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Creating a single entry point for long-term services and supports

Information about procurement for Independent Assessor Entity - February 16, 2024.

Table of Contents

Creating a single entry point for long-term services and supports

EOHHS is in the early stages of exploring the option to bring on an organization to be the Independent Assessor Entity (IAE) to improve the MassHealth member experience by simplifying and streamlining the assessment process and creating a single point of access for multiple long-term services and supports (LTSS) programs.

Currently, every LTSS provider and Integrated Care plan is responsible for administering their own clinical eligibility and rating category assessments for each MassHealth member.  This can lead to multiple assessments being done for a single member in the same year.  Additionally, the current system makes it difficult for members to learn about other LTSS programs/supports that they may be eligible for to meet the member's needs.

The IAE will enable timelier access to in-scope LTSS programs and create a smoother referral process for providers and members. Specifically, EOHHS expects that the IAE will reduce the length of time between initial intake and service enrollment for members, leading to faster interventions and better overall health outcomes.

EOHHS will be seeking an IAE with demonstrated experience administering assessments and:

  • Positive experience working with individuals with a disability;
  • Positive experience providing person-centered conflict-free counseling;
  • Knowledge of and expertise in helping people connect to LTSS and other community-based services and supports;
  • Expertise in providing culturally competent and linguistically appropriate services; and
  •  Expertise in providing a person-centered assessment experience.

 

Communication Regarding an Update to the Request for Responses (RFR) for an Independent Assessment Entity and Intent to Issue a Request for Information (RFI) Related to Independent Assessment Entity Procurement

On February 16, 2024, the Executive Office of Health and Human Services (EOHHS) posted a procurement to improve member experience by improving the timeliness of clinical assessments for certain long-term services and supports (LTSS) programs; creating a streamlined process for members to understand what LTSS benefits and programs they are eligible to receive; and reducing the number of assessments members must undergo each year. EOHHS received feedback from stakeholders requesting further opportunities for input and indicating concern about the speed of the procurement process. In response, EOHHS is planning to issue a Request for Information (RFI) to solicit additional input from members, advocates, and other stakeholders, will host a listening session, and intends to extend the timeline for the procurement to allow for this additional input.

The RFI will:

  1. Provide data to outline the member challenges the RFR is intending to address.
  2. Solicit key feedback and information from stakeholders, advocates, and members relating to the improvements to the member experience EOHHS seeks to implement via the Independent Assessment Entity as well as to the scope and design of the Independent Assessment Entity procurement.

Bidders should know that amendments may be made to the RFR, the model contract, or other procurement documents as a result of questions asked to date and as a result of information received by EOHHS through the RFI.

EOHHS intends to post on COMMBUYS responses to the questions received about the Independent Assessment Entity procurement and any amendments to the RFR, model contract, or other procurement documents by an estimated date of June 14, 2024. Following this posting, Bidders will receive at least six weeks to complete and submit Bids on COMMBUYS.

EOHHS intends to post the RFI by an estimated date of April 16, 2024, with responses due on an estimated date of May 17, 2024. The actual response due date for the RFI will be provided in the RFI.

Initial Timeline

Anticipated amended timeline (estimated)

EHS posts responses to questions and any amendments to the RFR and model contract April 5, 2024

EHS posts responses to questions and any amendments to the RFR and model contract June 14, 2024

N/A

ADDED time for bidders to ask questions June 14, 2024 to June 28, 2024

N/A

EHS posts responses to 2nd round of questions and any amendments to the RFR and model contract July 12, 2024

RFR responses due April 26, 2024

RFR responses due September 6, 2024

Vendor selection July 26, 2024

Vendor selection: January 1, 2025

Contract Execution (estimated) January 1st, 2025

Contract Execution (estimated) May 1, 2025

Pilot Start Date: (estimated) January 1st, 2026

Pilot Start Date: (estimated) Winter 2026

Independent Assessor Entity Implementation Advisory Council (IAEIAC) Information:

MassHealth is procuring for an Independent Assessor Entity Implementation Advisory Council (IAEIAC) to advise MassHealth in the implementation of the Independent Assessor Entity (IAE). 

