Section 508.008 - Senior Care Organizations(A)Enrollment Requirements. In order to voluntarily enroll in a senior care organization, a MassHealth Standard member must meet all of the following criteria:(1) be 65 years of age or older;(2) live in a designated service area of a senior care organization;(3) not be diagnosed as having end-stage renal disease;(4) not be subject to a six-month deductible period under 130 CMR 520.028: Eligibility for a Deductible;(5) not be a resident of an intermediate care facility for individuals with intellectual disabilities (ICF/ID); and(6) not be an inpatient in a chronic or rehabilitation hospital.(B)Selection Procedure. The MassHealth agency will notify members of the availability of a senior care organization (SCO) in their service area and of the procedures for enrollment. An eligible member may voluntarily enroll in any SCO in the member's service area. A service area is the specific geographical area of Massachusetts in which a SCO agrees to serve its contract with the MassHealth agency and the Centers for Medicare & Medicaid Services. Service area listings may be obtained from the MassHealth agency or its designee. The list of senior care organizations (SCOs) that the MassHealth agency will make available to members will include those SCOs that contract with the MassHealth agency and provide services within the member's service area.(C)Obtaining Services When Enrolled in a SCO. When a member chooses to enroll in a senior care organization (SCO) in accordance with the requirements under 130 CMR 508.008, the SCO will deliver the member's primary care and will authorize, arrange, integrate, and coordinate the provision of all covered services for the member. Upon enrollment, each SCO is required to provide evidence of its coverage, including a complete list of participating providers, the range of available covered services, what to do for emergency conditions and urgent care needs, and how to obtain access to covered services such as specialty, behavioral health, and long-term-care services.(D)Disenrollment from a Senior Care Organization. A member may disenroll from a SCO at any time by submitting a notice of disenrollment to the MassHealth agency or its designee. Disenrollment notices received by the MassHealth agency or its designee by the 20th day of the month will be effective the first day of the following month.(E)Discharge or Transfer. The MassHealth agency may discharge or transfer a member from a SCO where the SCO demonstrates to the MassHealth agency's satisfaction a pattern of noncompliant or disruptive behavior by the member or for other good cause. In each case, the MassHealth agency will state the good cause basis for discharge or transfer in a notice to the member.(F)Other Programs. While voluntarily enrolled in a senior care organization (SCO) under 130 CMR 508.008, a member may not concurrently participate in (1) any program described in 130 CMR 519.007: Individuals Who Would be Institutionalized, except the Home- and Community-based Services Waiver-frail Elder described in 130 CMR 519.007(B): Home- and Community-based Services Waiver-frail Elder;(2) any Medicare demonstration program or Medicare Advantage plan, except for Medicare Advantage Special Needs Plan for Dual Eligibles contracted as a SCO; or(3) an ICO described in 130 CMR 508.007.(G)Copayments. Members who are enrolled in a SCO must make copayments in accordance with the SCO's MassHealth copayment policy. Those SCO copayment policies must (1) be approved by MassHealth;(2) exclude the persons and services listed in 130 CMR 506.014: Copayments Required by MassHealth and 520.037: Copayment and Cost Sharing Requirement Exclusions;(3) not exceed the MassHealth copayment amounts set forth in 130 CMR 506.015: Copayment and Cost Sharing Requirement Exclusions and 520.038: Services Subject to Copayments; and(4) include the copayment maximums set forth in 130 CMR 506.018: Maximum Cost Sharing and 520.040: Maximum Cost Sharing. (See also 130 CMR 450.130: Copayments Required by the MassHealth Agency.)Amended by Mass Register Issue 1322, eff. 10/1/2016.Amended by Mass Register Issue S1345, eff. 8/11/2017.Amended by Mass Register Issue 1354, eff. 12/18/2017.