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