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Special terms and conditions agreement establishing federal and state obligations, program structure, financing mechanisms, compliance requirements, and reform objectives governing the Massachusetts MassHealth Section 1115 Medicaid demonstration for the 2017–2022 extension period.
Number:
11-W-00030/1
Program Title:
MassHealth Medicaid Section 1115 Demonstration
Awardee:
Massachusetts Executive Office of Health and Human Services (EOHHS)
Federal Agency:
Centers for Medicare & Medicaid Services (CMS)
State:
Massachusetts
Effective Date:
July 1, 2017
Expiration Date:
June 30, 2022
Demonstration Authority:
Section 1115(a) of the Social Security Act
Extension Approval Date:
November 4, 2016
Demonstration Period:
State Fiscal Years 2018–2022
Subject Areas:
Program Description and Objectives; General Program Requirements; Eligibility and Enrollment; Demonstration Programs and Benefits; Delivery System; Cost Sharing; Safety Net Care Pool; Reporting; Monitoring; Evaluation; Financial Requirements; Budget Neutrality; Schedule of Deliverables
Key Components:
Accountable Care Organization (ACO) initiative; Delivery System Reform Incentive Program (DSRIP); Safety Net Care Pool (SNCP)
Target Populations:
Medicaid beneficiaries; low-income uninsured individuals; former foster care individuals aged 18–26
Legal Compliance Requirements:
Federal non-discrimination statutes; Medicaid and CHIP law and regulation
Financial Framework:
Federal Financial Participation (FFP); budget neutrality agreement; allotment neutrality worksheet
Attachments:
A–S including Cost Sharing, SNCP Payments, DSRIP Protocol, ACO Payment Methodology, Evaluation Design
Price: 8 / 10 USD
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Year:
2025
Region / City:
Massachusetts
Subject:
Medicaid, Health Insurance
Document Type:
Amendment Request
Agency / Institution:
Executive Office of Health and Human Services
Author:
Not specified
Target Audience:
Stakeholders in healthcare policy and Medicaid administration
Effective Period:
2025-2027
Approval Date:
January 21, 2025
Amendment Date:
Pending
Year:
2024
Region / City:
Massachusetts
Topic:
Public expenditure process, temporary housing assistance
Document Type:
Policy Document
Agency / Institution:
Executive Office of Housing and Livable Communities (EOHLC)
Author:
Commonwealth of Massachusetts
Target Audience:
Government entities, healthcare providers, social service agencies
Period of Effect:
From September 30, 2024, onwards
Approval Date:
September 30, 2024
Amendment Date:
Not specified
Year:
2022-2027
Region / City:
Massachusetts
Topic:
Independent Evaluation Design
Document Type:
Evaluation Design Document
Organization / Institution:
UMass Chan Medical School, Massachusetts Executive Office of Health and Human Services, Centers for Medicare and Medicaid Services
Author:
UMass Chan Medical School
Target Audience:
Centers for Medicare and Medicaid Services, healthcare policymakers, health service providers
Approval Date:
December 2023
Amendment Date:
Not provided
Period of Validity:
2022-2027
Year:
2022-2027
Region / city:
Massachusetts
Topic:
Medicaid Demonstration
Document type:
Program Report
Agency / institution:
MassHealth
Author:
MassHealth
Target audience:
Stakeholders, Policy Makers, Health Providers
Effective period:
October 1, 2022 - December 31, 2027
Approval date:
October 1, 2022
Date of changes:
N/A
State:
Oklahoma
Demonstration name:
Institutions for Mental Diseases Waiver for Serious Mental Illness/Substance Use Disorder
Approval period for section 1115 demonstration:
12/22/2020-12/31/2025
SMI/SED demonstration start date:
12/22/2020
Implementation date of SMI/SED demonstration:
12/22/2020
SMI/SED demonstration goals and objectives:
Reduced utilization of emergency departments; Reduced preventable readmissions to acute care hospitals and residential settings; Improved availability of crisis stabilization services; Improved access to community-based services; Improved care coordination
SMI/SED demonstration year and quarter:
DY1 Q2
Reporting period:
04/01/2021 - 06/30/2021
Medicaid expansion start date:
07/01/2021
Managed care implementation status:
On hold pending legislative authority
Behavioral Health Homes sunset date:
09/30/2021
Certified Community Behavioral Health Clinics (CCBHCs) certified this period:
1
Total new CMHCs achieving CCBHC status since waiver submission:
4
State agency:
Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS)
Relevant national initiatives:
988 crisis response number
Year:
2022
Region / City:
Massachusetts
Theme:
Medicaid, Health Services, Demonstration Programs
Document Type:
Report
Agency / Institution:
Centers for Medicare & Medicaid Services, UMass Chan Medical School
Author:
Danielle Daly, Jay Himmelstein, Matthew Alcusky, Arlene Ash, et al.
