks
•	Align provider networks for One Care and SCO products to:
o	Promote enrollee choices and access to providers and services.
o	Improve ability for members to keep current providers when enrolling.
o	Enable MassHealth to be more efficient in contract management and oversight.
o	Simplify plan/provider operational processes.
•	Potential preference for bid responses that include aligned provider networks for both One Care and SCO products with certain exceptions.
o	Population-specific providers and expertise (e.g., LTS Coordinator in One Care and GSSC in SCO; Geriatricians, etc.)
o	Specific and limited other exceptions requested by plans and approved by MassHealth.
•	Build strong provider networks with access and availability standards appropriate for each program’s population.
•	Require plans to develop and deploy their expertise, services, and care models for the unique populations in One Care and SCO.
Slide 10: Consumer Reviews for Responses to the One Care and SCO Procurement
EOHHS will include consumer perspectives as part of its review of One Care and SCO health plan proposals.

•	In previously One Care plan procurements, MassHealth has sought and incorporated consumer perspectives on certain parts of those procurement bid responses.
•	MassHealth will provide an opportunity for individuals who have personal experience with disabilities and/or aging to apply to become a consumer reviewer.
•	Selected consumers would review certain parts of the plan procurement responses.
•	More information on the application process, timeline, and expected commitment for selected reviewers will be released in the future on COMMBUYS and on another public-facing website (TBD).
•	Stipends are expected to be available for Consumer Reviewers.
Sharing early to raise awareness for individuals who would be interested in participating.
Slide 11: Consumer Reviewer Opportunity
1.	What is the role of a Consumer Reviewer?
•	Review sections of the bids from organizations that want to be health plans for One Care and SCO.
•	Participate in meetings with MassHealth. 
•	Provide thoughtful feedback.
2.	Who can be a Consumer Reviewer?
In general, individuals who are described below may be eligible to apply to participate as a Consumer Reviewer. Specific criteria will be provided when the opportunity is announced.
•	Eligible for One Care or SCO or
•	Members of One Care or SCO or
•	Family members of individuals who are eligible (or members) of One Care or SCO
•	Implementation Council and SCO Advisory Committee members who are also consumers may apply.
3.	What supports will be available for Consumer Reviewers?
Consumer Reviewers will be provided with:
•	Applicable bid response sections in an accessible format convenient for their review (e.g., hard copy, electronic, accessible electronic, large print, etc.).
•	Reasonable accommodations to support their participation.
•	A facilitator and note taker from UMass to help organize their discussions with other participating reviewers.
•	A stipend for their participation.
Slide 12: Transition & Procurement Timeline (Preliminary)
Overall Transition Process
2023
•	EOHHS updates on policy direction and decisions in stakeholder forums (at least quarterly)
2024 -2025
•	Operations Planning, Medicaid Authority, State Regulations, etc. for 2026
•	EOHHS Procures and Contracts with One Care Plans and SCO Plans
•	Medicare Application & Contracting, 11/2024 - Fall 2025
2026
•	One Care Operates via FIDE SNPs 1/1/2026
Procurement Milestones
2023
•	Release RFR and Model Contracts (late 2023 - early 2024)
•	Consumer Reviewer Notice of Opportunity
2024
•	Bids Due (Spring 2024)
•	Select Plans (Fall/2024)
•	Medicare NOIA* (11/2024)
•	Medicare Application process begins with a Notice of Intent to Apply (NOIA) 14 months before the coverage year begins.
2025
•	EOHHS Readiness Reviews (Early 2025)
•	Sign EOHHS Contract (5/1/2025)
•	Medicare bids due:
o	2/2025
o	6/2/2025
•	Sign Medicare Contracts (7/2025)
•	Medicare Open Enrollment (Oct-Dec 2025)
2026
•	Enrollments Effective (1/1/26)
Implementation and Advisory Councils
2023-2024
•	Procure One Care Implementation Council & SCO Advisory Committee
2024
•	Orientation & Training for Committee Members
2024 - 2025
•	Advise on Implementation, Performance, and Monitoring Plans
2025
•	Updated (2026) Program Structure Training for Committee Members
Slide 13: Procurement Information for Stakeholders
•	COMMBUYS is the official source for all procurement-related information
•	Stakeholders can also find related announcements and information on upcoming forums at:
o	One Care Transition Planning 
o	One Care and SCO Procurement Information for Stakeholders
Email OneCare@Mass.gov to be added for future updates