Overview: Expansion of
Special Needs Basic Care
November 5, 2011
Outline of Session
Minnesota Health Care Managed Care Programs
Special Needs Basic Care (SNBC)
Coordination with Medicare and Medicare Part D
New legislation about enrollment changes in
Special Needs Basic Care
SNBC Enrollment phase in and opt out process
Rights of Enrollees
Where to get assistance with enrollment
Things to consider when enrolling in SNBC
How to help people with enrollment decisions
Stakeholder process and involvement
Overview Minnesota’s Managed Care
Population Eligibility Managed Enrollment
Families and • Medical Assistance Mandatory
Children • Minnesota Care
Non Disabled Mandatory
Adults without • Minnesota Care
Seniors (65+) Medical Assistance MSC+ Mandatory
People with Medical Assistance SNBC (all people Voluntary
Disabilities with disabilities in
PINs for people
with SPMI/SED in
What Do We Get From Health Plans?
Health plans provide additional customer services, interpreter
services, 24/7 nurse lines, navigation assistance, care management,
transportation, and oversight not included in current FFS systems
Since Medicare Part D is now delivered through managed care, to
coordinate drug coverage we need to work with Medicare plans
Working with health plans also participating in Medicare provides a
mechanism for improving coordination between Medicare and
Medicaid service delivery and financing
Health plans help leverage network access for people who have
difficulty accessing providers on their own (such as dental care)
Health plans help direct/manage providers to encourage preventive
care, best practices, care protocols, and work to measure improved
health outcomes across populations
Health plans conduct quality assurance and performance
improvement programs, disease management programs, pay for
performance programs and other incentives for improving and
Health plans have flexibility to pay providers and arrange care
differently to address access issues where State cannot
Administrative costs in MN health plan public programs are among
the lowest in the US, and are reasonable (about 8%)
All plans working with DHS are non profit
Minnesota Public Programs Contracted
Managed Care Organizations (MCOs)
Health Maintenance County-Based Purchasing
Organizations (HMO) (CBP) Entities
Blue Plus Itasca Medical Care
Medica PrimeWest Health
Metropolitan Health System (PW)
Plan (MHP) South Country
UCare Minnesota Health Alliance
Managed Care Enrollment Summary By Benefit
PINS ………………….................. ..........391
MSC+……………… ……………… …11,849
TOTAL MANAGED CARE 583,122
What is Special Needs BasicCare?
SNBC is a managed care program designed with
stakeholders especially for people with disabilities who
have Medical Assistance (Medicaid).
The goal of SNBC is to assure access to primary and
preventive care for members
SNBC can also assist in coordination of physical and
mental health needs.
Enrollment in SNBC is voluntary.
SNBC started in 2008 and has about 6,000 enrollees in 78
The State contracts with 5 health plans to provide SNBC.
SNBC enrollees have access to a care coordinator, care
guide or navigator to help them get physical health care,
mental health services, and support services.
Services for SNBC Members
People enrolled in SNBC have access to all of the
same basic care services provided under Medical
All Medicaid mental health benefits including Mental
Health Targeted Case Management are also
included in SNBC.
Up to 100 days of Medicare or Medicaid nursing
facility coverage and home health aide and skilled
RN visits are covered under SNBC by the health
SNBC DOES NOT INCLUDE personal care, ICF-MR,
home and community based services, private duty
nursing and county case management for people
with developmental disabilities
These and other long term care services continue to
be available through Medical Assistance fee-for-
service for SNBC members.
