Current through Register 1531, September 27, 2024
(A)
Mandatory Enrollment with a
MassHealth Managed Care Provider. MassHealth members who are
younger than 65 years old must enroll in a MassHealth managed care provider
available for their coverage type. Members described in 130 CMR 508.001(B) or
who are excluded from participation in a MassHealth managed care provider
pursuant to
130
CMR 508.002(A) are not
required to enroll with a MassHealth managed care provider.
(B)
Voluntary Enrollment in a
MassHealth Managed Care Provider. The following MassHealth members
who are younger than 65 years old may, but are not required to, enroll with a
MassHealth managed care provider available for their coverage type:
(1) MassHealth members who are receiving
services from DCF or DYS;
(2)
MassHealth members who are enrolled in the Kaileigh Mulligan Program, described
in
130 CMR
519.007(A): The
Kaileigh Mulligan Program. Such members may choose to receive all
services on a fee-for-service basis;
(3) MassHealth members who are enrolled in a
home- and community-based services waiver. Such members may choose to receive
all services on a fee-for-service basis; or (4) MassHealth members who are
receiving Title IV-E adoption assistance as described at
130 CMR
522.003: Adoption Assistance and
Foster Care Maintenance. Such members may choose to receive all
services on a fee-for-service basis.
(C)
Senior Care Organizations
(SCO). MassHealth members who are 65 years of age or older may
enroll in a SCO pursuant to
130 CMR
508.008(A).
(D)
Integrated Care Organizations
(ICO). Also referred to as "One Care plans." Members enrolled in
an ICO (One Care plan) are participants in the Duals Demonstration, also known
as "One Care." MassHealth members who are 21 through 64 years of age at time of
enrollment may enroll in an ICO pursuant to
130 CMR
508.007(A).
(E)
MassHealth Behavioral Health
Contractor.
(1) MassHealth
Standard and CommonHealth members who are younger than 21 years old and who are
excluded from participation with a MassHealth managed care provider under
130
CMR 508.002(A)(1) or (2)
must enroll with the MassHealth behavioral health contractor.
(2) MassHealth members who are receiving
services from DCF or DYS and who do not choose to enroll with a MassHealth
managed care provider must enroll with the MassHealth behavioral health
contractor.
(3) MassHealth members
who are enrolled in the Kaileigh Mulligan Program, described in
130 CMR
519.007(A): The
Kaileigh Mulligan Program and who do not choose to enroll with a
MassHealth managed care provider are enrolled with the MassHealth behavioral
health contractor. Such members may choose to receive all services on a
fee-for-service basis.
(4)
MassHealth members who participate in one of the Money Follows the Person
home-and community-based services waivers who are not enrolled with a
MassHealth managed care provider or not otherwise enrolled with the behavioral
health contractor must enroll with the behavioral health contractor.
(5) MassHealth members who are receiving
Title IV-E adoption assistance as described at
130 CMR
522.003: Adoption Assistance and
Foster Care Maintenance and who do not choose to enroll with a
MassHealth managed care provider are enrolled with the MassHealth behavioral
health contractor. Such members may choose to receive all services on a
fee-for-service basis.
