What does CCP stand for in Medicaid?
Comprehensive Care Program (CCP) The Comprehensive Care Program (CCP) is an expansion of the THSteps program and other Medicaid programs as mandated by the Federal Omnibus Budget Reconciliation Act (OBRA) of 1989. Clients eligible to receive CCP services must be THSteps eligible at the time of delivery.
What is a comprehensive care plan and how does it work?
This includes a comprehensive care plan that lists your health problems and goals, other providers, medications, community services you have and need, and other information about your health. It also explains the care you need and how your care will be coordinated. Your health care provider will ask you to sign an agreement to provide this service.
What is an MA CCP?
The Medicare Modernization Act of 2003 (MMA) established an MA CCP specifically designed to provide targeted care to individuals with special needs.
What is a CCIP in Ma?
Per 42 CFR 422.152 (a) (2) and (c), MA organizations are required to conduct Chronic Care Improvement Program (CCIP) initiatives. The statutory and regulatory intent of the CCIPs includes the promotion of effective chronic disease management and the improvement of care and health outcomes for enrollees with chronic conditions.
What is local CCP?
Local CCP includes Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and Provider Sponsored Organizations (PSO) but excludes Regional PPO and Private Fee For Service plans (PFFS).
Is Medicare Part C and Medicare Advantage the same?
A Medicare Advantage is another way to get your Medicare Part A and Part B coverage. Medicare Advantage Plans, sometimes called "Part C" or "MA Plans," are offered by Medicare-approved private companies that must follow rules set by Medicare.
What are the 4 types of Medicare?
There are four parts of Medicare: Part A, Part B, Part C, and Part D.Part A provides inpatient/hospital coverage.Part B provides outpatient/medical coverage.Part C offers an alternate way to receive your Medicare benefits (see below for more information).Part D provides prescription drug coverage.
Does Medicare Part C replace Original Medicare?
Medicare Advantage, also known as Medicare Part C, is an alternative to original Medicare. Medicare Advantage is an “all-in-one” plan that bundles Medicare Part A, Part B, and usually Part D. Many Medicare Advantage plans also offer benefits like dental, hearing, and vision that are not covered by original Medicare.
Why do I need Medicare Part C?
Medicare Part C provides more coverage for everyday healthcare including prescription drug coverage with some plans when combined with Part D. A Medicare Advantage prescription drug (MAPD) plan is when a Part C and Part D plan are combined. Medicare Part D only covers prescription drugs.
What is the average cost for Medicare Part C?
A Medicare Part C HMO plan costs about $23 per month, while local PPO plans average $43 per month. The most expensive plans are Regional PPO plans, which average $80 per month, and Private Fee-for-Service (PFFS) plans, which average $77 per month.
What happened to Medicare Part C?
Medicare Part C has not been discontinued. However, Medigap Plan C is no longer available to new Medicare enrollees from January 1, 2020. Medicare is a federal insurance plan for people aged 65 and older. It pays for many healthcare services.
What are the top 3 Medicare Advantage plans?
The Best Medicare Advantage Provider by State Local plans can be high-quality and reasonably priced. Blue Cross Blue Shield, Humana and United Healthcare earn the highest rankings among the national carriers in many states.
Why do doctors not like Medicare Advantage plans?
If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
Do you have to pay for Medicare Part C?
Medicare Part C premiums vary, typically ranging from $0 to $200 for different coverage. You still pay for your Part B premium, though some Medicare Part C plans will help with that cost.
What type of insurance is Medicare Part C?
Medicare Part C is a type of insurance option that offers traditional Medicare coverage plus more. It's also known as Medicare Advantage. Some Medicare Part C plans offer health coverage benefits such as gym memberships and transportation services.
Can you add Medicare Part C at any time?
It runs from October 15 to December 7 each year. You can add, change, or drop Medicare Advantage plans during the AEP, and your new coverage starts on January 1 of the following year.
What is chronic care management?
Chronic care management offers additional help managing chronic conditions like arthritis and diabetes. This includes a comprehensive care plan that lists your health problems and goals, other providers, medications, community services you have and need, and other information about your health. It also explains the care you need ...
What does a provider do with urgent care?
If you agree to get this service, your provider will prepare the care plan, help you with medication management, provide 24/7 access for urgent care needs, give you support when you go from one health care setting to another, review your medicines and how you take them, and help you with other chronic care needs.
What is deductible in Medicare?
deductible. The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay. and. coinsurance. An amount you may be required to pay as your share of the cost for services after you pay any deductibles.
Does Medicare pay for chronic care?
Chronic care management services. Medicare may pay for a health care provider’s help to manage chronic conditions if you have 2 or more serious chronic conditions that are expected to last at least a year.
What is SNP in healthcare?
A SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) ...
Why do SNPs need to provide Part D coverage?
All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
What is MIPPA for SNP?
