Great News! CCA One Care Enrollment Re-Opens
One Care Stakeholders:
Commonwealth Care Alliance (CCA) is accepting new One Care enrollments in ALL covered counties.
Suffolk and Worcester counties: Eligible members can now choose to enroll in One Care through either CCA or Tufts Health Unify.
Essex, Franklin, Hampden, Hampshire, Middlesex, Norfolk, Plymouth* counties: Eligible members can now enroll in One Care through CCA.
* In Plymouth county: Commonwealth Care Alliance's service area includes all of Plymouth County except for the towns of East Wareham, Lakeville, Marion, Mattapoisett, Wareham, and West Wareham.
To ENROLL in ONE CARE:
Contact MassHealth Customer Service (Monday-Friday, 8:00 a.m- 5:00 p.m.)
1-800-497-4648 -- TTY: For people who are deaf, hard of hearing, or speech disabled).
The calls are free.
For more information about One Care: www.mass.gov/masshealth/onecare.
One Care - OPEN Meeting: Tuesday, May 24, 2016
MassHealth will be holding their next One Care Open Meeting on Tuesday May 24, 2016, 10:00a - 12:00p to discuss One Care quality and finance data.
One Care Open Meeting
Tuesday, May 24, 2016, 10:00 am - 12:00 pm
1 Ashburton Place, 21st Floor
MassHealth welcomes the attendance of all stakeholders and members of the public with an interest in One Care.
Reasonable accommodations will be made for participants who need assistance. Please send your request for accommodations to Donna Kymalainen at Donna.Kymalainen@state.ma.us.
Important Update on Personal Care Attendant (PCA) Overtime
By: Bill Henning
On May 11, advocates for the PCA (Personal Care Attendant) program learned in a small meeting with MassHealth officials that overtime hours for people using Personal Care Attendants (PCAs) are expected to be curtailed. The basics of the state’s proposal, which will need to go through regulatory approval, and are expected to apply to those in One Care as well as others on MassHealth, are as follows:
PCA overtime (OT) will be permitted for those who are live-in PCAs as the state transitions to OT controls. An exception procedure will be developed to ensure continuity of care where a 40-hour restriction would be harmful, though we believe they wish a minimal number of permanent exceptions.
The cap for OT for exceptions will be 60 hours/week.
Implementation would start September 1, with the steps to begin the regulatory process starting in the next ten days or so. A public hearing will be held on or about May 31.
Administrative processes are in development and it is expected community input will be needed.
In discussing these plans, Dan Tsai, EOHHS (Executive Office of Health and Human Services) Assistant Secretary for MassHealth, emphasized a commitment to PCA services and no interest in cutting the program. But he equally emphasized steep fiscal challenges faced by MassHealth, citing these numbers:
Member growth last year was 1.8%.
In the past two years program expenses have grown from $574 million to $704 million (23% increase).
Recently implemented sick leave costs $21 million/year.
The state’s fiscal year 2017 budget, which begins July 1 of this year, adds over $60 million to the program but none for overtime. But in consideration of no new OT management policies being in place until September and continuing obligations with the proposed exceptions, they anticipate needing to add another $16-20 million to the FY 17 PCA budget.
$12 million/year is being spent on travel time and there would be no change in paying PCAs for eligible travel.
PCA overtime costs for SCO and One Care consumers are being covered by MassHealth (PCA OT costs were presumably not in the capitation rates [payments per person] established for these plans).
The approximate weekly costs of PCA overtime are $1 million.
In addition, Tsai indicated that 7,300 consumers use PCAs who are working over 40 hours per week, though in many instances these consumers uses multiple PCAs so there is not reliance on just one person.
During the meeting, Paul Spooner of the MetroWest Center for Independent Living and Dennis Heaphy of the Disability Policy Consortium, who both use PCAs, pointed out that the federal government reimburses MassHealth 50% of PCA costs; that support of PCAs is a significant economic investment in our communities; and that the PCA program remains critical in keeping people out of nursing homes.
If you have concerns or wish to be involved in any advocacy on this issue, you can contact Bill Henning of the Boston Center for Independent Living at firstname.lastname@example.org.
A member contacted the OCO after learning they had been disenrolled from their One Care Plan. The OCO worked in collaboration with the One Care Plan Customer Service Manager as well as the State Contract Manager to resolve the issue. Due to a glitch in the system the member was disenrolled but their enrollment status was reinstated within 48 hours.
One Care Plans