South Country Health Alliance Overview

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2. About this presentation How to view this presentation: Click to view the previous slide or go back to the top level slide. Click to view the next slide. Whenever you see a link like this, you can get further information. Click on the link to access the information. Other Resources Glossary of Acronyms Quick Contact Reference Updated: 3/16/2017

3. Our History • County-Based Purchasing (CBP) allows county governments to become buyers of health care for county residents eligible for state and federal health care programs. • Established as a County-Based Purchasing plan in 2001, South Country Health Alliance strives to integrate social services, public health, and medical services so members receive the right services, at the right time, in the right setting.

4. A Health Plan “Plus” More than just a health plan, South Country is a partner to the counties we serve. Through County Integration, we work together with the county toward: • Promoting and improving our members’ current state of health and well-being with Member Programs and Services. • Creating partnerships with county Public Health and Social Services as demonstrated with the Community Care Connector.

6. Service Area and Programs • South Country administers Medicare and Medicaid programs in a 12-county service area. • To meet the needs of residents eligible for state and federal health care programs within its service area, South Country offers seven programs.

7. Governance and Oversight • South Country is governed by a Joint Powers Boardmade of one county commissioner and one alternate from each county owner. • MN Department of Human Services (DHS) and Centers for Medicare and Medicaid Services (CMS) contract with South Country to administer government health care programs. • MN Department of Health (MDH) regulates insurance companies to ensure laws and rules are followed related to: • Financial solvency • Quality of care • Access to services • Complaints and appeals

8. Preventing Fraud, Waste, and Abuse • South Country is committed to preventing fraud, waste, and abuse, and encourages physicians, providers, and the community to help by reporting suspected activity. • Phone: 1-877-778-5463 – Username (SCHA), Password (Owatonna) • Website:www.reportit.net – Username (SCHA), Password (Owatonna) • Email: Jeff Marks – jmarks@mnscha.org • Mail: South Country Health Alliance, Attn: Compliance Officer, 2300 Park Dr., Suite 100, Owatonna, MN 55060

9. Funding • South Country was initially funded by an equity contribution by member counties and receives monthly capitation payments from DHS and CMS.

10. Quick Contact Reference Member Services: 1-866-567-7242 (TTY 1-800-627-3529 or 711) Fraud & Abuse: Internet: www.reportit.net • Username: SCHA Password: Owatonna Telephone: Toll-free hotline 1-877-778-5463 • Provide above username and password Write to: Compliance Officer at the address below Grievances & Appeals: Call Member Services Communications & Customer Relations: marketing@mnscha.org Website: www.mnscha.org – much information is here! Mail to: South Country Health Alliance 2300 Park Dr., Suite 100 Owatonna, MN 55060

11. Thank you for your interest inSouth Country Health Alliance.

12. Service Area and Programs Medicaid and Medicare Programs • SeniorCare Complete,a MN Senior Health Options (MSHO) program for people age 65 or older that combines Medicare and Medical Assistance benefits into an integrated health care plan. • Special Needs BasicCare(SNBC) is a MN program for people ages 18 to 64 with disabilities who are eligible for Medical Assistance with or without Medicare parts A and B. South Country has three SNBC programs: • AbilityCare (HMO SNP) combines Medicare and MA benefits into one integrated South Country health care plan. • SingleCare (SNBC) provides South Country MA benefits for individuals not eligible for Medicare benefits. • SharedCare(SNBC) provides South Country MA benefits for individuals who receive their Medicare benefits from other health plans. 24