![]() Parties may be referenced individually as “Party” and collectively as “Parties”. of of (herein referred to as “Partner B”). of of (herein referred to as “Partner A”) and The Massachusetts One Care contract addendum is posted below.This Memorandum of Understanding (MOU) is entered on the (number) day of (month) in (year) (herein referred to as the “Effecitve Date”) into by and between: Coding intensity is an adjustment that CMS applies to the Medicare payment rate to offset the differences in coding practices between Medicare fee-for-services and managed care (i.e., Medicare Advantage). Coding Intensity: CMS revised the coding intensity factor for 20, which will result in an increased capitation payment from Medicare to the One Care plans.The original three-way contract established risk corridors for the first year of the Demonstration MassHealth and CMS amended the three-way contract to include risk corridors for the second and third years. They also allow the Commonwealth and CMS to share in savings the One Care plans may achieve. Risk corridors in One Care are meant to lessen the financial risk One Care plans take on as they provide coordinated services to One Care enrollees. Risk Corridors: Risk corridors are a form of financial risk sharing and protection against financial losses and gains.The changes established risk corridors for Demonstration Years 2 and 3, and adjusted the Medicare coding intensity factor. In September 2014, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed changes to the One Care three-way contract (i.e., executed a contract addendum). The second Massachusetts One Care contract addendum is posted below. The January 2015 amendment increased risk sharing for Demonstration year 1. The original three-way contract established risk corridors for the first year of the Demonstration, and the September 2014 addendum amended the three-way contract to extend risk corridors for the second and third years. Risk Corridors - Risk corridors are a form of financial risk sharing and protection against financial losses and gains.The January 2015 addendum eliminated the HCRPs for 20 (Demonstration Year 1) and the plans’ contributions will be refunded. HCRPs were designed to redistribute funding between the One Care plans in the event of disproportionate enrollment of high-cost individuals. High Cost Risk Pools (HCRPs) - the three-way contract established HCRPs funded by a percentage of the MassHealth capitation.The January 2015 addendum reduced the savings percentages for Demonstration Years 2 and 3. Savings Percentages - the three-way contract includes savings percentages that are applied to the MassHealth and Medicare Parts A & B rate component.The addendum reduced the savings percentages, eliminated the first year of the High Cost Risk Pools (HCRPs), and modified the Risk Corridors. In January 2015, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care plans executed additional changes to the One Care three-way contract through a second addendum. The amendment is effective as of April 1, 2019. The Amendment incorporates changes to comply with the 2016 Medicaid Managed Care Rule, service updates and additions, including: Substance Use Disorder/Behavioral Health services authorized in the 2016 1115 MassHealth Demonstration Amendment and Community Support Program (CSP) services for chronically homeless individuals and a new rating category for a small number of enrollees who participate in the Transitional Living Program. The amended One Care contract also reflects feedback received from the One Care Implementation Council and the Ombudsman: it clarifies the process for making service requests, incorporates required plan coordination with the Ombudsman, updates requirements for LTS Coordinators and strengthens their integration with care teams, adds "sexual and reproductive health" to the comprehensive assessment domains (at the option of the Enrollee), and broadens risk for abuse and neglect to include "experience of violence. In May 2019, MassHealth, the Centers for Medicare & Medicaid Services (CMS), and the One Care Plans executed an amended and restated Three-Way Contract. ![]()
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