The link to the Notice of Opportunity to participate in the EOHHS Independent Assessor Entity Implementation Advisory Council (IAEIAC) for MassHealth is now posted on COMMBUYS as of March 1, 2024 with bid number BD-24-1039-EHS01-ASHWA-99189.

We encourage you to apply to be part of the IAEIAC. Please send in your application by Friday, March 29th, 2024 by 5pm.

Frequently Asked Questions

What programs will be impacted by the IAE?

Adult Day Health, Day Habilitation, Adult Foster Care, Group Adult Foster Care, PCA, PACE, SCO and OneCare are planned to be in scope.
 

Is MassHealth assuming that savings will result from implementing this program?

No. MassHealth is not assuming any budget savings tied to this proposal.
 

I am a member, how will this help me?

Members will see the following key improvements:

  • Single point of entry and one assessment
  • Improved understanding of the full range of program choices
  • Decreased length of time from initial referral to a completed assessment and initiation of services
  • Reduced assessment fatigue
     
I use the PCA program, will this change medicalize the PCA model of service?

No. The tool used to assess members for PCA services will not change. The change to IAE will facilitate faster access to PCA services.  
 

I use the PCA program, will this impact program eligibility or level of service?

No. The IAE will use the same assessment tool and follow the same guidelines that are used today.
 

How will the IAE change the experience of new members onboarding to the PCA program?

Today, there are several steps for a new member seeking PCA services: in determining eligibility, including an assessment of ability to manage PCA services, a clinical evaluation, gathering required documentation, physician signature of the evaluation summary, and submission and adjudication of a Prior Authorization (PA).  The IAE process shortens that period of time in all areas, most significantly by eliminating the PA requirement, which is currently a 21-day period. Today, it can take more than two months from the point of referral to approval. With the IAE, the evaluation and the PA will be essentially a single step and will shorten the time to when a member can begin using their PCA services.
 

How will this change impact members that want to access Adult Foster Care?

Adult Foster Care members will see the following improvements:

  • Single point of entry
  • Improved understanding of program choices and potential eligibility for other/additional services
  • Reduced length of time between initial intake and service enrollment, leading to faster interventions and better overall health outcomes
     
How will this change impact members that want to access Group Adult Foster Care?

Group Adult Foster Care members will see the following improvements:

  • Single point of entry
  • Improved understanding of program choices and potential eligibility for other/additional services
  • Reduced length of time between initial intake and service enrollment, leading to faster interventions and better overall health outcomes
     
How will this change impact members that want to access Adult Day Health?

Members will see the following key improvements:

  • Single point of entry
  • Improved understanding of program choices
  • Decreased length of time from initial referral to a completed assessment and services
  • Reduced assessment fatigue
     
How will this change impact members that want to access Day Habilitation services?

Members will see the following key improvements:

  • Single point of entry; all eligible services will be identified
  • Alternate means of referral, specifically for individuals who are not associated with DDS
  • Improved understanding of program choices
  • Referred program will have access to IAE assessment to help understand individualized needs
     
I am enrolled in PACE, how will this change impact me?

For members who have already joined a PACE program, there will be no impact.

Members who wish to join a PACE program will continue to coordinate with the PACE program of their choice for enrollment. PACE programs will be able to coordinate with the IAE to arrange a timely clinical eligibility determination as part of the broader intake process to help the member get to services more quickly. The implementation of the IAE will enhance the members experience by improving processing times to determine clinical eligibility and by creating a seamless experience through the enrollment process.
 

I am interested in enrolling in a SCO or One Care plan, how will this change impact me?

Members planning to enroll in a SCO or One Care plan will experience the following improvements for initial assessments:

  • Reduced wait time to complete the clinical assessment
Date published: February 29, 2024
Last updated: April 2, 2024

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