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| 2 | 2 | | SENATE DOCKET, NO. 636 FILED ON: 1/17/2023 |
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| 3 | 3 | | SENATE . . . . . . . . . . . . . . No. 382 |
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| 4 | 4 | | The Commonwealth of Massachusetts |
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| 5 | 5 | | _________________ |
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| 6 | 6 | | PRESENTED BY: |
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| 7 | 7 | | Edward J. Kennedy |
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| 8 | 8 | | _________________ |
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| 9 | 9 | | To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General |
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| 10 | 10 | | Court assembled: |
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| 11 | 11 | | The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill: |
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| 12 | 12 | | An Act relative to complex care needs for seniors in SCO programs. |
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| 13 | 13 | | _______________ |
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| 14 | 14 | | PETITION OF: |
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| 15 | 15 | | NAME:DISTRICT/ADDRESS :Edward J. KennedyFirst Middlesex 1 of 2 |
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| 16 | 16 | | SENATE DOCKET, NO. 636 FILED ON: 1/17/2023 |
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| 17 | 17 | | SENATE . . . . . . . . . . . . . . No. 382 |
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| 18 | 18 | | By Mr. Kennedy, a petition (accompanied by bill, Senate, No. 382) of Edward J. Kennedy for |
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| 19 | 19 | | legislation relative to complex care needs for seniors. Elder Affairs. |
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| 20 | 20 | | [SIMILAR MATTER FILED IN PREVIOUS SESSION |
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| 21 | 21 | | SEE SENATE, NO. 396 OF 2021-2022.] |
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| 22 | 22 | | The Commonwealth of Massachusetts |
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| 23 | 23 | | _______________ |
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| 24 | 24 | | In the One Hundred and Ninety-Third General Court |
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| 25 | 25 | | (2023-2024) |
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| 26 | 26 | | _______________ |
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| 27 | 27 | | An Act relative to complex care needs for seniors in SCO programs. |
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| 28 | 28 | | Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority |
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| 29 | 29 | | of the same, as follows: |
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| 30 | 30 | | 1 SECTION 1. Section 9D of chapter 118E of the General Laws, as appearing in the 2022 |
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| 31 | 31 | | 2Official Edition, is hereby amended by striking out subsection (e)(5) in its entirety and replacing |
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| 32 | 32 | | 3it with the following new section:- |
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| 33 | 33 | | 4 (5) The SCO shall be required to evaluate all its enrollees to determine if an enrollee has |
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| 34 | 34 | | 5complex care needs within 90 days of initial enrollment, as well as on an annual basis, or as |
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| 35 | 35 | | 6requested by the enrollee's primary care physician, or as requested by the enrollee or his |
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| 36 | 36 | | 7authorized representative. If it is determined that an enrollee has complex care needs, the |
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| 37 | 37 | | 8enrollee may receive the ongoing services of a primary care team. If the primary care team |
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| 38 | 38 | | 9determines that the complex care enrollee requires the ongoing services of a primary care team, |
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| 39 | 39 | | 10the primary care team shall develop and monitor a plan of care for said enrollee, and arrange for 2 of 2 |
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| 40 | 40 | | 11and deliver all services called for in the plan of care. If an enrollee is deemed to have complex |
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| 41 | 41 | | 12care needs, but the primary care team determines the complex care enrollee does not require the |
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| 42 | 42 | | 13services of a primary care team, the enrollee shall receive the services of a primary care |
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| 43 | 43 | | 14physician and may appeal to the SCO to receive primary care team services. The SCO shall |
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| 44 | 44 | | 15conduct a standard review and make a decision following receipt of all required documentation |
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| 45 | 45 | | 16and, if requested by the primary care physician, the SCO shall conduct an expedited review. The |
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| 46 | 46 | | 17timeline for standard and expedited reviews shall meet the requirements established under 42 |
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| 47 | 47 | | 18C.F.R. 422.568 and 422.572. The SCO shall develop criteria for the primary care team to employ |
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| 48 | 48 | | 19when determining whether the complex care enrollee requires the ongoing services of a primary |
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| 49 | 49 | | 20care team. The SCO shall submit the criteria to the division of medical assistance for its |
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| 50 | 50 | | 21approval. |
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| 51 | 51 | | 22 Summary: This language will amend the SCO enabling statute to extend the time frame |
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| 52 | 52 | | 23within which new SCO enrollees must be evaluated to assess their complex care needs. Since its |
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| 53 | 53 | | 24creation, SCO has been a program which new enrollees must proactively join. As part of its |
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| 54 | 54 | | 25Duals Demonstration 2.0 waiver request, MassHealth is seeking to passively enroll new |
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| 55 | 55 | | 26members into SCO. Given the differences in passive and active enrollment – difficulty reaching |
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| 56 | 56 | | 27and locating new members, assessing the complex care needs of members who are new to |
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| 57 | 57 | | 28managed care – it will be important for the SCO plans and their Aging Service Access Point |
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| 58 | 58 | | 29(ASAP) partners to have sufficient time to outreach and assess new members’ needs. |
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