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

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, 2022. MMQ 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, 2022. Posted MMQ rates can be found here. SWH is currently reviewing all active SNF contracts based on additional guidance provided by MassHealth on November 18, 2022. We will contact you directly if any additional information is needed as part of this review process. 

 

Other Initiatives

Updated Covid-19 Personnel Vaccination Requirement-Home Care Agencies and Non-Agency Based Home Care Workers (November 2022)

 

Extension of and Updates to Temporary Rate Increases for Home and Community-based Services and Behavioral Health Services of Integrated Care Plans extended through December 31, 2022 (October 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.

 

Childhood Immunization Data Sharing-MassHealth initiatives include tracking current and ongoing status of immunization rates for MassHealth children (<21-year-old) and further improve immunization rates. MassHealth intends to create a plan and provider-based immunization reports listing patients who are soon to be due or who are overdue for childhood or adolescent immunizations, and work to identify levers to improve immunization rates. 

Important MassHealth Resources

MassHealth Provider Home

MassHealth Provider Bulletins

MassHealth Provider Enrollment and Credentialing

MassHealth Provider Handbook

MassHealth Provider Regulations

MassHealth Provider Bulletin Notification Sign Up

MassHealth Coronavirus Guidance

 

MassHealth Contact Information

Phone: (800) 841-2900 (Monday-Friday 8 a.m.-5 p.m.), TTY (800) 497-4648

Email: providersupport@mahealth.net

Fax: (617) 988-8974

Address: MassHealth Customer Service Center, P.O. Box 278, Quincy, MA 02171