HealthPartners Inspire (SNBC) Overview
|
|
- Liliana Harvey
- 5 years ago
- Views:
Transcription
1 Draft HealthPartners Inspire (SNBC) Overview July 1,
2 What is SNBC? Special Needs Basic Care (SNBC) began in 2008 Voluntary health plan option for enrollees with disabilities ages 18 through 64 who have Medical Assistance Almost 50% of the population are over age 50 Enrollees can choose a health plan, if they do not DHS opts enrollees into available plans. Enrollees can select a new health plan or opt out to FFS monthly. About 50,000 enrollees statewide Refer to DHS website for more information on SNBC 2
3 SNBC eligibility Eligibility years old Enrolled in Medical Assistance Certified blind or disabled (federal or state) About 50% also have Medicare **DHS has changed the policy related to when SNBC enrollees turn age 65 and their ability to stay in the SNBC program. This option is being phased out, to learn more about eligibility visit the DHS website for SNBC. 3
4 SNBC MCO covered benefits Standard Medicaid benefits: Comprehensive primary, preventive and acute medical Hospital Diagnostic Therapeutic including rehabilitative Chemical dependency, behavioral and mental health Pharmacy Immunization Dental Eye exam Home care Care coordination Transportation to and from medical and dental appointments Support services 100 days of nursing home care for people residing in the community 4
5 SNBC benefits not covered by MCO The following are managed by the county for SNBC members Personal Care Assistance (PCA) Private Duty Nursing/Hourly Nursing Waivered services 5
6 Historical Context Institutional History of persons with disabilities being hidden away Denied education and subject to discrimination in employment, housing, transportation and many other aspects of daily life. De Institutionalized Movement to deinstitutionalize though there were not proper safety nets. Lacking public policy and funds to provide community support Medical Model Experience of focus on medical outcomes, not goals of the individual Fear of managed care and assumed lack of ability to self direct 6
7 Important Concepts for SNBC MN Olmstead Plan: The Olmstead Plan is a broad series of key activities our state must accomplish to ensure people with disabilities are living, learning, working, and enjoying life in the most integrated setting. Person centered: A term for healthcare and social services where the primary focus is on an individual s unique preferences, values and needs when planning services and strategies to address healthcare needs. Self Directed: Means that participants, or their representatives, have decisionmaking authority over certain services and take direct responsibility to manage their services with the assistance of a system of available supports. Self direction promotes personal choice and control and allows people to choose the level of risk they wish to take. 7
8 Unique Service Coordination Needs To find out if a HealthPartners member has a Care Coordinator, please contact Member Services at or Medicare Services Waiver Services Housing Providers PCA Services MH TCM & ACT Services 8
9 HealthPartners Inspire Non integrated (Medicaid only) Special Needs Basic Care 34 county service area July 1, 2016: 27 Greater Minnesota counties January 1, 2017: 7 Metro counties HealthPartners receives DHS enrollment file last week of the month 9
10 Service area Counties with HealthPartners Inspire 10
11 Our member services team Help locate in network options Member ID card Answer benefit questions Behavioral Health and Nurse Navigators Help find pharmacies and drugs on formulary Dental and Community Resources Navigator or Monday Friday 8 a.m. to 6 p.m. 11
12 Member ID card and Network approach No primary care clinic assignment Network of contracted providers Medical Dental Other services No referrals needed for in network providers virtuwell 24/7 online clinic Find a provider healthpartners.com/snbcinspire 12
