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Bigbypic2By Secretary of Health and Human Services Dr. JudyAnn Bigby

I am delighted to update you on a very important MassHealth initiative. Readers of “Commonwealth Conversations: Health and Human Services” may have read about this initiative in June. MassHealth and the federal government are working together to design and implement a new care model for individuals ages 21-64 who are eligible for both MassHealth and Medicare, so that they receive all of their benefits in a seamless, integrated way. 

Last week, MassHealth published a draft Demonstration Proposal that outlines our approach to this demonstration. For more information, read our proposal online (click on “Related Information” to find it). 

Fundamentally, we want this proposal to assist dual eligible individuals, ages 21-64, who choose this new option to experience improved quality of care and greater access to long-term community support services and behavioral health care. The new care model will:

  • Ensure that eligible individuals receive all of their MassHealth and Medicare benefits through a single program;

 

  • Enable dual eligible individuals to use new services that MassHealth and Medicare do not currently cover, including home modifications, peer supports, and expanded behavioral health services;

 

  • Provide each dual eligible individual with a care team that is responsible for helping the member access and manage acute medical, primary care and behavioral health services, and provides access to a coordinator of long-term supports and services;

 

  • Assign a team member to track and coordinate all of the providers involved in providing services and keeps the primary care team informed.

Behind the scenes, the new integrated care organizations (ICOs) that will be delivering this option will focus on ensuring that each member gets the right care at the right time and place. This means the ICOs will help people manage chronic illnesses, disabling conditions, and other health and wellness challenges from day to day, so they can avoid emergencies and hospitalizations and maintain functional status. The ICOs will be held accountable by MassHealth and Medicare for helping members stay as healthy as possible. The ICOs will also need to partner with others to ensure members receive the full spectrum of services, including Independent Living Centers (ILCs), Aging Service Access Points (ASAPs) home health agencies and behavioral health providers. In addition, primary care teams may include community health workers, peer specialists, and others who have expertise in helping individuals with disabilities.  

Numerous people and many organizations are involved in ensuring the success of this initiative. Input from members, advocates, community-based organizations, medical providers, health plans, and others has shaped MassHealth’s draft Demonstration Proposal. MassHealth has convened public meetings, sought feedback from members, received written comments, and has had countless conversations to inform this dialogue. Each stakeholder has a viewpoint worthy of consideration, and can play a role in making this program optimally beneficial to dual eligible individuals. We look forward to engaging in ongoing public dialogue, as we continue designing and proposing an implementation strategy.

After we receive public comment about our draft Demonstration Proposal, we will revise it before submitting it to CMS for ongoing negotiations about the details. There are upcoming public hearings on the proposal. Following are the details:

 –               December 16, 2011, 1 pm to 4 pm
                   Worcester Public Library
                   Saxe Room
                   3 Salem Square
                   Worcester

–                January 4, 2012, 10 AM to 1 PM*
                   State Transportation Building, Conference Rooms 2 & 3
                   10 Park Place
                   Boston 

*Please note:  change from the previously announced time 

Stay up to date with this project by visiting www.mass.gov/masshealth/duals and look for further updates in this blog space. We also welcome feedback from you!  Email your comments to: duals@state.ma.us.  I look forward to providing you more updates in the future.

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