WellCare SNP Model of Care Program

1. WellCare SNP Model of Care Program WellCare Special Needs Care Planning for Access and Select Members HFN Provider Training Slides 2009 Annual Training

2. WellCare SNP Model of Care • WellCare filed 2 Plans with CMS for SNP Model of Care enhanced Case Management services – the Access and Select Plans. • Members are considered enrolled in a WellCare SNP Program by virtue of being a dual-eligible member. • A member must be dual eligible to be in an Access or Select Plan. 2009 Annual Training

3. What is a SNP Model of Care Program • SNP Model of Care is the Architecture for Care Management policy, procedures, and operational data systems. • The focused Model of Care Program targets dual eligible Access and Select Plan members. • Care is coordinated through Case Management, with transition of care across health care settings. • All SNP Members will receive a comprehensive Health Risk Assessment, Individualized Care Plan, Regular telephone contact with an assigned Case Manager, regular Interdisciplinary Care Team meetings to re-evaluate members’ needs. • Access to preventive health, social and mental health services. 2009 Annual Training

4. Requirements for a SNP Model of Care Program • Proactive identification of members for Case Management services using available data systems. • Coordination of services for members with complex conditions and assistance for the members to access needed services, including mental health and social services. • Trained case managers to help members regain optimum health or improved functional capacity in the right setting and in a cost-effective manner. • Case Management involvement in developing a comprehensive assessment of a members’ condition, including clinical history, ADL’s, Mental Health stats, caregiver resources, determination of available insurance benefits and resources, individual care planning and performance goal development, self management activities and a monitoring and follow-up schedule. • An interdisciplinary care team approach to managing a member’s care including collaborative PCP involvement with the Care Team. • Management of the process of care transitions and identification of problems that could cause transitions, and, where possible, prevent unplanned transitions. • Coordination of Medicare and Medicaid benefits and services for members. 2009 Annual Training

5. PCP/Provider Requirements • WellCare is requesting HFN PCP’s and Specialists ongoing participation in this SNP Program: • To review faxed Care Plans for each SNP member to whom they provide care. • To update Care Plan with any changes and send back to Case Manager. • To communicate with the Interdisciplinary Care Team (ICT) as requested to ensure optimal coordination of care & transition of care. • Initial and annual training is required. Training can be web-based, self-study or by printed material or electronic media. 2009 Annual Training

6. PCP and Specialist Involvement • PCP’s will receive Member Care Plans throughout the year for existing and new members, including each time the Care Plan is updated. • Case Managers will facilitate regular communication with Providers. • Physician participation is requested to ensure the member understands their care plan and received needed care. 2009 Annual Training