Special Needs BasicCare Work Aid

Title:	65+ SNBC Transition to MSHO/MSC+
Program(s):	SNBC	Effective Date:	12/1/2016
Frequency:	Monthly	System(s):	Delegate EDI portal
Process Owner:	SNBC Leader Team	Back-up Owner:
Revised by:	Ashley Horak	Last Revision:	02/27/21
Preparation/Materials:	EDI portal report

Purpose:

To ensure SNBC members who are turning 65 and need to transition to MSHO or MSC+ are making an informed decision and do not have gaps in care coordination.

DHS Background and Process:

3 months before an SNBC enrollee turns 65, he or she will receive an enrollment packet in the mail from DHS. In general, the person will move to MSHO or MSC+ on the first day of the month following the month of his or her birthday. The only exception is if the person’s birthday is on the first day of that month. In that situation, the person will move to MSHO or MSC+ on his or her birthday. The enrollment packet will include a letter that will explain by what date they need to make their choice, and that they will get another letter telling them when their new health plan and health care program will start.

SNBC enrollees get a different letter depending on if they have ESRD, a medical spend down, and if they do or do not currently have Medicare parts A and B. If the member is eligible for Medicare parts A and B when they turn 65, they can enroll in MSHO. This letter will also explain how to find out if there are eligible for Medicare and how they should enroll prior to turning 65 years old.

All SNBC enrollees who turn 65 must transition out of SNBC.

*People transferring from SNBC can keep their disability waiver as long as they maintain eligibility criteria and choose to remain on the same waiver.

Those enrollees with PCA will get services arranged through HealthPartners if they choose to stay with HealthPartners.

All non-EW waivers are still managed by the county.

If an enrollee has a medical spenddown and they will have Medicare parts A and B by the time they are 65, they have a onetime opportunity to enroll in MSHO.

HealthPartners SNBC members turning 65 years of age are identified via reports produced by HealthPartners on a monthly basis. The reports are identifying members who are turning 65 in the next 90 days, giving care coordinators ample time to outreach and provide education and support.

When to use: When you receive notification from HealthPartners of members who have been identified as turning 65 years of age and required to transition to MSHO/MSC+.

Actions required by delegate/care coordinators:

Review spreadsheet of identified SNBC members who are turning 65 years of age and assigned to your entity for care coordination

Care coordinators need to reach out to members who are dually-eligible and have a medical spenddown to let members know they have a one-time opportunity to choose the MSHO program, otherwise the member will be moved to MSC+.

Have care coordinators reach out to remaining members to answer any questions and provide any needed support in assisting the member to facilitate a successful transition to MSHO or MSC+.

Care coordinators will need to complete the HCBS Waiver, AC and ECS Case Management Transfer and Communication Form (DHS-6037-ENG) that should include the following information as applicable under the “Current Issues/Considerations” section of this form:

Benefit Exceptions: If the member is currently receiving a benefit exception, document what the benefit is, the reason for the benefit exception, first name of the treating provider, last name of the treating provider, NPI of the treating provider, phone number of the treating provider, and ICD-10 diagnosis code.

Complex Care: Indicate if the member qualifies for HealthPartners’ definition of complex care and if the member is waiting for a transplant, is ventilator dependent, or uses a Wound Vac. Document the provider NPI.

Mental Health Services: Note if the member is utilizing mental health services which include Mental Health Targeted Case Management (TCM), Assertive Community Treatment (ACT), Intensive Residential Treatment Services (IRTS), Adult Rehabilitative Mental Health Services (ARMHS), or Crisis Residential services. Document date of service.

Medications used for off-label purpose: include the name of the medication, the dosage, the pharmacy, phone number of pharmacy, and prescriber.

Durable Medical Equipment (DME): Document if the member is currently in the process of buying a hospital bed or wheelchair, include the provider name, provider NPI, and provider phone number.

Recent hospitalizations: any known hospitalizations that occurred 60 days prior to transition date.

Chemical Health Treatment: Include the type of CD treatment, date of service, provider name, provider phone number, and provider NPI.

Delegate entities will send all DHS-6037 form and attach a copy of HRA and Care Plans if available on each member to HealthPartners SNBC team or when known, the new health plan member is transitioning to prior the 25th of the month SNBC eligibility ends.

If delegate works with new health plan, timely communication via the 6037 should be made in order to ensure continuity in care coordinator assignment.

The person can choose a health plan if there is more than one health plan available in their county for MSHO and MSC+. If a person doesn’t choose a health plan, they will be assigned to a MSC+ health plan by one of two ways:

If the health plan they are currently in for SNBC is available for MSC+ in their county, they will be assigned to that health plan.

If the health plan they are currently in is not available, they will be randomly assigned to an MSC+ health plan.

Members can contact the Senior Linkage Line at 800-333-2433 with questions or if they need assistance with health plan selection.