Target Audience:
Health Policy Makers, Researchers, Health Administrators
Evaluation Period:
June 2017 - December 2019
Approval Date:
September 29, 2022
Amendment Date:
March 18, 2022
Year:
2022
Region / City:
Massachusetts
Theme:
Healthcare, Medicaid
Document Type:
Quarterly Report
Organization / Institution:
Massachusetts Executive Office of Health and Human Services (EOHHS)
Author:
Not specified
Target Audience:
Policy makers, healthcare administrators, healthcare providers
Period of Action:
July 1, 2022 – September 30, 2022
Approval Date:
Not specified
Date of Changes:
June 9, 2022 (Temporary Extension)
Año:
2021
Región / ciudad:
Estados Unidos
Temática:
Derecho de marcas
Tipo de documento:
Instrucción judicial
Organismo / institución:
Oficina de Patentes y Marcas de EE.UU.
Autor:
Tribunal judicial
Público objetivo:
Abogados, jueces, partes involucradas en casos de infracción de marcas
Periodo de validez:
No especificado
Fecha de aprobación:
No especificado
Fecha de modificaciones:
No especificado
Note:
Descripción
Year:
2024
Region / City:
Massachusetts
Theme:
Medicaid, Healthcare, Integrated Care
Document Type:
Amendment Request
Organization:
Executive Office of Health and Human Services (EOHHS)
Author:
EOHHS
Target Audience:
Medicaid and Medicare beneficiaries, healthcare providers, policymakers
Effective Period:
2026
Approval Date:
Not specified
Date of Modifications:
Not specified
Year:
2015
Month:
October
ISBN:
978-0-478-43513-9
Document Code:
DGL 11/15
Country:
New Zealand
Issuing Authority:
Director of the Ministry of Civil Defence & Emergency Management
Publishing Organisation:
Ministry of Civil Defence & Emergency Management
Legal Basis:
Civil Defence Emergency Management (CDEM) Act 2002, section 9(3)
Type of Document:
Director’s Guideline
Subject:
Welfare services and needs assessment in emergencies
Scope:
National and CDEM Group levels
Responsible Agencies:
MCDEM and CDEM Groups including local authorities
Target Audience:
CDEM Groups and agencies with responsibilities for welfare services in an emergency
Related Framework:
National Civil Defence Emergency Management Plan 2015
Contact Address:
PO Box 5010 Wellington 6145 New Zealand
Website:
www.civildefence.govt.nz
Copyright Status:
Not copyright; reproduction permitted with acknowledgement
State:
Ohio
Demonstration Name:
Ohio Section 1115 Substance Use Disorder Waiver Demonstration
Approval Period:
10/01/2019 – 09/30/2024
SUD Demonstration Start Date:
10/01/2019
Implementation Date:
n.a.
Demonstration Year and Quarter:
DY2Q3
Reporting Period:
04/01/2021 – 06/30/2021
Demonstration Goals:
Increase identification, initiation, and engagement in treatment; improve retention and adherence; reduce overdose deaths; reduce inappropriate ED and inpatient utilization; reduce readmissions; improve access to physical health care for SUD beneficiaries
Metrics Reported:
ASAM level service utilization, MAT utilization, UDS utilization
Target Populations:
Youth, Dual, Criminal Justice Involved, Pregnant, Older Adults
Milestones:
Assessment of need and qualification for SUD services, Access to critical levels of care for OUD and other SUDs
Context:
Official state report providing quarterly metrics, milestone updates, and implementation details for the Ohio Section 1115 SUD Waiver Demonstration
Year:
2021
Region:
Massachusetts, United States
Subject:
Medicaid policy, postpartum coverage, maternal health, telehealth services
Document Type:
Public comments and testimony
Government Program:
MassHealth Section 1115 Demonstration Waiver
Submitting Organizations:
Massachusetts Chapter of the American Academy of Pediatrics; Massachusetts Section of the American College of Obstetricians and Gynecologists; Massachusetts Medical Society; Children’s Health Access Coalition; Boston Medical Center Health System; Commonwealth Care Alliance; Planned Parenthood League of Massachusetts; Massachusetts Health & Hospital Association; Massachusetts Law Reform Institute; Association for Behavioral Healthcare; Health Care For All; Massachusetts Academy of Family Physicians; Mass General Brigham
Individual Contributor:
Isabella Hernandez
Government Body Referenced:
Executive Office of Health and Human Services
Federal Agency Referenced:
Centers for Medicare and Medicaid Services
Public Comment Period:
March 23, 2021 to April 25, 2021
Key Policy Proposals:
