2023 Dual and Chronic Condition Special Needs Plans (D-SNP/C-SNP) Assessment UHC | Quizlet

What are Dual Special Needs Plans (D-SNP)?

*Medicare Advantage Plans uniquely designed for consumers enrolled in either Medicare or Medicaid.

*Medicare Advantage Plans uniquely designed for Medicare consumers with specific long-term illnesses.

Medicare Advantage Plans uniquely designed for Medicare consumers residing in contracted Skilled Nursing Facilities.

Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid.

Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid.

When does the Special Election Period for Dual/LIS Change in Status begin for D-SNP members that lose Medicaid eligibility?

After the grace period ends

The month after they are notified by the plan of the loss of Medicaid eligibility

Six months after they have been disenrolled from the D-SNP

Upon notification or effective date of the loss, whichever is earlier

Upon notification or effective date of the loss, whichever is earlier

A D-SNP might be in the best interest of which of these consumers?

Jerry, who makes $50,000 per year at his full-time job

David, who receives $125,000 per year from winning the lottery

Mary, who raises her two grandchildren and has a full-time job

Joe, whose low income qualifies him for full Medicaid coverage

Joe, whose low income qualifies him for full Medicaid coverage

Which statement is true about C-SNPs, D-SNPs, and prescription drug coverage?

C-SNPs and D-SNPs only offer coverage for generic drugs

C-SNPs and D-SNPs do not include Medicare Part D prescription drug coverage

C-SNPs and D-SNPs only cover drugs for diabetics

C-SNPs and D-SNPs include Medicare Part D prescription drug coverage

C-SNPs and D-SNPs include Medicare Part D prescription drug coverage

When selling D-SNPs, agents must:

Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B

Ensure that the consumer only has Medicare

Tell the consumer that the D-SNP is a zero-dollar premium plan

Inform the consumer that the state Medicaid program will pay the Medicare Advantage premiums or copayments

Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B

Which consumer may be a good candidate for a D-SNP?

James, who pays a monthly premium for his prescription drug coverage

Mary, who pays a percentage of charges when she receives medical care

Anne, who does not pay a percentage of charges when she receives medical care

Larry, who has a qualifying chronic condition and wants a plan that will help him manage his illness and health care costs

Anne, who does not pay a percentage of charges when she receives medical care

Which is a service provided to a C-SNP or D-SNP member placed in the low to moderate care management risk level?

Ongoing reassessment of risk level for status changes

Individualized plan of care

Interdisciplinary Care Team

Initial Health Assessment

All of the responses are correct.

All of the responses are correct.

Which statement is true about provider information on the Chronic Condition Verification Form?

The provider indicated on the form does not have to be contracted with the plan.

The provider indicated on the form must be contracted with the plan.

The provider indicated on the form must be the primary care provider.

The provider indicated on the form must be a specialist.

The provider indicated on the form does not have to be contracted with the plan.

Which statement is true about the Medicaid program?

The only eligibility requirement is that the consumer is under the age of 65.

Regardless of the state, it is always referred to as Medicaid.

It helps pay medical costs for certain groups of people with limited income and resources.

Benefits are exactly the same from state to state.

It helps pay medical costs for certain groups of people with limited income and resources.

Which statement is true of D-SNP members?

Members who are QMB+ or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs.

They can go to any Medicare participating provider.

Once the plan pays for their covered services, their provider should bill the member for any remaining balances instead of the state Medicaid program.

They must disenroll from Medicaid to enroll into the D-SNP.

Members who are QMB+ or are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs.

Ginny just enrolled in a C-SNP that uses the post-enrollment verification method. When will the plan send her a termination notification letter if it has not yet been able to verify a qualifying chronic condition?

At the end of her second month of enrollment

At the end of a six-month grace period

At the end of her first month of enrollment

30 days after the last attempt to contact the provider

At the end of her first month of enrollment

Members who lose their eligibility for the D-SNP due to a change or loss of Medicaid status are responsible for what cost sharing?

Only Part D premiums

Only Part A premiums

All, such as premiums, deductibles, copayments, and coinsurance

The same cost sharing as before they lost eligibility

All, such as premiums, deductibles, copayments, and coinsurance

Which statement describes the primary characteristic of a consumer who may benefit from a D-SNP?

Does not need any assistance with home care

Does not want to be limited by a network of providers

Does not need a prescription drug program

Is enrolled in their state Medicaid program, typically as a Full Dual, with their Medicare cost sharing paid by the state in which they reside.

Is enrolled in their state Medicaid program, typically as a Full Dual, with their Medicare cost sharing paid by the state in which they reside.

Which statement best describes a care management program that varies depending upon the level of the member's health risk?

