CIGNA Medicare Select Dual Special Needs Plan (D-SNP)
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1 A CIGNA Medicare Select Dual Special Needs Plan (D-SNP) Model of Care Training for Contracted Health Care Professionals Prepared: October 2010 CIGNA Medicare Services," "CIGNA Medicare Select Plus Rx" (HMO) and the "Tree of Life" logo are registered service marks of CIGNA Intellectual Property, Inc., licensed for use by CIGNA Corporation and its operating subsidiaries. CIGNA Medicare Select Plus Rx plans are offered by operating subsidiary CIGNA HealthCare of Arizona, Inc., and not by CIGNA Corporation. CIGNA HealthCare of Arizona, Inc. is a Medicare Advantage organization with a Medicare contract. As of the date of publication, CIGNA Medicare Select Plus Rx plans are offered to employers and individuals in Maricopa County and certain zip codes within Apache Junction and Queen Creek, Arizona only.
2 Objectives What is a SNP? SNP CIGNA Offers How to Identify a D-SNP Participant D-SNP Eligibility Requirements and Benefits Your Role with D-SNP Purpose of Model of Care CIGNA s Model of Care Programs CIGNA Offers CIGNA D-SNP Infrastructure D-SNP Cost Share Contact Information Glossary
3 What is a SNP? Special Needs Plans (SNPs) were created by Congress in the Medicare Modernization Act (MMA) of 2003 as a new type of Medicare managed care plan focused on certain vulnerable groups of Medicare beneficiaries: the institutionalized, dual-eligible and beneficiaries with severe or disabling chronic conditions. These beneficiaries are typically older, with multiple comorbid conditions, and thus are more challenging and costly to treat.
4 SNP CIGNA Offers D-SNP CIGNA HealthCare of Arizona offers: Medicare Select Plus Rx Dual (HMO SNP) To individuals with Medicare and Medicaid coverage or Medicare and some form of State assistance
5 How To Identify a D-SNP Enrollee D-SNP participants have unique group identification numbers: 4070 or 4071 CIGNA for Health Care Professionals website: provider/public/guest CIGNA Customer Service:
6 D-SNP Eligibility Requirements D-SNP enrollees must: Reside in the Service Area Maricopa County and certain zip codes in Apache Junction and Queen Creek, Arizona Have Medicare Part A and Part B Must Not have ESRD (unless enrolled in our commercial plan) Have Medicare & Medicaid coverage or Medicare & State Assistance (AHCCCS, QMB, SLMB, QI, LIS etc). D-SNP participants do not have lock-in periods D-SNP participants may enroll or disenroll at any time
7 D-SNP Benefits Each participant is entitled to: A comprehensive Health Risk Assessment (HRA) An Individual Care Plan (ICP) specific to their medical needs Care management by an Interdisciplinary Care Team (ICT) No or low copayments (depends on eligibility) for most services Free basic eyeglasses Free basic hearing aids Transportation - 24 free one-way trips (routine)
8 Your Role with D-SNP As a CIGNA health care professional your role is vital to our success! When CIGNA contacts you regarding a D-SNP participant: Please read the individual s care plan Share your medical expertise by providing your dictation, promptly Access the D-SNP training annually as this is required by CMS.
9 Model of Care (MOC) Manages the delivery of specialized services and benefits which is a CMS requirement Defines care management goals and the health outcome measures: Measurable Goals Interdisciplinary Care Team Staff Structure & Care Management Roles Provider Network Model of Care training Health Risk Assessment Communication network Performance and Health Outcomes
10 CIGNA s Model of Care Is a comprehensive plan designed to improve the outcomes of medical care and quality of life for our SNP participants Has a robust infrastructure which allows for the care management of the D-SNP population Is designed to: Improve Beneficiary Health Outcomes Improve Access to Care Improve the Coordination of Care Improve Transitions of Care Decrease Gaps of Care Increase Cost-Effectiveness Address Frail and End of Life Issues Safely Manage Complex Medical, Behavioral, and Social Issues
11 Programs CIGNA Offers Cigna Medical Group (CMG) is the designated network for CIGNA Medicare Select Plus Rx D-SNP enrollees. CIGNA provides these plan participants with access to the following services: Care Coordination 24 Hour Help Line Transition of Care Nurse Program ER (Emergency Room) Outreach Home Based Care Chronic Health Improvement Program (CHIP) Free Health Education and Wellness Programs
12 CIGNA D-SNP Infrastructure D-SNP Patient Care is managed by qualified CIGNA Care Coordinators who are trained in medical management, accessing community services and CIGNA systems. D-SNP Patient Care Oversight is managed by an Interdisciplinary Care Team (ICT). At a minimum, the ICT includes the participant s PCP, a behavioral health specialist and a social worker. D-SNP Program Oversight is managed by the CIGNA Medicare Administrative Team (MAT). The MAT is composed of Cigna Medical Group Operations, Utilization Management, Medicare Quality, Population Health, Medicare Operations and Compliance, Information Technology and CIGNA HealthCare of AZ Medical, Network, Contracting and Finance.
13 D-SNP Cost-Share Dual Eligible Cost-sharing Rules all health care professionals must abide by the following: 42 CFR (g)(1)(3) states: (iii) For all MA organizations with enrollees eligible for both Medicare and Medicaid, organizations must specify in their provider contracts and manuals that such enrollees will not be held liable for Medicare Part A and B when the State is responsible for paying such amounts. Plans may not impose cost-sharing that exceeds the amount of cost-sharing permitted under title XIX. Provider contracts must state that health care professionals will - (A) Accept the MA plan payment as payment in full, or (B) Bill the appropriate State source. Please refer to your Medicare Regulatory Addendum for details.
14 Contact Information 24 Hour Help Line: Available 24 hours a day, 7 days a week, including holidays What can the 24/7 Help Line do for you? Provide D-SNP updates Facilitate communication with a CMG physician Arrange for Home Health services Assist with direct Skilled Nursing Facility admits Facilitate prescription renewals Schedule follow-up appointments (CMG) Perform patient outreach calls Plus much, much more!
15 Glossary CFR Code of Federal Regulations D-SNP Dual Special Needs Plan CMG Cigna Medical Group MMA - Medicare Modernization Act RN Registered Nurse SNF Skilled Nursing Facility
16 Presentation Acknowledgement Physician/Group Name: Physician/Group TIN: Physician/Group Address: Physician/Group Telephone Number Physician/Group Fax Number Physician/Group Address Physician/Group Attendees: Acknowledgement Signature: Print Name: Sign Date Provider Services Representative Name
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