Health Home
The Behavioral Health Home, as managed by Bay Cove, is funded through the enhanced MassHealth insurance product known as One Care. This innovative program provides MassHealth members under 65, and who also have Medicaid, with comprehensive benefits and integrated care coordination. In this model, a member is assigned a Care Manager, who works with the member, their providers, and their insurance plan to promote integrated care and improve a member’s overall health and wellness.
The scope of work of the Behavioral Health Home team here at Bay Cove covers four broad categories: assessment, care planning, authorization management, and care coordination. Commonwealth Care Alliance (CCA) has been selected by MassHealth as an Integrated Care Organization (ICO) responsible for administering this MassHealth product across the state. Here in the Boston area, CCA has subcontracted the Care Coordination services to Bay Cove.
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The goal of the Behavioral Health Home is to integrate a member’s medical, behavioral health and community-based social services to ensure that each member’s complex needs are being met in a coordinated way.
Enhanced Benefits of One Care
No monthly plan premium, doctor’s office visit co-pays, or hospital co-pays
No prescription or over-the-counter drug co-pays
Free, complete annual eye exams, eyeglasses, contacts
Free, complete dental services including exams, x-rays, cleaning, fillings, root canals, crowns, and dentures
Free transportation to medical appointments
Free long-term services and supports (home health, personal care assistance, etc)
Free medical equipment and supplies
Free behavioral health services and support (mental health and substance abuse)
Peer Support Services
Tobacco Cessation Services
Personal Care assistance as needed
Interpreter services as needed
Hospital alternatives
Creative healthcare interventions and solutions
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Individuals who are enrolled in both MassHealth Standard or MassHealth CommonHealth, and Medicare parts A and B, with eligibility for part D. If a person drops either of these insurances, MassHealth will disenroll the member from One Care, which means they will be disenrolled from Bay Cove’s Behavioral Health Home. Both types of insurance must always be active to maintain their One Care coverage and membership in the Health Home.
Individuals between the ages of 21-64. When a member turns 65, they have the choice to either keep their One Care plan or select a Senior Care Options plan.
Any Bay Cove client that meets the above criteria can enroll in Bay Cove’s Behavioral Health Home, regardless of which service area or program serves them.
If a person meets the above criteria, they must notify MassHealth of their desire to enroll in One Care. If they wish to have Bay Cove’s Behavioral Health Home coordinate their care, they must select CCA as their One Care Plan. Once the referral goes to CCA, CCA will reach out to Bay Cove’s Health Home team to confirm that they are affiliated with Bay Cove. Once that is confirmed, the member will be enrolled in Bay Cove’s Health Home.
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1) Assessments
A Minimum Data Set (MDS) must be completed by the Health Home RN within 75 days of a member’s referral to Bay Cove.
The MDS takes a holistic view of the member and includes information on physical and behavioral health, dental health, functional abilities, and more.
The Health Home team sends the MDS to CCA, who forwards it to MassHealth.
An updated MDS must be completed annually.
2) Care Planning
The needs of the MDS inform the member’s Care Plan, a document that outlines how a member will move forward in their treatment.
The goals of a member’s Care Plan are broad, as the treatment(s) for chronic conditions may require a variety of interventions.
The Care Plan becomes CCA’s guide to what services they will need to cover.
The Care Plan evolves along with the member’s needs.
3) Authorization Management
Health Home team members authorize approvals for care on behalf of CCA.
Requests for authorization can come from the member or their family, from the Health Home team, from CCA, or from the member’s treatment team.
Approval or denial must be determined within 14 days of a request.
4) Care Coordination, which may include:
Scheduling healthcare appointments
Information sharing with providers
Advocacy on behalf of the member
Follow up that scheduled services were provided
Preparation for discharge from inpatient stays
Post-discharge activities, including checking with the member within 48 hours of a hospital discharge and again within seven days if the member was in a psychiatric inpatient setting.