What do SCO Plans cover?
SCO Plans cover all the services the member currently receives under MassHealth and Medicare. SCO Plans also cover all health and personal care services including, primary care and specialty physician visits, regular preventive services, prescription drugs (under the member's Medicare prescription drug coverage), emergency care, inpatient hospitalization, mental health and substance abuse treatment services, nursing facility care, transportation for medical care, and other services covered in the health-care plan.
I am a MassHealth-participating provider. I have patients who have both MassHealth and Medicare. What will change if these patients enroll in SCO?
Once a member enrolls in a SCO Plan, payment for services is made only by the SCO Plan. You can continue to provide services to your patients who enroll in a SCO if you are in the SCO Plan’s network of providers. You do not need to be in a SCO network to be paid for providing emergency services to a SCO Enrollee.
How can I determine if a patient is eligible or enrolled in a SCO Plan?
Providers should check the MassHealth Provider Online Service Center (POSC) regularly for member eligibility and plan enrollment.
- Click “Manage Members” then “Eligibility” then “Verify Member Eligibility”
- Input Member Information
- If eligible for SCO, the plan name will appear under “List of Managed Care Data (for MCO/ACO)
If I treat a SCO Plan member for an emergency, how do I get paid?
Emergency services provided to a SCO Plan member will be paid by the SCO Plan. The SCO Plan member's authorized representative or provider must notify the SCO Plan of the emergency as soon as possible.
If I do not have a contract with the member's SCO Plan, other than emergencies, are there any other services I will get paid for?
In some circumstances, the SCO Plan will authorize specific services from a non-contracted or out-of-network provider. For example, a SCO Plan may authorize and pay for health-care services delivered by a non-contracted provider if a contracted provider was not available to treat the SCO Plan member or if the member is temporarily out of the SCO Plan’s service area.
How can I become a contracted provider with a SCO plan?
To contract with a SCO plan, you must contact the SCO plan directly.
Will all MassHealth members aged 65 or older be required to join a SCO Plan?
No. Enrollment in a SCO Plan is voluntary but enrollment in a SCO Plan does offer seniors a variety of benefits such as individualized, managed, and supportive care services to assist them with their health care.
Are SCO Plans available statewide to MassHealth members?
Yes, SCO plans are available statewide.
Do SCO Plans replace MassHealth as the secondary insurer?
SCO Plans provide and pay for all of the services covered by Medicare Parts A and B and MassHealth Standard. There is no primary or secondary insurer. There are no fee-for-service payments, service exclusions, or crossover claims.
How will Medicare Part D affect SCO Plan patients?
It is not necessary for SCO Plan members to sign up for Medicare Part D, as the SCO Plan they belong to provides coverage of all drugs and pharmacy services covered under Medicare Part D. If a SCO Plan member signs up for Medicare Part D, they will be disenrolled from the SCO Plan they are currently enrolled in.