Former One Care Contracts

In September 2022, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed an addendum to the amended and restated One Care Three-way Contract that extends the demonstration period for One Care by one year through December 31, 2023. The addendum also specifies the quality withhold amounts, savings percentages, and risk corridor terms for Demonstration Year 10 (2023)The amendment also implements several policy items from the 2019 RFR, including: implementation of the deemed eligibility 2-month enrollment protection, clarifies plan requirements for how Enrollees may communicate with plans, adds Local Control provisions for procurement implementation, and specifies definitions for the expanded DME and Personal Assistance services . The contract addendum is posted below. The amendment is effective as of January 1, 2022.

In September 2021, MassHealth, the Centers for Medicare and Medicaid Services (CMS), and the three entities selected from the 2019 Request for Responses for One Care Plans – Commonwealth Care Alliance, Tufts Health Public Plans, and UnitedHealthcare Community Plans – executed Three-way Contracts. The Three-way Contracts are effective as of January 1, 2022 and contain requirements for Demonstration Year 9 of the current Duals Demonstration.

In July 2021, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed an addendum to the amended and restated One Care Three-way Contract that extends the demonstration period for One Care by one year through December 31, 2022. The addendum also specifies savings percentages and risk corridor terms for Demonstration Year 9 (2022), which are consistent with such terms for Demonstration Year 8 (2021). The quality withhold amounts for Demonstration Year 9 (2022) will be increased to 2.5% from 1.75% in Demonstration Year 8 (2021). ​The amendment also updates certain requirements for customer support and initial outreach, adds Electronic Visit Verification administrative requirements, COVID-19 payment provisions, COVID-19 vaccine incentive payments, and updates to Medical Loss Ratio requirements. The contract addendum is posted below. The amendment is effective as of August 1, 2021.

In July 2020, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed an addendum to the amended and restated One Care Three-way Contract that extends the demonstration period for One Care by one year through December 31, 2021. The addendum also specifies the quality withhold amounts, savings percentages, and risk corridor terms for Demonstration Year 8 (202​1), which are consistent with such terms for Demonstration Year 7 (2020).  ​The amendment provides additional flexibilities to quality withhold measures related to COVID-19 impacts. The amendment also incorporates changes made to Appendix P - Additional Medicare Waivers. The contract addendum is posted below. The amendment is effective as of August 1, 2020.​

In July 2019, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed an addendum to the amended and restated One Care Three-Way Contract that extends the demonstration period for One Care by one year through December 31, 2020. The addendum also specifies the quality withhold amounts, savings percentages, and risk corridor terms for Demonstration Year 7 (2020), which are consistent with such terms for Demonstration Year 6 (2019).  The contract addendum is posted below. The amendment is effective as of August 1, 2019.

In May 2019, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care Plans executed an amended and restated Three-Way Contract.  The Amendment incorporates changes to comply with the 2016 Medicaid Managed Care Rule, service updates and additions, including: Substance Use Disorder/Behavioral Health services authorized in the 2016 1115 MassHealth Demonstration Amendment and Community Support Program (CSP) services for chronically homeless individuals; and a new rating category for a small number of enrollees who participate in the Transitional Living Program. The amended One Care contract also reflects feedback received from the One Care Implementation Council and the Ombudsman: it clarifies the process for making service requests, incorporates required plan coordination with the Ombudsman, updates requirements for LTS Coordinators and strengthens their integration with care teams, adds "sexual and reproductive health" to the comprehensive assessment domains (at the option of the Enrollee), and broadens risk for abuse and neglect to include "experience of violence. The amendment is effective as of April 1, 2019.

In June 2018, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed an addendum to the amended and restated One Care Three-Way Contract that extends the demonstration period for One Care by one year through December 31, 2019. The addendum also specifies the quality withhold amounts, savings percentages, and risk corridor terms for Demonstration Year 6.The contract addendum is posted below. In addition to the contract addendum, a letter extending the Memorandum of Understanding (MOU) is also posted below in the MOU section

In July 2016, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care Plans executed an addendum to the amended and restated Three-Way Contract that extends the demonstration period for One Care by two years through December 31, 2018. The addendum also specifies the quality withhold amounts, savings percentages, and risk corridor terms for Demonstration Years 4 and 5. In addition to the contract addendum, a letter extending the Memorandum of Understanding (MOU) is also posted below in the MOU section.

