Mass Health Names Six As Designated Integrated Care ...

On Friday, Mass Health announced that the following six companies had been selected to administer the Commonwealth?s Dual Eligible Demonstration Project for individuals eligible for both Medicare and Medicaid:

• Blue Cross and Blue Shield of Massachusetts HMO Blue (MCBSMA)
• Boston Medical Center HealthNet Plan (MBCHP)
• Commonwealth Care Alliance (CCA)
• Fallon Total Care, LLC (FTC)
• Neighborhood Health Plan (NHP)
• Network Health, LLC

These selected organizations will be responsible for coordinating and delivering health care and some long term supports and services for nearly 110,000 Commonwealth citizens.? Under a little known provision of the Affordable Care Act, the Obama and Patrick Administrations have been working closely over the last two years to design a more efficient and coordinated system that will in the long run produce better outcomes for eligible individuals and save significant dollars.

Under the state?s plan, each ICO will be issued a formal three way contract between Mass Health, the federal government (CMS) and the ICO if the organization is able to pass a Readiness Review that includes partnering with a full array of health care and needed long term supports and service providers to form a full network.? Failure to do so may jeopardize the ICOs ability to be issued a final demonstration contract.
Complicating further steps in establishing a robust provider network are the yet to known rates to be paid to ICOs, and then in turn to health and service providers.? These rates are to be formulated by the federal government?s Center for Medicare and Medicaid Services (CMS).? Advocates and providers, as well as the ICOs worry that insufficient rates will damage the success of the Demonstration Project.

Speaking on behalf of Mass Health, Deputy Director Robin Callahan has indicated that current rates will likely be a floor for rate construction and should ensure that ICOs are not placed in a position of lowering current reimbursement rates or jeopardizing existing quality service standards.

To assist the Commonwealth in rolling out the Duals Demonstration Project, Mass Health Deputy Director also announced on Friday that the state will create an Implementation Council that will include public, consumer and provider members to monitor the roll out and operation of the Project. Additionally an Ombudsperson will be hired to help facilitate concerns that from consumers and Project stakeholders.

Source: http://www.bfair.org/news/mass-health-names-six-as-designated-integrated-care-organizations-icos/

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