Medical Matters: Responding to Your Questions About Special Needs Plans (SNPs)
Issue 2, 2006
In a recent issue of
Body Positive Magazine, we discussed some of the basics and benefits of HIV Special Needs Plans (SNPs, pronounced "snips"). In this issue, we review some of that information by answering questions that consumers and case managers have asked about SNPs since the last article.
What Is a Special Needs Plan (or SNP)?
A Special Needs Plan or "SNP" is a comprehensive health plan, which means that it addresses the full spectrum of medical and non-medical needs. SNPs are designed specifically to provide coordinated health care to persons living with HIV/AIDS (PWHAs).
Who Can Join a SNP?
Persons living with HIV/AIDS who have Medicaid and their children (up to age 19, regardless of HIV status). Enrollment is voluntary, and by "voluntary" we mean that you "choose" to join a SNP. No one can make you join a health plan! There is no lock-in period and SNP members can disenroll at any time.
Do PWHAs Who Join a SNP Lose Any Medicaid Benefits?
No, SNP members maintain the full Medicaid benefit package. Some of these services are paid directly by their health plan, such as emergency rooms, hospital, specialty and primary care. Providers will continue to bill Medicaid for dental, prescriptions, and COBRA case management services.
So, What Are the Benefits to Clients and Providers?
Same Day Services
In the general Medicaid program (fee-for-service), providers can bill Medicaid for only one service per day at their facility. This means that providers require PWHAs to come to the facility two, three, sometimes four times a week.
SNP members can see as many providers as needed on the same day, and the health plans pay the facility for every medical service.
HIV Experienced Providers
Many PWHAs are seeing primary care providers (PCP) who aren't credentialed HIV Specialists. Seeing a provider who isn't current on HIV care and treatment, or who isn't taking care of enough PWHAs to be an experienced provider of HIV services, has been shown to contribute to reduced health outcomes or even mortality.
SNP members are guaranteed a primary care provider who is a credentialed HIV Specialist PCP.
Choice & Extensive Provider Networks
Living with HIV disease today means more than just HIV care. PWHAs are living longer and developing other chronic health care conditions that require expert care. But in the general Medicaid program, how do you find a specialist that is knowledgeable about your condition -- who will also treat HIV patients? There is no phone directory to help you, nor any hotline to call. You pretty much have to rely on your PCP or his/her facility. But that can mean long waits for an appointment.
SNP members have access to a comprehensive network of specialists and mental health counselors, and they receive a Provider Directory that lists them by name, specialty, and location. These health plans contract with experienced providers who agree in advance to provide services to their members. This way if you're told you have to wait three months for an appointment, SNP members can pick other providers or call their health plan for assistance with an earlier appointment at another facility.
A Care Team That Works Together
Many PWHAs see providers at a number of different facilities or locations. In the general Medicaid program, often these providers aren't aware of each other or they don't share important clinical information in a timely manner. This can cause fragmented care, or even delay access to needed medical services, supportive housing, mental health care or substance abuse treatment.
SNP members have a Care Team that includes all their providers. A "Care Coordinator" at their health plan acts as the team leader. SNP members can call their Care Coordinator to get assistance with any problem, including access to care. Care Coordinators are in contact with SNP members to resolve issues that would prevent members from accessing needed care. Care Coordinators work to reduce missed appointments and to address nonmedical issues that can prevent PWHAs from keeping appointments.
24/7 Customer Service
What do PWHAs do on Friday night, or over the weekend, if they have a problem with their Medicaid card or cannot get the medical service they need? Most people have to wait until Monday morning. And then they have to call the Medicaid office to get help!
SNP members have access to their health plan 24 hours a day, 7 days a week. SNPs provide assistance to their members when they need it. Even when the Medicaid office is closed, SNPs can guarantee payment to a pharmacy for prescriptions (and they'll work with Medicaid office on Monday morning to resolve the issues).
Faster Decisions, More Provider Support
In the general Medicaid program, when a PWHA needs a piece of medical equipment, such as a wheelchair, their provider must submit documentation to the Medicaid office. Even in the best of scenarios, it often takes three to six months to get that equipment to a client's home.
SNPs can make decisions much faster, and guarantee expedited decision-making on durable medical equipment. If a provider didn't submit all the necessary information, these health plans contact providers and get the necessary information. With SNPs, these same decisions can take as little one to two weeks.
Many consumers still don't have enough information to make an informed decision about their health care options.
How Can I Contact a SNP?
If you need, or want, additional information on Special Needs Plans, please call the SNP member services lines at the phone numbers below.
Doug Wirth, MSW is the former Executive Director of the People with AIDS Coalition of New York (PWACNY), a past chairperson of the New York City AIDS Coalition, a member of the NYC HIV Planning Council, and a senior faculty member of the American Psychological Association's AIDS Hope Project. Doug is currently an independent health care consultant and maintains a private practice.
Back to Body Positive magazine, No. 2, 2006.
This article was provided by Body Positive. It is a part of the publication Body Positive.