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State Releases Draft Duals Proposal

State Releases Draft Duals Proposal

December 9, 2011

The process for improving care for disabled adults in Massachusetts took a step forward yesterday, as EOHHS and the Office of Medicaid released their proposal to the federal Center for Medicare and Medicaid Innovation. Entitled “State Demonstration to Integrate Care for Dual Eligible Individuals” it seeks to fully integrate the delivery and financing of Medicare and Medicaid services for dual eligible disabled adults who are between the ages of 21 to 64.

Detailed information is on the state's duals website: mass.gov/masshealth/duals. Some key points in the proposal are:

  • MassHealth and CMS will use combined Medicaid and Medicare funding to contract with Integrated Care Organizations (ICOs) by using a blended capitation financial mechanism.
  •  The ICOs will be accountable for the both the delivery and management of all covered medical and long-term services and supports.
  • The ICOs will employ or contract with providers who function as a person-centered medical home model to deliver team based integrated primary and behavioral health care.
  • This integration will extend to all administrative processes, including outreach, education functions, customer service, and grievances and appeals.
  • Eligible members will have the opportunity to preserve relationships with current providers and caregivers and the ability to change plans or opt out of the Demonstration at any time.

This initiative, due to start in 2012, will affect approximately 115,000 members at the time of implementation. Health Care For All is working closely with the DAAHR (Disability Advocates Advancing our Healthcare Rights) and others in the disabilities community to press for program designs and features that maximize community care, integration, independence and patient rights. The public comment period will remain open until January 10, 2012.  Comments may be sent to: duals@state.ma.us, or mailed to:

Executive Office of Health and Human Services
Attn:  Lisa Wong
One Ashburton Place, Rm. 1109
Boston, MA 02108

Additionally MassHealth will hold two public listening sessions about the proposal on:

  • December 16, 2011, 1 pm - 4 pm, at the Worcester Public Library, Saxe Room, 3 Salem Square, Worcester, MA
  • January 4, 2012, 9 am - 12 noon, at the State Transportation Building, Conference Rooms 2 & 3, 10 Park Place, Boston, MA

-Paul Williams