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| FORM 990, PART I, LINE 1 & PART III, LINE 1 | DETAIL REGARDING THE ORGANIZATION'S MISSION TUFTS HEALTH PUBLIC PLANS, INC. ("THPP") IS A NONPROFIT CORPORATION WHOSE PURPOSE IS TO GUIDE AND EMPOWER HEALTHIER LIVES FOR EVERYONE. THPP SEEKS TO IMPROVE THE HEALTH AND WELLNESS OF THE DIVERSE COMMUNITIES IT SERVES BY ARRANGING FOR THE PROVISION OF COMPREHENSIVE HEALTH CARE SERVICES, INCLUDING PROVIDING COMMUNITY OUTREACH AND EDUCATION TO THE COMMUNITY IT SERVES. THE ORGANIZATION AIMS TO IMPROVE THE LIVES OF MASSACHUSETTS AND RHODE ISLAND RESIDENTS BY PROVIDING ACCESS TO HIGH-QUALITY, AFFORDABLE HEALTH CARE, PRIMARILY THROUGH MANAGED CARE PROGRAMS DIRECTED AT LOW TO MODERATE INCOME RESIDENTS OF THE COMMONWEALTH OF MASSACHUSETTS AND STATE OF RHODE ISLAND. THPP IS PART OF THE POINT32HEALTH ("P32H") FAMILY OF COMPANIES. ---------- |
| FORM 990, PART III, LINE 4A | DETAIL OF PROGRAM SERVICE ACCOMPLISHMENTS - MASSACHUSETTS MEDICAID MCO AND ACO PLANS TUFTS HEALTH TOGETHER IS THE NAME OF THE ORGANIZATION'S MASSACHUSETTS MEDICAID MCO AND ACO PLANS THAT PROVIDE ACCESS TO AFFORDABLE HEALTH CARE FOR QUALIFIED RESIDENTS AND THEIR FAMILIES WHO MEET INCOME AND OTHER ELIGIBILITY REQUIREMENTS. MASSHEALTH IS THE NAME OF THE MASSACHUSETTS MEDICAID PROGRAM FUNDED BY THE FEDERAL GOVERNMENT AND THE STATE. MASSHEALTH HELPS PEOPLE WITH LIMITED INCOMES AND RESOURCES PAY FOR MEDICAL AND SUPPORT SERVICES. IT ALSO COVERS EXTRA SERVICES AND DRUGS. THE ORGANIZATION PROVIDES ACCESS TO AFFORDABLE HEALTH CARE THROUGH A MEDICAID MANAGED CARE ORGANIZATION CONTRACT WITH THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES FOR QUALIFIED RESIDENTS AND THEIR FAMILIES WHO MEET INCOME AND OTHER ELIGIBILITY REQUIREMENTS. THPP WAS AWARDED TWO MEDICAID ACCOUNTABLE CARE ORGANIZATION CONTRACTS BY EOHHS IN ADDITION TO ITS EXISTING MANAGED CARE ORGANIZATION CONTRACT. THROUGH CONTRACTS WITH TWO MASSACHUSETTS-BASED PROVIDER SYSTEMS, THE ORGANIZATION PROVIDES MEDICAID MANAGED CARE CLOSELY ALIGNED WITH PRIMARY CARE PHYSICIANS AND COMMUNITY PARTNERS. TUFTS HEALTH TOGETHER PROVIDES LOW TO MODERATE INCOME INDIVIDUALS WITH ACCESS TO THOUSANDS OF HIGH QUALITY PRIMARY CARE DOCTORS AND SPECIALISTS ACROSS THE STATE, SUPPORTIVE SERVICE REPRESENTATIVES, INFORMATION IN A NUMBER OF LANGUAGES, AS WELL AS PREVENTIVE MEASURES SUCH AS CAR SEATS AND FITNESS BANDS, INCENTIVES FOR HEALTHY BEHAVIORS, GYM FEE REIMBURSEMENTS, AND OTHER IMPORTANT TOOLS TO PROMOTE HEALTH AND WELLNESS. NCQA HEALTH PLAN ACCREDITATION AND HEALTH PLAN RATING EVALUATE HEALTH PLANS' STRUCTURE AND PROCESS, CLINICAL QUALITY AND PATIENT SATISFACTION. THPP'S TOGETHER MEDICAID PRODUCT MAINTAINS NCQA HEALTH PLAN ACCREDITATION AND HAS CONSISTENTLY RECEIVED