Ally Rx D-SNP Basics
What is a D-SNP?
A Dual-Eligible Special Needs Plan (D-SNP) is a special type of Medicare Advantage plan with prescription drug coverage that provides benefits to members who are entitled to both Medicare and Medicaid. The program is designed to provide targeted care to the identified member. With the D-SNP plan, Medicare is always the primary payer source. Medicaid is the payer of last resort and supplements Medicare coverage.
Security Health Plan’s Ally Rx D-SNP program is specifically designed to:
- Provide targeted care coordination to meet the special needs of these individuals
- Offer personalized guidance, with a care team consisting of a Registered Nurse, Community Support Specialist and Social Worker
- Provide resources to help members obtain the right care, at the right place, at the right time
- Serve a diverse population with complex medical, psychosocial, cognitive and socio-economic needs
- Identify gaps in care and ongoing health care needs
- Assist in improving access to high quality health care services and benefits
We partner with you to promote seamless care coordination between providers, Security Health Plan staff, facilities and care givers to achieve better health outcomes for your patients.
Care coordination assists with improving healthcare outcomes for your patients, such as:
- Decreased hospitalizations
- Decreased emergency room visits
- Managing chronic diseases
- Improving access to quality health care services and benefits
- Assisting with community resources
- Identifying gaps in care
- Provide targeted education after hospitalization, appointments and ongoing follow up
Interdisciplinary Care Team (ICT) role
The dedicated Ally Rx ICT offers the following:
- Care coordination with health care providers and family care organizations
- Connection to community resources and information (housing, food pantries, social activities, senior centers, churches, legal support, hospice and palliative care)
- Preparation for provider visits
- Explanation of provider’s recommendations and health conditions
- Support to address health and social barriers that hinder optimal health and wellness (communication, cultural uniqueness, social and community needs)
- Support for medication adherence and compliance
- Support with advance care planning
- Emotional support and family resources
- Assistance with Medicare and Medicaid benefit questions
Required Model of Care training for providers
The Model of Care (MOC) training for network providers and out of network providers encourages and supports better collaboration and communication in the care for the Ally Rx D-SNP member. Notification to new providers explains the importance of the training and the measure of participation.
Yearly, Ally Rx D-SNP providers receive an invitation to participate in the D-SNP MOC training. The providers are notified of where to locate the Ally Rx D-SNP program summary and PowerPoint presentation on the SHP website and provider portal. Training for all providers, contracted or non-contracted, is also available on the plan’s website. Because the trainings are electronic, they may be accessed at any time, making it easy for busy providers to complete as their schedule permits.
The Provider MOC Training content reviews the four key elements of the Model of Care:
- Description of the SNP Population
- Care Coordination
- Provider Network
- MOC Quality Measurement and Performance Improvement
Actions for ensuring that relevant training is completed and/or dealing with noncompliance are developed through coordinated efforts of Security Health Plan to ensure that the MOC training requirements are met. Possible actions could include, but are not limited to, the following:
- System of notification for reminders
- Education
- Individual disciplinary action plan
- Following applicable internal policies and procedures and contractual requirements. Security Health Plan may terminate an employee, provider, and or facility that do not comply.
Security Health Plan understands the importance of identifying and addressing these training challenges and has implemented the following efforts to maximize provider participation:
- Provider Manual and ad hoc communications remind contracted providers there are variances in MOCs between Special Needs types and plans.
- Availability of training on Security Health Plan’s website allows providers to complete the training at a convenient time and place.
- Participation in required training is part of the contractual relationship between the provider and Security Health Plan. This may be leveraged, if necessary. Security’s Provider Relations Department is alerted of challenges and noncompliance.
- Care Managers educate providers on applicable elements of the Model of Care, as needed.
Click here to learn more about the Ally Rx Model of Care.
Ally Rx D-SNP Benefits
Ally Rx D-SNP services covered include all benefits covered under Original Medicare. Supplemental benefits include:
- Preventive dental
- SilverSneakers (fitness membership)
- Over-the-counter (OTC) products
- Eyeglasses stipends
Support by our Ally Rx D-SNP Interdisciplinary Care Team (ICT)
- Assist each member in receiving the most appropriate, highest quality of care.
- Creation of an Individualized Care Plan (ICP) based on the results of the member’s comprehensive Health Risk Assessment (HRA).