13 RideCare Schedules rides for access and special transportation services Rides to and from medical and dental appointments (including pharmacy) Variety of rides bus, cab, volunteer drivers or Monday Friday, 7 a.m. to 5 p.m. 13
14 Member rewards Fitness benefit Flexible transportation Primary care visit Cervical cancer screening Healthy pregnancy New mom Learn more at healthpartners.com/snbcrewards 14
15 What s included Care Coordinator Behavioral Health Disease & Complex Case Management Health Promotion Visit the Provider Portal for a full list of services. Members can visit healthpartners.com. 15
16 HPConnect One stop referral source Visit the Provider Portal and complete the Disease, Case & Lifestyle Management Services Form OR Call or
17 Prior authorizations Behavioral health Behavioral Health Navigators, or Prior Here authorization are is required for a very limited number of services. some call outs Medical services Nurse Navigators, or Find forms on the Provider Portal UR Team authorization requests: Member or provider can call BH UR triage line at Provider can fax to
18 Questions? We re here to help HealthPartners Member Services or Monday Friday 8 a.m. to 6 p.m. RideCare or Monday Friday, 7 a.m. to 5 p.m. Claims Customer Service or HealthPartners Contacts Contact your Contract Manager with any specific questions. Provider Portal Click on Admin Tools for the Provider Resource Manual 18
Special Needs BasicCare
Minnesota Disability Health Options (MnDHO) Special Needs BasicCare (SNBC) Special Needs Purchasing Deb Maruska Program Coordinator Susan Kennedy Project Coordinator Managed Care Programs for People with
More informationHealthPartners SNBC Inspire
Click to edit Master title style HealthPartners SNBC Inspire March 28 & 30, 2017 Agenda New Team Members DHS SNBC Audit 6 Month Follow Up Calls Benefit Exception Inquiry Form Adjustments HealthPartners
More informationMarshall County Social Services. Address: 208 E. Colvin Ave. Ste 14 Warren, MN 56762
Marshall County: County Administration: Agency Name: Director s Name: Marshall County Social Services Chris Kujava Address: 208 E. Colvin Ave. Ste 14 Warren, MN 56762 Telephone Number: FAX Number: 218-745-5260
More informationINSTRUCTIONS FOR INSPIRE (SNBC) CARE PLAN
INSTRUCTIONS FOR INSPIRE (SNBC) CARE PLAN INFORMATION ABOUT ME 1. Name: Enter member s name. 2. My DOB: Enter member s date of birth. 3. Health Plan ID Number: Enter member s HealthPartners Member ID number.
More information2017 ADDENDUM TO THE MEMBER HANDBOOK (formerly known as Evidence of Coverage (EOC)) FOR PREPAID MEDICAL ASSISTANCE PROGRAM (PMAP)
HealthPartners Member Services MS 21103R 8170 33rd Avenue South P.O. Box 9463 Minneapolis, MN 55440-9463 Telephone: 952-967-7998 or 1-866-885-8880 (toll free) TDD/Hearing Impaired: 952-883-6060 or 1-800-443-0156
More informationMaryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012
Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint
More informationUCare Connect Care Coordination Requirement Grid Updated effective
UCare Connect Care Coordination Requirement Grid Updated 8.1.18 effective 9.1.18 The assigned Care Coordinator (CC) must meet the required definition of a qualified professional. Care coordination services
More informationSpring 2016 Health & Wellness Newsletter
Spring 2016 Health & Wellness Newsletter In This Issue Check out what Molina offers online... 1-3 Annual Checkup...3 Are You Taking Any Medicine?...3 Benefits of Health Programs for Woman...4 Your Extra
More informationMental Health Targeted Case Management. What is MH-TCM the basics. What is MH-TCM the basics
Mental Health Targeted Case Management Managed Care Programs: Case Management, Care Coordination, and Care Management In Managed Care July 23, 2009 Videoconference Richard Seurer, DHS-Adult Mental Health
More informationIA Health Link and Amerigroup Iowa
IA Health Link and Amerigroup Iowa Navigating the Transition to Amerigroup Foster Care Caretaker Orientation 1 Who is Amerigroup Iowa? A partner with the Iowa Department of Human Services (DHS), which
More informationDraft Children s Managed Care Transition MCO Requirements
