MassHealth
Chapter 171 Report and
Annual Individual and Family
Support Plan
Fiscal Year 2021
February 2021
 MassHealth Chapter 171 Annual Family Support Plan for Fiscal Year 2021
MassHealth Chapter 171 Annual Family Support Plan
Fiscal Year 2021 (FY20)
Overview of Family Support
What is your agency’s definition of family support?
The Executive Office of Health and Human Services (EOHHS) serves as the single state agency for
Medicaid in Massachusetts. EOHHS, through its Office of Medicaid and in conjunction with its
constituent agencies, administers the MassHealth program, which pays for medically necessary health
care services for eligible individuals. Through its various operational areas, MassHealth routinely seeks
input and consultation from families and constituents. This report describes a variety of routes for this
input. Family support includes consultation with families of individuals who utilize MassHealth
supported services, both on an individual basis and on a system level.
Describe where family support fits within your overall agency.
This report describes several key areas wherein MassHealth creates opportunities for input and
consultation from members and families. In addition, various operational units of MassHealth seek input
from members, families, advocates and stakeholders.
How was substantial consultation and input from families obtained in the development of this plan?
During FY20, EOHHS actively reached out to members and families for consultation on several key
program areas, including One Care, the Personal Care Attendant (PCA) program, behavioral health care,
and Home and Community Based Services (HCBS) waivers. EOHHS regularly consults with
stakeholders who represent the interests of members and families. Extensive consultation with members,
families, and stakeholders has been a very important aspect of the ongoing restructuring effort to develop
and implement an accountable, person-centered model of care.
One Care is an integrated health care option for people with disabilities who enroll between the ages of 21
to 64 years old and are eligible for both MassHealth and Medicare. One Care makes it easier for a person
to get all of the services they need, including all their MassHealth and Medicare benefits, plus additional
behavioral health and community support services, expanded dental services, and care coordination, from
a single plan. MassHealth regularly obtains consultation and input from a wide variety of stakeholders,
including consumers and their family members, and caregivers. Throughout the past year, MassHealth
communicated regularly with stakeholders through monthly meetings of the Implementation Council
(One Care’s stakeholder advisory board with a majority consumer membership), email, updates to the
website (www.mass.gov/one-care), and a dedicated email box (onecare@state.ma.us). Beginning in April,
2020 MassHealth successfully transitioned monthly Implementation Council meetings to a virtual
platform and updated the Implementation Council’s website so dial-in and video attendance options were
available to the public. MassHealth also ensured that Implementation Council meetings include live
subtitles of the discussion via CART and on-camera ASL interpreters.
On February 11, 2019, MassHealth released a new Request for Responses (RFR) for One Care Plans.
Selected plans were originally expected to begin serving One Care members on January 1, 2021. On
January 7, 2020, MassHealth announced the selection of five plans to enter into contract negotiations.
With the pivot to the COVID-19 pandemic response, implementation of the procurement – including
contract negotiations - have been pushed back by one year. Selected entities that successfully complete
1
 MassHealth Chapter 171 Annual Family Support Plan for Fiscal Year 2021
contract negotiations and readiness reviews are now expected to begin serving members on January 1,
2022. Additionally, MassHealth worked with CMS to extend the current Duals Demonstration and Three-
way Contracts for the two current One Care plans through the end of 2021, with a contract amendment
expected to go into effect on August 1, 2020.
The Personal Care Attendant (PCA) Workforce Council provides opportunities to families and members
for input into the MassHealth PCA program. Chaired by the Undersecretary for Health Policy, designated
by the Secretary, the Council consists of MassHealth members who use PCA services. The role of the
Council is to ensure the quality of long-term, in-home, personal care by recruiting, training, and
stabilizing the work force of personal care attendants. The Council has a website that encourages
families/caregivers and members using PCA services to share their views and ideas about the PCA
program. The Council also holds quarterly meetings that are open to the public. The website link is
www.mass.gov/pca/. During FY16 and FY17, the Council established a workforce subcommittee and
stakeholder work groups to provide feedback and input on initiatives to promote consumer access to
quality personal care services and PCA retention rates across the state. One outcome of this process is a
new online PCA referral directory that launched in 2018. This directory provides upgrades and
functionality to expand Consumer and PCA access and utilization. In 2019, the PCA program procured
the PCA Enhancements Advisory council, consisting of Consumers, surrogates, caregivers and family
members, as well as advocates, to assist MassHealth in forming policy decisions and programmatic
change. Also in 2019, MassHealth re-procured the Personal Care Management (PCM) agency network
including contract revisions effective January 2020 that highlighted the need for family involvement at
the PCM level through Consumer Advisory Boards (CAB), required to biannually at a minimum.
