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Continuity of Care in MassHealth Managed Care after March 1, 2018

Date: 
04/06/2018
Author: 
Office of Medicaid and Others

March 1, 2018 over 1 million members will be moving to new kinds of health plans. This affects individual under age 65 with MassHealth as their only coverage. Individuals should have received notice of the change from MassHealth and their new plans. There are protections in place to try to avoid disruptions in care during a temporary transition period. This is called  the continuity of care period. During this period, members can continue to see old providers even if not in the network of the new plan, and continue to get services authorized by the old plan even if not authorized by the new plan. Some members may not have received their new cards by March 1. However, even without a card, starting March 1, providers will be able to see in which plan a member is enrolled & should make arrangements to bill the new plan. During this period, members and their providers and plans may need to take additional steps to assure ongoing services after the continuity of care period expires. The minimum continuity of care period is 30 days. For non-diversionary behavioral health care, the continuity of care period is 90 days. Plans can provide longer continuity of care periods, and the Tufts Health Plan Together plans will be using a 90 day continuity of care period. We will post additional information as we get it. 

APRIL 6, 2018 Update: See attached documented for updated information: MassHealth has extended the continuity of care period to 90 days for all servies ie. through May 31, 2018. It has also extended the plan selection period from June 1 to July 1, 2018. Finally, it has developed new guidance on grounds for enrolling in an MCO or ACO-Partnership Plan that does not otherwise cover the town in which you live. 

The website linked below contains more information from MassHealth 

Attached are the following documents:

MassHealth Guidance, "Continuity of Care through transition to new managed care arrangements, " (Feb. 21, 2018)
Pharmacy Facts with BIN numbers (updated Feb. 22, 2018)
Beacon Health Options Alert to Providers (behavioral health)
Mass. Behavioral Health Partnership Alert to Providers in PCC Plan & example of alert to providers in a Partnership Plan
Tufts, Information for Tufts Health Plan Providers on MassHealth Continuity of Care
MassHealth FAQ on Continuity of Care (updated Mar 16, 2018)
Additonal Member Supports through Transition to New Plans (April 6, 2018) NEW

 

 

 


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