HealthPartners Inspire (SNBC) Overview
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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
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