In December 2015, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care Plans executed an amended and restated three-way contract. The amended One Care contract includes general clean-up and technical changes, references updated state and federal laws and regulatory policies, incorporates the two previous One Care contract addenda, and implements changes to the financial methodology as negotiated with CMS in September 2015.

In January 2015, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed additional changes to the One Care three-way contract through a second addendum. The addendum reduced the savings percentages, eliminated the first year of the High Cost Risk Pools (HCRPs), and modified the Risk Corridors.

• Savings Percentages - the three-way contract includes savings percentages that are applied to the MassHealth and Medicare Parts A & B rate component. The January 2015 addendum reduced the savings percentages for Demonstration Years 2 and 3.
• High Cost Risk Pools (HCRPs) - the three-way contract established HCRPs funded by a percentage of the MassHealth capitation. HCRPs were designed to redistribute funding between the One Care plans in the event of disproportionate enrollment of high-cost individuals. The January 2015 addendum eliminated the HCRPs for 2013 and 2014 (Demonstration Year 1) and the plans’ contributions will be refunded.
• Risk Corridors - Risk corridors are a form of financial risk sharing and protection against financial losses and gains. Risk corridors in One Care are meant to lessen the financial risk One Care plans take on as they provide coordinated services to One Care enrollees. They also allow the Commonwealth and CMS to share in savings the One Care plans may achieve. The original three-way contract established risk corridors for the first year of the Demonstration, and the September 2014 addendum amended the three-way contract to extend risk corridors for the second and third years. The January 2015 amendment increased risk sharing for Demonstration year 1.

The second Massachusetts One Care contract addendum is posted below.

In September 2014, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed changes to the One Care three-way contract (i.e., executed a contract addendum). The changes established risk corridors for Demonstration Years 2 and 3, and adjusted the Medicare coding intensity factor.

• Risk Corridors: Risk corridors are a form of financial risk sharing and protection against financial losses and gains. Risk corridors in One Care are meant to lessen the financial risk One Care plans take on as they provide coordinated services to One Care enrollees. They also allow the Commonwealth and CMS to share in savings the One Care plans may achieve. The original three-way contract established risk corridors for the first year of the Demonstration; MassHealth and CMS amended the three-way contract to include risk corridors for the second and third years.
• Coding Intensity: CMS revised the coding intensity factor for 2014 and 2015, which will result in an increased capitation payment from Medicare to the One Care plans. Coding intensity is an adjustment that CMS applies to the Medicare payment rate to offset the differences in coding practices between Medicare fee-for-services and managed care (i.e., Medicare Advantage).

The Massachusetts One Care contract addendum is posted below.

On July 16, 2013, MassHealth and CMS announced that we had signed contracts with three health plans to participate in One Care: MassHealth plus Medicare - Commonwealth Care Alliance (CCA), Fallon Total Care (FTC), and Network Health.  The original announcement is on the Related Information  page. The original Massachusetts One Care three-way contract is posted below.

Extension Letter – June 2018

In June 2018, MassHealth and the Centers for Medicare & Medicaid Services (CMS) extended the demonstration period for One Care by one year through December 31, 2019. The letter below extends the authorities from the MOU through December 31, 2019.  In addition to the letter, a contract addendum extending the contracts between MassHealth, CMS, and the One Care plans is posted above in the contract section.

Extension Letter – July 2016

In July 2016, MassHealth and the Centers for Medicare & Medicaid Services (CMS) extended the demonstration period for One Care by two years through December 31, 2018. The letter below extends the authorities from the MOU through December 31, 2018.  In addition to the letter, a contract addendum extending the contracts between MassHealth, CMS, and the One Care plans is posted above in the contract section.

EOHHS and CMS signed a Memorandum of Understanding (MOU) authorizing the Massachusetts Duals Demonstration on August 22, 2012. The MOU signifies CMS’s official approval of the Massachusetts Duals Demonstration.

The MOU and an addendum to the Final Demonstration Proposal are posted below.