Slide 1 One Care: MassHealth plus Medicare MassHealth Demonstration to Integrate Care for Dual Eligibles July 2018 Enrollment Report Slide 2 Monthly Enrollment Report MassHealth issues monthly reports on One Care enrollment activity Reports are issued near the end of the month Reports are intended to provide general information to stakeholders Slide 3 One Care Rating Category Definitions F1 Facility-based Care. Individuals identified as having a long-term facility stay of – more than 90 days C3 Community Tier 3 High Community Need. Individuals who have a daily – – skilled need; two or more Activities of Daily Living (ADL) limitations AND three days of skilled nursing need; and individuals with 4 or more ADL limitations In CY2014, C3 split into two subsets: C3B: for C3 individuals with certain diagnoses (e.g., quadriplegia, ALS, Muscular Dystrophy and Respirator dependence) leading to costs considerably above the average for current C3 for remaining C3 individuals C3A: C2 Community Tier 2 Community High Behavioral Health. Individuals who have – – a chronic and ongoing Behavioral Health diagnosis that indicates a high level of service need In CY2014, C2 split into two subsets C2B: for C2 individuals with co-occurring diagnoses of substance abuse and serious mental illness C2A: for remaining C2 individuals C1 Community Tier 1 Community Other. Individuals in the community who do not – meet F1, C2 or C3 criteria Slide 4 Total Enrollment Effective July 1, 2018, total number of enrollees: 20,930
Slide 1 One Care: MassHealth plus Medicare MassHealth Demonstration to Integrate Care for Dual Eligibles July 2018 Enrollment Report Slide 2 Monthly Enrollment Report MassHealth issues monthly reports on One Care enrollment activity Reports are issued near the end of the month Reports are intended to provide general information to stakeholders Slide 3 One Care Rating Category Definitions F1 – Facility-based Care. Individuals identified as having a long-term facility stay of more than 90 days C3 – Community Tier 3 – High Community Need. Individuals who have a daily skilled need; two or more Activities of Daily Living (ADL) limitations AND three days of skilled nursing need; and individuals with 4 or more ADL limitations In CY2014, C3 split into two subsets: C3B: for C3 individuals with certain diagnoses (e.g., quadriplegia, ALS, Muscular Dystrophy and Respirator dependence) leading to costs considerably above the average for current C3 C3A: for remaining C3 individuals C2 – Community Tier 2 – Community High Behavioral Health. Individuals who have a chronic and ongoing Behavioral Health diagnosis that indicates a high level of service need In CY2014, C2 split into two subsets C2B: for C2 individuals with co-occurring diagnoses of substance abuse and serious mental illness C2A: for remaining C2 individuals C1 – Community Tier 1 Community Other. Individuals in the community who do not meet F1, C2 or C3 criteria Slide 4 Total Enrollment Effective July 1, 2018, total number of enrollees: 20,930