The MassHealth Office of Behavioral Health engages the Massachusetts Behavioral Health Partnership
(MBHP) to provide behavioral health services for many MassHealth members. MBHP has a Family
Advisory Council which consists of family members of members with behavioral health conditions and
family advocates. The role of the council is to provide oversight and input into the quality management
process as it relates to the development and implementation of services and their delivery to Members and
their family members.
Home and Community Based Services (HCBS) waivers are alternative long-term services and support
programs that support MassHealth members to live in community settings who would otherwise require
care in a facility, such as a nursing facility, long-stay hospital, or intermediate care facility. MassHealth
operates ten HCBS waiver programs in collaboration with EOHHS sister agencies. Each waiver must be
approved for renewal by CMS every five years. Each time an HCBS waiver is renewed or substantively
amended, information regarding the renewal or amendment is posted on the MassHealth website and
input regarding the changes is solicited from members and their families. In FY20, MassHealth received
input from stakeholders including families and advocacy groups representing individuals and families
regarding the renewal of the Children’s Autism Waiver, operated by the Department of Developmental
Services (DDS). Such input informed aspects of the waiver program ranging from provider qualifications
to services.
In addition, the Office of Medicaid holds a monthly meeting with consumer advocates who provide input
to the agency on a wide range of matters. These meetings allow advocates to share issues or concerns that
consumers, families, or caregivers may have with their MassHealth benefits. The meetings also provide a
forum through which MassHealth can solicit feedback on member and other public facing materials. The
monthly agenda includes updates about new initiatives and changes being made to existing programs at
MassHealth, and dedicates time to respond to specific questions submitted by advocates in advance of the
meeting.
2
 MassHealth Chapter 171 Annual Family Support Plan for Fiscal Year 2021
In the summer of 2019, EOHHS held 8 statewide listening sessions as part of an effort to design and
create an improved ambulatory behavioral health treatment system. Members of the public were invited to
provide information and feedback related to accessing behavioral health treatment. MassHealth members
and their families were widely represented at each of the listening sessions and provided feedback to
EOHHS leadership about their experience with the treatment system and their ideas for its improvement.
A subsequent Request for Information reinforced many of the same themes as the listening sessions. The
combined input was incorporated into the EOHHS’ Roadmap for Behavioral Health Reform: Ensuring the
right treatment when and where people need it, which was announced in January 2021.
I. Family Empowerment
EOHHS has incorporated opportunities for member and family input on polices, program development,
and program evaluation into many MassHealth programs, including One Care, behavioral health care, and
HCBS Waivers. MassHealth relies on member and family input to assess managed care contractors.
Public input from members, families, and advocates is actively solicited through a variety of sources to
improve the family-friendliness of a wide variety of MassHealth programs.
What is the agency currently doing to promote or enhance family input or direction in the development
of agency policies and procedures, program development, and evaluation of services?
In an effort to reach out to and include families and members, One Care, MassHealth’s integrated health
plan for adults with disabilities in Medicare and MassHealth, convened an Implementation Council
entirely made up of stakeholders. The Implementation Council plays a key role in monitoring access to
health care and compliance with the Americans with Disabilities Act (ADA), tracking quality of services,
providing support and input to EOHHS, and promoting accountability and transparency. The
Implementation Council’s membership requires that at least 51% of seats be held by consumers or their
family members, and it welcomes attendance at its meetings from all stakeholders and members of the
public with interest in One Care.
For example, MassHealth engages with members of the Implementation Council and other stakeholders
on an ongoing basis to develop online webinars and training modules to help educate One Care plan staff
and providers about topics related to providing effective and culturally competent care to individuals
living with disabilities, and ensuring that One Care enrollees are always at the center of the care planning
process. Over the past year, topics included: 1) A two-part series – Discussing the Housing Landscape;
and 2) Assistive Technologies.
MassHealth launched new advisory committees for both the Senior Care Options (SCO) and the Program
of All-Inclusive Care for the Elderly (PACE) programs with newly procured membership in September
2019. These committees will promote input from current and/or former family members and caregivers to
SCO and PACE enrollees. A second meeting of each of the advisory committees occurred in February
2020, and MassHealth intends to conduct the next set of meetings virtually following a similar process as
outlined for the One Care Implementation Council above.
Another example of obtaining family input to evaluate services is the MBHP Family Advisory Council,
through which family members provide oversight and input into quality management processes associated
with the development, implementation, and delivery of services to MassHealth members.
