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130 CMR: DIVISION OF MEDICAL ASSISTANCE

Trans. by E.L. 251 Rev. 02/13/2026

130 CMR 501.000: HEALTH CARE REFORM: MASSHEALTH: GENERAL POLICIES

behavioral health care, and long-term services and supports that integrates all components of care, either directly or through subcontracts, and has contracted with the Executive Office of Health and Human Services (EOHHS) and the Centers for Medicare & Medicaid Services (CMS) and been designated as an ICO to provide services to dual eligible individuals under M.G.L. c. 118E. ICOs are responsible for providing enrollees with the full continuum of Medicare- and MassHealth-covered services.

Interpreter. A person who translates for an applicant or member who has limited English proficiency or a hearing impairment.

Lawfully Present Immigrants. See 130 CMR 504.003(A): Lawfully Present Immigrants.

Limited English Proficiency. Persons who are unable to communicate effectively in English because their primary language is not English and who have not developed fluency in English.

Lump-sum Payment. A one-time only payment that represents either a windfall payment, or the accumulation of recurring countable income, such as retroactive unemployment compensation or federal veterans’ retirement benefits. Payments such as gifts, inheritances, and personal injury awards, to the extent that they are not included in modified adjusted gross income, are not considered lump-sum payments.

Managed Care. A system of primary care and other medical services that are provided and coordinated by a MassHealth managed care provider, a SCO, an ICO, or the behavioral health contractor in accordance with the provisions of 130 CMR 450.117: Managed Care and 130 CMR 508.000: MassHealth: Managed Care Requirements.

Managed Care Organization (MCO). Any entity with which the MassHealth agency contracts under its MCO program to provide, arrange for, and coordinate care and certain other medical services to members on a capitated basis, and is approved by the Massachusetts Division of Insurance as a health maintenance organization (HMO) and is organized primarily for the purpose of providing health care services.

MassHealth Agency. The Executive Office of Health and Human Services in accordance with the provisions of M.G.L. c. 118E.

MassHealth MAGI Household. See 130 CMR 506.002(B): MassHealth MAGI Household Composition.

MassHealth Managed Care Provider. An MCO, Accountable Care Partnership Plan, Primary Care ACO, or the Primary Care Clinician Plan.

MCO-administered ACO. A type of ACO with which the MassHealth agency contracts under its ACO program and is administered through an MCO.