Draft Children s Managed Care Transition MCO Requirements OVERVIEW On February 1 st, New York State released for stakeholder feedback a draft version of the Medicaid Managed Care Organization (MCO) Children
More information3 rd Quarter MSHO/MSC+ Care Coordination Training
3 rd Quarter MSHO/MSC+ Care Coordination Training Care Systems & UCare Care Coordinators: September 13 th, 2017 Recorded WebEx: September 14 th, 2017 Agenda STARS Cindy Radke Bus Pass Transportation Jeremy
More informationTHIS INFORMATION IS NOT LEGAL ADVICE
Medicaid Medicaid is a federal/state program that gives certain groups of people a card that can be used to get free medical care, nursing home care, and prescription drugs at reduced prices. In general,
More informationTransition Period. Parallel Paths to Purchasing Transformation 2020: RSAs. Fully Integrated Managed Care System
2 Parallel Paths to Purchasing Transformation 2020: Fully Integrated Managed Care System Transition Period 2014 Legislative Action: SSB 6312 By January 1, 2020, the community behavioral health program
More information2009 BENEFIT HIGHLIGHTS HEALTH NET PEARL HAWAII OPTION 1
2009 BENEFIT HIGHLIGHTS HEALTH NET PEARL HAWAII OPTION 1 Hawaii, Honolulu, Kalawao, Kauai and Maui counties MEDICAL COVERAGE Monthly Plan Premium $0 Calendar Year Out-Of-Pocket Maximum1 $1,200 Inpatient
More informationBulletin. DHS Provides Policy for Certified Community Behavioral Health Clinics TOPIC PURPOSE CONTACT SIGNED TERMINOLOGY NOTICE NUMBER DATE
Bulletin NUMBER 17-51-01 DATE February 27, 2017 OF INTEREST TO County Directors Social Services Supervisors and Staff Case Managers and Care Coordinators Managed Care Organizations Mental Health Providers
More informationEnterprise Health Solutions (EHS) Processing Platform
1 Enterprise Health Solutions (EHS) Processing Platform West Virginia Family Health Plan (WVFH) transitioned to the EHS claims processing platform on 1/1/18. The system transition will provide you with
More informationDHS-7659-ENG MEDICAID MATTERS The impact of Minnesota s Medicaid Program
DHS-7659-ENG 2-18 MEDICAID MATTERS The impact of Minnesota s Medicaid Program -9.0-8.0-7.0-6.0-5.0-4.0-3.0-2.0-1.0 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0 INTRODUCTION It s been more than 50 years
More informationHHSC Value-Based Purchasing Roadmap Texas Policy Summit
HHSC Value-Based Purchasing Roadmap Texas Policy Summit Andy Vasquez, Deputy Associate Commissioner MCS, Quality & Program Improvement Section October 19, 2017 1 HHSC Value-Based Purchasing Roadmap Topics
More informationHCCP0005 (3/15) Hoosier Care Connect. IHCP 1st Quarter 2015 Workshops. A wise choice for you and your family.
HCCP0005 (3/15) Hoosier Care Connect IHCP 1st Quarter 2015 Workshops A wise choice for you and your family. What is Hoosier Care Connect (HCC)? Hoosier Care Connect is a new coordinated care program which
More informationArticles of Importance to Read: AmeriChoice Tennessee s Provider University. Spring 2010
Important information for physicians and other health care professionals and facilities serving AmeriChoice members Spring 2010 AmeriChoice Tennessee s Provider University AmeriChoice Tennessee s Provider
More informationTriennial Compliance Assessment. HealthPartners. Performed under Interagency Agreement for: Minnesota Department of Human Services
Triennial Compliance Assessment Of HealthPartners Performed under Interagency Agreement for: Minnesota Department of Human Services By Minnesota Department of Health (MDH) Managed Care Systems Section
More informationUPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS
UPDATE ON MANAGED CARE IN NY STATE: IMPLICATIONS FOR PROVIDERS November 18, 2013 NYS OMH Behavioral Health Transition 2 Key MRT initiative to move fee-for-service populations and services into managed
More informationIntroduction for New Mexico Providers. Corporate Provider Network Management
Introduction for New Mexico Providers Corporate Provider Network Management Overview New Mexico snapshot. Who we are. Why Medicaid managed care? Why AmeriHealth Caritas? Why partner with us? Medical Management