Special Needs BasicCare (SNBC)
SNBC COVERED SERVICES
Adult Mental Health Rehab Services: Crisis Medical Supplies and Equipment
Services, Assertive Community Treatment Medical Transportation Services
(ACT), Adult Rehabilitative Services (ARMHS), Mental Health Services including: diagnostic
Intensive Residential Treatment Services assessment and testing, crisis assessment and
(IRTS) intervention, day treatment/partial
Advanced Practice Nurse Services hospitalization, individual and family group
Cancer Clinical Trials therapy, inpatient and outpatient treatment,
Care Management Services - (Acute Medical) neuropsycnologicai assessment and rehab,
Chemical Dependency Treatment Services medication management
Child and Teen Checkups Nursing Home services (100 days for people
Children’s Residential Mental Health Treatment admitted from the community)
Chiropractic Services OBRA Level 1 (NF)
Clinic Services Obstetrics and Gynecological Services
Dental Services Outpatient Hospital Services
Disease Management Physician Services
Family Planning Services Podiatric Services
Home Care Services - Specified: Prescription and Over-the-Counter Drugs Not
Otherwise Covered by Part B or D
Home Health Aid (HHA), Skilled Nurse Prosthetic and Orthotic Devices
Visit (SNV), Home Care Therapies (PT, OT,
RT, ST) Public Health Services
Hospice Services Reconstructive Surgery
Inpatient Hospital Services Regional Treatment Centers (under certain
Interpreter Services circumstances)
Laboratory, Diagnostic and Radiological Rehabilitation and Therapeutic Services
Services (PT, OT, RT.ST)
Medical Emergency, Post-Stabilization Care, Transplants
and Urgent Care Services Tuberculosis-Related Services
Mental Health Targeted Case Management Vaccines and Immunizations
Vision Care Services
Special Needs BasicCare (SNBC)
SERVICES CONTINUED UNDER FEE-FOR-SERVICE
BASIC CARE SERVICES HOME AND COMMUNITY BASED
SERVICES WAIVER SERVICES
Abortion Services, as specified
by State and Federal law Community Alternative for Disabled
Child Welfare Targeted Case
Management Community Alternative Care (CAC)
Circumcision for Newborns, as Traumatic Brain injury (TBI-NF, TBI-
specified by State law NB)
Individual Education Plan (IEP) Developmental Disabilities (DD)
and Individual Family Service Waiver Case Management
Plan (IFSP) Services Long Term Care Coordination
ICF-MR Services (LTCC)
Long Term Nursing Home OBRA assessments, Level 1 and 2
services (post 100 days) (waivers)
OBRA Level 2 assessments Relocation Service Coordination
Personal Care Assistance (RSC)
SERVICES COVERED ELSEWHERE
Private Duty Nursing (PDN) Group Residential Housing (GRH)
Vulnerable Adult - Developmental SSI
Disability (VADD) Targeted Case SSDI
Section 8 Housing
Minnesota Department of Human
How Does SNBC Work?
There are no premiums or additional costs for enrolling
People enroll by signing an enrollment form or having
their guardians or authorized representatives sign it.
Members can disenroll (or enroll) in any month by
sending a written request to the State or the MCO
(effective the 1st of the next month).
SNBC health plans provide additional navigation
assistance and care coordination to members to help
them use the health care system.
SNBC plans are required to assist members to receive
primary and preventive care physician visits.
SNBC health plans must also assist with coordination
of Medicare benefits.
Some SNBC plans offer an integrated Medicare plan
that includes Part D drugs.
Key SNBC Contract
Health Risk screening within 30 days of enrollment
Medical home/Primary Care Clinic
Facilitation of annual physician visits
Broad availability and access to specialists,
transportation and specialty DME suppliers
Extended health related case management
24/7 RN call lines
Disability competent member services
Provide information to enrollees about clinic
Disease management programs specific to people with
Health plans will cover most Medicaid co-pays for both
duals and non duals.
Communication protocols for working with counties
and providers who are highly involved (eg residential,
Special Needs Basic Care
SNBC health plans either directly manage or
coordinate with Medicare Parts A, B, D coverage for
people who are eligible for both Medicare and Medical
Assistance (often called “Dually Eligible”).
Three of the SNBC plans also offer a Medicare Special
Needs Plan (SNP) for people with disabilities that
provides all Medicare services including Part D
prescription drugs under one card.
SNBC members can choose to enroll in these
“integrated” Medicare and Medicaid SNP plans.
For those who don’t enroll in a SNP Medicare remains
fee-for-service including Part D drugs.
Some parts of the State do not have SNP options.
SNBC and Medicare Part D Drugs
Medicare Part D is now responsible for most drugs for people
who are dually eligible for Medicare and Medicaid.
Medicare eligible people must choose a Part D Plan.
Enrollment in SNBC will not change a person’s enrollment in a
Medicare Part D Drug Plan.
SNBC plans must coordinate with Medicare Part D Plan
However, if a Medicare eligible SNBC enrollee chooses to also
enroll in their SNBC plan’s Medicare SNP, their Part D coverage
will change to that SNP plan. This allows coordination of all
Medicare and Medicaid prescription drugs under one health
Dual eligibles are charged copays for Part D drugs
Institutional enrollees are exempt from Part D co-pays
Health Plans MCOs are NOT ALLOWED to waive Part D Medicare
drug co-pays per federal Center for Medicaid and Medicare
Services (CMS) rules.
