NEW: Worcester’s Fallon Total Care Offering Coverage on October 1

Tuesday, September 03, 2013

GoLocalWorcester Health Team

Fallon Total Care, a Massachusetts One Care plan for adults between the ages of 21 and 64 who are dually eligible for both Medicare and Medicaid, will begin offering coverage effective October 1.

Fallon Total Care, a wholly-owned subsidiary of Fallon Community Health Plan (FCHP), is an integrated approach to coordinating behavioral health, medical care and community support all in one plan — providing members with more benefits than traditional Medicare and MassHealth combined.

Massachusetts will be the first state in the nation to launch an integrated dual-eligible plan sponsored by the federal government’s Centers for Medicare & Medicaid Services and the Commonwealth’s Executive Office of Health and Human Services to address enrollees’ full range of medical and behavioral health needs.

Dual-eligible adults under the age of 65 typically have complex chronic care or behavioral health needs. Fallon Total Care Navigators will work with members, their caregivers and their health care providers to coordinate services that meet the member's physical, behavioral and social needs. An individual care plan and central electronic medical record aid the member's care team in delivering high quality and coordinated care that improves the member's ability to live independently in the community.
“As a health care services leader with a history of providing coordinated care and coverage for individuals eligible for both Medicare and Medicaid, Fallon Community Health Plan has long believed in the concept of integrated care,” said Patrick Hughes, President and CEO of Fallon Community Health Plan. “Through Fallon Total Care, we’ve leveraged our experience and knowledge and have developed a member-centered model of care designed to provide choices and encourage collaboration, and built specifically for the unique needs of One Care members.”

Who Can Participate?

Participation in the program will allow Fallon Total Care to serve dual-eligible residents in three counties across Massachusetts: Worcester, Hampden and Hampshire. Fallon Total Care is open to people who:

• Are 21-64 years old (people who turn 65 after enrollment can continue
to be members after their 65th birthday or select other options);
• Have Medicare Parts A & B and are eligible for Part D;
• Have MassHealth Standard or MassHealth Common Health;
• Live in the Fallon Total Care service area; Hampden, Hampshire and Worcester Counties
• Have no other private insurance.

“With FCHP’s experience and innovation, Fallon Total Care is well poised to move beyond the traditional care management structure and integrate medical, behavioral and community based care,” said Mary Ritter, President and CEO of Fallon Total Care. “Fallon Total Care will work to make a positive difference for each individual as we become part of the solution in health care reform in Massachusetts.”