Amendment #77 to H3400

SCO Program Reforms

[Sponsors] Mr. Chan of Quincy moves to amend the bill by adding the following new sections:-

SECTION __________.   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 on an annual basis shall notify all MassHealth  beneficiaries over 65 or older of the option of enrolling in a Senior Care Options plan, the names and contact information for the plans, general contact information for MassHealth and a general description of the benefits of joining a SCO in clear and simple  language and method to request for the same information in a language other than English. The division will work with the SCOs and other appropriate consumer groups to craft the language for the annual notifications and assess whether and to what extent barriers  to enrollment shall be alleviated through modifications to the program and or the enrollment process.”

SECTION __________. 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 _________. 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 _________. 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.”