How is SNBC Going for Enrollees
SNBC has low voluntary disenrollment rates (about 3%)
High satisfaction (60% rate health plan a 9 or 10 on scale 1-10)
89% report they are satisfied with their involvement in planning
Low complaint and appeals rates
Over 30% of current SNBC enrollees have a serious mental health
condition with over 80% having some mental health diagnosis
SNBC enrollees have more health and mental health need (about
15-20% higher) than average fee-for-service enrollees (Risk
Mental Health Targeted Case Management access rates in SNBC
are also about 20% higher
DHS is working with the Institute of Community Integration at the
U of M on a large evaluation related to SNBC
SNBC also is the platform for the Preferred Integrated Network
(PIN) project, a partnership between Medica and Dakota County to
integrate physical and mental health needs of enrollees
Case studies illustrate how SNBC can be beneficial for enrollees
Medicaid payments to the health plans are “risk
adjusted” based on the diagnoses and costs of each
individual enrollee through the Chronic Disability
Payments have been specially adjusted to include
additional provisions for mental health services and
This system will provide higher payments to health
plans who enroll high cost enrollees, and lower
payments for those who enroll more low cost
Payments are designed to be budget neutral to
current fee for service costs for enrollees
Medicare also provides a separate risk adjusted
payment for dual eligible enrollees for people enrolled
Enrollees of SNBC have access to the same rights to
appeal Medicaid Assistance coverage issues as they
do under fee for service.
Members receive explanations of these appeal rights
upon enrollment and DHS also sends additional
information during the year to all members.
Enrollees are encouraged to call the health plan to let
them know of problems and can also make oral or
written grievances/appeals to the health plan.
Enrollees can also appeal directly to DHS through the
State fair hearing process or appeal both to DHS and
the health plan.
For Medicare services, enrollees also have the right
to appeal by contacting the health plan.
Enrollees can also call the Ombudsman for State
Managed Health Care Programs for assistance:
1-800-657-3729 or 651-431-2660
When SNBC Enrollees have a question or a
problem with access, services or billing,
they may contact:
Health Plan Member Services.
The County Advocate.
The Ombudsman for State Managed Care Health
Care Programs (651) 431-2660.
Care Navigator, Care Guide or Care Coordinator
DHS Appeals Office.
DHS developed SNBC with the assistance of a broad
group of stakeholders, including disability
advocates, consumers, counties, providers and
health plan representatives.
This Statewide group will continue to meet to
provide input to DHS in monitoring and oversight of
SNBC. The group meets quarterly and meetings are
open to the public.
Contact Cindy Czech 651-431-2514 to be added to
the mailing list.
Each health plan participating in SNBC is required
to have a similar local stakeholder’s group.
This is an opportunity for consumers and health
plans to work together to improve SNBC on an
What are the Special Needs BasicCare
Health Plan Options?
MCO PLAN SNBC PROGRAM NAME
Medica AccessAbility Solution
Prime Health Complete
PrimeWest Health *
South Country Health *
UCare UCare Connect
* Offers Medicare SNP 21
Beginning Jan. 1, 2012, people with
disabilities under age 65 (including children)
who have Medical Assistance fee-for-service
coverage will be asked to enroll in an SNBC
health plan for their health care. Some
people may be excluded. Anyone can
choose not to enroll and “opt out” to stay in
fee-for-service. Those who do not opt out
will be enrolled.
This expansion of SNBC was mandated by
the 2011 Minnesota Legislature (256B.69,
subd. 28) 24
SNBC Expansion Legislation
New legislation requires that adults and children with disabilities
receiving Medical Assistance (MA) be assigned to a Special
Needs BasicCare (SNBC) health plan unless individuals choose
to opt out of enrollment
Beginning Jan. 1, 2012, people with disabilities who have MA
must be asked to join a health plan participating in SNBC.
People may choose to opt out of enrollment or to disenroll at
any time and return to MA fee-for-service (FFS).
Estimated 78,216 adults and 11,544 children with disabilities
could be affected by the new law.
Preliminary analysis indicates about 19,600 (25%) of these adults
have a serious mental illness.
Enrollment will be phased in between January and July 2012. The
legislation projected that 50 percent would choose to opt out.
SNBC is still considered a “voluntary” program under federal
regulations due to the opt out provision.
People enrolling under the new legislation for Medicaid would not
be required to enroll in the Medicare SNP portion of SNBC but25
could do so at any time.
New SNBC Enrollment Process
SNBC enrollment expansion will be phased in between January
and July 1, 2012.
All potential enrollees will receive letters informing them of the
new enrollment process.
The mailing will include information on SNBC, the health plan
available in their county, their rights, the opt out process and
how to contact the Disability Linkage Line for assistance.
An opt out form will be included . People who want to opt out can
return the form by the deadline and they will not be enrolled.
People will NOT be enrolled before they are given a chance to opt
If they do not return the form, they will be enrolled in one of the
plan choices in their area by the State.
People who have been enrolled can opt out at any time effective
the next month.