HIGH SCORES BASED ON NCQA'S HEALTH PLAN RATING METHODOLOGY AND ACHIEVED A RATING OF 4.5 OUT OF 5 FOR THE NCQA HEALTH PLAN RATINGS WHICH WERE RELEASED IN 2023. THPP CONTINUES TO IMPLEMENT OUTREACH PROGRAMS WITH BOTH PROVIDERS AND MEMBERS WITH THE GOAL OF IMPROVING THE QUALITY OF CARE PROVIDED AND RECEIVED. UPDATED RATINGS FOR 2024 WILL BE POSTED IN SEPTEMBER 2024. THPP WAS THE FIRST PLAN IN MASSACHUSETTS AND AMONG THE FIRST IN NEW ENGLAND TO ACHIEVE NCQA HEALTH EQUITY ACCREDITATION. ---------- |
| FORM 990, PART III, LINE 4B | DETAIL OF PROGRAM SERVICE ACCOMPLISHMENTS - MASSACHUSETTS QUALIFIED HEALTH PLAN COVERAGE TUFTS HEALTH DIRECT IS AN INDIVIDUAL AND SMALL GROUP QUALIFIED HEALTH PLAN ("QHP") ESTABLISHED BY THE ORGANIZATION AFTER THE ENACTMENT OF THE AFFORDABLE CARE ACT TO PROVIDE ACCESS TO AFFORDABLE HEALTH CARE FOR INDIVIDUALS AND FAMILIES WHO ARE NOT ELIGIBLE FOR AFFORDABLE EMPLOYER-SPONSORED INSURANCE, AND SMALL EMPLOYER GROUPS WITH 1-50 EMPLOYEES. THESE PLANS ARE SOLD PRIMARILY THROUGH THE MASSACHUSETTS HEALTH CONNECTOR, THE MASSACHUSETTS STATE RUN EXCHANGE. TUFTS HEALTH DIRECT IS ACCREDITED BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE. AS OF DECEMBER 31, 2023, THE ORGANIZATION SERVED APPROXIMATELY 124,000 CONNECTORCARE MEMBERS (A SUBSET OF TUFTS HEALTH DIRECT MEMBERS WHO RECEIVE BOTH STATE AND FEDERAL SUBSIDIES). ALSO, AS OF DECEMBER 31, 2023, THPP SERVED AN APPROXIMATELY 66,000 ADDITIONAL TUFTS HEALTH DIRECT MEMBERS WHO EITHER PURCHASED INDIVIDUALLY OR OBTAINED THEIR COVERAGE THROUGH A SMALL EMPLOYER OFFERING THE DIRECT PRODUCT. ---------- |
| FORM 990, PART III, LINE 4C | PROGRAM SERVICE ACCOMPLISHMENTS - DUAL-ELIGIBLE PROGRAM TUFTS HEALTH UNIFY/ONE CARE IS A MEDICARE-MEDICAID PLAN ("MMP") FOR INDIVIDUALS AGE 21-64 WHO ARE ELIGIBLE FOR BOTH MEDICARE AND MEDICAID. TUFTS HEALTH UNIFY/ONE CARE IS ONE OF THREE MASSACHUSETTS ONE CARE PLANS PARTICIPATING IN THE FINANCIAL ALIGNMENT INITIATIVE ('DUALS DEMONSTRATION') TO INTEGRATE BENEFITS AND CARE FOR MEDICARE-MEDICAID ENROLLEES. THE PLAN CONTRACTS WITH THE CENTERS FOR MEDICARE AND MEDICAID SERVICES AND THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES TO PROVIDE THE BENEFITS OF BOTH PROGRAMS TO LOW AND MODERATE INCOME INDIVIDUALS WITH DISABILITIES. THE ORGANIZATION ALSO PROVIDES ACCESS TO AFFORDABLE CARE THROUGH A FULLY INTEGRATED DUAL-ELIGIBLE SPECIAL NEEDS PLAN THROUGH THE MASSACHUSETTS SENIOR CARE OPTIONS PROGRAM. THPP PROVIDES COVERAGE FOR PEOPLE AGE 65 OR OLDER WHO ARE ELIGIBLE FOR MASSHEALTH STANDARD, HAVE BOTH MEDICARE PART A AND B, AND HAVE NOT BEEN DIAGNOSED AS HAVING END STAGE RENAL DISEASE. THIS PROGRAM INTEGRATES MEDICAID AND MEDICARE BENEFITS AND SERVICES, PROVIDING THOSE ELIGIBLE WITH COORDINATED HIGH-QUALITY AND COST-EFFECTIVE HEALTH CARE. ---------- |
