D-SNP for Providers Frequently Asked Questions

Reach out to your provider team to confirm your participation as a D-SNP provider in the 2024 D-SNP Plan Network.

Wellcare By Health Net is assessing their networks to determine differences and working to ensure minimal disruption to members and providers.

Should any of their current providers choose to not participate with the Wellcare By Health Net D-SNP program, members are eligible for continuity of care for 12 months following the transition.

No. You do not need to be contracted with Health Net or CalViva Health Medi-Cal to provide Medicare covered services to our D-SNP members. You would only need to be contracted with CalViva Health or Health Net Medi-Cal if you are providing Medi-Cal covered services not covered by Medicare (such as LTC or CBAS).

Use your existing provider services contact number.

D-SNP network.

Only if that provider is part of the D-SNP Network.

Dual eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility. States and health plans may vary in determining their eligibility categories.

A dual eligible beneficiary should join a D-SNP because it provides a more streamlined, hassle-free experience in navigating through benefits. This is because the plan provides care coordination services designed to help arrange services on the member's behalf, and often offers extra benefits beyond what beneficiaries can get from Original Medicare and Medi-Cal.

Each D-SNP may have different requirements.

For Wellcare By Health Net D-SNPs, enrollees must be Full Benefit Dual Eligible, Qualified Medicare Beneficiary Plus and Specified Low-Income Medicare Beneficiary Plus.

Definitions of all types of Qualified Medicare Beneficiary programs are available on the Centers for Medicare & Medicaid Services Medicare-Medicaid Coordination Office website.

Current D-SNP members will remain enrolled in the Wellcare By Health Net D-SNP plan even though their Medi-Cal managed care assignment will change from Health Net to a different health plan effective January 1, 2024.

Under exclusively alignment enrollment, members enroll in a dual eligible special needs plan (D-SNP) for Medicare benefits and in an Medi-Cal Managed Care Plan for Medi-Cal benefits, which are both operated by the same parent organization for better care coordination and integration.

Exclusively aligned enrollment D-SNPs offer an integrated approach to care and care coordination. The matching Medicare D-SNP and Medi-Cal plans will work together to deliver all covered benefits to their members. And as all members in the plan are also enrolled in the matching managed care plan, they can receive integrated member materials, such as one integrated member ID card.

Enrollment into the exclusively aligned enrollment D-SNP will result in the member's Medi-Cal plan changing to the same parent organization's Medi-Cal managed care plan.

Wellcare By Health Net's parent organization is Centene, Inc.

For Centene plans in California, the exclusively aligned enrollment D-SNP plans will be:

• Wellcare By Health Net D-SNP with a Health Net Medi-Cal plan in Los Angeles, Sacramento, and Tulare.
• Wellcare By Health Net D-SNP with a CalViva Health Medi-Cal plan in Fresno, Kings, and Madera counties.

Enrollment in the exclusively aligned enrollment D-SNP will trigger the Department of Health Care Services to reassign the member's Medi-Cal plan to the same parent organization.

These plans will be available through various health plans in multiple counties throughout California.

Example:

1. Mr. Smith is a full dual beneficiary with Medicare fee-for-services and Plan A for his Medi-Cal managed care plan.
2. Mr. Smith applies for enrollment into Plan B's exclusively aligned enrollment D-SNP to take advantage of care coordination and benefits. Mr. Smith can choose a primary care physician/participating physician group within Plan B's provider network on his exclusively aligned enrollment D-SNP application.
3. When approved by the Centers for Medicare & Medicaid Services, Mr. Smith's Medi-Cal managed care plan will change automatically to Plan B's Medi-Cal managed care plan.

Only D-SNP members who are in a new exclusively aligned county for 2024 will be automatically enrolled into exclusively aligned D-SNP plan/Medicare Medi-Cal plan effective January 1, 2024, if they do not elect another plan/option to receive their Medicare benefits.

For Wellcare By Health Net, this will occur in Fresno, Madera, Sacramento, and Tulare counties.

Only if one is offered in the service area where the beneficiary lives. Medicare.gov can help identify plans available in the ZIP Code of the beneficiary.

No, only full benefit dual eligible beneficiaries will be able to enroll into an exclusively aligned enrollment D-SNP if there is one offered in their county of residence.

A Medicare Medi-Cal Plan (MMP or Medi-Medi Plan) is a type of Medicare Advantage plan. It is for people who have both Medicare and Medi-Cal. It combines Medicare and Medi-Cal benefits and Medicare prescription drug benefits into one plan.

Medi-Medi Plans will coordinate all benefits and services across both programs, including all Medicare and Medi-Cal covered services.

• One care team to coordinate care.
• One health plan to coordinate delivery of services, including medical supplies, transportation, and long-term services and supports.
• One set of benefits and a network of providers, including doctors, hospitals, clinics, labs, pharmacies, and medical equipment suppliers.
• Members may get extra benefits like dental, hearing, or vision coverage, in addition to what Medi-Cal covers (refer to the Member Handbook for the full benefit details).

