MassHealth 1115 Demonstration Amendment Request As Posted for Public Comment - October 2024
On October 11, 2024, Massachusetts announced its intent to submit a request to CMS to amend the MassHealth Section 1115 Demonstration. The Amendment Request outlines the specific authorities being requested from CMS including, 1) Require One Care and Senior Care Options (SCO) plans to cover certain expanded and additional services that enable members with disabilities and older adults to live successfully in the community; 2) Implement certain enrollment flexibilities to ensure maximum possible alignment with Medicare enrollments and to prevent or minimize disruption of a member’s managed care enrollment; and 3) Permit eligible individuals with MassHealth CommonHealth to enroll in SCO when they otherwise meet SCO participation requirements. For more information, and to review the Amendment Request, please visit the MassHealth Section 1115 Demonstration Waiver webpage.
Additional Resources
Transition Background
In Spring 2022, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule “Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs.” The Final Rule was published in the Federal Register on May 9, 2022 (2022-09375.pdf (govinfo.gov).
The Final Rule included certain flexibilities for Dual Eligible Special Needs Plans (D-SNPs) and a transition for Medicare-Medicaid Plans (MMPs) from Demonstration to D-SNP authority. One Care provides comprehensive integrated care to dual eligible adults with disabilities (ages 21-64 at enrollment) through MMPs. As the Rule requires, EOHHS is planning to transition One Care to a D-SNP platform effective January 1, 2026. The process for developing the Transition Plan in consultation with stakeholders is described in the Initial Transition Plan submitted to CMS.
For reference, see EOHHS comments submitted to CMS on the proposed rule on March 7, 2022.
Initial Plan for Transition Process
September 30, 2022
The initial Transition Plan lays out the process EOHHS expects to use to determine the structural, policy, and operational elements of its Transition. This plan will be considered a living document that will be updated and expanded based on the feedback received from stakeholders and CMS. EOHHS is committed to an engagement process with a wide array of stakeholders to promote collaborative discussion on the planning and implementation as it begins its transition planning process.
Additional Resources
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Open PDF file, 272.13 KB, One Care Initial Plan for Transition Process (English, PDF 272.13 KB)
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Open DOCX file, 105.91 KB, One Care Initial Plan for Transition Process (English, DOCX 105.91 KB)
Stakeholder Engagement
Please visit this page for upcoming public meetings and information related to MassHealth's ongoing engagement with various Stakeholder groups.
Additional Resources
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Open PDF file, 266.1 KB, One Care Transition Plan – Stakeholder Forum (May 25, 2023) (English, PDF 266.1 KB)
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Open RTF file, 206.28 KB, One Care Transition Plan – Stakeholder Forum (May 25, 2023) (English, RTF 206.28 KB)
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Open PDF file, 290.56 KB, One Care Transition Plan – Stakeholder Forum (March 15, 2023) (English, PDF 290.56 KB)
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Open DOCX file, 36.08 KB, One Care Transition Plan – Stakeholder Forum (March 15, 2023) (English, DOCX 36.08 KB)
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Open PDF file, 239.08 KB, One Care Transition Plan – Stakeholder Forum (December 15, 2022) (English, PDF 239.08 KB)
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Open DOCX file, 24.8 KB, One Care Transition Plan – Stakeholder Forum (December 15, 2022) (English, DOCX 24.8 KB)
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Open PDF file, 196.83 KB, One Care Transition Plan - Stakeholder Forum (October 6, 2022) (English, PDF 196.83 KB)
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Open DOCX file, 54.62 KB, One Care Transition Plan - Stakeholder Forum (October 6, 2022) (English, DOCX 54.62 KB)
Plan Procurement for 2026
Date published: | September 30, 2022 |
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Last updated: | November 13, 2024 |