More informationFostering Quality Improvement in the SC Medicaid Program
Fostering Quality Improvement in the SC Medicaid Program Medicaid Matching Expenditures as a Percent of Total State General Fund Revenue Medicaid is approximately 1/5 2015 2010 2005 2000 1995 $0 $2,000,000,
More informationUCare Connect + Medicare Care Coordination Requirement Grid Updated
UCare Connect + Medicare Care Coordination Requirement Grid Updated 1.1.18 The assigned Care Coordinator (CC) must meet the required definition of a qualified professional. Care coordination services incorporate
More informationModa Health Enrollment Service Area
Moda Health v Moda Health Enrollment Service Area Moda Health Medicare Supplement Plan and Moda Health Non- Medicare PPO Plans PERS Moda Health PPORX Plan (Medicare Advantage) The Value of Moda Health
More information2018 Authorization and Notification Requirements Medical Services
2018 Authorization and Notification Requirements Medical Services For the following plans: MSHO=Minnesota Senior Health Options MSC Plus=Minnesota Senior Care Plus Connect=Special Needs BasicCare Connect
More informationSection IX Special Needs & Case Management
Section IX Special Needs & Case Management Special Needs and Case Management 181 Integrated Health Care Management (IHCM) The Integrated Health Care Management (IHCM) program is a population-based health
More informationMedicaid Transformation
Medicaid Transformation Debra Farrington Senior Program Manager August 18, 2017 Medicaid Managed Care Already Exists in NC What North Carolina Has Now PRIMARY CARE CASE MANAGEMENT (CCNC) Primary care provider-based
More informationAHCA is Focused on Quality Inside & Out
Presentation to the Medical Care Advisory Committee September 23, 2014 AHCA is Focused on Quality Inside & Out Marie Donnelly Chief, Medicaid Quality Bureau MAKING MEDICAID MANAGED CARE WORK FOR FLORIDA
More informationFlorida Medicaid: Performance Measures (HEDIS)
Florida Medicaid: Performance Measures (HEDIS) Justin M. Senior Florida Medicaid Director Agency for Health Care Administration Senate Health Policy October 20, 2015 Statewide Medicaid Managed Care (SMMC)
More informationReforming Health Care with Savings to Pay for Better Health
Reforming Health Care with Savings to Pay for Better Health Mark McClellan, MD PhD Director, Initiative on Health Care Value and Innovation Senior Fellow, Economic Studies October 2014 National Forum on
More informationMedicaid Managed Care Managed Long Term Care and Fully Integrated Dual Advantage Plans. August 2, 2012
Medicaid Managed Care Managed Long Term Care and Fully Integrated Dual Advantage Plans August 2, 2012 Community Health Advocates Community Health Advocates (CHA) is a network of 31 organizations that assist
More informationMedical Management. G.2 At a Glance. G.2 Procedures Requiring Prior Authorization. G.3 How to Contact or Notify Medical Management
G.2 At a Glance G.2 Procedures Requiring Prior Authorization G.3 How to Contact or Notify G.4 When to Notify G.7 Case Management Services G.10 Special Needs Services G.12 Health Management Programs G.14
More informationMedical Management. G.2 At a Glance. G.3 Procedures Requiring Prior Authorization. G.5 How to Contact or Notify Medical Management
G.2 At a Glance G.3 Procedures Requiring Prior Authorization G.5 How to Contact or Notify Medical Management G.6 When to Notify Medical Management G.11 Case Management Services G.14 Special Needs Services
More informationMedicaid-CHIP State Dental Association
Medicaid-CHIP State Dental Association Financing Oral Health Care for Pregnant Women MARY E. FOLEY, MPH Executive Director Medicaid-CHIP State Dental Association 2013 National Oral Health Conference April
More informationHealthPartners Minnesota Senior Health Options (MSHO) (HMO SNP)
2013 HealthPartners MSHO Summary of Benefits HealthPartners Minnesota Senior Health Options (MSHO) (HMO SNP) 420089 Individual MSHO (9/12) H2422_54016 CMS Accepted 9/1/2012 H2422 American Indian Language