Only Dual Special Needs Plan (D-SNP) members who are in a new exclusive aligned county for 2024 will be automatically enrolled into exclusive aligned D-SNP plan/Medicare Medi-Cal plan effective January 1, 2024, if they do not elect another plan/option to receive their Medicare benefits.

• For Wellcare By Health Net, this will occur in Fresno, Madera, Sacramento, and Tulare counties.
• For D-SNP members in Fresno and Madera counties, their Medi-Cal plans will be assigned to CalViva.
• For D-SNP members in Sacramento and Tulare counties, their Medi-Cal plans will be assigned to Health Net.

Members will be notified of 2024 plan changes by mail via the Annual Notification of Changes (ANOC) in September 2023 and/or the standard non-renewal notice sent in October 2023.

The Annual Notification of Change will outline specific changes in benefits between the current year (2023) and the next plan year (2024).

Advise your patients to ensure their Medicare plan has their current address and phone number so they receive the information.

Providers will receive communications related to this transition throughout 2023, and after the transition occurs, as needed. Providers are also encouraged to access the D-SNP Resources for Providers page for the most current resources and updates, as the page is updated regularly.

Medi-Cal awards for Health Net determine where Wellcare By Health Net can have an exclusive aligned/Medi-Medi plan.

As such, there will be 4 distinct D-SNP plans in Calif. for 2024:

1. Standard D-SNP plans in Amador, Imperial, Kern, Placer, San Francisco, San Joaquin, and Stanislaus counties.
2. Exclusive Aligned D-SNP plans in Fresno, Kings, and Madera counties where the member is aligned with CalViva Health.
3. Exclusive Aligned D-SNP plans in Los Angeles, Sacramento, and Tulare counties where the member is aligned with Health Net.
4. Grandfathered/"Do-Not-Sell" D-SNP plans in Orange, Riverside, San Bernardino, and San Diego counties.

CalViva Health is a Medi-Cal Managed Care Plan not affiliated or owned by Centene. They are the Local Initiative Health Plan for Medi-Cal managed care in Fresno, Kings, and Madera Counties (Central Valley). CalViva Health is a full-service health plan contracting with DHCS to provide Medi-Cal Covered Services to Medi-Cal managed care enrollees under the Two-Plan model in all zip codes in Fresno, Kings, and Madera Counties. CalViva Health contracts with Health Net Community Solutions, Inc. on a capitated basis to provide and arrange for Medi-Cal Covered Services in all zip codes in Fresno, Kings, and Madera Counties.

To meet the goals of the CalAIM Program, CA Medi-Cal plans will be required to also have a Medicare Advantage D-SNP Plan. CalViva Health only has the Medi-Cal contract with the State and does not have any Medicare contracts with CMS. Since Health Net’s parent organization, Centene, has a Medicare Contract, CalViva Health and Wellcare by Health Net have partnered to provide an Exclusive Aligned Enrollment D-SNP plan in Fresno, Kings and Madera Counties for 2024

If a dual eligible beneficiary joins the Wellcare By Health Net D-SNP plan in Fresno, Kings, and Madera counties, they will be automatically assigned to CalViva Health for their Medi-Cal Managed Care Plan.

For dual eligible beneficiaries who choose to enroll in a Medicare Advantage (MA) plan in those counties, their Medi-Cal plan must align with their MA plan choice, if there is a Medi-Cal plan affiliated with their MA plan. The Medi-Cal matching plan policy does not change or impact a beneficiary's MA plan choice.

D-SNP matching plan counties

• The 12 counties with the Medi-Cal matching plan policy in 2023 are: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, Santa Clara, and Stanislaus counties.​
• Starting in January 2024, this policy will be implemented in three additional counties: Kings, Madera, and Tulare counties.​

Some D-SNP members are having to transition to a different D-SNP plan for 2024 because DHCS is requiring the health plans to consolidate all D-SNP plans into a single CMS H-contract. The Wellcare By Health Net D-SNP plan will be under the H3561 contract and the associated provider network.

Yes, contact Provider Services at 800-929-9224 to confirm your participation as a dual eligible Special Needs Plan (D-SNP) provider in the H3561 network or any question about the transition. (This could be different from the previous year's D-SNP network).

Wellcare By Health Net is assessing their networks to determine differences and working to ensure minimal disruption to members and providers.

Should any of their current providers choose to not participate with the Wellcare By Health Net D-SNP program, members are eligible for continuity of care for 12 months following the transition.

The members in the Alameda County will receive the 90-day non-renewal notice in mail in October informing them about the change in their plans along with some options to enroll. If a member does not select a different plan, he/she will transition to a Medicare fee-for-service or a Part D Standalone plan.

Inform the member to contact the health plan by using the phone number on the back of their ID card for any Medicare and Medi-Cal benefits related questions.

• For D-SNP members in Fresno, Kings, and Madera counties, call 833-236-2366
• For D-SNP members in all the other counties, call 800-431-9007

Inform the member to contact Member Services for support.

Also remind the member that any referral for services which require an approval will generate a written response to them. And if denied, the member will be provided with their appeal rights.

