The Centers for Medicare & Medicaid Services (CMS) regulations require that health plans provide their Special Needs Plan provider network with information on their basic Model of Care. This applies to our Dual Eligible Special Needs Plan (D-SNP) members, who are eligible for both Medicare and Medicaid, and Chronic Condition Special Needs members (C-SNP), who have one or more qualifying conditions.
We have included a self-study program that outlines the basic Model of Care requirements for our providers. We also have a Special Needs Plan (SNP) FAQ Page containing frequently asked questions and other helpful information.
CMS requires us to educate providers who usually treat our SNP members annually about Wellcare’s Model of Care. Annually we will update the provider training material to align with the current year Model of Care.
Current Medicare Provider Expectations – Model of Care
We ask that you partner with us to ensure we are giving the highest quality of care possible to our SNP members by performing the following steps:
- Review the member care plans Wellcare faxes to you
- Update the care plan with any required changes and fax the revised plan back to Wellcare at 1-866-287-3286.
- Call 1-866-635-7045 with questions or to further discuss the care plan.
- Please keep a copy of the updated care plan to review with the SNP member during the next office visit.
- Participate in the Interdisciplinary Care Team (ICT) for all SNP members and give feedback as appropriate.
- Partner in the transition of care process when a SNP member is admitted and is discharged from an inpatient and/or subacute setting of care.
- Inpatient and subacute providers: During planned and unplanned transitions of care communicate with the next level of care provider, the member’s primary care practitioner or specialist, to share updated treatment plans including: diagnoses, test results, and treatments/procedures performed, discharge instructions and a current medication list to assist with coordination of care.
- Primary Care Practitioners: We will inform you when a member admits to an inpatient and/or subacute level of care when we are notified of this admission. We ask facility and facility providers share the member’s diagnoses, test results, and treatments/procedures performed, discharge instructions and a current medication list. If you have not received this information, please request this information via the electronic health record, if available, or the medical records department at the facility to help update the member’s chart and assist in coordination of care. Complete a medication reconciliation within 30 days of discharge.
We appreciate the quality care you provide to our members and your support of our efforts to meet the CMS regulations regarding the SNP Model of Care.