Audit of the Office of Medicaid (MassHealth) - Massachusetts Delivery System Reform Incentive Payment Program

This is a state performance audit of MassHealth payments under the Delivery System Reform Incentive Payment program from January 1, 2018 through December 31, 2020.

“OSA has conducted an audit of certain payments made by MassHealth under the Delivery System Reform Incentive Payment (DSRIP) Program for the period January 1, 2018 through December 31, 2020.”

The auditor checked whether MassHealth followed its own DSRIP rules when giving funding to accountable care organizations.

“The purpose of this audit was to determine whether MassHealth effectively administered DSRIP Program payments to ACOs in accordance with its Massachusetts Delivery System Reform Incentive Payment (DSRIP) Protocol (Attachment M).”

Late budget submissions could interfere with the program’s goals, timely payments, and possibly care coordination for MassHealth members.

“Late submissions of budget proposals may prevent MassHealth from achieving the goals of the DSRIP Program and from making timely payments to ACOs; it could also affect healthcare services provided to MassHealth members.”

If you are a Massachusetts taxpayer or MassHealth member, this matters because MassHealth serves about 1.8 million people and uses a large share of the state budget.

“MassHealth provides access to healthcare services for approximately 1.8 million eligible low- and moderate-income children, families, seniors, and people with disabilities annually.”

The auditor’s main conclusion was that MassHealth did not fully comply with the budget-submission timing requirement for these payments.

“Did MassHealth ensure that Delivery System Reform Incentive Payment (DSRIP) Program funding was allocated to accountable care organizations (ACOs) in accordance with Sections 3.3 and 3.4.4.1 of its Massachusetts Delivery System Reform Incentive Payment (DSRIP) Protocol (Attachment M)?”

The auditor recommended that MassHealth add monitoring so every accountable care organization submits its budget proposal before each budget period starts.

“MassHealth should establish monitoring activities to ensure that every ACO submits its budget proposal before the beginning of each budget period.”

This audit involved a major Medicaid reform effort: MassHealth distributed more than $500 million to accountable care organizations during the period reviewed.

“To do this, MassHealth disbursed approximately $500,176,599 to its ACOs.”

An accountable care organization is a group of healthcare providers that coordinates many kinds of care for a member, including medical care, behavioral health, and long-term supports.

“ACOs are networks of physicians, hospitals, and other community-based healthcare providers that are responsible for coordinating all of a member’s medical care, behavioral health services, and long-term services and supports.”