SECTION 1. Subsection (e)(3)of section 9D of Chapter 118E of the Massachusetts General Laws is hereby amended by inserting at the end of said subsection the following: “The division shall work jointly with each of the contracted senior care organizations to better market, encourage and promote voluntary enrollment in the senior care options program and to ensure that the option to enroll in a senior care options program is fully presented to all appropriate individuals. This work shall include an assessment of whether and to what extent barriers to enrollment should be alleviated through modifications to the network or the program. Through procurement policies that promote the maximum participation of disability-competent SCOs, the division shall actively promote the expansion of the Senior Care Options model of contracting and care to disabled consumers under sixty-five who are dually-eligible for Medicare and Medicaid services.
SECTION 2. Subsection (d) of section 9D of Chapter 118E of the Massachusetts General Laws is hereby amended by inserting at the end of said subsection the following: “A personal care attendant providing PCA services as a benefit to enrollees in accordance with 130 CMR 422 shall be compensated by the senior care organization in accordance with the collective bargaining agreement entered into by 1199SEIU and the PCA Quality Home Care Workforce Council. Any and all changes to personal care attendant compensation as negotiated under this and any subsequent collective bargaining agreement shall be reflected in and fully considered by the division in the development of the prospective risk-adjusted premiums for payment to SCOs for Medicaid services as detailed in Section (4)(i) of Chapter 118E.”
SECTION 3. Subsection (h)(3) of section 9D of Chapter 118E of the Massachusetts general laws is hereby amended by inserting at the end of said subsection the following: “This assessment shall include an assessment to determine the enrollee’s eligibility for consumer-directed care options and an assessment of whether personal care attendant services as detailed in 130 CMR 422 are appropriate to meet the enrollee’s identified need for medically necessary services.”
SECTION 4. Subsection (b) of section 9D of Chapter 118E of the Massachusetts general laws is hereby amended by inserting at the end of said subsection the following: “The division shall establish prospective risk-adjusted payment rates with the senior care organizations that are actuarially sound and transparently derived for each of the SCO’s specific enrolled sub-populations.”
SECTION 5. The Division of Medical Assistance shall amend the current contracts with senior care organizations to replace the current contract model where SCOs assume full financial risk with commensurate rights to all savings with a contract model that includes both shared risk and shared savings between the state and the contractor with respect to the totality of Medicare and Medicaid premium received by the contractor. A similar shared risk/ shared savings contract model shall also govern any SCO contracts to provide care for to disabled consumers under sixty-five who are also dually-eligible for Medicare and Medicaid services. The 2004-2006 SCO demonstration contracts meet the intent of this Section.
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