2012 One Care Plan Procurement

See below for initial ICO Procurement Documents for the beginning of the Demonstration in 2013 (last updated August 2012)

RFR Amendments and Q&As

MassHealth has issued two Amendments to the Duals Demonstration RFR and two Q&A documents, based on questions submitted by interested organizations. These documents are available below and on Comm-PASS under the Document Number 12CBEHSDUALSICORFR.

Please note that the deadline for responses to the RFR has been extended to August 20, 2012.

Additional Resources

RFR Amendment 1

RFR Amendment 1

RFR Amendment 2

RFR Amendment 2

RFR Q&A 1

RFR Q&A 1

RFR Q&A 2

RFR Q&A 2

Request for Responses from Integrated Care Organizations

The Executive Office of Health and Human Services (EOHHS) is issuing a Request for Responses (RFR) to solicit proposals from Integrated Care Organizations (ICOs) to participate in the Duals Demonstration program. The purpose of this Demonstration is to improve quality of care and reduce health disparities, improve health and functional outcomes, and contain costs for dual eligibles. Under this program the selected ICOs will be accountable for the delivery and management of all covered medical, behavioral health, and long-term services and supports for their enrollees.

The RFR and related appendices are posted below and on Comm-PASS under the Document Number 12CBEHSDUALSICORFR.

Additional Resources

Duals Demonstration RFR

Duals Demonstration RFR

Appendix A – Div BH Definitions

Appendix A – Div BH Definitions

Appendix B – BH Inpatient and Outpatient Services Definitions

Appendix B – BH Inpatient and Outpatient Services Definitions

Appendix C – List of Covered Services

Appendix C – List of Covered Services

Appendix D – Community Support Services

Appendix D – Community Support Services

Appendix E – BH Integration

Appendix E – BH Integration

Appendix F – Acceptable Admitted Assets

Appendix F – Acceptable Admitted Assets

Appendix G – Emergency Services Program Providers

Appendix G – Emergency Services Program Providers

Appendix H – Encounter Data Specifications

Appendix H – Encounter Data Specifications

Data Book for Organizations Interested in Serving as Integrated Care Organizations

The Executive Office of Health and Human Services (EOHHS) has issued a Request for Responses (RFR) from Integrated Care Organizations (ICOs) for the Duals Demonstration. To assist respondents, EOHHS is providing a Data Book composed of two files.

One file includes summary demographic, utilization, cost and disease prevalence data for CY2009 and CY2010 based on Medicare parts A and B and Medicaid data. A second file provides information based on Medicare Part D data, including number of utilizers and prescriptions filled in CY2010, statewide and by county.

The Data Book files are posted at www.comm-pass.com. Please follow these instructions to access the files:

1. Click on COMMBUYS Resource Center .
2. Near the bottom of the page, click on the hyperlink that reads: “Search for Solicitations.”
3. When the Search page comes up, scroll down to the section that says “Search by Specific Criteria” and in the document number box, enter the following: 12CBEHSDUALSDEMOORGANIZATION.
4. The Search result will appear as a hyperlink at the top of the new page. It should read: “There is 1 solicitation(s) found that match your search criteria.” Click on this sentence and it will take you to the Comm-PASS listing for this solicitation.
5. Click on “view” (the eyeglasses on the right) and you will get the summary page for the Duals Demonstration: Information for Interested Organizations.
6. Click on the blue folder-type tab called “Intent” and you will see all documents that have been posted for this topic, including the two Data Book files. To view the documents, click on the eyeglasses to the right of the title of each document.

FAQs and Other Materials for Organizations Interested in Serving as Integrated Care Organization

The Executive Office of Health and Human Services (EOHHS) has issued a Request for Responses (RFR) from Integrated Care Organizations (ICOs) for the Duals Demonstration. The EOHHS and the Centers for Medicare and Medicaid Services (CMS) in the U.S. Department of Health and Human Services will jointly select ICOs to participate in this Duals Demonstration.

MassHealth is preparing responses to questions (FAQs) submitted to us by organizations interested in serving as ICOs. These FAQs are provided for informational purposes only and are not binding on EOHHS; to the extent there is any inconsistency or ambiguity between the RFR and the FAQs, it shall be resolved in favor of the RFR terms and provisions.

Please note that as EOHHS continues to work with CMS and other parties, changes, refinements, and additional information regarding these FAQs may occur.

MassHealth expects to post additional FAQs and other documents as questions arise and responses become available. These materials will also be posted on COMMBUYS Resource Center .

Additional Resources

Duals Demonstration FAQs

Duals Demonstration FAQs

Duals Demonstration Covered Benefits

Duals Demonstration Covered Benefits

Duals Demonstration FAQs for May 11, 2012

Duals Demonstration FAQs for May 11, 2012

Duals Demonstration – Target Population Current LTSS Providers

Duals Demonstration – Target Population Current LTSS Providers

Pharmacy Guidance

Pharmacy Guidance