People who opted out may also choose to enroll at a later time.
SNBC Revised Implementation Schedule:
First Phase: January 1, 2012
Adults (Approx. 8700), not on HCBS waivers, in
counties currently served by Medica, SCHA and
PrimeWest where there is only one plan choice
(Counties with no choice of health plan – the person
is enrolled in whatever health plan serves that
The initial mailing notifying people of the managed
care program called Special Needs BasicCare
(SNBC) and the legislation enrolling them in a SNBC
unless they choose not to join SNBC is expected to
be sent the week of November 7th.
Second Phase: February 1, 2012
Adults (Approximately 6300), not on HCBS waivers, in
counties served by UCare where there is only one plan choice
(UCare is the only health plan choice). The initial mailing
notifying people of the managed care program called Special
Needs BasicCare (SNBC) and the legislation enrolling them in
a SNBC unless they choose not to join SNBC will be sent the
week of December 5.
Third Phase: March 1, 2012
Enroll adults on HCBS waivers (CAC/CADI/TBI/DD) in all
counties (Approximately 20,628 adults) currently served by
SNBC MCOs. The initial mailing notifying people of the
managed care program called Special Needs BasicCare
(SNBC) and the legislation enrolling them in a SNBC unless
they choose not to join SNBC will be sent the week of January
Fourth Phase: April 1, 2012
Enroll all remaining adults (Approximately 41,000 adults not
on waivers) in counties with choice currently served by SNBC
MCOs. The initial mailing notifying people of the managed care
program called Special Needs BasicCare (SNBC) and the
legislation enrolling them in a SNBC unless they choose not to
join SNBC will be sent the week of February 1st.
Fifth Phase: July 1, 2012
Enroll all eligible children (approximately 11,000) statewide
plus adults (Approximately 1900) in the 9 counties currently
without SNBC MCO product. The initial mailing notifying
people of the managed care program called Special Needs
BasicCare (SNBC) and the legislation enrolling them in a
SNBC unless they choose not to join SNBC will be sent the
week of May 1sth.
Some people are excluded from enrollment in SNBC:
People with other cost effective insurance or other HMO
People with only Medicare A or only Medicare B
People living in IMD/RTCs
People receiving services through the Consumer Support Grant
Other small groups such as people with ESRD, terminally ill
individuals, torture victims, and American Indians in certain
circumstances may be excluded.
Monthly spenddowns: SNBC will no longer enroll new members
with monthly income spenddowns to enroll.
Current members with spenddowns may remain enrolled
Those already enrolled may continue in SNBC if they later incur
a spenddown but they agree to pay the spenddown to the State.
Phase-in enrollment mailings:
Each enrollment phase in group will be sent a mailing 45
days prior to their specific enrollment date with materials
for enrolling in a plan or opting out.
The mailing will specify a date by which they must notify
DHS 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 Medical Assistance enrollees will be sent information
on SNBC, current plan choices and the opportunity to opt
out or enroll.
Tracking of those who opt out will be maintained by DHS
People are encouraged to call the Disability Linkage Line for
assistance with enrollment if they have questions or need
help with their options. (1-866-333-2466).
DHS will do the enrollments, not the counties.
People enrolling under the new legislation for Medicaid
would not be required to enroll in the Medicare SNP
portion of SNBC but could do so at any time.
Disability Linkage Line: assists Medicare recipients of
all ages with problems with their Medicare coverage
and with selecting a Medicare Part D plan (SNBC
include Medicare Parts A, B & D benefits).
Disability Linkage Line: 1-800-333-2466
The Linkage Line can also help with SNBC SNP
Medicare: answers questions about Original Medicare
Information from the Health Plan
Shortly after enrollment enrollees should get information
from the health plan including:
Evidence of Coverage
Explains what is covered and what is not covered by the
How to get the care needed or prescriptions filled
What to do if unhappy with something related to getting
covered services or prescriptions filled
Members rights and responsibilities
Health Plan Member Card
Card includes member ID on the front
Health Plan contact numbers are on the back (member
services and 24-hour nurse line)
Carry member cards at all times
A list of the Health Plan’s network providers
All health plan information must be reviewed and approved
by the State.
Things to think about
when choosing a plan.
Get information about the doctors available to
serve you and the hospitals and other health care
providers affiliated with the plan. If you want to
keep the doctors you are with find out which
health plans your provider is associated with. Are
your specialists associated with the health plan?
Determine whether the plan’s providers are in a
location convenient to you and whether
transportation is available for you.
Determine if your prescription drugs are covered
by the health plan.
