Proposed rule on MassHealth Managed Care Lock-in: August 10 Public Hearing

In January, EOHHS announced plans to implement a Managed Care lock-in policy effective October 1, 2016.  This would restrict the ability of MassHealth members to freely change managed care plans. Despite opposition from most consumer, legal aid and disability rights groups, EOHHS is moving full speed ahead to implement this change. 

Proposed rules are posted on the MassHealth website with a publication date of July 20, 2016.  A public hearing is scheduled for Wed. August 10 at 10 am in Boston. Written comments are also due by 5 pm August 10. 

The public notice, proposed rules, current rules, and a link to sign up to testify are all posted at

https://www.mass.gov/service-details/masshealth-proposed-regulations

Notice of Public Hearings 

The MassHealth Managed Care rules are at 130 CMR 508.000. Because the entire rule has been reorganized, we don't have the benefit of the usual redline version that makes the changes easy to spot.

The lock-in changes are in the Transfer rules (current rule 508.002(E)) Proposed rule 508.004(C )(MCO) and 508.005(C)(PCCP)

The current rules at 508.002(E) allow MassHealth members to transfer between MCOs or MCOs and the PCCPlan at any time. The only restriction is for people in CarePlus whose transfers take effect on the first of the following month unless the transfer is "for cause" in which case the transfer happens right away.  The rule lists 4 kinds of cause.

Proposed MCO transfer rule

Under the proposed MCO rule (508.004(C): MassHealth members can transfer freely as they do now only during a "plan selection period." This is a 90-day period that for new members begins with enrolling into an MCO and for continuing members will be during an annual 90 day period announced by MassHealth.Â

Any time outside this 90 day "plan selection period" is a "fixed enrollment period" during which MassHealth members can switch plans only "for cause" as determined by MassHealth. The grounds for switching plans "for cause" include the 4 grounds  in the current CarePlus cause rules and 7 other grounds.

The proposal specifies that the agency's denial of a request to transfer for cause is appealable to the Board of Hearings. 

This is not an open enrollment period like the one in ConnectorCare. MassHealth members can still apply and enroll at any time.

Proposed PCC transfer rule (no change). 

The current rules stays the same for the PCC Plan. Proposed 508.005(C). People in the PCC Plan can transfer out to an MCO at any time, but then will be locked into the MCO.

Proposed changes to services needing a PCCP referral.

There are also changes to the PCC Plan referral rules in 130 CMR 450 the Administrative and Billing rules.

The referral rules at 130 CMR 450.118(J) currently say that people enrolled in the PCC Plan need to get a referral from their PCC to see any other providers except for those listed below in the rule.  The Proposal removes some services from the "no referral" list; this means MassHealth members will need to ask their PCC for a referral for these services. This proposal is not eliminating services from the PCC Plan --the Administration has threatened to do just that in October 2017 --but right now the only change is to require a PCC referral for services that currently do not require a referral including orthotics, prosthetics, hearing aids and chiropractic services.