The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) lifted the Medicare, Medicaid, and SCHIP Extension Act of 2007 moratorium on approving new SNPs. MIPPA further extended the SNP program through December 31, 2010, thereby allowing CMS to accept MA applications for new SNPs and SNP service area expansions until CY 2010. CMS accepted SNP applications from MA applicants for creating new SNPs and expanding existing CMS-approved SNPs for all three types of specialized SNPs in accordance with additional SNP program requirements specified in MIPPA. CMS regulations that implement and further detail MIPPA application requirements for SNPs are located at 42 CFR 422.501-504.
Do SNPs have to follow Medicare?
SNPs are expected to follow existing MA program rules, including MA regulations at 42 CFR 422, as modified by guidance, with regard to Medicare- covered services and Prescription Drug Benefit program rules. All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
What is a CCIP in MA?
Per 42 CFR 422.152 (a) (2) and (c), MA organizations are required to conduct Chronic Care Improvement Program (CCIP) initiatives. The statutory and regulatory intent of the CCIPs includes the promotion of effective chronic disease management and the improvement of care and health outcomes for enrollees with chronic conditions. CMS recommends MAOs conduct CCIPs over a three-year period.
When do MAOs report CCIP?
MAOs must use the Health Plan Management System (HPMS) to report the status of their CCIP to CMS by December 31 annually. Submissions include an attestation by the MAO regarding its compliance with the ongoing CCIP requirement (42 CFR 422.152 (c) (2)).
Do MAOs have to submit annual updates to CMS?
MAOs must conduct the activities described in the Plan Sections and Annual Update sections as required by 422.152, but there is no requirement to submit them to CMS. In addition, MAOs should assess and internally document activities related to these quality initiatives on an ongoing basis, as well as modify interventions and/or processes as necessary. MAOs must make information on the status and results of ongoing projects available to CMS upon request (42 CFR 422.152 (c) (2)). Model templates for both CCIP components are available for reference in the CCIP Resource Document below.
What is a special needs CCP?
The Medicare Modernization Act of 2003 (MMA) established an MA CCP that was specifically designed to provide targeted care to individuals with unique special needs. In the MMA, Congress identified "special needs individuals" as: 1) institutionalized beneficiaries; 2) dual eligibles; and/or, 3) individuals with severe or disabling chronic conditions, as specified by CMS. MA CCPs that are established to provide services to these special needs individuals are called “Specialized MA plans for Special Needs Individuals,” or SNPs. 42 CFR Section 422.2 defines special needs individuals and specialized MA plans for special needs individuals. SNPs were first offered in 2006. The MMA gave the SNP program the authority to operate until December 31, 2008.
When does the CMS contract end?
The contract must include the full CMS contract cycle, which begins on January 1 and ends on December 31. The MA organization may also contract with additional LTC facilities throughout the CMS contract cycle.
What is a D-SNP?
Regulations at 42 CFR Section 422.102(e) allow dual eligible special needs plans (D-SNPs) that meet a high standard of integration and specified performance and quality-based standards to offer supplemental benefits beyond those currently permitted for MA plans. CMS has limited this benefit flexibility to qualified D-SNPs because CMS believes those plans are best positioned to achieve the objective of keeping dual eligible beneficiaries who are at risk of institutionalization in the community. In order to meet the minimum contract requirements for purposes of qualifying for the benefits flexibility, the D-SNP must:
What is an OEPI?
An open enrollment period for institutionalized individuals (OEPI) is available for individuals who meet the definition of “institutionalized individual” to enroll in or disenroll from an I-SNP. Refer to Chapter 2 of the Medicare Managed Care Manual for further information about the
What is an all dual D-SNP?
An all-dual D-SNP enrolls beneficiaries who are eligible for Medicare Advantage and who are entitled to medical assistance under a State/Territorial plan under Title XIX of the Act. An all-dual D-SNP must enroll all categories of dual eligible individuals, including those with comprehensive Medicaid benefits as well as those with more limited cost sharing.
Do D-SNPs have to have a contract with Medicaid?
As provided under Section 164(c)(2) of MIPPA, and as amended by Section 3205(d) of the ACA, D-SNPs that continue to operate in their existing service areas were not required to have a contract with their State Medicaid Agencies until January 1, 2013. Beginning January 1, 2013, all D-SNPs are required to have an executed contract with applicable State Medicaid agencies. Note that the requirement for a State contract and the requirement for NCQA MOC approval discussed in Section 40.2 of this chapter are separate requirements. D-SNPs must meet both requirements in order to operate.
Do SNPs have to have Part D coverage?
All SNPs must include required Part D prescription drug coverage , regardless of whether the MA organization offers a CCP in the area with Part D benefits. Refer to Chapter 4 of the Medicare Managed Care Manual for more information about this requirement.
What Is A Special Needs Plan?
Statutory and Regulatory History
- Chronic care management offers additional help managing chronic conditions like arthritis, asthma, diabetes, hypertension, heart disease, osteoporosis, and mental health and other conditions. This includes a comprehensive care plan that lists your health problems and goals, other health care providers, medications, community services you have and n...
Requirements and Payment Procedures
Site Overview
- A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following: 1. An institutionalized individual, 2. A dual eligible, or 3. An individual with a severe or disabling chr...