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Provider D-SNP Frequently Asked Questions

Provider Network

Reach out to your provider team to confirm your participation as a dual eligible Special Needs Plan (D-SNP) provider. 

Wellcare is assessing their networks to determine differences and working to ensure minimal disruption to members and providers. 

Should any of their current providers choose to not participate with the Wellcare D-SNP program, members are eligible for continuity of care for 12 months following the transition.

Contact Wellcare. If you are already a Cal MediConnect provider, use your existing provider services contact number.

Dual Eligible Special Needs Plans

Dual eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility. States and health plans may vary in determining their eligibility categories.

Each D-SNP plan may have different requirements. 

For Wellcare D-SNP plans, enrollees must be Full Benefit Dual Eligible, Qualified Medicare Beneficiary Plus and Specified Low-Income Medicare Beneficiary Plus. 

Definitions of all types of Qualified Medicare Beneficiary programs are available on the Centers for Medicare and Medicaid Services (CMS) Medicare-Medicaid Coordination Office website.

What will happen with current D-SNP members in Coordinated Care Initiative counties: Los Angeles, Riverside, San Bernardino, Orange, San Diego, San Mateo1, Santa Clara?1

If the D-SNP Medicare plan (parent organization) has a Medi-Cal contract,2 members will be passively transitioned into an exclusively aligned enrollment (EAE) D-SNP, effective January 1, 2023, and the Department of Health Care Services will reassign their Medi-Cal managed care plan to that parent organization’s Medi-Cal plan. Members will be notified via the current Evidence of Coverage and Annual Notice of Change materials sent in September.

If the D-SNP Medicare plan (parent organization) does not have a Medi-Cal contract in that county,3 members will remain in an unaligned D-SNP. Members will be notified via the current Evidence of Coverage and Annual Notice of Change materials sent in September.

1Wellcare does not currently (2022) have D-SNP in Santa Clara or San Mateo counties.

2For Wellcare D-SNP, this will occur in Los Angeles, Riverside, San Bernardino and San Diego counties.

3For Wellcare D-SNPs, this will occur in Orange County.

The member may be enrolled in a D-SNP Look-Alike (LAL) plan through December 31, 2022.

If they are not in a D-SNP LAL plan, their Annual Notice of Change will advise of any changes applicable to their benefits/plan for 2023.

D-SNP “Look-Alike” (LAL) Transition

D-SNP Look-Alike (LAL) plans (sometimes called “mirror” plans) are Medicare Advantage plans that are designed specifically to attract dual eligible beneficiaries who have secondary coverage through Medi-Cal.

As part of the 2021 Medicare Advantage and Part D (MA-PD) Final Rule (CMS-4190-F1), the Centers for Medicare & Medicaid Services (CMS) finalized new contracting limitations for D-SNP LAL plans at 42 CFR § 422.514(d) and (e): any non-D-SNP MA-PD plan with 80% or more full Medicaid members (full duals) will not be renewed for the 2023 plan year.

Effective January 1, 2023 Health Plans will transition To a: If one is not avaialbe then: 
Full benefit dual eligible

D-SNP the same service area if one is available.


Note: The D-SNP may be an exclusively aligned enrollment (EAE) D-NSP an, therefore, would also impact the member's Medi-Cal plan.

 

The non-renewal notice going out October 2022 will include options available to the member.

Non-full dual members

Non-D-SNP Medicare Advantage Part D plan in the same service area if one is available. 

 

The non-renewal notice going out October 2022 will include options available to the member.

Generally, a member may not know if they are enrolled in a D-SNP LAL plan.

The Wellcare plan offered in 2022 and identified by the Centers for Medicare & Medicaid Services as D-SNP LAL plan is the Wellcare Plus (HMO) H5087-002.

Transitions into the exclusively aligned enrollment D-SNP will trigger the Department of Health Care Services to reassign the member’s Medi-Cal managed care plan to the same parent organization.

For Wellcare, this will occur in Los Angeles, Riverside, San Bernardino and San Diego counties. This means that the members Medi-Cal plan will become Health Net’s Medi-Cal plan.

Example:

1. Mr. Smith lives in Los Angeles County and has a D-SNP LAL with Plan A, and for his Medi-Cal managed care plan he has Plan C.

