Information for Providers

Special Needs Plans (SNP)

If you are currently a CarePlus Health Plans, Inc.'s provider and have any questions with regards to SNPs, please contact your CarePlus Health Plans, Inc.'s Account Representative or e-mail us at CPHP_SNPInfo@CarePlus-HP.com.

It is important for Primary Care Providers (PCPs), specialists, and other health care providers to understand SNPs and the responsibilities they have for their CarePlus-covered SNP patients. Please click the links provided below to view Part 1 and Part 2 of the provider's educational presentations.

• CarePlus SNP Provider Education Part 1: SNP History and CarePlus Plans
• CarePlus SNP Provider Education Part 2: Model of Care and Physician Roles

Special Needs Plans Model of Care – Full Version

The CarePlus Health Plans Inc. Models of Care (MOC) focuses on delivering and coordinating care management and services for our special needs members. It addresses preventive care as well as acute and chronic disease processes across the continuum of care. This process is member centric and based on an Interdisciplinary Care Team (ICT) approach, which includes participation by members, their families and/or caregivers, Primary Care Provider (PCP), Care Managers, specialty physicians, ancillary providers and/or vendors involved in the treatment of the member. In addition, CarePlus incorporates evidence based care management protocols and nationally recognized care guidelines when applicable. We ask that you please take the time to review both the Dual Eligible and Chronic Care SNP Models of Care, as they contain important information regarding our SNP program goals and processes.

• 2011 SNP MOC CareNeeds (HMO) & CareNeeds Plus (HMO) – Dual Eligible
• 2011 SNP MOC CareDirect (HMO) – Diabetes

CarePlus Health Plans, Inc.'s Dual Eligible Special Needs Plan (SNP) Benefit Overview

CarePlus Health Plans, Inc. offers two (2) Dual Eligible SNP (HMO) plans for eligible members:

• CareNeeds (HMO SNP): The beneficiary must be eligible for Medicare and also eligible for full or partial levels of assistance from the state's Medicaid program.
• CareNeeds PLUS (HMO SNP): The beneficiary must be eligible for Medicare and have QMB or QMB Plus at the time of enrollment to qualify.

It is important that you as a participating provider integrate these program benefits. For your convenience, we have included below our member document, "Dual Eligible Special Needs Plans Overview". This document provides a comparison of the covered benefits offered by the plan and the benefits covered by the state's Medicaid program that will help you become more acquainted with the new plan benefits. We encourage you to review the document below and share it with your employees to ensure services are seamless across all programs.

Dual Eligible Special Needs Plans Overview

English version

Spanish version

The following Agency for Health Care Administration (AHCA), and the Florida Medicaid resources may help you with the understanding and integrating of covered Medicare and Medicaid benefits and services:

• AHCA Florida Medicaid Summary of Services Booklet (Fiscal Year 11/12)
• AHCA Florida Medicaid Provider Handbooks

Delegated Provider Resources

CarePlus Health Plans, Inc. and its parent company (Humana) are committed to informing you about legislative changes as we learn of them. To meet that commitment, we have a process for you to be able to access the new/revised legislation at your convenience.

Simply click on the link below and you will be directed to the "Delegated Provider Resources" Website.

• Delegated Provider Resources

As part of your responsibilities as a delegated health care provider, we encourage you to visit this site regularly and implement any applicable legislative changes. Please note that any legislative changes may become part of the delegation compliance oversight process.

For questions or concerns involving the CarePlus delegated functions, please contact the CarePlus Provider Service queue at 1-866-220-5448, Monday through Friday from 8 a.m. to 4 p.m. You may also submit your inquiries via e-mail at: cphpdelegation@careplus-hp.com.

Cultural and Linguistic Competency Resources

CarePlus Health Plans, Inc. recognizes cultural differences and the influence that race, ethnicity, language and socioeconomic status have on the health care experience and health outcomes. We are committed to developing strategies that eliminate health disparities and address gaps in care. Please refer to the below document for detailed information:

• CPHP Gaps in Care Providers

Multilingual Health CareResources

Learn about CarePlus Health Plans, Inc.'s multilingual health resources for health care providers and access to helpful links. We invite providers to review the information provided in the document below:

• CPHP Multilingual Health Resources

Clinical Practice Guidelines

These clinical practice guidelines are taken from national organizations generally accepted in their fields as experts, to include but not limited to: the American Diabetes Association (ADA), the American College of Cardiology (ACC), the American Heart Association (AHA), the National Heart, Lung, and Blood Institute, the National Kidney Foundation, and the Agency for Healthcare Research and Quality (AHRQ). Information contained in the guidelines inside the document below is not a substitute for a health care professional's clinical judgment and is not always applicable to an individual. Therefore, the health care professional and patient should work in partnership in the decision-making process regarding the patient's treatment. None of the information in the guidelines is intended to interfere with or prohibit clinical decisions made by a treating health care professional regarding medically available treatment options of patients.

• Clinical Practice Guidelines

Quality Resources for Healthcare Providers

Increasingly, state and federal governments are moving toward a health care industry driven by quality. Health care providers have likely noticed increased activity among Medicare Advantage payers, regarding quality initiatives.

CarePlus has developed the resources below to help health care providers navigate the new quality landscape. We'll add to this list as additional materials are completed, so we encourage you and your staff to check back often.

Should you have any questions regarding these materials, you may contact your assigned Provider Service Executive or call the CarePlus Provider Service Queue at 1-866-220-5448, Monday through Friday from 8:00 a.m. to 4:00 p.m.

• What is HEDIS, CAHPS & HOS? (579ALL0910-F)
• Quality Indicator Physician HEDIS, HOS, CAHPS and Part D Safety Measures Guide for 2012 (Measurement Year 2011) (750ALL0811-L)

Provider Crisis Contact/Location Information

Please complete the form below if a disaster or other crisis requires evacuation from your geographic area and/or relocation of your provider office(s). This information is needed so that the CarePlus Member Services department will have the most current information to provide to our members who may call for assistance in locating their providers during emergency situations. If you have any questions on when or how to use this form, please contact your assigned CarePlus Account Representative or call the CarePlus Provider Service queue at 1-866-220-5448, Monday through Friday from 8 a.m. to 4 p.m..

• Provider Crisis Contact/Location Information

Updates and Educational Resources

The Centers for Medicare & Medicaid Services (CMS) issues program transmittals to communicate new or changed policies, and/or procedures that are being incorporated into a specific CMS program manual. The cover page (or transmittal) summarizes the new material, specifying what is changed. Furthermore, CMS has developed MLN Matters® which provides Medicare coverage and reimbursement rules in a brief, accurate and easy-to-understand format.

It's important that you remain up-to-date on all regulatory changes as it is your responsibility to implement any applicable changes.

To find specific CMS transmittals or MLN Matters® articles, please visit the CMS Website at the following addresses:

• CMS Transmittals Overview
• MLN Matters Articles Overview

From time-to-time CMS makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations. You can access the NCD information by using the link below.

• National Coverage Determinations

What Health Care Providers Should Know About HB 935 – Health Care Price Transparency

We want to make you aware of recent legislation that became effective on July 1, 2011. Read the Florida Senate's Committee on Health Regulation summary of HB 935 – Health Care Price Transparency

For more information, visit the Florida Senate website.