MCO-Contracted ACOs Sample Clauses

MCO-Contracted ACOs. MassHealth will select certain qualified ACOs through a competitive selection process, for accountability for services furnished through MassHealth ACOs. These “MCO-Contracting ACOs” will be provider-led entities such as health systems or groups of health care providers that contract with MCOs to provide care coordination and management and to take financial accountability for cost and quality of care for certain attributed MCO enrollees. They are not managed care entities under 42 CFR 438 and there will not be a separate delivery system or enrollment option for MCO enrollees attributed to MCO- contracting ACOs; such individuals will receive services from the MCO service delivery system. MCO enrollees who receive primary care from primary care providers who participate in MCO- contracting ACOs are considered attributed to those ACOs for the purposes of this cost and quality accountability. MassHealth MCO contracts will include requirements for MCOs to contract with MCO-Contracted ACOs using a MassHealth-approved alternative payment contract framework that includes risk tracks and schedules set by the state, which will be broadly consistent with 42 CFR 438.6(c). This alternative payment contract framework will hold MCO-Contracted ACOs financially accountable through shared savings and shared losses (i.e., downside risk), including potentially asymmetric risk (i.e., potential shared savings exceed potential shared losses). As with MCO enrollees not attributed to ACOs, these MCO enrollees may experience fixed enrollment to their MCO, and receive services from their MCO’s provider network (except for certain Direct Coverage services provided directly by ▇▇▇▇▇▇▇▇▇▇, as described above) subject to their MCO’s rules for referral, prior authorization, and primary care provider assignment. See Attachment O for additional detail on pricing for MCO-Contracted ACOs.