2. Mr. Smith is transitioned to Plan A’s exclusively aligned enrollment D-SNP plan, effective January 1, 2023.

3. Mr. Smith's Medi-Cal managed care plan will change automatically to Plan A's Medi-Cal managed care plan, effective January 1, 2023, to align for better care coordination.

Non-renewal notices will be sent to members in October 2022. The notice will include if the member will be transitioned to another plan. If the health plan does not have a D-SNP in the service area, the plan will provide them with their options.

Reassure them their Medicare D-SNP LAL plan will communicate with them via mail in October 2022. 

Ask them to make sure their Medicare plan has their current address and best contact phone number so they receive the information.

Yes. As a new D-SNP member, they are subject to the D-SNP Model of Care requirements and will be required to have an updated D-SNP HRA and individualized care plan.

The D-SNP HRAs for the transitioning D-SNP LAL members will be completed by Wellcare.

Exclusively Aligned Enrollment (EAE) D-SNP Plans

Under exclusively alignment enrollment, members enroll in a dual eligible special needs plan (D-SNP) for Medicare benefits and in a Medi-Cal managed care plan for Medi-Cal benefits, which are both operated by the same parent organization for better care coordination and integration.

Exclusively aligned enrollment D-SNPs offer an integrated approach to care and care coordination. The matching Medicare D-SNP and Medi-Cal plans will work together to deliver all covered benefits to their members. And as all members in the plan are also enrolled in the matching managed care plan, they can receive integrated member materials, such as one integrated member ID card.

Enrollment into the exclusively aligned enrollment D-SNP will result in the member’s Medi-Cal plan changing to the same parent organization’s Medi-Cal managed care plan.

Wellcare’s parent organization is Centene, Inc.

For Centene plans in California, the exclusively aligned enrollment D-SNP plans will be Wellcare D-SNP with a Health Net Medi-Cal plan in Los Angeles County.

Enrollment in the exclusively aligned enrollment D-SNP will trigger the Department of Health Care Services to reassign the member’s Medi-Cal plan to the same parent organization.

These plans will be available through various health plans in Coordinated Care Initiative counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Mateo and Santa Clara.

Example:

1. Mr. Smith is a full dual beneficiary with Medicare fee-for-services and Plan A for his Medi-Cal managed care plan.

2. Mr. Smith applies for enrollment into Plan B’s exclusively aligned enrollment D-SNP to take advantage of care coordination and benefits. Mr. Smith can choose a primary care physician/participating physician group within Plan B’s provider network on his exclusively aligned enrollment D-SNP application.

3. When approved by the Centers for Medicare & Medicaid Services, Mr. Smith's Medi-Cal managed care plan will change automatically to Plan B's Medi-Cal managed care plan.

Only D-SNP look-alike members who are full dual Medi-Cal and their Medicare plan (parent organization) has a Medi-Cal contract will be transitioned into an exclusively aligned enrollment D-SNP effective, January 1, 2023, if they do not elect another plan/option to receive their Medicare benefits.

For Wellcare, this will occur in Los Angeles, Riverside, San Bernardino and San Diego counties.

Only if one is offered in the service area where the beneficiary lives. Medicare.gov can help identify plans available in the Zip Code of the beneficiary.

No, only full benefit dual eligible beneficiaries will be able to enroll into an exclusively aligned enrollment D-SNP.

Communications

Members will be notified of 2023 plan changes by mail via a Member Handbook or Evidence of Coverage and the Annual Notification of Change in September. For non-renewing plans with or without a transition to a new plan, the standard non-renewal notice will be sent to members in October 2022. 

The Annual Notification of Change will outline specific changes in benefits between the current year (2022) and the next plan year (2023).

Advise your patients to ensure their Medicare plan has their current address and best contact phone number so they receive the information.

Providers will receive communications related to this transition throughout 2022, and after the transition occurs, as needed. Providers are also encouraged to access the D-SNP Resources for Providers page online for the most current resources and updates, as the page is updated regularly.

General Information

To date, the Department of Health Care Services and Centers for Medicare & Medicaid Services have advised there will be no change to how they access their Medicare benefits.

Starting January 1, 2023, the Department of Health Care Services will require any new dually eligible beneficiary to enroll in a Medi-Cal managed care plan.