Early Insights from One Care: Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries
Issue Brief
U.S. Department of Health and Human Services, New Flexibility for States to Improve Medicaid and Implement Innovative Practices, Press Release, April 14, 2011, available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MedicaidAnnouncement4_11.pdf.
For more information, see Kaiser Commission on Medicaid and the Uninsured, Financial and Administrative Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS (July 2014), available at https://www.kff.org/medicaid/issue-brief/financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared/.
MOU between CMS and the Commonwealth of Massachusetts Regarding a Federal-State Partnership to Test a Capitated Financial Alignment Model for Medicare-Medicaid Enrollees, Demonstration to Integrate Care for Dual Eligible Beneficiaries, August 22, 2012, available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MassMOU.pdf.
For more information, see Kaiser Commission on Medicaid and the Uninsured, Massachusetts’ Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries (October 2012), available at https://www.kff.org/medicaid/issue-brief/massachusetts-demonstration-to-integrate-care-and-align/.
Massachusetts Executive Office of Health and Human Services (EOHHS), “Senior Care Options (SCO),” 2015, available at http://www.mass.gov/eohhs/consumer/insurance/senior-care-options/.
The Medicare A/B rate blends the Medicare Fee for Service (FFS) Standardized County Rate and the Medicare Advantage projected rate for the year, weighted by the proportion of the population that would be enrolled in each option in the absence of the demonstration. A separate rate is used for enrollees with end stage renal disease (ESRD).
Massachusetts Executive Office of Health and Human Services (EOHHS), Demonstration to Integrate Care for Dual Eligible Individuals (One Care), CY2014 Final Rate Report, January 29, 2014, available at http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/state-fed-comm/onecare-rate-report-ico-fy2014.pdf.
Massachusetts Executive Office of Health and Human Services (EOHHS), Demonstration to Integrate Care for Dual Eligible Individuals (One Care), CY2014 Final Rate Report, January 29, 2014,” available at http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/state-fed-comm/onecare-rate-report-ico-fy2014.pdf.
Massachusetts Executive Office of Health and Human Services (EOHHS), MassHealth Presentation: MassHealth Demonstration to Integrate Care for Dual Eligibles - Implementation Council Meeting January 9th 2015, available at http://www.mass.gov/eohhs/provider/guidelines-resources/services-planning/national-health-care-reform-plan/federal-health-care-reform-initiatives/integrating-medicare-and-medicaid/implementation-council.html.
For One Care plan gains or losses between 1.1% and 3% of the Medicare A/B and Medicaid eligible expenditures, CMS and MassHealth share 90%, while the plan pays 10%. For plan gains or losses between 3.1% and 20%, CMS and MassHealth share 50% while the plan pays the other 50%.
For more information on the high risk pools, see CMS and MassHealth Demonstration to Integrate Care for Dual Eligible Individuals (One Care), CY2014 Final Rate Report, January 29, 2014, available at http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/state-fed-comm/onecare-rate-report-ico-fy2014.pdf.
For more information, see Contract between United States Department of Health and Human Services Centers for Medicare & Medicaid Services in Partnership with the Commonwealth of Massachusetts and Commonwealth Care Alliance, Inc., Fallon Community Health Plan, and Network Health, LLC. July 11, 2013, available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MassachusettsContract.pdf.
MOU between CMS and the Commonwealth of Massachusetts Regarding a Federal-State Partnership to Test a Capitated Financial Alignment Model for Medicare-Medicaid Enrollees, Demonstration to Integrate Care for Dual Eligible Beneficiaries, August 22, 2012, available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MassMOU.pdf.
For more information, see Contract between United States Department of Health and Human Services Centers for Medicare & Medicaid Services in Partnership with the Commonwealth of Massachusetts and Commonwealth Care Alliance, Inc., Fallon Community Health Plan, and Network Health, LLC. July 11, 2013, available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MassachusettsContract.pdf.
Massachusetts Medicaid Policy Institute, Overview of the Massachusetts One Care Initiative for Non-Elderly Dual Eligibles (April 2014), available at http://bluecrossmafoundation.org/sites/default/files/download/publication/OneCare_Report_FINAL.pdf.
Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) Office of Medicaid, Proposal to the Center for Medicare and Medicaid Innovation: State Demonstration to Integrate Care for Dual Eligible Individuals, February 16, 2012, available at http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/prev-meetings/2012/120216-final-proposal.pdf.
For more information, see Contract between United States Department of Health and Human Services Centers for Medicare & Medicaid Services in Partnership with the Commonwealth of Massachusetts and Commonwealth Care Alliance, Inc., Fallon Community Health Plan, and Network Health, LLC. July 11, 2013, available at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MassachusettsContract.pdf.
Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) Office of Medicaid, Proposal to the Center for Medicare and Medicaid Innovation: State Demonstration to Integrate Care for Dual Eligible Individuals, February 16, 2012, available at http://www.mass.gov/eohhs/docs/eohhs/healthcare-reform/prev-meetings/2012/120216-final-proposal.pdf.
Massachusetts Medicaid Policy Institute, Overview of the Massachusetts One Care Initiative for Non-Elderly Dual Eligibles (April 2014), available at http://bluecrossmafoundation.org/sites/default/files/download/publication/OneCare_Report_FINAL.pdf.
Massachusetts Executive Office of Health and Human Services, “One Care Early Indicators Project (EIP) Reports,” 2014, available at http://www.mass.gov/eohhs/consumer/insurance/one-care/one-care-early-indicators-project-eip-reports.html.
Massachusetts Executive Office of Health and Human Services, “One Care Early Indicators Project (EIP) Reports,” 2014, available at http://www.mass.gov/eohhs/consumer/insurance/one-care/one-care-early-indicators-project-eip-reports.html.
For more information, see Kaiser Commission on Medicaid and the Uninsured, Financial Alignment Demonstrations for Dual Eligible Beneficiaries: A Look at CMS’s Evaluation Plan (July 2014), available at https://www.kff.org/medicaid/issue-brief/financial-alignment-demonstrations-for-dual-eligible-beneficiaries-a-look-at-cmss-evaluation-plan/.