Fallon Total Care Delayed
The launch of Fallon Total Care, a Worcester-based pilot health insurance program designed for people eligible for Medicare and Medicaid benefits, has been delayed due to ongoing discussion about plan rates, according to the Massachusetts Executive Office of Health and Human Services (EOHHS).
The program is one of just a handful that have been designated by the federal Centers for Medicare and Medicaid (CMS) to provide services to the dual-eligible population, made up of patients with complicated health care needs, including those with disabilities and mental illness.
On May 17, EOHHS announced a new plan name, One Care: MassHealth Plus Medicare. The program was formerly known as the Duals Demonstration program.
Fallon Community Health Plan (FCHP) of Worcester and Connecticut-based Magellan Health Services announced the program as a joint venture in March 2012. They later named FCHP's Mary C. Ritter as CEO, and signed an office lease at 100 North Pkwy. in Worcester.
Fallon Total Care planned to begin enrolling patients this spring, but enrollment has been pushed to October, according to a statement from EOHHS.
"The timeline was impacted by the considerable time that has been needed over the past few months to discuss rates with CMS and the (prospective plans). Preliminary rates were released in February. Since then, there has been an ongoing process of discussion and updates to the rates between MassHealth, CMS and the plans," EOHHS said.
Officials at Fallon Total Care were notified of the delay May 24, according to a statement from Ritter.
"Even with this timeline change, Massachusetts will be the first state to go live with this innovative model that is designed to improve outcomes and reduce disparities in care for these individuals. Several other states are slated to go live in 2014 and 2015," Ritter said.
According to EEOHS, 111,000 Massachusetts residents age 21 to 64 are eligible for coverage under the dual-eligible pilot plans. Fallon Total Care will provide services to people in 10 counties, including Worcester, Middlesex and Norfolk.
A public awareness campaign will kick off in July, EOHHS said.
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