One Care Plan slated to start in two months


The Patrick Administration announced on July 16 that three managed care health plans had passed their “readiness review” and now have signed contracts to participate in the new “One Care” integrated health care pilot for adults age 18 and over with disabilities, who receive both MassHealth and Medicare benefits. This announcement caps more than two years of joint development between the federal Centers for Medicare and Medicaid Services (CMS) and the state’s Executive Office of Health & Human Services. In a press release, the Patrick Administration said the new plan would provide “better coordination of care for this population through global payments and personalized services.”

The 3 health plans participating in One Care include: Commonwealth Care Alliance, Fallon Total Care, and Network Health. When the state announced interested parties in May of 2011 for the plan then called the “Integrated Care Organization,” there were a total of 14 parties considering contracting with the state. Several plans were later rejected by the state, and six became finalists for the One Care project. In the end, half of the plans dropped out: the Blue Care Partnership, Neighborhood Health Plan, and BMC Health Net–,mostly over disagreements about rate inadequacy.  Because only 3 plans remained in competition, one of the most controversial elements of the plan had to be modified: passive enrollment.

Under passive enrollment, duals members would be “auto assigned” to a managed care plan if they did not voluntarily pick one. Members retain the right to “opt out” of the plan—but they will have to proactively make such a choice. As the plan stands now, the only counties where members will be forced to pick a plan is where more than two One Care plans exist. There are 5 counties where no plans exist (Barnstable, Dukes, Nantucket, Bristol and Berkshire.) Only 4 counties will have passive enrollment (Hampden, Hampshire, Suffolk and Worcester.) In 5 counties (Essex, Franklin, Middlesex, Norfolk, and Plymouth) there will only be voluntary enrollment. Disability rights groups argued that no one should be passively enrolled, but the Patrick Administration stuck with its plan to force members into a plan. Ultimately the Administration has had to accept passive enrollment in 4 counties, and the total number of individuals eligible to enroll has been dropped from 110,000 to 90,000. The Administration says the plan is for people age 18 to 64—but people in the plan who turn 65 can stay in the plan regardless of how old they get. So the One Care plan has become a de facto program serving more and more elders over time.

“The organizations participating in One Care have shown a high degree of collaboration, innovation, and commitment to serving our members under this new integrated care model,” said HHS Secretary John Polanowicz. “I look forward to working with them to strengthen outcomes for this population, while also reducing health care costs.”

According to the Administration, the One Care plan will “improve coordination of services provided to these individuals; the majority of whom have extremely complex medical care needs. The One Care program will also offer services that are personalized to an individual’s needs and preferences; focus on independent living and community-based supports; improve functional and health outcomes for individuals; and help reduce undesirable cost-drivers such as potentially unnecessary emergency room use, readmissions, facility-based care, and unmanaged chronic diseases.”

One Care plans will also offer behavioral health and community support services that are not currently covered by either program. These are services such as peer supports, home care services, non-medical transportation, access to community health workers, and the behavioral health community supports. The One Care plan also gives consumers the right to have an independent Long Term Services and Supports (LTSS) Coordinator on their team, to advocate for non-medical supports. One Care plans must have contracts with at least two entities providing LTSS Coordinators, one of which must be an Independent Living Center. One Care plans can contact also with Aging Services Access Points (ASAPs) and the plans must inform members who turn 60 of their right to have an ASAP LTSS Coordinator on their team.

The concept of an independent, conflict-free agent on the member’s team was originally proposed by Mass Home Care, and was written into state law. The One Care plans themselves, which will be working with seniors, have no requirement for geriatricians on staff, and no requirements to demonstrate network adequacy and staffing to serve the needs of elders. Because of MassHealth rules, people turning 65 may become ineligible for the One Care program because of stricter asset and income rules for seniors on MassHealth. Mass Home Care has filed legislation to make income and asset rules for adults on MassHealth the same regardless of age, but that bill has not be approve yet by the General Court.

Enrollments in One Care plans has been twice delayed, but now is expected to begin October 1, 2013. MassHealth has hired a PR firm to rollout a public awareness campaign to help inform people on Medicare and MassHealth about the One Care plan. The first mailings are expected to reach this low-income population in September.