MassHealth
Senior Whole Health offers a Senior Care Option ("SCO") plan to members throughout the Commonwealth which covers all of the services normally paid for through Medicare and MassHealth. Through this partnership with MassHealth the plan provides services to members through a Senior Care Organization and its network of providers. SCO offers the opportunity to receive quality health care by combining health services with social support services. It does this by coordinating care and specialized geriatric support services, along with respite care for families and caregivers. SCO offers an important advantage for eligible members over traditional fee-for-service care. There are no copays for members enrolled in SCO.
Enrollment in this managed care program is voluntary, and once enrolled, a member may disenroll any month of the year. Enrollment is open to MassHealth Standard members who meet the following criteria:
- are aged 65 or older;
- live at home or in a long-term-care facility (member cannot be an inpatient at a chronic or rehabilitation hospital or reside in an intermediate care facility for people with intellectual disabilities);
- are not subject to a six-month deductible period under MassHealth regulations at; and
- live in an area served by a SCO plan.
Current Initiatives/Recent Updates
Redeterminations-Effective April 1, 2023 MassHealth began the process of renewing all member's health coverage to ensure they still qualify for their current benefit. These renewals will take place over 12 months, from April 2023 to April 2024. MassHealth will be communicating to members via text, email, and mail. A renewal notice will come via mail in a blue envelope. For assistance please utilize this toolkit.
Billing Responsibilities and Billing for Retroactively Reinstated Members reminder.
Provider Enrollment-Senior Whole Health is working with MassHealth on Provider Enrollment. Federal Regulations require all Managed Care Entity ("MCE") network providers to enroll with MassHealth. All MCE network providers must have two provider contracts in place: (1) a network provider contract with Senior Whole Health and (2) a provider contract with MassHealth. To complete this process please complete the MassHealth Nonbilling MCE Network-only Provider Contract. If you wish to enroll as a fully participating MassHealth provider please visit MassHealth's Provider Regulations. If you have further questions on this initiative please utilize this FAQ.
Skilled Nursing Rates-Senior Whole Health recently received communication that MassHealth has published the most recent rate updates, with an effective date of October 1, 2023. Rates for our Skilled Nursing Facility ("SNF") partners are automatically updated based on these notices from MassHealth, in accordance with your individual contracts. We have confirmed these rates have been updated with a retroactive effective date of October 1, 2023. Posted rates can be found here. Additional guidance from MassHealth can be found here. SWH Contract Managers will contact you directly with an updated contract shortly.
Other Initiatives
Obesity Drugs and 340B Drug Pricing Program Summary
Day Habilitation Admission and Re-engagement Services Update
Prior Authorizations Set to Resume March 7, 2023
In accordance with MassHealth guidance in December 2022, all Massachusetts Association of Health Plans’ member plans will resume prior authorization procedures for admissions from acute care hospitals to sub-acute care facilities and rehabilitation facilities across all lines of business effective March 7, 2023.
For more information on SWH’s Prior Authorization policies and requirements, please refer to our Provider Manual and Utilization Management Reference Page.
MassHealth guidance and expectations for Plans around hospital discharge planning for members experiencing or at risk of homelessness
Updated Covid-19 Personnel Vaccination Requirement-Home Care Agencies and Non-Agency Based Home Care Workers (November 2022)
American Rescue Plan Act (ARPA) Temporary Rates - In April 2022, MassHealth issued Managed Care Entity Bulletin 87, MCE 87 2022.04, instructing Senior Care Options plans to extend enhanced rates for certain behavioral health outpatient and diversionary services as part of the American Rescue Plan Act (ARPA). Senior Whole Health continues to process claims to ensure providers delivering behavioral health services outlined in MassHealth Managed Care Entity Bulletin 87, April 2022, are paid accordingly.
Gender-Affirming Care Provider Self-Identification-If you are an active MassHealth Provider, use this form to tell MassHealth about any gender-affirming care services you provide.
Important MassHealth Resources
MassHealth Provider Enrollment and Credentialing
MassHealth Provider Regulations
MassHealth Provider Bulletin Notification Sign Up
MassHealth Coronavirus Guidance
MassHealth Coverage and Reimbursement Policy for COVID-19
MassHealth Contact Information
Phone: (800) 841-2900 (Monday-Friday 8 a.m.-5 p.m.), TTY (800) 497-4648
Email: provider@masshealthquestions.com (Non-member specific questions, Email box not secure)
Fax: (617) 988-8974
Address: MassHealth Customer Service Center, P.O. Box 278, Quincy, MA 02171
Claims: MassHealth Customer Service Center, P.O. Box 7, Quincy, MA 02171