On January 1, 2021, MassHealth launches its fourth year of providing health care through Accountable Care Organizations (ACOs). While most ACO, Managed Care Organization (MCO), and Primary Care Clinician (PCC) Plan members will not change plans, members whose primary care provider (PCP) is moving to an ACO will change plans so that they are in the same plan with their PCP. MassHealth will notify these members who then have the option of staying with their PCP or selecting a different plan.
MassHealth is committed to working with members, providers, and other stakeholders to promote continuity of care. To support a successful transition, these members will have a 90-day continuity of care period to ease the adjustment to their new plans.
Important things for you to know
These changes apply to MassHealth ACO, MCO, and PCC Plan, members whose PCP is moving to an ACO on January 1, 2021.
Member-specific information to ease the transition
- Members changing plans because their PCP is joining an ACO on January 1, 2021 can continue to see their existing providers for 90 days, even if those providers are not in their new plan’s network.
- Members can contact their new plan now to let them know of any ongoing treatments or scheduled appointments.
- 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
- Providers who are not in a new plan’s network must contact the new plan to make appropriate payment arrangements.
- Providers will be able to see new plan information in the MassHealth Eligibility Verification System (EVS) starting January 1, 2021. They can contact the new plan at that time for new authorization requests or with any questions or concerns
- While ACOs are ultimately responsible for coordinating member’s transition and service coordination into their new health plan, both MassHealth and ACOs will ensure escalation protocols are in place for continuity of care issues that may arise.
- We are asking all plans, providers, and assisters to reinforce this Continuity of Care policy and to ensure that members continue to receive all needed health care services during this transition.