On March 1, 2018, new Accountable Care Organization (ACO) and Managed Care Organization (MCO) contracts became effective to improve accountability and integration of care for MassHealth members.
MassHealth is committed to working with all relevant parties to ensure continuity of care for the many members who are moving to new plans, whether they are going to or from an ACO Partnership Plan, a Primary Care ACO, an MCO, or the Primary Care Clinician (PCC) Plan.
To this end, MassHealth has issued “Continuity of Care–Supporting Member Transitions to New MassHealth Plan Options” to explain how MassHealth is working with ACOs, MCOs, and providers to ease this transition to new plans. Please review this important document and follow the instructions within, as applicable.
Important things for you to know
These changes apply to MassHealth managed care members (generally, this includes members under age 65 who do not have another primary insurer, either commercial or Medicare, and are not in a long-term facility)
- All members have a minimum 30-day Continuity of Care period.
- During the Continuity of Care period, all existing prior authorizations for services and for provider referrals, will be honored by the member’s new plan. Members can continue to see their existing providers for at least 30 days, even if those providers are not in their new plan’s network.
- Providers who are not in the new plan’s network must contact the new plan to make appropriate payment arrangements.
- In some cases, the Continuity of Care period may be extended. For example, members who are pregnant can continue seeing their existing OB/GYN providers throughout their pregnancy and up to six weeks postpartum.
- We are asking all plans, providers, and assisters to reinforce this message and to ensure that members continue to receive all needed health care services during this transition.
- Members can contact their new plan now to let them know of any ongoing treatments or scheduled appointments.
- Providers will be able to see new plan information in the MassHealth Eligibility Verification System (EVS) starting March 1. They can contact the new plan at that time for new authorization requests, or with any questions or concerns.
- MassHealth and all ACOs and MCOs have escalation protocols in place for continuity of care issues that may arise. Contact phone numbers are attached.