Code of Massachusetts Regulations › 130 CMR - DIVISION OF MEDICAL ASSISTANCE › Title 130 CMR 450.000 - Administrative and Billing Regulations › Section 450.117 - Managed Care

Current through Register 1525, July 5, 2024
(A) MassHealth
			 members participate in managed care pursuant to
			 130 CMR
			 508.001:
MassHealth Member
			 Participation in Managed Care
. MassHealth members may be excluded from
			 participating in managed care pursuant to
			 130
			 CMR 508.002:
MassHealth Members
			 Excluded from Participation in Managed Care
.
(B) MassHealth managed care provides for the
			 management of medical care, including primary care, behavioral health services,
			 and other medical services. MassHealth members who participate in managed care
			 obtain services as follows:
(1) Members who
			 enroll with an MCO obtain services in accordance with
			 130 CMR
			 508.004(B):
Obtaining Services when Enrolled in an MCO
.
(2) Members who enroll with the PCC Plan
			 obtain services in accordance with
			 130 CMR
			 508.005(B):
Obtaining Services when Enrolled with the PCC Plan
.
(3) Members who enroll with an Accountable
			 Care Partnership Plan obtain services in accordance with
			 130 CMR
			 508.006(A)(2):
Obtaining Services when Enrolled in an Accountable Care Partnership
			 Plan
.
(4) Members who
			 enroll with a Primary Care ACO obtain services in accordance with
			 130 CMR
			 508.006(B)(2):
Obtaining Services when Enrolled in a Primary Care
			 ACO
.
(5) Members who
			 enroll with an ICO obtain services in accordance with
			 130 CMR
			 508.007(C):
Obtaining Services when Enrolled in an ICO
. Members who enroll
			 in the Duals Demonstration Program may continue to receive services from their
			 current providers who accept current Medicare or Medicaid fee-for-service
			 provider rates during a continuity-of-care period. A continuity-of-care period
			 is a period beginning on the date of enrollment into the Duals Demonstration
			 Program and extends to either of the following:
(a) up to 90 days, unless the comprehensive
			 assessment and the individualized-care plan are completed sooner and the
			 enrollee agrees to the shorter time period; or
(b) until the comprehensive assessment and the individualized-care
			 plan are complete.
(6)
			 Members who enroll with a SCO obtain services in accordance with
			 130 CMR
			 508.008(C):
Obtaining Services when Enrolled in a SCO
.
(7) Members who are Native Americans (within
			 the meaning of "Indians" as defined at
			 42 U.S.C.
			 1396u-2) or Alaska Natives and who
			 participate in managed care may choose to receive covered services from an
			 Indian health-care provider. All participating MCOs, Accountable Care
			 Partnership Plans, SCOs and ICOs must provide payment for such covered services
			 in accordance with the provisions of
			 42 U.S.C.
			 1396u-2(h) and
			 comply with all other provisions of
			 42 U.S.C.
			 1396u-2(h).
			 For the purposes of 130 CMR 450.117(B)(7), the term Indian health-care provider
			 means a health care program, including contracted health services, operated by
			 the Indian Health Service or by an Indian tribe, Tribal Organization, or Urban
			 Indian Organization as those terms are defined in § 4 of the Indian Health
			 Care Improvement Act (25 U.S.C. 1603)
			 .