Providers | Blue Shield of California Promise Health Plan

Special Needs Plan (SNP)

Model of Care

The Centers for Medicare & Medicaid issued final regulations on Medicare Improvements for Patients and Providers Act of 2008, also known as MIPPA. As part of this regulation, the Special Needs Plan Model of Care requires implementation by January 1, 2010.

The SNP Model of Care requires that all SNP members receive an initial Health Risk Assessment (HRA) within 90 days of enrollment, and that an Individualized Care Plan (ICP) be created for each member. The ICP will be developed and shared with the member, the PCP and any other parties involved in managing the member's care such as IPA case managers or social workers. The purpose is to encourage the early identification of the member's health status, and allow coordinated care to improve their overall health.

Health Risk Assessment (HRA) Process:
Blue Shield of California Promise Health Plan created a standardized HRA that evaluates the physical, psychosocial, cognitive, and functional needs of the SNP member. Blue Shield of California Promise Health Plan has contracted with a vendor to perform the telephonic HRA. The process is as follows:

  • All HRAs will be conducted telephonically from vendor's centralized call center.
  • All calls, successful and unsuccessful attempts will be documented and reported to Blue Shield of California Promise Health Plan on a weekly basis.

Care Plan Process:
Depending on the answers to specific HRA questions an Individualized Care Plan is generated. The Care Plan is comprised of problems, interventions and goals. The problem is specific to the identified issue based on the member's answer to the particular question. The intervention is targeted to address the associated problem and either a short term or long term goal is triggered.

The member and member's PCP receives a cover letter explaining the HRA process and the Individual Care Plan. The PCP also receives a summary of the member's responses to the HRA.

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