MassHealth Community Partners (CP) Program: Information Overview

• Reaffirm MassHealth’s commitment to providing community-based outreach and enhanced supports for the highest-risk members and leveraging the expertise of community-based organizations;
• Simplify and streamline the relationships between CPs, ACOs, and MCOs;
• Heighten, clarify, and standardize the expectations of CPs related to both Care Coordination and accountability for outcomes, and align the LTSS CP and BH CP programs;
• Continue to incentivize strong and seamless partnerships among the physical health, behavioral health, long-term services and supports, and health-related social needs delivery systems; and
• Continue to incentivize value-based care and trend management using an updated accountability model.

Definitions

Member: a person determined by EOHHS to be eligible for MassHealth.

CP Enrollee: a person who is enrolled in the CP Program.

Nursing Facility Client (NF Client): a person who is determined through a Pre-Admission Screening and Resident Review (PASRR) Level II evaluation to have serious mental illness and is authorized by DMH. If a Level II evaluation determines that nursing facility services are needed for up to 12 months, the NF Client meets the rules for the Community Partners Program. BH CPs may support these clients until they are discharged from the nursing facility.

The new CP Program Enrollment Portal launched in late fall 2024. ACO, MCO, and CP submitters submitting a batch file for enrollments, disenrollments, and transfers must use a batch template in Microsoft Excel.

CPs perform enhanced care coordination activities, including

• conducting in-person or virtual outreach to the CP enrollee to initiate contact and confirm CP Program participation;
• conducting a Comprehensive Assessment covering immediate care needs and current services, health conditions, medications, communication abilities, functional status and needs, and a Health Related Social Needs (HRSN) screening;
• developing a Person-Centered Treatment Plan (Care Plan) reflecting the preferences, goals, and needs of the CP enrollee;
• forming and coordinating a Care Team for the CP enrollee to facilitate communication among providers, assist the CP enrollee in accessing services, and provide ongoing care planning;
• coordinating and managing care across services including medical, behavioral health, long-term services and supports, and other state agency services, as appropriate;
• providing supports for transitions of care;
• providing options counseling;
• providing health and wellness coaching; and
• connecting CP enrollees to social services and community resources.

When CP enrollees have other state agency or provider supports (unless specified above), CPs will supplement and coordinate with those supports, but they will not duplicate the functions provided by those supports.

CPs do not authorize services for CP enrollees. Service authorizations continue to follow the same processes as those already in place for members enrolled in an ACO or MCO, the PCC plan, or the MassHealth FFS program. Providers of services that require prior authorization must continue to submit authorization requests to ACOs, MCOs, the MassHealth behavioral health vendor, and MassHealth, as applicable.

Information about Enrollment into the CP Program

• ACOs and MCOs identify eligible members for the CP Program based on the member’s service history. These members are enrolled with a CP in their area.
• Adult Community Clinical Services (ACCS/Post-ACCS) Clients who are eligible for the CP Program are identified and referred to the CP Program by the Department of Mental Health (DMH).
• MassHealth sends a letter to each CP enrollee. CP staff will also contact enrolled members to explain the CP Program. Letters will be mailed on an ongoing basis to newly assigned CP enrollees.
• CP enrollees may request a different CP in their area or may decline to participate in the CP Program at any time. Their decision will not impact their MassHealth benefits in any way.
• MassHealth members may submit a request to participate in the CP program to their ACO or MCO. A provider can also submit a request on a member’s behalf. The member’s ACO or MCO will decide whether to assign a CP.
• Those who meet the rules for the BH CP in NFs program are identified by the DMH PASRR Office. Please see the Behavioral Health Community Partners in Nursing Facilities Fact Sheet for more information.

Eligibility

A MassHealth member is eligible for the CP Program if they are

• enrolled in an ACO or MCO;
• receiving (or have received) ACCS/Post-ACCS (if so, the member is not required to be enrolled in an ACO or MCO to qualify for the program); or
• an NF Client who has received a 12-month determination from a PASRR Level II evaluation or a 90-day determination from PASRR Level II after a 12-month PASRR Level II evaluation. Payer source (for example, MassHealth coverage or commercial coverage) is not a factor for program eligibility.

MassHealth members are NOT eligible for the CP Program if they are NF Clients who have received a 90-day determination from PASRR Level II or if they are enrolled in any of the following programs.

• The Primary Care Clinician (PCC) Plan or the MassHealth Fee-For-Service (FFS) Program (excluding members enrolled in DMH ACCS/Post-ACCS services)
• One Care
• Senior Care Options (SCO)
• Program of All-Inclusive Care for the Elderly (PACE)
• DMH’s Program of Assertive Community Treatment (PACT);
• Intensive Care Coordination (ICC)
• CARES 4 Kids Program
• Other programs identified by EOHHS as being duplicative of the CP Program

Age Eligibility

• BH CP: 18-64 years old
• LTSS CP: 3-64 years old
• BH CP in NFs: 18 and older

• April 1, 2023 - MassHealth launched the new Community Partners Program, an updated version of the program featuring new and enhanced responsibilities for Community Partners such as medication reviews, connections to options counseling, conducting of the comprehensive assessment, and the inclusion of nursing staff for CP Enrollees within LTSS CPs.
• April 1, 2023 through June 30, 2023 - The CP Continuity of Care Period ensured a smooth transition between the original 2018-2023 CP Program and the new CP Program.
• July 3, 2023 - The CP Program launched the Behavioral Health Community Partners (BH CP) in Nursing Facilities (NFs) Program (BH CP in NFs Program) to support members who have been determined to have serious mental illness (SMI) and are deemed appropriate for NF care for 12 months through a PASRR Level II evaluation. This support is for members with significant behavioral health needs, including SMI. The goal of BH CP in NFs is to ensure behavioral health care in NFs is coordinated the same way it would be in the community.

MassHealth providers must continue to deliver services in accordance with all applicable regulations, program or service specifications, agency guidance, and contracts with ACOs, MCOs, and the MassHealth behavioral health vendor.

Community Partners coordinate with providers and supplement, but do not duplicate, functions performed by other providers. CPs are a resource and support for coordinating with the CP enrollee’s providers and ACO/MCO. For example, CPs support integration by making sure that ACOs/MCOs, PCPs, and other providers share the appropriate information and coordinate services, including additional social services, through a single Care Plan.

Providers who believe a member they serve might benefit from the CP Program should contact the Member’s ACO/MCO to discuss participation in the CP Program. A resource for locating ACO and MCO contact information can be found on the Full list of MassHealth ACOs and MCOs page.

Behavioral Health Community Partners in Nursing Facilities: PDF | Word

MassHealth Behavioral Health and Long-Term Services and Supports Community Partners Program: PDF | Word