Support provided only to D-SNP members that may have unique health care needs

Support provided only to members who have multiple chronic conditions and receive state Medicaid benefits

Support provided only to C-SNP members that may have unique health care needs

Support provided to C-SNP and D-SNP members that may have unique health care needs

Support provided to C-SNP and D-SNP members that may have unique health care needs

Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of:

Selling C-SNPs

Selling any health insurance plans

Disenrolling from a D-SNP

Selling DSNPs

Selling DSNPs

The consumer states they currently pay a percentage of charges when they receive medical care. This means:

The consumer is not likely to be a Full Dual-Eligible; however, the DSNP is always the best option in which to enroll this consumer.

The consumer is most likely a Full Dual-Eligible; you can proceed with enrollment in a DSNP.

The consumer is enrolled in a Medicare Supplement Insurance Plan.

The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan.

The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in another type of plan.

Which of the following consumer characteristics demonstrates a good fit for a C-SNP?

A consumer with a qualifying chronic condition who wants a plan that will help them manage their illness and health care costs

A consumer who travels and does not want the limitations of a provider network

A consumer who lives outside of the plan's service area

A consumer who is not Medicare eligible

A consumer with a qualifying chronic condition who wants a plan that will help them manage their illness and health care costs

On May 10, Michael meets with an agent and says he is enrolled in another carrier's C-SNP due to his diabetes. When can Michael enroll in a different C-SNP that also covers diabetes (his only chronic condition), assuming he has not moved out of his current plan's service area?

Only during the Open Enrollment Period (OEP)

Anytime using the SEP (SEP-Special Need/Chronic)

During the Annual Election Period (AEP) or Open Enrollment Period (OEP)

Only during the Annual Election Period (AEP)

During the Annual Election Period (AEP) or Open Enrollment Period (OEP)

You must advise consumers enrolling in a D-SNP that:

They are not required to pay copayments for Medicare-covered services received from a D-SNP network provider if they are Full Dual-Eligible or determined D-SNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program.

Once the plan pays for the member's covered services, the provider should bill the member for any remaining balances instead of the state Medicaid program.

They must disenroll from Medicaid to enroll into the D-SNP.

They can go to any Medicare participating provider.

They are not required to pay copayments for Medicare-covered services received from a D-SNP network provider if they are Full Dual-Eligible or determined D-SNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program.

Using the post-enrollment method, when will a new member be disenrolled from their C-SNP if a qualifying condition cannot be verified?

At the end of the first month of enrollment

At the end of the second month of enrollment

30 days after the last attempt to contact the provider

After a 6-month grace period

At the end of the first month of enrollment

Meredith, a D-SNP member, loses Medicaid eligibility. What impact does this have on her D-SNP enrollment?

The only impact is disenrollment at the end of a grace period unless she reestablishes Medicaid eligibility.

She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility.

There is no impact to her current enrollment.

The only impact is that she will be responsible for plan cost sharing.

She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility.

Which consumer might benefit the most by enrolling in a D-SNP?

Alice, who is a Specified Low-Income Medicare Beneficiary (SLMB)

Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+)

Elsa, who pays a Part D income-related monthly adjustment amount (IRMMA)

Alvin, who has a Medicare Supplement Insurance policy

Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+)

Which of the following consumers may not be a good candidate for a D-SNP?

Susannah, who has a permanent disability and receives Supplemental Security Income (SSI)

Frank, who lives in subsidized housing and receives help with his heating bills

Jeff, who receives the meals on wheels community service

Maria, who pays a percentage of charges when she receives medical care

Maria, who pays a percentage of charges when she receives medical care

John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition. Can John enroll in a Chronic Special Needs Plan (C-SNP) that covers his chronic condition?

No, he can only enroll during the Medicare Advantage Open Enrollment Period (OEP)

No, he can only enroll during the Annual Election Period (AEP)

Yes, he can enroll using Medicare Supplement Insurance Guaranteed Issue

Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic)

Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic)

How long do plans using the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request?

By the end of the month in which the enrollment request is made.

Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer).

Within 7 days of the request for additional information.

Within 21 days of the request for additional information.

Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer).

Which program is available to support the unique health care needs of C-SNP and D-SNP members?

An online chat forum for members to discuss changes to their plan benefits

Gift cards for every year of enrollment

A support group for members to share their health care experiences with each other

A care management program that varies depending upon the level of the member's health risk level

A care management program that varies depending upon the level of the member's health risk level

What is the purpose of the Chronic Condition Verification form?

It authorizes the plan to contact the consumer's current health care plan to verify that the consumer's claim data suggests a chronic condition.

It authorizes the plan to contact the provider identified on the form in order to verify that the consumer has at least one of the qualifying chronic conditions covered by the C-SNP.

It authorizes the plan to accept the consumer's attestation as verification of having at least one of the qualifying chronic conditions covered by the C-SNP.

It authorizes the plan to contact CMS to determine if the consumer is eligible for a C-SNP.

It authorizes the plan to contact the provider identified on the form in order to verify that the consumer has at least one of the qualifying chronic conditions covered by the C-SNP.