More informationColorado Choice Health Plans
Quality Overview Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace ) Full Full: Organization demonstrates full compliance
More informationGetting started. 1. Is it on the formulary? Medicines on the formulary will. cost you less. 2. Is it a brand name or generic? Generic medicines will
Getting started Choosing the right health plan may feel like a challenge, but we can help. Our shopping tools and award-winning customer service make it easy to find the best plan for you. As you compare
More informationThe University of Chicago Guide to Student Health and Counseling Services
The University of Chicago Guide to Student Health and Counseling Services 2017 2018 Welcome to the University of Chicago! We believe good health is essential for academic success. At the University of
More informationKY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
More informationDentaQuest/Superior Health Plan Training 2018 STAR Health (Foster Care) STAR + PLUS STAR Value Added Services
DentaQuest/Superior Health Plan Training 2018 STAR Health (Foster Care) STAR + PLUS STAR Value Added Services Agenda STAR Health (Foster Care) STAR + PLUS STAR Pregnant Women Value Added Service (VAS)
More informationFrom Fragmentation to Integration: Bringing Medical Care and HCBS Together. Jessica Briefer French Senior Research Scientist
From Fragmentation to Integration: Bringing Medical Care and HCBS Together Jessica Briefer French Senior Research Scientist 1 Integration: The Holy Grail? An act or instance of combining into an integral
More informationPlan Payment Requirements for Existing Providers of Care
Plan Requirements for Existing Providers of Care MyCare Ohio plans entered into contracts with CMS and Ohio Medicaid in February 2014 to achieve integrated delivery of medical, behavioral, and long term
More informationKY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
More informationElderly Waiver/Alternative Care Programs. Lisa Rotegard Manager Aging and Adult Services MN Department of Human Services
Elderly Waiver/Alternative Care Programs Lisa Rotegard lisa.rotegard@state.mn.us Manager Aging and Adult Services MN Department of Human Services 1 Who is Eligible for EW? Age 65 or older Eligible for
More informationQUALITY IMPROVEMENT PROGRAM
QUALITY IMPROVEMENT PROGRAM EmblemHealth s mission is to create healthier futures for our customers and communities. We will do this by providing members with a broad range of benefits and conscientious
More informationSUMMARY OF BENEFITS 2009
HEALTH NET VIOLET OPTION 1, HEALTH NET VIOLET OPTION 2, HEALTH NET SAGE, AND HEALTH NET AQUA SUMMARY OF BENEFITS 2009 Southern Oregon Douglas, Jackson, and Josephine Counties, Oregon Benefits effective
More informationFIDA. Care Management for ALL
Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative
More informationNorth Carolina Medicaid Reform
North Carolina Medicaid Reform Sandy Terrell Director, Clinical Policy Health and Human Services NC Health Care History c.1952 Good Health Act 1965 Medicare & Medicaid c.1972 Office of Rural Health 1877
More informationHealthPartners MSHO (HMO SNP) Enrollment Form
HealthPartners MSHO (HMO SNP) Enrollment Form HealthPartners Enrollment Telephone Numbers 952-883-5050 or 877-713-8215. TTY for the hearing impaired at 711. The call is free. HealthPartners Member Services
More informationAssistance. Improving. Consumer Health. Strategies for
Assistance Strategies for Improving Consumer Health A resource to help educate consumers about available preventive health incentives and eliminating barriers to receiving care www.bhpi.org www.healthsharesolutions.org
More informationMinnesota Accountable Health Model Accountable Communities for Health Grant Program
Request for Proposals Minnesota Accountable Health Model Accountable Communities for Health Grant Program September 2, 2014 Page 1 of 79 Contents: 1. Overview... 3 2. Available Funding and Estimated Awards...
