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MassHealth Demonstration to Integrate Care for Dual Eligibles. One Care: MassHealth plus Medicare. MassHealth Updates to the Implementation Council May 30, 2014,1:00 PM – 3:00 PM One Ashburton Place, 21 st Floor Boston, MA. Agenda for MassHealth Updates. Enrollment Status

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masshealth demonstration to integrate care for dual eligibles

MassHealth Demonstration to Integrate Care for Dual Eligibles

One Care: MassHealth plus Medicare

MassHealth Updates to the Implementation Council

May 30, 2014,1:00 PM – 3:00 PM

One Ashburton Place, 21st Floor

Boston, MA

agenda for masshealth updates
Agenda for MassHealth Updates
  • Enrollment Status
  • Auto-Assignment Update
  • LTS Coordinator Role
  • Contract Management/Monitoring Activities

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total enrollment
Total Enrollment
  • Effective May 1, total number of enrollees: 13,274

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*Rating categories for three enrollments were unavailable at the time of this report.

lts coordinator
LTS Coordinator

MassHealth is collaborating with LTS Coordinator providers, advocates, Implementation Council members, One Care plans, and other state agencies to ensure that we have an effective Independent Living and Long Term Services and Support (LTS) Coordinator role in One Care

Out of these discussions, MassHealth and stakeholders identified the need for:

A standard overview document describing the LTS Coordinator role for members

Data on member access to and use of LTS Coordinators

Training opportunities for LTS Coordinator providers and plan staff

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action steps and status
Action Steps and Status

LTS Coordinator overview document

Developed in collaboration with stakeholders

Will be translated into Spanish, and available in Braille, large print, and as an ASL vlog

Anticipate distributing final version to One Care plans, CBOs, the One Care Ombudsman, state agencies, and others in July

Current and future One Care enrollees will receive the document

MassHealth will also make the document available on the One Care website for people to refer to when making enrollment decisions

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action steps and status cont d
Action Steps and Status, cont’d

LTS Coordinator utilization data

Data collection from One Care plans on member referrals to and refusals of LTS Coordinators has begun

MassHealth continues to work with the plans and CMS to ensure standardization and consistency in reporting

Preliminary data for the Oct.-Dec. 2013 period have been shared with the EIP

4,482 enrollments

1,752 with identified LTSS needs; of this group:

563 (32%) referred

558 (32%) refused referral

1,121 (64%) either referred or refused referral to an LTS Coordinator

Data is very preliminary, and was collected retroactively; may not completely capture actual performance

The data establish a baseline for ongoing improvement efforts

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Training

MassHealth and UMass Medical School are working with stakeholders to develop training on the LTS Coordinator role for LTS Coordinators, One Care plan staff, and providers

MassHealth has shared an initial outline for a webinar with stakeholders and is seeking additional input on content, format, presenters, etc.

Additional trainings and other formats (e.g. online modules, in-person sessions) may be developed to meet the needs of different audiences

Action Steps and Status, cont’d

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one care contract management monitoring activities update
One Care Contract Management/Monitoring Activities Update
  • Joint MassHealth/Centers for Medicare and Medicaid Services (CMS) One Care Management Team conducts ongoing contract management and monitoring activities
  • Highlights of some activities and areas of focus include:
  • Quality Monitoring and Outcomes Measurement
  • Plan Monitoring
  • Behavioral Health Privacy
  • Provider Input and Engagement
quality monitoring and outcomes measurement
Quality Monitoring and Outcomes Measurement
  • MassHealth to present on quality management strategy to EIP work group in June
  • Inaugural meeting of the quality work group to be held this summer
  • The quality work group will:
  • Review quality and outcome measures
  • Identify initiatives and/or metrics for ongoing collaboration
  • Develop and implement timelines and work plans for joint MassHealth/Implementation Council Quality monitoring activities
plan monitoring
Plan Monitoring
  • Continue ongoing programmatic oversight activities
    • Just concluded initial round of quarterly onsite meetings with One Care plans
    • Discussed initial results of LTS Coordinator reports with all One Care plans to ensure date consistency and results to date
  • Gearing up for accelerated monitoring for July passive enrollment 
    • Weekly contract management calls
    • Test calls to member services lines
    • Monitoring denials of claims
  • MassHealth and CMS are reviewing data reported by the One Care plans for auto-assignment planning
behavioral health privacy
Behavioral Health Privacy
  • MassHealth is convening a discussion with Department of Mental Health (DMH), Department of Public Health (DPH) and One Care plans to begin a dialogue and address privacy concerns
    • Working the Mental Health Legal Advisors Committee to prepare discussion topics and questions in advance of the initial meeting (2-3 wks)
  • MassHealth will work with and include identified Implementation Council representatives in the conversations  
provider input and engagement
Provider Input and Engagement
  • Developing initiatives to address behavioral health needs of people who are experiencing homelessness
    • Identified homeless members with behavioral health needs as most vulnerable
    • Scheduling a series of discussions with high volume behavioral health providers in all counties served
    • Will work with behavioral health providers and One Care plans to identify best practices and successful initiatives to ensure continuity of care and reduce adverse health outcomes
  • One Care Program Management staff would like to work with Council leadership to identify additional provider engagement activities
continued collaboration
Continued Collaboration

MassHealth recognizes the critical role the Implementation Council plays in One Care and will continue to collaborate with the Council to respond to issues including:

Information and data reported through the EIP workgroup and the One Care Ombudsman

Strategies for engaging providers

Methods for One Care plans to find and engage hard to reach populations

Outreach strategies to target and engage underserved populations

Understanding and improving accessibility

Enrollee privacy

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Visit us at www.mass.gov/masshealth/onecare

Email us at OneCare@state.ma.us