MassHealth continuity of care transition for Accountable Care Organizations/Managed Care Organization Plans

Effective March 1, 2018

On February 21, 2018, MassHealth issued a continuity of care memo to support the transition to new ACO/MCO arrangements. This memo included expectations of all ACO and MCO plans to execute Continuity of Care authorizations for all MassHealth patients for a minimum of 30 (thirty) days.

Continuity of Care (COC) is a term that is used to prevent any disruption of care when people move from one health insurance carrier to another. In this instance, authorizations will allow claims to pay and treatment to continue without disruption even if the provider is out of network and/or the service being provided requires an authorization. Fallon’s COC authorizations will also cover the requirement for PCP referrals during the designated timeframe.

During the COC timeframe, providers are able to meet with new members, complete applicable assessments and put ongoing or new services in place.

Fallon Health has made the business decision to provide continuity of care service above and beyond the recommendation of EOHHS. All of Fallon’s ACO plans will provide a 90-day continuity of care process for patients with an effective membership date of March 1. Fallon has made this decision because it is in the best interest of their patients. We are committed to ensuring a smooth transition for these patients and believe that an interruption of care is not acceptable. Additionally, the 90-day process will allow network providers time to put into place new referrals and authorizations as required, for any new services your patients may need once they have become effective in one of our ACOs. Please note that the 90-day process only applies to patients effective in an ACO plan as of March 1. Those with effective dates post March 1 will follow the usual 30-day continuity of care process.

Fallon Health is working with our sister payers in Massachusetts to share authorization information, allowing a smoother transition for all MassHealth members, regardless of what plan they are in.

There are certain scenarios that may require a longer period of COC coverage. These scenarios include:

  • If a member is pregnant at the time of the health plan effective date, she must be allowed to remain with her OB/GYN provider through her 6 week post-partum visit
  • Ongoing ABA therapy when a fragile member has developed a solid relationship with his/her providers
  • Ongoing treatment such as chemotherapy and/or radiation, dialysis (with an out-of-network provider), certain drug therapy regimens that must not be interrupted and significant or complex medical needs that are being treated by out-of-network providers
  • Ongoing lengthy admissions

After March 1, 2018, new requests for coverage of services that require a prior authorization will need to go through the process presently in place with Fallon. This process can be accessed through use of the Standard PA Form. For behavioral health services please contact Fallon Health’s Behavioral Health provider, Beacon Health Options at 1-781-994-7556.

For ongoing, transitional support over the next few months, please feel free to contact the appropriate person in the table below:


Key contact

Email address


Integrated Utilization Management (IUM)

Pam Cardaci. Sr. Director



Katie Snyder, Manager, Prior Auth



Kim Schortmann, UM Manager


Care Management (MOC)

Deb Simmons, Director


Care Management (MOC)

Kristen Lumsden, Manager


Care Management (MOC)

Lois Amponsah, Supervisor CM Navigators

1-508-792-1766, ext. 78247

Customer Service – Berkshire Fallon Health Collaborative




Customer Service – Fallon 365 Care




Customer Service – Wellforce Care Plan




Provider Relations