More informationUCare Connect (Special Needs BasicCare) Enrollment Form
UCare Connect (Special Needs BasicCare) Enrollment Form UCare Connect Enrollment Telephone Numbers 612-676-3554 or 1-800-707-1711 toll free. TTY for the hearing impaired at 612-676-6810 or 1-800-688-2534
More informationCOVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE
COVERED SERVICES LIST FOR HNE BE HEALTHY MEMBERS WITH MASSHEALTH STANDARD OR COMMONHEALTH COVERAGE This is a list of all covered services and benefits for MassHealth Standard and CommonHealth members enrolled
More informationA guide to choosing your Anthem Blue Cross health plan MANPOWER TEMPORARY SERVICES (NON-CORE HMO) Effective January 1, 2016
What's Inside Getting started with health insurance...3 A health plan that works for you...4 More coverage for you...5 Frequently asked questions (FAQs)...6 A guide to choosing your Anthem Blue Cross health
More informationNew provider orientation. IAPEC December 2015
New provider orientation IAPEC-0109-15 December 2015 Welcome 2 Agenda Introduction to Amerigroup Provider resources Preservice processes Member benefits and services Claims and billing Provider responsibilities
More informationCommunity Health Worker Enrollment, Coverage and Payment under Minnesota Health Care Programs. December 3, 2014
Community Health Worker Enrollment, Coverage and Payment under Minnesota Health Care Programs December 3, 2014 Community Health Worker Enrollment, Coverage and Payment under Minnesota Health Care Programs
More informationMY BENEFITS GUIDE. MCDTX_17_ Valid September 1, 2017 to February 28, 2018
2 MY BENEFITS GUIDE MCDTX_17_57630 09182017 Valid September 1, 2017 to February 28, 2018 Table of contents 4-5 Introduction Important phone numbers My Cigna-HealthSpring benefits 10-11 Members with Medicaid
More informationDivision of Medical Assistance Programs Client and Provider Education
DMAP Organization Chart... 1 Quick reference... 2 Main contact information... 2 DMAP mail codes... 2 E-mail addresses by topic... 2 Helpful telephone numbers... 2 Office of the State Medicaid Director...
More informationHealthPartners MSHO (HMO SNP) Enrollment Form
HealthPartners MSHO (HMO SNP) Enrollment Form HealthPartners Enrollment Telephone Numbers 952-883-5050 or 877-713-8215. TTY for the hearing impaired at 952-883-6060 or 800-443-0156. The call is free. HealthPartners
More informationEnrollment of Medicaid Managed Care Behavioral Health Providers in Medicaid
Enrollment of Medicaid Managed Care Behavioral Health Providers in Medicaid Section 5005(b)(2) 21st Century Cures Act November 8, 2017 November 8, 2017 2 Agenda What is this about? Outreach Letter Sent
More informationProvider Manual. Utilization Management Care Management
Provider Manual Utilization Management Care Management Utilization Management This section of the Manual was created to help guide you and your staff in working with Kaiser Permanente s Resource Stewardship
More informationVIRGINIA S MEDICARE AND MEDICAID INTEGRATION EXPERIENCE 12/2/2016
VIRGINIA S MEDICARE AND MEDICAID INTEGRATION EXPERIENCE The Honorable Dr. William Hazel Secretary of Health and Human Resources Commonwealth of Virginia Why Is It Important to Integrate Medicare and Medicaid
More informationOverview for Acute, Hospital & Ancillary Care Providers
Overview for Acute, Hospital & Ancillary Care Providers Agenda Overview Medicaid Waivers and Plan Network Services Prior Authorization and Clinical Information Billing and Claims Information Resources
More informationKaiser Permanente Group Plan 301 Benefit and Payment Chart
301 Kaiser Permanente Group Plan 301 Benefit and Payment Chart 10119 CITY AND COUNTY OF SAN FRANCISCO About this chart This benefit and payment chart: Is a summary of covered services and other benefits.
