Special Needs Plan(s)/Model of Care Training

A Chronic Condition Special Needs Plan (C-SNP) Focused on Diabetes Care

Medicare Advantage Special Needs Plans are designed to provide targeted care and services to individuals with unique needs. The Generations Advantage Focus DC (HMO SNP) plan is a Chronic Condition Special Needs Plan (C-SNP) designed for Medicare-eligible people diagnosed with diabetes as a chronic or disabling condition. The plan provides complete medical, hospital, and Part D Prescription Drug coverage, with focused care and benefits for people living with diabetes in Cumberland County, Maine only. All benefits are for in-network services only, except urgent and emergency care.

The Special Needs Plan structured processes strive to meet the specialized needs of our members with a goal to optimize health outcomes. Care is coordinated by having a care manager as the point of contact who works in conjunction with the member’s primary care physician (PCP) and other interdisciplinary care team members. An interdisciplinary team can include but not is limited to caretakers, specialists, pharmacist, and community organizations. The model of care for this plan offers improved coordination and communication to ensure care is not fragmented and needed services are offered. 

Mandatory Training for Network Providers

The plan’s Model of Care is a comprehensive plan to deliver coordinated, integrated care management for individuals with severe or disabling chronic conditions by promoting care management, quality, standards, and procedures. Through our contract with the Centers for Medicare and Medicaid Services (CMS) this plan requires providing mandatory model of care education to network providers upon admission to the SNP network and then annually.

Network providers can find an overview of the plan, its Model of Care, and the benefits your patients receive on the plan in our Model of Care training. 

Model of care training: This mandatory training provides an overview of the plan, its Model of Care, and the benefits your patients receive on the plan. The training is available here:
https://rise.articulate.com/share/4AdVEAmA5IOFKWE6-d4ndwkTiZd3cFT7#/

Attestation Form: Attest to your completed training by filling out our Special Needs Plans (SNP) Model of Care Training Attestation Form (PDF).

Our Expectation for SNP Network Providers:
  • Provide care per clinical practice guidelines unless variation is warranted.
  • Provide our annual physicals and annual wellness visits for the plan members.
  • Ensure complete and accurate diagnosis coding and documentation.
  • Review care plans when received and reach out with any concerns, questions, or additions. Individualized Care plans are developed with input from multiple sources. This can include medical records, interdisciplinary team meetings, or through assessments of the member
  • Participate in interdisciplinary team meetings. Meetings are conducted with participants involved in the member’s care and are conducted annually at a minimum. 

Our Commitment as a Health Plan

As a primary care provider, you can expect:
  • Notification when your patient has enrolled into the Focus DC plan.
  • An invitation to participate in formal care reviews with the member’s interdisciplinary care team.
  • Care coordination support, as needed, for your Focus DC patients - including but not limited to:
    • Transitions of care
    • Community resources
    • Benefit optimization