Find out about any additional benefits the health
There is a good guide on the SNBC training site
(Go to MCO grid for comparison, and “Guide to
Enrollment – on DHS website) 34
Primary Care Clinic
Primary Care Clinic: the clinic you chose
for your routine care. Most of your cares
will be provided or approved by this clinic.
The name of your clinic appears on your
health plan card.
Must select a primary care clinic or one
will be selected for you.
Some health plans allow you to choose a
specialist as a primary care provider.
Assistance with Implementation
Providers/stakeholders can help individuals and assist with a
smooth transition in the SNBC Expansion by:
Identifying which clients/individuals are likely impacted by
the SNBC Expansion
Familiarize yourself and staff with the SNBC expansion
implementation schedule, and the draft of the letter eligible
people will be receiving in the mail from DHS.
At appointments/contacts, ask the individual if he/she
received a letter from DHS about their health care
coverage, did the individual open it and read it, review it
with him/her, tell him/her that it is important (don’t throw it
away), where he/she can get more information and help
(DLL, SNBC website, MCO member services, MCO
Encourage individual to discuss this information with their
support networks such as family/friends.
Assistance with Implementation –
Download the “Guide for Enrollment” and distribute to
Assist in communication with DLL, if needed. DLL is happy to
do three-way conversations:
Follow up with him/her at future contacts to see if the person
has the needed information for person to make decisions, and
take actions/mail response, if needed.
Help the individual transition (if changes in doctors, clinics,
providers, to MCO/different MCO)
GOAL: INDIVIDUAL MAKES INFORMED CHOICE/S
What if your prescription is not on
your copy of the formulary
Confirm the health plan does not cover the drug
Call your care navigator/care guide
Call member services
If the prescription is not covered
Ask your doctor if you can switch to another drug that is
covered by the health plan
You or your doctor can ask to make an exception to
cover your drug
If you recently joined the health plan you may be able to
get a temporary supply of a drug you were taking when
you joined the health plan. Work with member services
or your care navigator on the transition.
The health plan is responsible for care when an
enrollee is changing from fee-for-service or from
one health plan to another. The plan may develop
a transition plan special situations.
Contact the plans member services when
continuity of care is needed for this type of
service, such as;
Services previously authorized
At risk pregnancy
Chemical dependency treatment service
Mental health services
Information for Providers
Identify which and how many of your current and future
clients will likely be impacted by the expansion of SNBC.
Identify which MCOs currently and in 2012 will serve
eligible individuals residing in your service area.
Determine if your organizations contracts with the MCO/s to
provide the services your organization is providing for your
clients. Discuss with MCO topics, such as, strategy for
“preparing for the expansion”, helping enrollees transition,
and impact on referrals.
If your agency is interested in joining the provider network
of MCO – Identify your organizations strengths, costs and
questions to discuss with MCO/s. Contact MCO for
discussion/information about contracting with the MCO/s.
DON’T contact MCO about specific individual client until
after the client’s “Group” is enrolled – MCO will not have
individual specific information until then. 40
Call the MCO first – most
questions/problems can be resolved
by contacting them directly.
If problem is not resolved, call the
DHS Provider HelpDesk 651- 431-
2700 who will put you in touch with a
Topic Driven Workgroups
SNBC Web Site
DHS Managed Care
Pam Parker, Manager,
Sue Kvendru, Senior Programs in Managed Care Program Policy
Deb Maruska, People with Disabilities Managed Care Program Policy
Susan Kennedy, SNBC Coordinator
Cindy Czech, Stakeholders Workgroup
JoAnn Jones, Lead Worker Service Implementation
Where to Access
SNBC on the Web
The SNBC color map:
Managed Care Enrollment Figures:
SNBC web site:
CAC- Community Alternative Care Waiver
CADI – Community Alternatives for Disabled Individuals Waiver
CBP – County Based Purchasing
CMS - Centers for Medicare and Medicaid Services
DD – Developmental Disability Waiver
Dual eligibles – Person eligible for both Medicare and Medicaid
DHS – Department of Human Services
EOC- Evidence of Coverage
EW- Elderly Waiver Program
FFS – Fee For Service
HMO – Health Maintenance Organization
MCO- Managed Care Organization
MHCP- Minnesota Health Care Program
MSC+- Minnesota Senior Care Plus
MSHO - Minnesota Senior Health Option
NF – Nursing Facility
PMAP - Prepaid Medical Assistance Plan
PINs- Preferred Integrated Network
SNBC – Special Needs BasicCare
SNP – Special Needs Plan
TBI- Traumatic Brain Injury
VADD - Vulnerable adult/developmental disability targeted case management services
When Health Care
we will make
health care work
Not to be copied or distributed without DHS