More informationIV. Benefits and Services
IV. Benefits and A. HealthChoice Benefits This table lists the basic benefits that all MCOs must offer to HealthChoice members. Review the table carefully as some benefits have limits, you may have to
More informationHealth Advocate Core Advocacy. Features
Health Advocate Core Advocacy Features Meeting Every Need Efficient and Dependable The Personal Health Advocate (PHA) is a trained professional, typically a registered nurse, supported by medical directors
More informationThe Healthy Michigan Plan Handbook
The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health
More informationMedicaid Home- and Community-Based Waiver Programs
INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Danyell Punelli, Legislative Analyst 651-296-5058 Updated: October 2016 Medicaid Home-
More informationPlan Overview. Health Net Platinum 90 HSP. Benefit description Member(s) responsibility 1,2
PureCare HSP is available through Covered CA in Kings, Madera, Sacramento, and Yolo counties, and parts of El Dorado, Fresno, Nevada, Placer, and Santa Clara counties. Plan Overview Health Net Platinum
More informationEmergency Medical Assistance Report
This document is made available electronically by the Minnesota Legislative Reference Library as part of an ongoing digital archiving project. http://www.leg.state.mn.us/lrl/lrl.asp Emergency Medical Assistance
More informationMedicaid Fundamentals. John O Brien Senior Advisor SAMHSA
Medicaid Fundamentals John O Brien Senior Advisor SAMHSA Medicaid Fundamentals Provides medical benefits to groups of low-income people with no medical insurance or inadequate medical insurance. Federally
More informationIowa Medicaid Family Planning 2012
Iowa Medicaid Family Planning 2012 What is Medicaid? A public health program through which a comprehensive range of health services for persons having no income, or a low income, are provided. 1965 amendment
More informationIndiana Medicaid Update
Indiana Medicaid Update HIP 2.0 Financing, Hospital Assessment Fee (HAF), and Other Updates November 27, 2017 Basics of the HAF Legal authority for fees Who is assessed or exempt Basis of fee Fee rates
More informationWelcome to Health Net
Welcome to Health Net When it comes to Medicare coverage, the right choice depends on your health, your budget and your lifestyle. Health Net makes choosing quality, cost-effective health care coverage
More informationSteps for Success. Personal Care Assistance
Steps for Success Personal Care Assistance Why are you here? An overview of: PCA Program guidelines Eligibility Covered services How a person gets services 2 Why are you here? Program policy requirements
More informationMedicare Plus Blue Group PPO. We have the solution.
Medicare Plus Blue Group PPO We have the solution. 1 What is Medicare Advantage? Plans offered by private insurance companies that contract with The Centers for Medicare and Medicaid Services (CMS). The
More informationFREQUENTLY ASKED QUESTIONS (FAQS) FOR PROVIDER INDUSTRY
FREQUENTLY ASKED QUESTIONS (FAQS) FOR PROVIDER INDUSTRY 1. What changes are proposed for the Medicaid Program in the State Fiscal Year 2012 budget? Will clients be notified if these changes are not approved
More informationModel of Care Heritage Provider Network & Arizona Priority Care Model of Care 2018
Model of Care Model of Care 2018 Learning Objectives Program participants will be able to: List two differences between the Complex Care Management (CCM), and Special Needs Program (SNP) programs. Identify
More informationWHAT DOES MEDICALLY NECESSARY MEAN?
WHAT DOES MEDICALLY NECESSARY MEAN? Your Primary Care Provider (PCP) will help you get the services you need that are medically necessary as defined below. Medically Necessary means appropriate and necessary
More informationTRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED CARE Frequently Asked Questions March 2015
ANDREW M. CUOMO Governor HOWARD A. ZUCKER, M.D., J.D. Acting Commissioner SALLY DRESLIN, M.S., R.N. Executive Deputy Commissioner TRANSITION OF NURSING HOME POPULATIONS AND BENEFITS TO MEDICAID MANAGED
More informationNorth Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011
North Country Community Mental Health Response to MDCH Request for Information Medicare and Medicaid Dual Eligible Project September 2011 1. What is working well in the current system of services and supports
More informationOverview of Medicaid Program
Joint HHS Appropriations Subcommittee FY 2017-19 Overview of Medicaid Program Steve Owen, Fiscal Research Division Overview of Medicaid WHAT IS MEDICAID? Medicaid is funded through Title XIX of the Social
More information3.4.2 Scope This applies to all AHCCCS eligible members and Non-Title XIX/XXI eligible persons determined to have a Serious Mental Illness (SMI).
