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What's new for 2019: Medicare Advantage dual special needs plan

12/27/2018

In 2019, we will offer a special needs plan (SNP) for Medicare beneficiaries who also qualify for full Medicaid benefits through Connecticut’s HUSKY program.

Medicare Special Needs Plans (SNP) are Medicare Advantage plans that serve individuals with specific characteristics, chronic conditions or disabling conditions. The state of Connecticut will cover some Medicare costs, depending on the individual’s eligibility.

Our special needs plan is known as the Passage Dual (HMO SNP) plan. Like our other Passage products, members with this special needs plan are required to get referrals from their Passage primary care providers (PCPs) to see certain specialists in our ConnectiCare network.

Referral requirements for the Passage HMO SNP plan are similar to the commercial Passage plans sold to individuals under 65 and offered by employers. ConnectiCare review and approval of referrals are not required. Referrals are effective on the “Start Date” entered by the Passage PCP.

However, referrals for Passage HMO SNP plan members can only be submitted to us by faxing this form to 866-706-6929, attention ConnectiCare, Passage Dual (HMO SNP) plan referrals. Specialists who need to check Passage HMO SNP referrals have to call Medicare provider services at 1-877-224-8230 from 8 a.m. to 6 p.m. Monday through Friday.

Treatment of Passage HMO SNP plan members will follow the same ConnectiCare Medicare Advantage policies and procedures, including preauthorization request, medical and pharmacy policy criteria and other ConnectiCare policies and procedures. Claim and appeal submissions will also be the same as all other ConnectiCare Medicare plans.

Providers will need to call Medicare provider services to check benefits and eligibility of our Passage HMO SNP members. Our Passage HMO SNP members will have member ID numbers that start with K and will have the following Member ID card:

Passage Dual (HMO SNP) id card

As part of our special needs plan, we will be offering a Model of Care training for providers, as required by the Centers for Medicare & Medicaid Services (CMS). The training serves as a vital quality improvement tool and integral component to help make sure the unique needs of a SNP member are identified and addressed. It also helps providers deliver coordinated and quality care to your patients. Stay tuned for more details about the model of care training.