In spring 2017, MassHealth engaged with consumers and other stakeholders to develop a new
MassHealth Health Plan Ombudsman program, now known as My Ombudsman (MYO), currently
administered through a contract with the Disability Policy Consortium (DPC). The MYO program
provides an independent resource to MassHealth members in managed and integrated care programs, and
3
 MassHealth Chapter 171 Annual Family Support Plan for Fiscal Year 2021
their families, to help them access their benefits and services, with a particular focus on matters related to
disability, accessibility, long-term services and supports (LTSS) and behavioral health (BH) services as
MassHealth works towards delivery system reform across managed care programs. My Ombudsman
provides free assistance to help members connect to community-based resources, identify and address
access concerns, and support members seeking help accessing their MassHealth benefits and services.
Many MYO staff are themselves individuals with lived experience of disability. MYO services are
available to any member enrolled in one of MassHealth’s managed care programs, including ACOs,
MCOs, Senior Care Options (SCO), One Care, the Massachusetts Behavioral Health Partnership
(MBHP), and the Program of All-Inclusive Care for the Elderly (PACE), as well as individuals enrolled
in the Community Partners program. More information about the MYO program can be found at:
https://myombudsman.org/.
MassHealth Behavioral Health leadership meets monthly with the Department of Mental Health (DMH)
and the Massachusetts chapter of the Federation for Families, known as the Parent/Professional Advocacy
League (PPAL), to identify any issues that arise related to children with behavioral health issues needs
and those of their families. The combined EOHHS leadership elicits and responds to input from PPAL
leadership and provides information about policy changes that may impact children and their families.
EOHHS also periodically attends PPAL statewide meetings to get input from a broader group of family
stakeholders.
How will agencies change how they are currently doing business to make their agency and services
more family-friendly and provide opportunities for families and individuals to have greater input and
influence?
One Care is a good example of how MassHealth has embraced input from consumers/family members.
Consumers, families and caregivers helped develop the One Care public awareness and enrollment
materials, the One Care Website, and continue to serve as advisors and presenters in the development of
training webinars as described above with at least one parent of a One Care member currently serving on
the One Care Implementation Council. The new SCO Advisory Committee includes members of each
Plan’s own consumer advisory boards, and the PACE Advisory Committee includes the voices of family
members. MassHealth will continue stakeholder meetings to provide wide and timely opportunities for
input, discussion and consultation from consumers, families, and caregivers. The PCA website provide
members, families, and caregivers with extensive information and access to updates, as well as the
opportunity to ask any questions. More generally, the Office of Medicaid Advocates group mentioned
above will devote regular and consistent meeting time to provide input and consultation regarding
MassHealth efforts to provide flexible supports to families.
II. Family Leadership
MassHealth continues to expand and enhance training opportunities for caregivers in the PCA and CBHI
programs. Regular input from members, their families, and others provides MassHealth with continued
feedback and helps to identify opportunities for future improvements in training and support. The One
Care Implementation Council is an innovative model for promoting members’ development of leadership
skills.
What training opportunities does the agency currently offer to families/individuals that would enhance
their repertoire of skills?
In FY14, the PCA Workforce Council and the MassHealth Office of Long-Term Services and Supports
(OLTSS) implemented a new three-hour training and orientation requirement for PCAs. The
consumer/employer has the option to choose to provide their own training in lieu of the classes provided
4
 MassHealth Chapter 171 Annual Family Support Plan for Fiscal Year 2021
by OTLSS and the PCA Workforce Council. In FY15, the PCA Workforce Council and OLTSS reviewed
the requirements implemented in FY14 to ensure that appropriate training is provided to new PCAs and to
appropriately track the PCAs who completed the training and the staff who provided the training. The
PCA Workforce Council and OLTSS also initiated reviews to ensure that those consumers/employers
who conduct their own trainings are properly trained. Today, free PCA skills training workshops,
featuring topics and content developed from consumer input, are offered in convenient locations
statewide. For information, see http://www.mass.gov/pca/training/training-opportunities-for-pcas.html.
MassHealth’s adult foster care program (AFC) provides care management and nursing oversight along
with a financial stipend to family and non-family caregivers to support members who live with their
caregiver and require assistance with at least one activity of daily living (ADL). As a part of the care
management function of the AFC program, AFC caregivers are provided with initial and ongoing
caregiver training as well as ongoing caregiver support. AFC caregivers must receive a minimum of eight
hours of in-service training per year with at least one hour of training on recognizing, responding to,
communicating and reporting changes in condition, critical incidences, emergencies, and knowledge of
emergency procedures, including the AFC provider’s fire, safety, and disaster plans. The initial
orientation training sessions must include techniques of providing safe delivery of ADLs, IADLs, and any
other personal care; good body mechanics; the AFC program and AFC provider services including the
regulations governing the program; caring for people with disabilities, elders, individuals with
Alzheimer’s disease and related disorders, behavioral health issues and cognitive impairments including
behavioral interventions, behavior acceptance, and accommodations; observation, reporting and
documentation of the member’s status and the care provided including AFC caregiver log entries; basic
fi