Office Of Medicaid (MassHealth)—Massachusetts Delivery System Reform Incentive Payment Program
Learn how the AI-generated research projects were createdOverall Conclusion
MassHealth did not ensure that DSRIP funding was allocated to ACOs in accordance with the Massachusetts Delivery System Reform Incentive Payment Protocol (Attachment M).
Source Document
Audit Scope
Performance audit of MassHealth's Delivery System Reform Incentive Payment (DSRIP) Program payments to accountable care organizations (ACOs) during January 1, 2018 through December 31, 2020, conducted under the Massachusetts Office of the State Auditor's purview. The audit evaluated MassHealth's administration of the DSRIP Program in accordance with the Massachusetts Delivery System Reform Incentive Payment (DSRIP) Protocol (Attachment M), specifically Sections 3.3 and 3.4.4.1, including the process for ACO budget proposals submission and approval by the independent assessor prior to budget period start dates (calendar years 2018–2020), the role of the independent assessor in reviewing budgets, the timing of quarterly DSRIP payments disbursed through MMIS, and data reliability of MMIS transaction data. The scope encompasses the period, the transition to an ACO care model under the 1115 waiver from July 1, 2017 through June 30, 2022, and notes that MassHealth provided approximately $500,176,599 to its ACOs during the audit period.
Key Findings Summary
MassHealth did not ensure that accountable care organizations submitted their budget proposals before the beginning of the budget period. In 2020, none of the 17 ACOs that received DSRIP Program funding submitted a budget proposal to MassHealth until after the beginning of the budget period. In 2018, 1 ACO did not submit its budget proposal until after the b…
AI-Assisted
AI Scope Summary
Assess whether MassHealth administered DSRIP program funding to ACOs in accordance with the DSRIP Protocol, focusing on budget submission timing and approvals prior to each budget period.
AI-Generated Insight
This audit highlights governance gaps in MassHealth's oversight of the DSRIP program during 2018-2020, a period of transition to an ACO-based care model supported by a 1.8B federal investment. The finding that budgets were not consistently submitted before the budget period raises concerns about timely funding, program effectiveness, and potential impact on care coordination. The report's recommendations urge formal monitoring processes, though MassHealth disputes the need, emphasizing protocol flexibility. The implications stress the importance of robust controls in performance-based payment programs to ensure accountability and timely execution.