| FORM 990, PART III, LINE 4D | DETAIL OF OTHER PROGRAM SERVICE ACCOMPLISHMENTS RHODE ISLAND MEDICAID COVERAGE- THE ORGANIZATION ALSO OFFERS MEDICAID COVERAGE TO RHODE ISLAND RESIDENTS THROUGH A MEDICAID MANAGED CARE ORGANIZATION PLAN. THE ORGANIZATION'S COVERAGE IS CALLED TUFTS HEALTH RI TOGETHER AND IS SIMILAR TO THE MEDICAID COVERAGE OFFERED IN MASSACHUSETTS. AS OF THE END OF 2023, THE ORGANIZATION HAD APPROXIMATELY 17,500 ENROLLEES IN TUFTS HEALTH RI TOGETHER. ---------- |
| FORM 990, PART VI, LINE 2 | DETAIL OF FAMILY OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIP - THE FOLLOWING INDIVIDUALS SERVED ON THE BOARDS OR WERE AN OFFICER OR KEY EMPLOYEE OF ONE OR MORE FOR-PROFIT ORGANIZATIONS AFFILIATED WITH THE FILING ORGANIZATION FROM 1/1/2023 TO 12/31/2023: CAIN HAYES, PRESIDENT & CEO TISA HUGHES, CLERK/SECRETARY SUSAN KEE, CLERK/SECRETARY (START 12/11) EILEEN AUEN, DIRECTOR, CHAIR UMESH KURPAD, CFO (END 7/4) R. SCOTT WALKER, CFO (START 7/5) ------------ |
| FORM 990, PART VI, LINE 3 | DELEGATION OF CONTROL OF MANAGEMENT DUTIES THE FILING ORGANIZATION'S SOLE MEMBER IS P32H. ITS AFFILIATE, POINT32HEALTH SERVICES, INC., PERFORMS CERTAIN MANAGEMENT, ADMINISTRATIVE, AND MARKETING SERVICES FOR THE FILING ORGANIZATION AND OTHER AFFILIATES. THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES LISTED IN PART VII, SECTION A ARE EMPLOYEES OF POINT32HEALTH SERVICES, INC. THEIR COMPENSATION IS LISTED IN PART VII, SECTION A AND SCHEDULE J. ---------- |
| FORM 990, PART VI, LINE 6 | MEMBERS OR STOCKHOLDERS POINT32HEALTH, INC. ("P32H") IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. ---------- |
| FORM 990, PART VI, LINE 7A | POWER TO ELECT OR APPOINT MEMBERS P32H AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ELECTS THE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. ---------- |
| FORM 990, PART VI, LINE 7B | DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS P32H, AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, HAS THE RIGHT TO MAKE CERTAIN DECISIONS REGARDING THE ORGANIZATION, AND IS REQUIRED TO APPROVE ANY CHANGES TO THE ORGANIZATION'S BYLAWS. ---------- |
| FORM 990, PART VI, LINE 8B | CONTEMPORANEOUS BOARD MEETING DOCUMENTATION FOR A MAJORITY OF THE TIME, THE ORGANIZATION CONTEMPORANEOUSLY DOCUMENTS MEETINGS HELD AND WRITTEN ACTIONS UNDERTAKEN BY ITS GOVERNING BODY AND COMMITTEES. HOWEVER, ON LIMITED OCCASIONS, THE GOVERNING BODY OR A COMMITTEE MAY HAVE A SERIES OF CONFERENCE CALLS AND MINUTES FOR THOSE CALLS ARE NOT APPROVED UNTIL THE NEXT MEETING. ---------- |
