Special Needs Plan Model of Care Self-Study Program
The Centers for Medicare & Medicaid Services (CMS) requires health plans to provide annual education and training on Wellcare By Allwell’s Model of Care to providers who treat our Special Needs Plan (SNP) members. This applies to our Dual Eligible Special Needs Plan (D-SNP) members, who are eligible for both Medicare and Medicaid, and our Chronic Condition Special Needs Plan (C-SNP) members, who have one or more qualifying conditions.
As stated in the Provider Manual, all providers who treat SNP members must complete Wellcare By Allwell’s Model of Care training and submit an Attestation.
We appreciate the quality care you provide to our members and your support of our efforts to meet CMS regulations.
Please click the link below to take the Required Medicaid Buckeye Orientation. This link takes you to the video training, that includes the required Attestation Form at the end.
The PDF link below provides you the orientation content in an easily accessible format for reference purposes only. Please note: reviewing just this PDF does NOT meet the requirement to view the video training above, along with the attestation.
CMS recently issued a requirement related to the settlement of the 2013 Jimmo v. Sebelius class action lawsuit. The settlement addresses the delivery of skilled nursing services to Medicare beneficiaries and applies to nursing facilities, home health and outpatient therapy benefits when a beneficiary needs skilled care in order to maintain function or to prevent or slow decline or deterioration (provided all other coverage criteria are met).
All Medicare providers are required to review this training in order to ensure that services are provided and coverage determinations are adjudicated accurately and appropriately in accordance with existing Medicare policy. Please click on the link below to access the training materials.
Effective 12/31/2018, the Ohio Department of Medicaid (ODM) and Buckeye Health Plan (Buckeye) will implement new signature requirement for MyCare waiver services. On and after that date, waiver service providers will be required to sign the individual’s person-centered service plan (service plan). This change meets the Centers for Medicare and Medicaid Services’ (CMS) 42 CFR 441.301 rule requiring the service plan “be finalized and agreed to, with the informed consent of the individual, in writing, and by all people and providers responsible for its implementation.”
The provider’s signature confirms that the provider acknowledges and agrees to provide the waiver service, as authorized in the waiver service plan. The signed service plan must be completed and returned to Buckeye to ensure timely payment for services. Requirements will vary depending upon the services provided.
Please watch the video presentation below with voice-over narration or view a PDF of the presentation.