One Care Capitated Rate Reports

Demonstration to Integrate Care for Dual Eligible Individuals (One Care) CY 2021 Final Medicare-Medicaid Rate Report January 1, 2021 through December 31, 2021

The Centers for Medicare & Medicaid Services (CMS), in conjunction with MassHealth, is providing final information regarding the Medicare and Medicaid component of the CY 2021 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals (One Care).

One Care (Duals Demonstration) CY2020 Payment Rates to One Care Plans – Issued February 10, 2021

MassHealth, in conjunction with the Centers for Medicare & Medicaid Services (CMS), is releasing the final Medicaid and Medicare components of the CY 2020 rates for One Care, the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals. Effective January 1, 2020, these rates replace the Demonstration rates included in the CY 2019 rate report. Included in this report are the final CY 2020 Medicaid rates and Medicare county base rates and information supporting the estimation of risk adjusted Medicare components of the rate.

(Note that the spacing and page numbers may vary between the Word and the PDF versions of each document due to accessibility updates, but the content is the same.)

Duals Demonstration (One Care) CY2019 Payment Rates to One Care Plans – Issued October 10, 2019

MassHealth, in conjunction with the Centers for Medicare & Medicaid Services (CMS), is releasing the final Medicaid and Medicare components of the CY 2019 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals (One Care). Effective January 1, 2019, these rates replace the Demonstration rates included in the CY 2018 rate report. Included in this report are the final CY 2019 Medicaid rates and Medicare county base rates and information supporting the estimation of risk adjusted Medicare components of the rate.

(Note that the spacing and page numbers may vary between the Word and the PDF versions of each document due to accessibility updates, but the content is the same.)

Duals Demonstration (One Care) CY2018 Payment Rates to One Care Plans – Issued November 20, 2018

MassHealth, in conjunction with the Centers for Medicare & Medicaid Services (CMS), is releasing the final Medicaid and Medicare components of the CY 2018 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals (One Care). Effective January 1, 2018, these rates replace the Demonstration rates included in the CY 2017 rate report. Included in this report are the final CY 2018 Medicaid rates and Medicare county base rates and information supporting the estimation of risk adjusted Medicare components of the rate.

Duals Demonstration (One Care) CY2017 Payment Rates to One Care Plans – Issued February 13, 2017

MassHealth, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the final Medicaid and Medicare components of the CY 2017 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals (One Care). The Medicare component incorporates new revisions to the CMS-Hierarchical Condition Category (HCC) Risk Adjustment Model to better predict costs for beneficiaries based on their dual status and aged/disabled status. Effective January 1, 2017, these rates replace the Demonstration rates included in the CY2016 rate report. Included in this report are final CY 2017 Medicaid rates and updated CY 2017 Medicare county base rates.

Duals Demonstration (One Care) CY2016 Payment Rates to One Care Plans – Issued February 26, 2016

MassHealth, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the final Medicaid and Medicare components of the CY 2016 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals (One Care). Effective January 1, 2016, these rates replace the Demonstration rates included in the CY2015 rate report. Included in this report are final CY 2016 Medicaid rates and updated CY 2016 Medicare county base rates. 

Duals Demonstration (One Care) CY2015 Payment Rates to One Care Plans – Revised January 14, 2016

MassHealth, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing updated final Medicaid and Medicare components of the CY 2015 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals (One Care). These adjustments were available to One Care plans through execution of contract amendments and are conditional upon continued participation in the demonstration through December 31, 2016.  In accordance with the Three-Way Contract as amended and restated in December 2015, these updates to the rates replace the Demonstration rates included in the CY 2015 rate report dated March 5, 2015.

Duals Demonstration (One Care) CY2015 Payment Rates to One Care Plans – Issued March 5, 2015

MassHealth, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the final Medicaid and Medicare components of the CY 2015 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals (One Care). Effective January 1, 2015, these rates will replace the Demonstration rates included in the CY 2014 rate report. Included in this report are final CY 2015 Medicaid rates and Medicare county base rates and information supporting the estimation of risk adjusted Medicare components of the rate.

Duals Demonstration (One Care) CY2014 Payment Rates to Integrated Care Organizations (ICOs) – Issued January 29, 2014

MassHealth, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing the final Medicaid and Medicare components of the CY 2014 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals (One Care). Effective January 1, 2014, these rates will replace the Demonstration rates included in the CY 2013 rate report. Included in this report are final CY 2014 Medicaid rates and Medicare county base rates and information supporting the estimation of risk adjusted Medicare components of the rate.

Duals Demonstration CY2013 Payment Rates to Integrated Care Organizations (ICOs) — Revised August 2013

MassHealth, in conjunction with the Centers for Medicare and Medicaid Services (CMS), is releasing final CY2013 rates for the Massachusetts Demonstration to Integrate Care for Dual Eligible Individuals. This report includes updates to the previously posted May 15, 2013 report. Compared to the May 15, 2013 Rate Report this document includes updates related to: start date; savings percentages; risk corridors; the default rate; the impact of sequestration; administrative expense update to the MassHealth component; and other minor clarifications. The MassHealth component of the rates is now final.

Duals Demonstration CY2013 Payment Rates to Integrated Care Organizations (ICOs) – Issued May 2013

MassHealth, in conjunction with the Centers for Medicare and Medicaid Services (CMS), has released final payment rates for ICOs for calendar year 2013 (CY2013). The general principles of the rate development process for the Demonstration are outlined in the Memorandum of Understanding (MOU) between CMS and the Commonwealth of Massachusetts. Included in this report are final Medicare county base rates, information supporting the estimation of risk-adjusted Medicare components of the rate, details related to the development of the MassHealth portion of the rate, and some information supplemental to the July 2012 MassHealth Data Book to support comparisons of projected spending on the target population to the rates. The MassHealth component of the rate remains subject to final review and approval by CMS.