| FORM 990, PART VI, LINE 11B | PROCESS USED TO REVIEW THE FORM 990 THIS FORM 990 WAS PREPARED BY THE ORGANIZATION'S EXTERNAL ACCOUNTANT, REVIEWED BY P32H FINANCE DEPARTMENT AND CERTAIN SECTIONS ARE REVIEWED FOR INPUT BY SUBJECT MATTER PERSONNEL IN OTHER DEPARTMENTS THROUGHOUT THE ORGANIZATION. THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS BEFORE FILING. ---------- |
| FORM 990, PART VI, LINE 12A & 12C | MONITORING & ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE P32H'S CONFLICT OF INTEREST ("COI") POLICY AND PROCEDURES ("P&P") APPLIES TO THE FILING COMPANY AS A SUBSIDIARY ORGANIZATION. P32H'S COI P&P IS REVIEWED ANNUALLY, REVISED AS NEEDED AND APPROVED UPON MATERIAL REVISIONS. THE POLICY REQUIRES ALL EMPLOYEES, INCLUDING THE PRESIDENT AND CEO AND GOVERNING BODY MEMBERS TO COMPLY WITH THE COI POLICY AND PROCESSES. ALL EMPLOYEES RECEIVE ANNUAL COMPLIANCE TRAINING WHICH INCLUDE EXPECTATIONS RELATED TO FOLLOWING THE COI P&P. THE COI P&P REQUIRES THE OFFICERS, KEY EMPLOYEES AND BOARD OF DIRECTORS OF THE TAX-EXEMPT ENTITIES TO COMPLETE AND SUBMIT AN ANNUAL DISCLOSURE SURVEY AND STATEMENT TO THE CHIEF LEGAL OFFICER ("CLO") OR DESIGNEE IN THE LEGAL DEPARTMENT, LISTING ANY OUTSIDE RELATIONSHIPS, INCLUDING FINANCIAL AND/OR BOARD RELATIONSHIPS THAT THEY OR A FAMILY MEMBER HAVE WITH P32H'S (OR ITS SUBSIDIARIES) SUPPLIERS, PURCHASERS, PROVIDERS AND/OR COMPETITORS. ADDITIONALLY, P32H. REQUIRES EXECUTIVE MANAGEMENT AND SENIOR MANAGEMENT (AS DEFINED IN THE COI POLICY) TO COMPLETE AND SUBMIT AN ANNUAL DISCLOSURE SURVEY AND STATEMENT TO THE CHIEF COMPLIANCE OFFICER OR DIRECTOR, CORPORATE COMPLIANCE. BY COMPLETING THE ANNUAL DISCLOSURE STATEMENT, THESE INDIVIDUALS ACKNOWLEDGE THE POINT32HEALTH COI P&P. ALL EMPLOYEES ARE REQUIRED TO REPORT THE OFFER BY AN OUTSIDE ENTITY OF GIFTS OVER $250, HONORARIA OR COVERAGE OF BUSINESS EXPENSES, OR OTHER EVENTS OR RELATIONSHIPS THAT MAY BE PERCEIVED AS CONFLICTS TO THE CHIEF COMPLIANCE OFFICER, DIRECTOR, CORPORATE COMPLIANCE OR DESIGNEE AND THE EMPLOYEE'S MANAGEMENT. BOTH MUST APPROVE BEFORE ACCEPTANCE IS ALLOWED. THERE ARE PROTOCOLS AND PROCESSES TO REVIEW ANY DISCLOSURE THAT MIGHT BE A POTENTIAL CONFLICT OF INTEREST. BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES' RESPONSES TO THE DISCLOSURE SURVEY AND STATEMENT ARE REVIEWED BY THE CLO, WHO WILL REVIEW THE SELF-DISCLOSURE WITH THE CHAIR OF THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS Of P32H AND DETERMINE EXPECTATIONS AND RECOMMENDED ACTIONS IF NEEDED. A SUMMARY REPORT OF ALL DISCLOSED ACTUAL OR POTENTIAL CONFLICTS ALONG WITH ANY RECOMMENDED ACTIONS TO ADDRESS A DISCLOSED ACTUAL OR POTENTIAL CONFLICT IS REVIEWED AND APPROVED BY THE GOVERNANCE COMMITTEE AND THE COMMITTEE'S REVIEW/FINDINGS ARE REPORTED TO THE FULL BOARD. THE CLO COMMUNICATES THE RECOMMENDED ACTIONS TO INDIVIDUAL SURVEY RECIPIENTS. THE CHIEF COMPLIANCE OFFICER IS CONSULTED AND INFORMED OF THE DECISIONS MADE BY THE CLO OR LEGAL DESIGNEE. EXECUTIVE MANAGEMENT AND SENIOR MANAGEMENT'S RESPONSES TO THE DISCLOSURE SURVEY AND STATEMENT ARE REVIEWED BY THE DIRECTOR, CORPORATE COMPLIANCE, LEGAL, AND CHIEF COMPLIANCE OFFICER, WHO WILL REPORT TO THE CLO ANY POTENTIAL CONFLICTS ALONG WITH ANY RECOMMENDED ACTIONS TO ADDRESS THE POTENTIAL CONFLICT, IF NECESSARY. RECOMMENDED ACTIONS/EXPECTATIONS ARE COMMUNICATED BY THE DIRECTOR, CORPORATE COMPLIANCE, LEGAL, AND CHIEF COMPLIANCE OFFICER TO IMPACTED INDIVIDUALS. FOR CONFLICT DISCLOSURES INVOLVING THE CHIEF COMPLIANCE OFFICER, THE CLO WILL MAKE THE FINAL DETERMINATION. ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST THAT ARISES AFTER COMPLETION OF THE DISCLOSURE SURVEY WILL FOLLOW THE SAME REVIEW PROCESS. ---------- |
| FORM 990, PART VI, LINE 13 | WRITTEN WHISTLEBLOWER/NON-RETALIATION POLICY THE FILING ORGANIZATION IS SUBJECT TO THE WRITTEN WHISTLEBLOWER/NON-RETALIATION POLICY WITHIN THE CODE OF CONDUCT THAT WAS APPROVED BY THE BOARD OF DIRECTORS OF P32H. ---------- |
| FORM 990, PART VI, LINE 14 | WRITTEN DOCUMENT RETENTION POLICY THE FILING ORGANIZATION IS SUBJECT TO THE WRITTEN DOCUMENT RETENTION POLICY AND RECORD RETENTION SCHEDULE OF P32H. ---------- |
| FORM 990, PART VI, LINE 15A AND 15B | COMPENSATION REVIEW AND APPROVAL THE FILING ORGANIZATION'S PARENT COMPANY, POINT32HEALTH, INC. HAS AN INDEPENDENT HUMAN RESOURCES COMMITTEE (THE "COMMITTEE") THAT ANNUALLY REVIEWS THE TOTAL REMUNERATION OPPORTUNITIES, POLICIES AND PROGRAMS OF THE CEO AND CERTAIN EXECUTIVES, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES AS WELL AS INDIVIDUALS THE COMMITTEE DEEMS APPROPRIATE TO REVIEW. THE COMMITTEE IS COMPRISED OF INDEPENDENT DIRECTORS OF THE COMPANY. THE COMMITTEE CONSIDERS MARKET DATA AND ANALYSES ASSEMBLED BY INDEPENDENT AND INTERNAL COMPENSATION CONSULTANTS WITH THE GOAL TO DETERMINE EXECUTIVE TOTAL REMUNERATION THAT IS REASONABLE AND COMPETITIVE WITHIN THE INDUSTRY AND GEOGRAPHY IN WHICH P32H OPERATES. ---------- |
| FORM 990, PART VI, LINE 19 | PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION'S GOVERNING DOCUMENTS, COI POLICY, AND ANNUAL FINANCIAL REPORT AND QUARTERLY FINANCIAL UPDATES ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. ---------- |
| FORM 990, PART XI, LINE 9 | DETAIL OF OTHER CHANGES IN NET ASSETS CHANGE IN NON-ADMITTED ASSETS $13,641,384 ------------ TOTAL $13,641,384 ---------- |
| FORM 990, PART XII, LINE 1 | ACCOUNTING METHOD USED TO PREPARE FORM 990 THPP FOLLOWS THE STATUTORY ACCOUNTING METHOD PRESCRIBED BY THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS' ACCOUNTING PRACTICES AND PROCEDURES MANUAL FOR STATUTORY ACCOUNTING PRINCIPLES. ---------- |
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