Beginning Jan. 1 through July 2012 Minnesota adults and children with disabilities receiving Medical Assistance (MA) will be asked to join a Special Needs Basic Care (SNBC) health plan by Department of Human Services (DHS). This is a result of state legislation passed in 2011.
The new law provides that people may choose to opt out of enrollment at any time and return to MA fee-for-service (FFS). If someone initially opted-out and then wants to be on an SNBC plan, they can decide to do so at the end of each month. People who do decide to enroll in an SNBC plan will also be able to return to their original fee-for-service medical assistance plan if they decide the SNBC plan is not a good fit. People in counties where more than one plan is available will have the option to switch to a different SNBC plan as well.
The first thing those affected by this change need to do is watch their mailboxes. Each enrollment phase-in group will be sent a mailing 40-60 days prior to their specific enrollment date for enrolling in a plan or opting out. The mailing will specify a date by which they must notify DHS which SNBC they want join or that they want to opt out. People who have chosen to opt out would receive information annually from DHS about current plan choices and the opportunity to enroll. New MA enrollees will be sent information on SNBC, current plan choices and the opportunity to opt out.
The goal of SNBC is to promote access to primary and preventive care, including coordination with Medicare. The changes can be confusing, so consumers and their family members need to educate themselves about these SNBC’s programs and what they would mean for them.
SNBC covered benefits includes basic care services (also called State Plan services) including behavioral health services, skilled nurse visits and home health aide services. Under SNBC, most long-term care services and most waivers services will continue to be provided through MA fee-for-service. Medical assistance copays will be waived by the health plans.
SNBC plans also currently provide care coordinators or care guides to assist SNBC members with accessing benefits. Make sure the plan you choose covers your preferred providers (psychiatrist, physician, therapist, etc.) and your medications. Also check if the plan requires Prior Authorization or Step Therapy (trying an older, cheaper medication first) for your medications; if this is the case the plan may not be a good choice for you. SNBC plans are also required to provide special training to their member services staff around the needs of people with disabilities.
SNBC is not a new program, but not everyone is familiar with it. The SNBC managed care program was designed for people with disabilities, including those dually eligible for Medicare benefits with the assistance from the Disability Managed Care Stakeholders’ group. The legislation continues to require ongoing involvement of the Disability Stakeholders’ group in the oversight of the SNBC program: SNBC began in 2008 and now serves about 6,000 adults ages 18 to 64. While SNBC plans have been serving adults for several years, now they will begin enrolling children under 18. DHS expect to conduct reviews with the plan to consult with the stakeholders’ group to review contract requirements for serving children. DHS is recommending that people get involved with their local stakeholders’ group to help the program grow and better fit each individual’s needs.
SNBC is delivered through five health plans covering 78 counties; 57 counties have one plan option, 20 counties have two plan options, and one county has three plan options. Nine counties do not have SNBC plan options currently, even though it is required.
Three of the SNBC plans are integrated with Medicare through Medicare Advantage Special Needs Plans (SNPs.) South Country Health Alliance (SCHA), Prime West (PW), MHP. UCare and Medica SNBC plans are Medicaid only plans and coordinate services with Medicare. When joining an SNBC plan you can maintain the Medicare Part D you are in or join a Medicare Advantage Special Needs Plan, if it’s offered in the plan you choose.
If you have waivered services you can join an SNBC but waivered services remain covered under Medical Assistance Fee-For-Service (MAFFS). Important to understand, SNBC do not include personal care assistance (PCA) or private duty nursing (PDN) services.
These services continue to be provided under MA-FFS for SNBC enrollees. DHS intends to apply current managed care enrollment exclusions to SNBC. After exclusions are applied, about 78,216 adults and 11,544 children under 18 would be eligible to enroll.
Managed care exclusions can vary but the people excluded may include: people with other cost effective insurance or other HMO coverage, people with only Medicare A or only Medicare B, individuals on a spend down, people living in IMD/RTCs, people receiving services through the Consumer Support Grant (CSG), other small groups such as people with ESRD, terminally ill individuals, torture victims, and American Indians in certain circumstances may also be excluded.
DHS has created an Interdivisional SNBC Expansion Team that includes representatives of all divisions involved with care for people with disabilities.
This team meets monthly to identify special issues and assist with implementation and communications.
Also, the Managed Care Stakeholders group has established a list serve and updating DHS website. Each SNBC plan must operate a local stakeholders group and is required to respond to their concerns. Special Needs Plans have been encouraged to begin adding additional stakeholders representing children to their groups.
DHS has purposed establish several workgroups as part of the stakeholders’ group that will meet in between the larger group meetings. DHS is interested in stakeholders’ thoughts about these groups and other options.
Suggested workgroups: Children with Disabilities in Managed Care: issues and Readiness Reviews, Consumer Education, Involvement and Outreach, Evaluation, Care Coordination and Transitions.
Check the website www.dhs.state.mn.us/SNBC for meetings schedules and times. The answers to most questions can be found by either calling the health plan, visiting their website or by calling the Disability Linkage Line at 1-866-333-2466.