Extension of postpartum coverage to 12 months; authorization of coverage regardless of immigration status; expansion of Medicare Savings Programs eligibility; community support services for justice-involved individuals; telehealth payment flexibility
Date of Testimony:
April 20, 2021
Year:
2017
Region / City:
Massachusetts
Topic:
Healthcare, Medicaid
Document Type:
Official Communication
Organization / Institution:
Centers for Medicare & Medicaid Services
Author:
Angela D. Garner
Target Audience:
State Officials, Healthcare Administrators
Period of Validity:
N/A
Approval Date:
May 15, 2017
Date of Changes:
N/A
Jurisdiction:
Massachusetts, United States
Program:
MassHealth Medicaid Section 1115 Demonstration
Document Type:
Program protocol
Subject:
Health care delivery system reform and incentive payment framework
Administering Agency:
MassHealth
Related Authority:
Centers for Medicare & Medicaid Services (CMS)
Program Components:
Accountable Care Organizations (ACOs), Community Partners (CPs), Community Service Agencies (CSAs)
Funding Mechanism:
Delivery System Reform Incentive Payment (DSRIP)
Approval Period:
July 1, 2017 – December 31, 2027
Key Topics:
Participation plans, budgets, payment methodologies, accountability framework, statewide investments, reporting and oversight
Stakeholders:
ACOs, Community Partners, Community Service Agencies, State government, CMS
Evaluation and Oversight:
CMS oversight and state evaluation requirements
Year:
2022
Region / City:
Massachusetts
Theme:
Medicaid, CHIP, Healthcare Waivers
Document Type:
Demonstration Waiver Approval
Institution:
Massachusetts Executive Office of Health and Human Services (EOHHS)
Author:
Centers for Medicare & Medicaid Services
Target Audience:
Government officials, healthcare providers, policy makers
Period of Validity:
October 1, 2022 – December 31, 2027
Date of Approval:
October 1, 2022
Date of Changes:
N/A
Year:
2025
Region / City:
Massachusetts
Subject:
Health Insurance, Medicaid, and CHIP
Document Type:
Implementation Guide
Organization / Institution:
MassHealth
Author:
MassHealth
Target Audience:
Healthcare providers, trading partners, and Managed Care Entities
Effective Period:
From January 1, 2012
Approval Date:
August 2025
Date of Changes:
Future updates will be included in subsequent versions
Context:
Implementation guide for electronic healthcare transactions, specifically for Medicaid and CHIP encounter data reporting under the HIPAA standards for MassHealth Managed Care Entities.
Year:
2025
Region / City:
Massachusetts
Subject:
Healthcare, Medicaid, Claims Reporting
Document Type:
Companion Guide
Organization:
MassHealth
Author:
MassHealth
Target Audience:
Healthcare providers, Trading Partners, Managed Care Entities (MCEs)
Effective Period:
From August 2025
Approval Date:
August 2025
Revision Date:
Not specified
This document is a companion guide for the ASC X12N 005010X299A1 Post-Adjudicated Claims Data Reporting:
Institutional standard, aimed at assisting MassHealth Managed Care Entities in reporting claims electronically in compliance with HIPAA.
Year:
2023
Region / City:
Massachusetts
Topic:
Disability Benefits Application
Document Type:
Application Instructions
Agency:
Executive Office of Health and Human Services
Author:
Commonwealth of Massachusetts
Target Audience:
Individuals applying for MassHealth due to disability
Period of Validity:
Not specified
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2025
Jurisdiction:
Commonwealth of Massachusetts
Region:
Massachusetts
Document type:
Evaluation report
Program:
MassHealth
Policy area:
Medicaid managed care quality
Issuing body:
Executive Office of Health and Human Services, Office of Medicaid
Publication date:
February 2025
Evaluation period:
Calendar Years 2022–2024
Measurement years covered:
2020–2022
Regulatory framework:
42 CFR §438.340(c)(2)
Related strategy:
MassHealth Comprehensive Quality Strategy (published June 2022)
Care programs covered:
ACO Program, MCO Program, PCC Plan, One Care, Senior Care Options
Quality domains:
Care quality, equity, value-based care, person- and family-centered care, care coordination
Source type:
Government administrative evaluation
Year:
2023
Region / City:
Massachusetts
Theme:
Health Care, Medicaid
Document Type:
Companion Guide
Organization / Institution:
MassHealth
Author:
Not specified
Target Audience:
Technical and operational staff
Period of validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified