Special Needs Plan Provider Education
|
|
- Sybil Heath
- 8 years ago
- Views:
Transcription
1 Special Needs Plan Provider Education Reviewed September 2014
2 Learning Goals What is a Special Needs Plan (SNPs) What differentiates a SNP from other MA plans What SNPs are offered by Freedom Health and Optimum Healthcare 2
3 Care Management for the Most Vulnerable Subpopulation Vulnerable members are those members who could benefit from additional specialized monitoring. For example, members with the following issues or diagnoses would be considered more vulnerable : Frail Disabled End-stage renal disease diagnosis after enrollment End-of-life Multiple and complex chronic conditions 3
4 Special Needs Plans Characteristics Limited enrollment. Qualifying condition or Medicaid status. Beneficiaries are typically older, with multiple comorbid conditions and are more challenging to treat. SNP benefit plans are custom designed to meet the needs of the designated population. SNP members normally have additional election periods Medicare coverage. to change their Must have a comprehensive model of care (MOC) based on based guidelines. evidence 4
5 Sample SNP Benefits No or low co-pays to encourage use of preventive and ambulatory services e.g. $0 PCP co-pay Transportation services to increase access to care Post hospitalization meal benefit to support frail member needs Enhanced Over-The-Counter benefit $0 co-pay for home Oxygen for COPD SNP 5
6 Our Plan Model of Care Philosophy Primary Care Physician (PCP) is medical home Tiered care plans representing hierarchy of disease severity Chronic condition management through integrated benefits, network, and care management activities Facilitates access to necessary care especially for Dual Eligibles 6
7 Model of Care Elements SNP Target Population Measurable Goals Staff Structure and Care Management Roles Interdisciplinary Care Team Provider Network Having Special Expertise and use of clinical Practice Guidelines Model Of Care Training Health Risk Assessment Individualized Care Plan Communication Network Care Management for the most vulnerable Subpopulation Performance and Health Outcome Measurement 7
8 SNP Target Population Medicare Eligible members with the following Chronic diseases: Congestive Heart Failure Cardiovascular Disease Pulmonary/Chronic Obstructive Pulmonary Disease Diabetes Medicare and Medicaid Dual Eligible members. 8
9 Identifying SNP Members - Freedom Cards and Products Plan Name Type Description ID VIP Care Chronic CHF, CVD, and Diabetes VIP Care COPD Chronic COPD, Chronic Lung Disorders, Asthma, Chronic Bronchitis, Emphysema, Pulmonary Fibrosis Freedom VIP Savings Chronic CHF, CVD, Diabetes Health VIP Savings COPD Chronic COPD, Chronic Lung Disorders, Asthma, Chronic Bronchitis, Emphysema, Pulmonary Fibrosis Medi Medi - Full Dual $0 Cost Share M edicare/medicaid Duals Medi Medi - Partial Dual Non $0 Cost Share M edicare/medicaid Duals 9
10 Identifying SNP Members - Optimum Cards and Products ID Optimum HealthCare Diamond Rewards Chronic CHF, CVD, and Diabetes Diamond Rewards Chronic COPD, Chronic Lung Disorders, Asthma, COPD Chronic Bronchitis, Emphy sema, Pulmonary Fibrosis Emerald- Full Dual $0 Cost Share Me dicare/medicaid Duals Emerald- Partial Dual Non $0 Cost Share Medicare/M edicaid Duals 10
11 Enrollment Process for SNPs Chronic/Pulmonary Enrollees Member elects Plan by stating they have the disease required to qualify Member will be required to have a physician complete a disease verification form and submit to Plan Members not verified by their Physician within 60 days of enrollment must be disenrolled Dual-Eligible Enrollees Member qualifies by receiving both Medicare and Medicaid benefits Member must retain Medicaid eligibility in order to remain in SNP 11
12 Staff Structure & Care Management Roles Administrative Staff Impacting Members All Health Plan staff members interact with SNP beneficiaries to facilitate and prov ide coordinated care. 12
13 Provider Care Management Patient Centered Medical Home Model PCP Delivers clinical care Coordinates care across continuum (specialist and facility) using referrals and authorization requests Utilizes evidence based care plans Plan Develops care plans, PCP and member education materi als and guidelines Drives multidisciplinary team Comprehensive disease and case management Social services suppo rt Utilization manageme nt support Implements quality ma nagement program 13
14 Coordination of Benefits Chronic, Pulmonary & Dual Eligible SNPs Member receives all services from the Plan utilizing Plan providers Explanation of Coverage and Summary of Benefits are provided to member and available on Plan website Dual Eligible SNP While enrolled in SNP Plan, there is no coordination of services through Medicaid and no billing of any services to Medicaid Plan provides all services and adjudicates all claims 14
15 Case Management Coordination of Care Resource for member to coordinate with PCP Counsels members Disease stages Health status change Care plan details Discharge plans and needs for service Transitions of care Coordination of care Documentation All contacts Actions taken Utilize electronic care management system Review of ongoing reports and communicate with members Reports Identify members with planned and unplanned transitions of Identify members who are at high risk care 15
16 Interdisciplinary Care Team (IDCT) Purpose Reviews and approves care plan models (problems, interventions, goals) Reviews and approves care management policies for SNP plans Forum to discuss and receive input on cases (PCPs may be invited to attend case discussions) Periodic review and update of clinical guidelines 16
17 Interdisciplinary Care Team Members Cardiology (Board Certified) Chief Medical Officer-Chair Plan Medical Director Pulmonary (Board Certified) Clinical Pharmacist Member if requested Interdisciplinary Team PCP as needed Plan Clinical Administrative Staff: Quality Improvement Director Vice President of Health Services Utilization Management Director/Manager Manager/Director of Special Needs Plan Certified Dietician Endocrinology (Board Certified) Case and Disease Ma nagement Nurses Social W orkers * Frequency: Quarterly meetings 17
18 Provider Network Health Plan Provider Network has specialized clinical expertise pertinent to SNP Population. Credentialing is the process used to ensure facilities are accredited, specialist have the required experience and training. 18
19 Health Risk Assessment Annual health assessment for all SNP members: Health Assessment Tool (HAT) Disease Specific Health Assessment Tool (DSHAT) Disease/Cas e Management A ssessment By mail upon enrollment Annually to all SNP members Mailed based on HAT responses Or disease specified for chronic SNP enrollment DSHAT scored with most severe referred to Disease/Case Management Nurse/ Social Serv ices interv iew & care planning 19
20 Health Assessment Tools HAT DS HA T 20
21 Individual Care Plans Tier 1 1. Applicable to all members of SNP population by disease ty pe or dual status 2. Plan provide to PCP Tier 2 1. Develop from DSHA T responses specific to member (claims and pharmacy data incl uded) 2. Plan provide to PCP Tier 3 1. Results from extensi ve nurse and/or social services case/dise ase management assessment 2. Generates member specific care plan 3. Plan provide to PCP All Care plans use problem, intervention, goal format 21
22 Tier 1 Care Plan 22
23 Tier 2 Care Plan Page 1 & 2 23
24 Tier 2 Care Plan Page 3 24
25 Tier 3 Care Plan 25
26 Communication Network Plan COMMUNICATION Provider Member Communication Avenues: Plan web-based Provider Portal Provider Manual Member-specific written Care Plans Faxes and communication from the Plan Face to Face utilizing Provider Relations Reps. Provider phone line Web-based meetings and conference calls Call in line for provider inquiries Participation in standing/ad hoc committee meetings Communication Avenues: Plan Member web-site Educational information and SN P Member newsletters Member services phone lines s and calls with Care team members Written Care Plans Call in line for Member inquiries, co mplaints & grievances Access to toll-free communication Direct access to SNP Case/Dis ease Management through a toll-free phone number with TTY /TDD Conference call communication Additional Communication Avenues/Health plan Services: Regulatory Agencies, CMS, Community based services IDCT 26
27 SNP Newsletter 27
28 Quarterly SNP Education Material 28
29 Performance & Health Outcomes Management Goals are established according to either internal and/or external benchmarks (for example Medicare or Medicaid national percentiles, NCQA, HEDIS or other accrediting organization/best practice etc.) The plan reviews and reports performance on an ongoing basis (Sample on next slide) Each special needs plan has specific goals relevant to membership 29
30 Performance & Health Outcomes Management 30
31 References: Clinical Practice Guidelines Required Annual Provider and Health Plan Employees SNP Training Resources on Plan websites: Provider and Member Newsletters Provider Manual Educational Material 31
32 Training Documentation 32
Special Needs Plan Model of Care 101
Special Needs Plan Model of Care 101 What is a Special Needs Plan? First of all it s a Medicare MA-PD, typically an HMO Consists of Medicare enrollees who meet special eligibility requirements In our case
More informationWe are delighted to announce that Ace Hodgin, M.D.
Spring 2010 The Freedom Health Provider Newsletter Freedom Health Welcomes a New Chief Medical Officer We are delighted to announce that Ace Hodgin, M.D. has joined our team as Chief Medical Officer (CMO).
More information2015 Optimum Healthcare Sales Presentation Video Transcript-
2015 Optimum Healthcare Sales Presentation Video Transcript- H5594_15SalesPresVidv2_CMS_Approved Welcome to this presentation on Optimum HealthCare s Medicare Advantage Plans. Today you will learn about
More information2015 Freedom Health Sales Presentation Video Transcript- (Host) (Member Testimony) H5427_15FHSalesPresVidv2_CMS Approved
2015 Freedom Health Sales Presentation Video Transcript- H5427_15FHSalesPresVidv2_CMS Approved Welcome to this presentation on Freedom Health s Medicare Advantage Plans. Today you will learn about the
More informationOptimum HealthCare Sales Video Script - H5594_14SalesVideo_CMS Approved
Optimum HealthCare Sales Video Script - H5594_14SalesVideo_CMS Approved Thank you for joining us for this special presentation on Optimum HealthCare s Medicare Advantage Plans. Today we will explain the
More informationCoventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Summit Health Plan of Florida Medicare Quality Management Program Overview Quality Improvement (QI) Overview At Coventry, we
More information(Host) Freedom Health 2014 Video Script - H5427_14SalesVideo_CMS Approved
Thank you for joining us for this special presentation on Freedom Health s Medicare Advantage Plans. Today we will explain the tremendous value of a Freedom Health plan which offers benefits and savings
More informationSpecial Needs Plans Structure & Process Measures. Policy Clarifications and Frequently Asked Questions (FAQs)
Effective June 4, 2010 Special Needs Plans Structure & Process Measures Policy Clarifications and Frequently Asked Questions (FAQs) CMS Contract No. HHSM-500-2006-00060C Contents General Questions Q1:
More informationMODEL OF CARE OVERVIEW
MODEL OF CARE OVERVIEW Gateway Health SM (Gateway) currently offers four Special Needs Plans (SNPs): Gateway Health Medicare Assured Diamond SM Is a Dual Eligible Special Needs Plan (DSNP) and covers those
More informationVNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City. Roberta Brill Vice President, VNS Health Plans
VNS CHOICE: Managing Complex Care Needs for the Frail Elderly of New York City Roberta Brill Vice President, VNS Health Plans VNS CHOICE Organization Subsidiary of the Visiting Nurse Service of New York
More informationMedicare Managed Care Manual Chapter 5 - Quality Assessment
Medicare Managed Care Manual Chapter 5 - Quality Assessment Transmittals Issued for this Chapter Table of Contents (Rev. 117, 08-08-14) 10 Introduction 20 Medicare Quality Improvement Program 20.1 Chronic
More informationMedicare Advantage special needs plans
C h a p t e r14 Medicare Advantage special needs plans R E C O M M E N D A T I O N S 14-1 The Congress should permanently reauthorize institutional special needs plans. COMMISSIONER VOTES: YES 16 NO 0
More informationClinic/Provider Name (Please Print or Type) North Dakota Medicaid ID Number
Contract to Provide Health Management Services Supplementary Agreement Between The Department of Human Services, Medical Services Division (North Dakota Medicaid) and Clinic/Provider Name (Please Print
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
Page1 G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify G.6 When to Notify G.11 Case Management Services G.14 Special Needs Services G.16 Health Management Programs
More informationSNP Model of Care Provider Training
SNP Model of Care Provider Training The Centers for Medicare and Medicaid Services (CMS) requires all Medicare Advantage Special Needs Plans (SNPs) to have a Model of Care (MOC) All information about the
More information2014 Model of Care Training SHP_2014838A
2014 Model of Care Training SHP_2014838A 1 Model of Care Training This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plans. It also ensures
More informationCoventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Quality Management Program 2012 Overview Quality Improvement
More informationMODULE 11: Developing Care Management Support
MODULE 11: Developing Care Management Support In this module, we will describe the essential role local care managers play in health care delivery improvement programs and review some of the tools and
More informationUTILIZATION MANAGEMENT PROGRAM Introduction Health Care Services
UTILIZATION MANAGEMENT PROGRAM Introduction Health Care Services Call us: 1-888-898-7969, Option 1, then Option 4 Fax us: 1-800-594-7404 Business hours: Monday Friday (excluding holidays), 8:30 a.m. to
More informationJohns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases
Johns Hopkins HealthCare LLC: Care Management and Care Coordination for Chronic Diseases Epidemiology Over 145 million people ( nearly half the population) - suffer from asthma, depression and other chronic
More informationMedicare Advantage special needs plans
O n l i n e A p p e n d i x e s14 Medicare Advantage special needs plans 14-A O n l i n e A p p e n d i x Additional data on Medicare Advantage special needs plans and information on quality TABLE 14 A1
More informationHumana Medicare Advantage and Prescription Drug Plans
2015 Presentation Humana Medicare Advantage and Prescription Drug Plans Y0040_SPM_SPRE_MAPD_15 Approved GNHH31KHH_15 Let s talk about... Are you eligible? Choosing the right Humana plan for you Your Medicare
More informationMore than a score: working together to achieve better health outcomes while meeting HEDIS measures
NEVADA ProviderNews Vol. 3 2014 More than a score: working together to achieve better health outcomes while meeting HEDIS measures We know you ve heard of Healthcare Effectiveness Data and Information
More informationPatient Centered Medical Home
Patient Centered Medical Home 2013 2014 Program Overview Florida Blue is a trade name of Blue Cross and Blue Shield of Florida Inc., an Independent Licensee of the Blue Cross and Blue Shield Association.
More informationYour Guide to Medicare Special Needs Plans (SNPs)
CENTERS FOR MEDICARE & MEDICAID SERVICES Your Guide to Medicare Special Needs Plans (SNPs) This official government booklet has important information about Medicare Special Needs Plans, including the following:
More informationMedicare: 2015 Model of Care Training 04/2015
Medicare: 2015 Model of Care Training 04/2015 1 Model of Care Training This course is offered to meet the CMS regulatory requirements for Model of Care Training for our Special Needs Plans. It also ensures
More informationUtilization Management Program
Utilization Management Program The Utilization Management (UM) Program facilitates quality, cost-effective and medically appropriate services across a continuum of care that integrates a range of services
More informationKey Points about Star Ratings from the CMS 2016 Final Call Letter
News from April 2015 Key Points about Star Ratings from the CMS 2016 Final Call Letter On April 6, 2015 CMS released the Announcement of Methodological Changes for Calendar Year 2016 for Medicare Advantage
More informationGateway Health Medicare Assured RubySM (HMO SNP) $6,700 out-of-pocket limit for Medicare-covered services. No No No No. Days 1-6: $0 or $225 copay per
Assured RubySM (HMO Premium $0 monthly plan $0 - $33.90 monthly plan Assured GoldSM (HMO $12.40 - $46.30 monthly plan $43.90 - $77.80 monthly plan In Network Maximum Out-of-Pocket $3,400 out-of-pocket
More informationKaiser Permanente Guide to Medicare Basics
Kaiser Permanente Guide to Medicare Basics The National Medicare program, which was created in 1965, has given people peace of mind and the security of knowing they ll have access to health coverage. Medicare
More informationRisk Adjustment in the Medicare ACO Shared Savings Program
Risk Adjustment in the Medicare ACO Shared Savings Program Presented by: John Kautter Presented at: AcademyHealth Conference Baltimore, MD June 23-25, 2013 RTI International is a trade name of Research
More informationH7833_150304MO01. Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas
H7833_150304MO01 Information for Care Providers about UnitedHealthcare Connected (Medicare- Medicaid Plan) in Harris County, Texas Agenda Connecting Medicare and Medicaid Eligible Members Service Coordination
More informationCONTENTS. o o o o o o o o o o o o
CONTENTS o o o o o o o o o o o o What Are Medicare Advantage (MA) Plans? Who Can Join and When? MA Trial Right Special Election Period How MA Plans Work MA Costs Types of Medicare Advantage Plans Rights
More informationQuality Improvement Program
Quality Improvement Program Section M-1 Additional information on the Quality Improvement Program (QIP) and activities is available on our website at www.molinahealthcare.com Upon request in writing, Molina
More informationHigh Desert Medical Group Connections for Life Program Description
High Desert Medical Group Connections for Life Program Description POLICY: High Desert Medical Group ("HDMG") promotes patient health and wellbeing by actively coordinating services for members with multiple
More informationSYNOPSIS OF HEALTH CARE QUALITY MANAGEMENT SYSTEMS
SYNOPSIS OF HEALTH CARE QUALITY MANAGEMENT SYSTEMS Administration for Community Living CBO Learning Collaborative Webinar Presenter: Sharon R. Williams, Health Care Consultant April 2, 2014 2 QUALITY ASSURANCE:
More informationGLANCE GATEWAY. Providers AT A. for Medicare Assured SM. Gateway Health Medicare Assured SM 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222-1222
GATEWAY AT A GLANCE for Medicare Assured SM Providers Gateway Health Medicare Assured SM 444 Liberty Avenue, Suite 2100 Pittsburgh, PA 15222-1222 YOUR PROVIDER NUMBERS: Group Provider Number : Individual
More informationHospital April 2016. EHR Interoperability in Conjunction with Inovalon Pilot
Hospital April 2016 IN THIS EDITION: EHR Interoperability in Conjunction with Inovalon Pilot Lifestyle Management Programs Model of Care Overview Reminder on Prior Authorization EHR Interoperability in
More informationBreathe With Ease. Asthma Disease Management Program
Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program
More informationMedicare doesn t have to be complicated. This guide is provided to help you better understand Medicare and how a Medicare Advantage plan may offer
clarity YOUR GUIDE TO MEDicare AdvantaGE Medicare doesn t have to be complicated. This guide is provided to help you better understand Medicare and how a Medicare Advantage plan may offer the coverage
More informationPartners in Care Molina Healthcare of Florida Fall 2011
Partners in Care Molina Healthcare of Florida Fall 2011 Managing Influenza and Pregnancy Source: Responding to Influenza: A Toolkit for Prenatal Care Providers, http://www.cdc.gov/flu/pdf/freeresources/pregnant/2011_influenza_prenatal_toolkit.pdf
More informationMVP SmartFundTM (MSA) A $0 Premium Medicare Medical Savings Account
MVP SmartFundTM (MSA) A $0 Premium Medicare Medical Savings Account Y0051_2766 Accepted 09/2015 MVP Health Care is excited to offer the SmartFund (MSA) health plan. SmartFund combines a high-deductible
More informationA partnership that offers an exclusive insurance product! The Chambers of Commerce in Hamilton County and ADVANTAGE Health Solutions, Inc.
The Chambers of Commerce in Hamilton County and ADVANTAGE Health Solutions, Inc. SM A partnership that offers an exclusive insurance product! CHAMBER OF COMMERCE The Chambers of Commerce in Hamilton County
More informationUCare provides case management for all UCare members not affiliated with one of the above listed care systems. 2011 UCare for Seniors
Case Requirements Updated 3/16/2011 According to the Case Society of America (CMSA), Case Model Act of 2009, Case management is a collaborative process of assessment, planning, facilitation, care coordination,
More informationCall-A-Nurse Location
Call-A-Nurse A 24-hour medical call center, specializing in registered nurse telephone triage, answering service, physician and service referral, and class registration. Call-A-Nurse Location Call-A-Nurse
More informationUnitedHealth Premium SM
Physician s Commonly Asked Questions June 17, 2005 UnitedHealth Premium SM Designation Program 1. What is the UnitedHealth Premium designation program? The UnitedHealth Premium designation programs recognizes
More informationMedicare. What you need to know. Choose the plan that s right for you GNHH2ZTHH_15
Medicare What you need to know Choose the plan that s right for you GNHH2ZTHH_15 Choosing a Medicare plan is a lot like buying a car. There are lots of options to consider. And what s right for you may
More informationPamela Tropiano, RN, CCM, BSN, MPA. CareSource
Annual Education Conference September 30 October 3, 2012 Orlando, FL 1.7 Creative Case Management Pamela Tropiano, RN, CCM, BSN, MPA Senior Vice President, Health hservices CareSource Mission: The CareSource
More informationAllegian Advantage (HMO) H8554_001-2015 Accepted
Allegian Advantage (HMO) H8554_001-2015 Accepted IMPORTANT This presentation is for the exclusive use of Allegian Advantage (HMO) Allegian Health Plans is an HMO plan with a Medicare contract. Enrollment
More informationYour Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Molina Medicare Options Plus HMO SNP
January 1 December 31, 2015 Evidence of Coverage: Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Molina Medicare Options Plus HMO SNP This booklet gives you the
More informationMedicare Advantage Plans: An Overview
Medicare Advantage Plans: An Overview June 2014 Prepared by: Penny Finch, Benefits Consultant Copyright 2014 by The Segal Group, Inc. All rights reserved. 5432273.1 CONTENTS Medicare 101 Understanding
More informationMedicare Advantage Plans: What is it and what does it cover?
Medicare Advantage Plans: What is it and what does it cover? Medicare and Medigap have been around since the mid-60s. Then in the 70s, the government authorized private health plans to offer an alternative
More informationModule 5: Bill s Search for Lois
COMPANION GUIDE Module 5: Bill s Search for Lois Tips for facilitators: Watch the Module 5 DVD prior to the training so that you can anticipate questions and identify supplementary materials needed for
More informationSales Presentation The Michigan Medicare Plans Designed Around YOU
Sales Presentation The Michigan Medicare Plans Designed Around YOU HARBOR MEDICARE (HMO) HARBOR MEDICARE SELECT (HMO) H7960_003-2016 Approved WHAT YOU CAN EXPECT FROM THIS PRESENTATION PART 1 Introduction
More information504 Lavaca Street Suite 850 Austin, Texas 78701 PROVIDER NEWSLETTER
504 Lavaca Street Suite 850 Austin, Texas 78701 PROVIDER NEWSLETTER PROVIDER REPORT www.cenpatico.com Welcome to the first Cenpatico provider report for 2013. We re excited to share with you details on
More informationFrequently Asked Questions: Medicare Supplement & Medicare Advantage
Frequently Asked Questions: Medicare Supplement & Medicare Advantage Who is eligible for CBIA s Medicare program? A CBIA Health Connections participant is eligible for either plan if they are qualified
More informationFUNDAMENTALS OF MANAGED CARE
FUNDAMENTALS OF MANAGED CARE HIV/AIDS BUREAU HEALTH RESOURCES AND SERVICES ADMINISTRATION HRSA HIV/AIDS Bureau 1 FUNDAMENTALS OF MANAGED CARE 1. Managed Care Elements 2. Organizational Models 3. Continuum
More informationAccountable Care Fundamentals for Medical Practice Executives
Accountable Care Fundamentals for Medical Practice Executives Nathan Anspach, FACMPE Senior Vice President and Chief Executive Officer John C. Lincoln Accountable Care Organization and John C. Lincoln
More informationJohn R. Kasich, Governor Mary Taylor, Lt. Governor/Director. OSHIIP Medicare Advantage Update Webinar
John R. Kasich, Governor Mary Taylor, Lt. Governor/Director OSHIIP Medicare Advantage Update Webinar Session Topics This session will help you to Define Medicare Advantage (MA) Plans Explain eligibility
More informationSpecial Needs Plans (SNPs) Model of Care
Special Needs Plans (SNPs) Model of Care Annual Training Herminia Escobedo Health Net Presentation for Provider Teleconference 2/25/15 Presentation by Candace Ryan, QI Manager Medicare Rhonda Combs, Director
More informationWelcome to Optimum Special Needs Plan. In this newsletter, we will give you some general information about your Plan.
Spring 2012 Newsletter In This Issue: 2 3 4 5 6 8 About Special Needs Plan What is a Care Plan? Nurse Case Management Education Information Care Transitions Assistance Dual Eligible Members Hospital Admissions
More informationSuperior HealthPlan. Assisted Living, Residential Care and Adult Foster Care SHP_2014635
Superior HealthPlan Assisted Living, Residential Care and Adult Foster Care SHP_2014635 Who is Superior HealthPlan? Superior HealthPlan is a subsidiary of Centene Management Corporation, a Fortune 500
More informationYour complimentary Medicare Guidebook
Learn Protect Assess Enroll Your complimentary Medicare Guidebook About this Guidebook If you or someone you care for is new to Medicare or will be soon, this Guidebook will help make Medicare easier to
More informationYour complimentary Medicare Guidebook
Learn Protect Assess Enroll Your complimentary Medicare Guidebook Learn Original Medicare... 4 Medicare Prescription Drug Coverage.............. 6 Medicare Supplement Insurance... 8 Medicare Advantage...
More informationCoordinating care for dual-eligible beneficiaries
C h a p t e r5 Coordinating care for dual-eligible beneficiaries C H A P T E R 5 Coordinating care for dual-eligible beneficiaries Chapter summary In this chapter Beneficiaries who qualify for Medicare
More informationColorado Choice Health Plans
Quality Overview Colorado Choice Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace HMO) Provisional Accreditation Commercial
More informationGeneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population
Geneva Association 10th Health and Aging Conference Insuring the Health of an Aging Population November 18, 2013 Diana Dennett EVP, Global Issues and Counsel America s Health Insurance Plans (AHIP) America
More informationApplied Behavior Analysts (ABA) Provider Orientation
Applied Behavior Analysts (ABA) Provider Orientation Objectives Overview of Horizon Behavioral Health and ValueOptions Qualified ABA Services and Covered Treatment Providers Covered ABA Codes/AMA CPT Codes
More informationSpecial Needs Plans Structure & Process Measures. CMS Contract No. HHSM-500-2006-00060C
Special Needs Plans Structure & Process Measures CMS Contract No. HHSM-500-2006-00060C 1 Contents SNP 1: Complex Case Management... 4 Element A: Identifying Members for Case Management... 4 Element B:
More informationChronic Care Management. WPS Chronic Care Management Next Generation Disease Management
Chronic Care Management WPS Chronic Care Management Next Generation Disease Management Taking on Chronic Illness and Winning. People with chronic illnesses make up only 20 percent of your employee population,
More informationHARBOR ADVANTAGE (HMO) H7960-002-2015 Accepted
HARBOR ADVANTAGE (HMO) H7960-002-2015 Accepted IMPORTANT This presentation is for the exclusive use of Authorized Plan Representatives of Harbor Advantage (HMO). Harbor Health Plan is an HMO plan with
More informationGUILDNET HEALTH ADVANTAGE MODEL OF CARE
GUILDNET HEALTH ADVANTAGE MODEL OF CARE Introduction: GuildNet Health Advantage is a dual eligible SNP. The plan provides a rich benefit package to beneficiaries eligible for Medicare and full Medicaid
More informationWelcome! Medicare Advantage. Elderplan Advantage Institutional Special Needs Plan
Elderplan Advantage Institutional Special Needs Plan 1 Welcome! Goals for today: To give you an overview of Medicare Advantage Works To give you a sense of the role of ISNP in an SNF To provide a description
More information$0 per month. $0 per month. $0 per month. $0 per month. $55 per month $59 per month. $0 per month
Medicare Advantage (MA) Individual Enrollment Request Form Please contact CareMore Health Plan if you need information in another language or format (Braille). To enroll in CareMore Health Plan, please
More informationConnect4 Patients CCCM Primary Care Community. Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM
Connect4 Patients CCCM Primary Care Community Presented By: Veronica Mansfield, DNP, APRN, AE-C, CCM Kit McKinnon, MBA, BSN, RN, CDE, CCM September 17, 2015 Objectives: Describe innovative care management
More informationWhat s a Medicare Advantage Plan?
Revised April 2015 What s a Medicare Advantage Plan? You can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). If you have Original Medicare, the
More information8/14/2012 California Dual Demonstration DRAFT Quality Metrics
Stakeholder feedback is requested on the following: 1) metrics 69 through 94; and 2) withhold measures for years 1, 2, and 3. Steward/ 1 Antidepressant medication management Percentage of members 18 years
More informationBuilding an Accountable Care Organization. Jean Malouin, MD MPH University of Michigan Health System September 21, 2012
Building an Accountable Care Organization Jean Malouin, MD MPH University of Michigan Health System September 21, 2012 Agenda UMHS overview PGP demo ACO precursor Current efforts underway Role of primary
More informationMedicare Advantage Plan Information
Medicare Advantage Plan Information Thank you for your interest in applying for the HealthNet Medicare Advantage plan. Below are links to the items which are part of the Enrollment Packet you would receive
More informationWhat is a Medicare Advantage Plan?
CENTERS FOR MEDICARE & MEDICAID SERVICES What is a Medicare Advantage Plan? A Medicare Advantage Plan (like an HMO or PPO) is a way to get your Medicare benefits. Unlike Original Medicare, in which the
More informationContinuity of Care Guide for Ambulatory Medical Practices
Continuity of Care Guide for Ambulatory Medical Practices www.himss.org t ra n sf o r m i ng he a lth c a re th rou g h IT TM Table of Contents Introduction 3 Roles and Responsibilities 4 List of work/responsibilities
More informationHealth Homes (Section 2703) Frequently Asked Questions
Health Homes (Section 2703) Frequently Asked Questions Following are Frequently Asked Questions regarding opportunities made possible through Section 2703 of the Affordable Care Act to develop health home
More informationA. IEHP Quality Management Program Description
A. IEHP Quality Management Program Description A. Purpose: The purpose of the QM Program is to provide operational direction necessary to monitor and evaluate the quality and appropriateness of care, identify
More informationNational Association of State United for Aging and Disabilities September 17, 2014
National Association of State United for Aging and Disabilities September 17, 2014 What s Driving Health Plan Quality? Sharon R. Williams, CEO/Founder, Williams Jaxon Consultants, LLC Merrill Friedman,
More informationFACT SHEET Medicare Advantage (Part C): An Overview (C-001) p. 1 of 5
FACT SHEET Medicare Advantage (Part C): An Overview (C-001) p. 1 of 5 Medicare Advantage (Part C): An Overview Medicare Advantage is also known as Medicare Part C. A Medicare Advantage (MA) plan is an
More informationSpring 2016 Partners in Care Newsletter
Spring 2016 Partners in Care Newsletter Important Message Updating Provider Information It is important for Molina Healthcare of Texas (Molina Healthcare) to keep our provider network information up to
More informationMedicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year
Medicare Shared Savings Program Quality Measure Benchmarks for the 2015 Reporting Year Release Notes/Summary of Changes (February 2015): Issued correction of 2015 benchmarks for ACO-9 and ACO-10 quality
More informationHDE FREE WEBINAR SERIES: BIDDING, RISK ADJUSTMENT, AND STARS. May 3, 2012
HDE FREE WEBINAR SERIES: BIDDING, RISK ADJUSTMENT, AND STARS May 3, 2012 AGENDA Impact of Star Ratings on 2013 Part C bid Looking ahead: 2014 & beyond How risk scores & QBPs work hand-in-hand to maximize
More informationVirginia s Healthy Returns Alternative Benefit Design
Virginia s Healthy Returns Alternative Benefit Design Presentation to the: National Governors Association s Center for Best Practices: State Defined Benefit Package Workshop Patrick W. Finnerty, Director
More informationNetworkCares (PPO SNP) 2016 Model of Care Training. H5215_360r1_092714 NHIC 12/2015 m-cnm-ncprovpres-1215
NetworkCares (PPO SNP) 2016 Model of Care Training H5215_360r1_092714 NHIC 12/2015 m-cnm-ncprovpres-1215 Introduction This course is offered to meet the CMS regulatory requirements for Model of Care Training
More informationParamount Health Care Administrative Services Only (ASO)
Paramount Health Care Administrative Services Only (ASO) The majority of Paramount large group clients self-fund their healthcare programs. Paramount maintains the staff and resources it takes to deal
More information2015 Orange County HICAP Medicare Advantage Special Needs Plans Comparison Chart
Brand New Day Brand New Day Brand New Day Brand New Day Bridges Drug Savings Bridges Extra Care Harmony Healthy Heart Drug Savings dementia. dementia. chronic and disabling mental health conditions. chronic
More informationPriority Health Medicare
Priority Health Medicare To enroll online please visit our website at prioritymedicare.com Enrollment instructions To avoid delays in processing your enrollment, please follow these helpful tips. Make
More informationMaking the most of Medicare
Making the most of Medicare S5743_102714_K04_RE Internal Approval 10/27/2014 Today s Topics What is Medicare Who s eligible Medicare coverage Options to fill coverage gaps When you can enroll Finding the
More information27. Will the plan pay for radiology done in the provider s office?... 10 28. How do providers request assistance with care management issues?...
Provider Q&A Contents 1. Who is Florida True Health?... 3 2. What is the new product name?... 3 3. Does the plan have a website?... 3 4. How will physicians be paid? (FFS or capitation)... 3 5. What clearing
More informationManaging Patients with Multiple Chronic Conditions
Best Practices Managing Patients with Multiple Chronic Conditions Advocate Medical Group Case Study Organization Profile Advocate Medical Group is part of Advocate Health Care, a large, integrated, not-for-profit
More informationProvider Manual. Section 18.0 - Case Management and Disease Management
Section 18.0 - Case Management and Disease Management 18.1.1 Introduction 18.2.1 Scope 18.3.1 Objectives 18.4.1 Procedures Case Management 18.4.1-A. Referrals 18.4.1-B. Case Management Mercy Maricopa Acute
More information2016 Guide to Understanding Your Benefits
2016 Guide to Understanding Your Benefits Additional information about covered benefits available from Health Net Healthy Heart (HMO) Plan Alameda, Stanislaus counties, CA Lisa Pasillas-Le, Health Net
More informationNJ DEPARTMENT OF HUMAN SERVICES FREQUENTLY ASKED QUESTIONS (FAQS)
NJ DEPARTMENT OF HUMAN SERVICES FREQUENTLY ASKED QUESTIONS (FAQS) Dual Eligible Special Needs Plans (D-SNP) and NJ FamilyCare Managed Long Term Services and Supports (MLTSS) (Revised November 6, 2014)
More informationDEPARTMENT OF HEALTH AND HUMAN SERVICES. Medicare Program; Request for Applications for the Medicare Care Choices Model
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-5512-N] Medicare Program; Request for Applications for the Medicare Care Choices Model AGENCY: Centers for Medicare
More information