Inform the member to contact Member Services for support.

Also remind the member that any referral for services which requires an approval will generate a written response to them. And if denied, the member will be provided with their appeal rights.

Research the findhelp platform, which can provide the member with the Community Supports, and help the member get connected to the services. You can also submit a request for care coordination to Wellcare By Health Net using the referral form (PDF).

The Public Programs team will help our members connect to these Community Supports via help_referral@healthnet.com.

All providers are identified in the provider directory under "Other Facilities" Members can self-refer to the Community Support service.

The Community Resource/Supports may include, but is not limited to, the following services:

1. Housing Transition Navigation Services (homeless, or about to become)
2. Housing Deposits
3. Housing Tenancy and Sustaining Services
4. Short-Term Post Hospitalization Housing
5. Recuperative Care (medical respite)
6. Respite Services
7. Day Rehabilitation
8. Nursing Facility Transition/Diversion to Assisted Living Facilities
9. Community Transition Services/Nursing Facility Transitions to a Home
10. Personal Care and Homemaker Services
11. Environmental Accessibility Adaptations (home modifications)
12. Meals/Medically Tailored Meals
13. Sobering Centers

Inform the member that they can contact Member Services for support but, if they are still having trouble scheduling an appointment with the County Behavioral Health Services, they can contact the ombudsman:

Medi-Cal Managed Care Ombudsman: 888-452-8609

Inform the member that they can contact the Member Services for support. Agents are trained to coordinate the transportation benefits between the Medicare and the Medi-Cal benefits. There is no trip limit when you combine the Medicare and Medi-Cal benefits.

It should go through the normal prior authorization process for exception as has been done in the past.

You can reach out on the member's behalf or ask the member to reach out to help_referral@healthnet.com to access incontinence supplies or DME. The email is triaged by the Public Programs team and will support access to incontinence supplies.

Have the member reach out to the County Department of Social Services directly. Alternatively, if they need help with the application, the Public Programs team can help. Have them reach out to help_referral@healthnet.com.

Have the member to reach out to the CBAS center directly. If they need help finding or identifying a CBAS center, help them reach out to help_referral@healthnet.com. The Public Programs team will support access to the CBAS program.

To date, the Department of Health Care Services and Centers for Medicare & Medicaid Services have advised there will be no change to how they access their Medicare benefits.

Starting January 1, 2023, the Department of Health Care Services required any new dually eligible beneficiary to enroll in a Medi-Cal managed care plan. For more information, visit the DHCS website.

Yes, the members can continue to see their Med-Cal dentists for Medi-Cal covered dental services.

Only if that dentist is on the Delta Dental Medi-Cal Network. Refer to the Delta Dental website for more detail.

For 2024, Wellcare's D-SNP dental coverage is intended to supplement the Medi-Cal covered dental services and covers services which are NOT covered by Medi-Cal dental program.

• They will need to see a dentist who is in the applicable Medi-Cal Dental program
• They will present their BIC card (the one with the poppies on it) to that dentist office
• The dentist will bill Medi-Cal dental for the services covered under the Medi-Cal dental program

Medi-Cal Dental covers the following:

• Exams (Covered benefit once every 6 months)
• Emergency Service
• X-Rays
• Teeth Cleaning
• Fluoride Varnish
• Deep Cleaning- Scaling and Root Planning
• Fillings
• Tooth Removal
• Root Canals
• Crowns (Crowns on molars or premolars [back teeth] may be covered in some cases)
• Partial Dentures
• Full Dentures
• Denture Reline
• Sedation
• See the Medi-Cal Dental Handbook for all details

• Each member is assigned to a dentist who takes BOTH Medi-Cal FFS Dental & Delta Dental upon enrollment (no dentist choice on the enrollment form/Acsend; network search only)
• Each member receives a Delta Dental ID card & Letter advising of the Dentist assignment
• The letter received gives instructions on how to change dentists, if necessary. The best way is to call our call center using Wellcare custom phone line. Then the member can also get questions answered at the same time: 855-643-8515 (Delta Wellcare Line)

You can access the Wellcare D-SNP Dental Evidence of Coverage (EOC) and Summary of Benefits (SOB) or contact Delta Dental directly at 855-643-8515 for more information.

No, they can still provide the Medi-Cal covered dental services to the Wellcare D-SNP member.

No, they can still provide the Wellcare D-SNP covered dental services to the Wellcare D-SNP member.

There is NO "primary" payer! The member has two plans with different benefits that do not coordinate with each other.

Two (2) claims are needed – One to Medi-Cal for Medi-Cal covered services, and a second claim to Delta for the D-SNP plan covered services.

CA Department of Health Care Services (DHCS) is requiring (PDF) the state specific D-SNP only contracts for 2024, which requires transition of both CA Wellcare members in H contract H5087 and Wellcare By Health Net members in H contract H0562 to be moved to contract H3561 effective January 1, 2024.

All Wellcare By Health Net D-SNP members will need to use the providers contracted under H3561. There are impacts to the provider network.