Guide MassHealth Community Partners (CP) Program: Information for Providers

Behavioral Health (BH) and Long-Term Services and Supports (LTSS) Community Partners (CPs) are community-based entities that work with Accountable Care Organizations (ACOs) and Managed Care Organizations (MCOs) to provide care management and coordination to certain members identified by MassHealth, ACOs, and MCOs. BH CPs provide supports to certain members with significant behavioral health needs, including serious mental illness and addiction. LTSS CPs provide supports to certain members with complex LTSS needs, such as children and adults with physical and developmental disabilities and brain injuries.

MassHealth members enrolled in an ACO or MCO may be eligible to participate in the CP program. CPs are not available to members enrolled in the Primary Care Clinician (PCC) Plan or in Mass Health’s fee-for-service (FFS) program unless the member is affiliated with the Department of Mental Health’s Adult Community Clinical Supports program. When members have other state agency or provider supports, CPs supplement and coordinate with those supports but do not duplicate the functions provided by them.

Table of Contents

Objectives

  • Support members with significant BH needs and complex LTSS needs to help them navigate the BH and LTSS healthcare systems in Massachusetts.
  • Improve member experience and continuity and quality of care by holistically engaging members with significant BH needs (SMI, and addiction) and complex LTSS needs.
  • Create opportunity for ACOs and MCOs to leverage the expertise and capabilities of existing community-based organizations serving populations with BH and LTSS needs.
  • Invest in the continued development of BH and LTSS infrastructure (e.g. technology, information systems) that is sustainable over time.
  • Improve collaboration across ACOs, MCOs, CPs, and community organizations addressing the social determinants of health, and BH, LTSS and physical health care delivery systems in order to break down existing silos and deliver integrated care.
  • Support values of Community First[1], recovery principles, independent living, and promote cultural competence.

[1] Community First is a policy agenda that seeks to empower and support people with disabilities and elders to live with dignity and independence in the community by expanding, strengthening, and integrating systems of community-based long-term supports that are person-centered, high in quality and provide optimal choice.

Supports Provided by Community Partners

BH CP Supports

BH CPs perform comprehensive care coordination and care management, including

  • Outreach and engagement
  • Comprehensive assessment and ongoing person-centered treatment planning
  • Care coordination and care management across services including medical, behavioral health, long-term services and supports, and other state agency services
  • Support for transitions of care
  • Medication reconciliation support
  • Health and wellness coaching
  • Connection to social services and community resources

LTSS CPs

LTSS CPs are experts who perform LTSS care coordination, including

  • Outreach and engagement
  • care planning including providing informed choice of services and providers
  • Care team participation
  • LTSS care coordination, including social services and services provided by other state agencies
  • Support for transitions of care
  • Health and wellness coaching
  • Connection to social services and community resources

CPs are not responsible for authorizing services for members. All person-centered treatment plans and LTSS care plans must be approved and signed by the member's PCP or PCP designee. Providers of services that require prior authorization should continue to submit authorization requests to Accountable Care Partnership Plans, MCOs, and MassHealth, as applicable. Providers should refer to MassHealth or managed care contracts, regulations, bulletins, and provider manuals, as appropriate, for all applicable requirements for their respective programs and MassHealth services.

Key Actions for Supports Provided by Community Partners

Information about Member Assignment to a CP

  • MassHealth, ACOs, and MCOs identify memberfor the program based on their service history. These members may be assigned to a CP in their area.
     
  • Each assigned member receives a letter from MassHealth and is contacted by CP staff who explains the program.
     
  • Members may request a different CP in their area or may decline to participate in the program at any time. This decision will not impact the members MassHealth benefits in any way.
     
  • Members who are not identified by MassHealth or assigned to a CP may submit a request to participate in their MCO or ACO. This request could come from a provider on the members behalf. The members MCO or ACO will determine whether to assign the member to a CP.

Program Implementation Timeline

  • June 2018 - MassHealth began to identify members for the Community Partners Program based on service utilization data.
  • July 2018 – Community Partners Program began.  Community Partners began supporting members identified by MassHealth.
  • Ongoing – MassHealth and ACOs and MCOs continue to identify members for the Community Partners Program on a quarterly basis.
  • 2020 - ACOs and MCOs will begin accepting referrals for the Community Partners Program. 

What Community Partners means to providers

Providers of MassHealth services and programs should continue to deliver services in accordancwith all applicable regulations, program or service specifications, agency guidance, and contracts with ACOs, MCOs, and the MassHealth behavioral health vendor.

Community Partnercoordinate with providers to supplement but do not duplicate functions performed by providers. CPs are a resource and support for coordinating with the members providers, ACO and MCO. For example, a CP may support integration making sure that ACOs, MCOs, PCPs and other providers share the right information and coordinate services, including additional social services, through a single care plan.

Providers that believe a member they serve might benefit from CP supports, should contact the members PCP, ACO, or MCO to discuss participation in the CP program. A resource for locating ACO and MCO contact information is below.

Community Partners Fact Sheet

An Introduction to MassHealth Long Term Services and Supports and Other Covered Services for Providers

This Guide provides basic information about and gives context to the range of State Plan LTSS and Other Covered Services. MassHealth intends for this Guide to be a resource for care managers, care  coordinators, and physician offices within Accountable Care Organizations (ACOs, including Accountable Care Partnership Plans, Primary Care ACOs, and MCO-Administered ACOs) and Managed Care Organizations (MCOs), as well as Community Partners (CPs), and providers as they serve MassHealth members who may benefit from LTSS or Other Covered Services.

Additional Resources for An Introduction to MassHealth Long Term Services and Supports and Other Covered Services for Providers

Introduction to Community Partners Training for Providers

This training offers providers an introduction to Community Partners training in phase III of the PCDI training.

 

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