Section 3.4 Copayments 3.4.1 Introduction 3.4.2 Scope 3.4.3 Definitions 3.4.4 Objectives 3.4.5 Procedures 3.4.5-A. Collecting Copayments 3.4.6-B. Copayments 3.4.5-C. Member Copay Matrix 3.4.5-D. Other
More informationRFS-7-62 ATTACHMENT E INDIANA CARE SELECT PROGRAM DESCRIPTION AND COVERED BENEFITS
The following services are covered by the Indiana Care Select Program. Dual-eligible members, those members eligible for both IHCP and Medicare, will not receive any benefits under Indiana Care Select,
More informationDesigning a Medicaid ACO Program: Insights from Trailblazing States
Designing a Medicaid ACO Program: Insights from Trailblazing States February 11, 2016, 3:30 5:00 pm ET For Audio Dial: 877-830-2582 Passcode: 805070 Made possible by The Commonwealth Fund www.chcs.org
More informationBenefits and Premiums are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY
The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Primary Care Physician Selection Optional There is no requirement for member pre-certification.
More informationKaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION
Kaiser Foundation Health Plan, Inc. A NONPROFIT HEALTH PLAN - HAWAII REGION 2019 Summary of Important Changes for Contract Renewals for the Kaiser Permanente Group Plan (These changes are subject to regulatory
More informationFQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction
FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction Meaghan McCamman Assistant Director of Policy California Primary Care Association 1 Agenda Incentives in PPS: what does
More information10/6/2017. FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction. Agenda. Incentives in PPS: what does excludable mean?
FQHC Incentive Payments: A Critical Practice for Quality and Patient Satisfaction Meaghan McCamman Assistant Director of Policy California Primary Care Association Agenda Incentives in PPS: what does excludable
More informationDRUG MEDI-CAL ORGANIZED DELIVERY SYSTEM (DMC-ODS) YEAR 1 PERFORMANCE METRICS (version 10/24/17)
1 Access Enrollment information to include the number of DMC- ODS beneficiaries served in the DMC-ODS program Clients Served: 1. Number of DMC-ODS beneficiaries served (admissions) by the DMC- ODS County
More informationNative American Frequently Asked Questions
Native American Frequently Asked Questions What is Centennial Care? Centennial Care is the new name of the New Mexico Medicaid program. Centennial Care will begin January 1, 2014 and services will be provided
More informationImplementing Medicaid Behavioral Health Reform in New York
Redesign Medicaid in New York State Implementing Medicaid Behavioral Health Reform in New York HIV Health and Human Services Planning Council of New York March 19, 2014 Agenda Goals Timeline BH Benefit
More informationOptions for Integrating Care for Dual Eligible Beneficiaries
CHCS Center for Health Care Strategies, Inc. Technical Assistance Brief Options for Integrating Care for Dual Eligible Beneficiaries By Melanie Bella and Lindsay Palmer-Barnette, Center for Health Care
More informationProvider Manual Section 7.0 Benefit Summary and
Provider Manual Section 7.0 Benefit Summary and Exclusions Table of Contents 7.1 Benefit Summary 7.2 Services Covered Outside Passport Health Plan 7.3 Non-Covered Services Page 1 of 7 7.0 Benefit Summary
More informationPartnering with Public Health Departments in Managed Care. THIS AREA CAN BE LEFT BLANK or ADD A PICTURE
Partnering with Public Health Departments in Managed Care THIS AREA CAN BE LEFT BLANK or ADD A PICTURE 2/3/2017 The Value of Medicaid Managed Care States Have Seen the Value of Medicaid Managed Care 75
More information2015 Member Incentive. Program Evaluation. Our mission is to improve the health and quality of life of our members
25 Member Incentive Program Evaluation Our mission is to improve the health and quality of life of our members 25 Member Incentive Program Evaluation Annual Participation Rate Program Title: Member Incentive
More informationExtra Value Summary YOU HAVE CHOICES ABOUT HOW TO GET YOUR MEDICARE BENEFITS TIPS FOR COMPARING YOUR MEDICARE CHOICES
INTRODUCTION TO THE SUMMARY OF BENEFITS FOR January 1, 2016 - December 31, 2016 Central Alabama and Mobile Area SECTION I INTRODUCTION TO THE SUMMARY OF BENEFITS This booklet gives you a summary of what
More information