Primary Care Clinician Plan and Primary Care Accountable Care Organization Plans
Primary Care Clinician Plan
In the Primary Care Clinician (PCC) Plan, primary care providers (PCPs) are called PCCs. The MassHealth network of PCCs, specialists, and hospitals delivers services. PCC Plan members have access to the entire MassHealth fee-for-service (FFS) network for care other than primary care and behavioral health (BH) services. PCC Plan members receive BH services through enrollment with the MassHealth BH vendor (currently the Massachusetts Behavioral Health Partnership, or MBHP).
Upon enrollment in the PCC Plan, members can select a service location and an individual PCC 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. You can find more information for PCC Plan providers in the PCC Provider Handbook.
Primary Care Accountable Care Organizations
An accountable care organization (ACO) is a provider-led health plan that holds participating providers financially accountable for both cost and quality of care for members. Primary care ACOs (PCACOs) are a type of ACO in which a network of PCPs has joined together to provide integrated and coordinated care for members.
Members receive all their primary care from primary care sites (called participating PCPs) that are part of their particular PCACO. Each member of a PCACO is enrolled at a specific primary care site within that PCACO. The PCACO and its participating PCPs contract directly with MassHealth, and members use the MassHealth FFS provider network of specialists and hospitals. Members who enroll in a PCACO receive BH services through MBHP. No matter which PCACO a member is enrolled in, they have access to the whole MassHealth FFS network of providers for care other than primary care and BH services. Because participating PCPs are also contracted MassHealth FFS network providers, they can be eligible to provide specialist care to other MassHealth members who are not part of the PCACO.
PCACO members who need additional care coordination and management can receive those services from staff members of their primary care site or staff members employed directly by the PCACO.
Primary Care Exclusivity and Exceptions
Practices enrolled in a PCACO as a participating PCP location may only be paid to provide primary care services and to see managed care eligible members who are enrolled in that PCACO for primary care services. This restriction does not apply to members who are not eligible for PCACOs (members of Senior Care Options [SCO], Program of All-inclusive Care for the Elderly, One Care, etc.). This restriction also does not apply to those practices when they are providing specialist care (like obstetric and gynecological services) to members.
BH Care for Certain Managed Care Members
MBHP manages BH care for members of MassHealth PCACOs and the PCC Plan.
Managed Care Entities
Managed care entities (MCEs) and Accountable Care Partnership Plans (ACPPs) are MassHealth-contracted health plans that manage separate provider contracts and networks from the MassHealth billing and non-billing programs.
MCOs
MCOs are health plans run by health insurance companies that provide care through their own provider network that includes PCPs, specialists, BH providers, and hospitals. Care coordinators are employed by the MCO.
ACCPs
An ACCP is a provider-led health plan that holds participating providers financially accountable for both cost and quality of care for members. ACPPs are a type of ACO. In this type of ACO, a network of PCPs works with just one health plan to create a full network that includes PCPs, specialists, BH providers, and hospitals. PCPs plan and coordinate care to meet the needs of the member.
Integrated Care Programs
MassHealth’s Integrated Care Programs are voluntary MassHealth-contracted programs for individuals who are dually eligible for both Medicare and MassHealth.
One Care
One Care is a managed care program that integrates Medicare and Medicaid benefits into one plan for dually eligible members who are between the ages of 21 and 64 at the time they enroll. Services are developed and delivered based on an enrollee’s assessment and care plan. Care coordinators and care managers are employed by the One Care plans.
SCO
SCO is a managed care program that integrates Medicare and Medicaid benefits for dually eligible members ages 65 and older. Services are developed and delivered based on an enrollee’s assessment and care plan. Care coordinators and care managers are employed by the SCO plans.
PACE
PACE is administered by MassHealth and Medicare to provide a wide range of medical, social, recreational, and wellness services to eligible participants. PACE organizations offer services to eligible individuals ages 55 and above who are clinically assessed to require a nursing-home-certifiable level of care. PACE is not a managed care program but includes several features of managed care, including integrated MassHealth and Medicare benefits. You can learn more about the PACE program on our PACE web page.
| Date published: | July 29, 2022 |
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| Last updated: | August 21, 2026 |