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Primary Care Clinician Plan & Primary Care Accountable Care Organizations

MassHealth Managed Care (MassHealth Provider Network)

This is part of the MassHealth Provider Handbook.

Table of Contents

Primary Care Clinician (PCC) Plan

MassHealth PCC Plan image

In the PCC Plan, primary care providers (PCPs) are called primary care clinicians (PCCs). The MassHealth network of PCCs, specialists, and hospitals delivers services. PCC Plan members have access to the entirety of the MassHealth Fee-for-Service network for non-primary care.

Upon enrollment into the PCC Plan, members may select a service location and an individual health care provider from among MassHealth participating PCC Plan network providers. The member’s PCC is responsible for providing and/or coordinating most of the member’s medical care and, as necessary, referring the member to other MassHealth providers for non-primary care services. More information for PCC plan providers can be found in the Primary Care Clinician (PCC) Provider Handbook.

Primary Care Accountable Care Organizations (PCACOs)

An ACO is a provider-led health plan that holds participating providers financially accountable for both cost and quality of care for members. In this type of ACO, a network of PCPs has joined together into an ACO to provide integrated and coordinated care for members.

Woman looking at notes

Members will receive all of their primary care from primary care sites that are part of their particular Primary Care ACO, unless they receive a referral to go elsewhere. All members in a Primary Care ACO are enrolled at a single primary care site within that ACO. The ACO contracts directly with MassHealth and uses the MassHealth FFS provider network of specialists and hospitals. Members who enroll in a Primary Care ACO receive behavioral health services through the Massachusetts Behavioral Health Partnership. No matter which Primary Care ACO a member is enrolled in, they have access to the entirety of the MassHealth Fee-for-Service network of providers for non-primary care. It is important to note that primary care sites are also contracted MassHealth FFS network providers and can provide specialist care to other MassHealth members who are not part of the Primary Care ACO. 

Primary Care Exclusivity and Exceptions

Practices enrolled in a Primary Care ACO as a participating primary care practice location may only see managed care eligible members who are enrolled in that Primary Care ACO for primary care, unless they receive a referral. This restriction does not apply to members who are not managed care eligible (SCO, PACE, One Care, etc.) or who are involved in the Special Kids Special Care program of the Department of Children, Youth and Families. This restriction also does not apply to practices if they are providing specialist care to those members (OB/GYN services for example).

The Massachusetts Behavioral Health Partnership (MBHP)

MBHP logo

MBHP manages behavioral health care for more than 500,000 MassHealth members statewide. Working with its network of providers, MBHP offers high quality, accessible, culturally sensitive health care to members of the MassHealth Primary Care Clinician (PCC) Plan, Community Care Cooperative (C3), Partners HealthCare Choice, Steward Health Choice, and the BeHealthy Partnership plan. The MBHP also serves children in state custody and others. For more information, please visit the MBHP website.

Date published: July 29, 2022

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