| SNiP Tips
Starting Out
What information will my client get from the HIV SNP after joining?
Once a person joins an HIV SNP, the plan will send:
- A medical provider directory that includes all participating
providers by specialty and a list of facilities, including Designated AIDS Centers
for the county or borough in which the enrollee lives.
- An ID card that includes the name of the enrollee's clinic
(if they go to one), the name and phone number of the PCP, the member services
toll-free number, and the 24-hour toll-free number that enrollees can use to get
services when the PCP isn't available. The card does not say "Special Needs Plan,"
"SNP," "HIV," or "AIDS." This ID card has to be sent within 14 days of the enrollment
date. Enrollees should ask the plan how to use their enrollment confirmation notice
or another document to get services before they get their ID card.
- A member handbook, which the HIV SNP has to send within 14 days,
explains how the HIV SNP works and highlights enrollee rights and responsibilities.
Also, the HIV SNP has to contact your client in person, by phone, or by mail
within 15 days of joining. The staff has to tell your client about the plan, and
find out if your client has any special medical, social, or communication needs.
The HIV SNP will also help your client pick a primary care provider if he or she
hasn't already.
| SNiP Tip: In addition to the HIV
SNP member ID card, advise your client to keep their
regular Medicaid cards. They will need them to get some
services including pharmacy benefits, non-network family
planning services, and non-network tuberculosis diagnosis
and treatment. (See page 11, "Benefits.") |
What help can the HIV SNP's member services department give?
Each HIV SNP has to operate a toll-free member services hotline during regular
business hours. There might be a separate line for complaints and utilization review
inquiries. (See page 17, "Solving Problems I: Complaints and Appeals.") There also
has to be a hotline that can take calls or give instructions outside of normal
business hours.
Enrollees can call member services for any reason including:
- Explanations of how to get services
- Help in picking or changing PCPs
- Help in making appointments
- Questions about complaints, appeals, and fair hearings (See page 17, "Solving
Problems I: Complaints and Appeals," and page 20, "Solving Problems II: Fair Hearings.")
- Explanation of anything in the member handbook
What kinds of translation and interpretation services are available for my
clients who don't speak English or who have special communication needs?
If enough people in an area speak a language other than English, the HIV SNP has to
provide written materials in that language. Also, the plan and participating providers
must have interpreters for people who don't speak English, if not in person, then at
least by telephone.
Written materials might only be available in English and Spanish. People who are
not comfortable in either of these languages can decide to have someone help them
understand written materials. They can also get interpretation services for appointments
and for phone calls. But, they may also decide not to join the plan if they can't get
a PCP who speaks their language or if they are not comfortable without written materials
in their language.
The plan and participating providers must have services in place for communicating
with people who have visual, hearing, speech, physical, or developmental disabilities.
These include Braille or audiotapes, TTY access, and American Sign Language.
| SNiP Tip: Call the HIV SNP member
services hotline with questions about getting care in
a language that is best for your client. The plan's
PCP should speak your client's language, or have staff
that can translate medical terminology. |
How can my client pick a primary care provider?
Advise your client to pick a primary care provider right after
joining if he or she did not pick one during the enrollment process. All HIV SNP
primary care providers are HIV specialists. This means they have
experience and training in treating people with HIV. (For non-infected children,
the PCP doesn't have to be an HIV specialist.)
| SNiP Tip: Advise your clients to pick a primary care provider (PCP),
instead of letting the plan pick one. Choosing a PCP gives your client more control
over their health care. Clients should set up an appointment with their PCP right away.
Tell the PCP about on-going treatment needs when setting up the appointment. |
The plan has to offer enrollees a choice of at least three PCPs. If your client
does not pick a PCP within 30 days of being told of enrollment, the HIV SNP will
automatically pick a PCP for your client.
Enrollees can decide to have one PCP for the whole family if they're all
members, or different PCPs for different members. Women can pick an OB-GYN
(obstetrician/gynecologist) in addition to a PCP.
SNiP Tip: Your clients may want
to think about what matters most to them in a primary
care provider. Different things may matter more to
different people. Some questions that they might think
about include:
- Do I want a PCP that I already know?
- Do I want a PCP very close to my home?
- What are the PCP's office hours?
- Does the PCP speak my language or have staff that does?
- Is the PCP familiar with my culture?
|
Can my client keep seeing a non-network provider?
Usually, the HIV SNP will allow enrollees to see providers only within the plan's
network. But, in two situations new enrollees can keep seeing a health care provider
who isn't part of the network for up to 60 days after joining. The non-participating
provider has to agree to follow the plan's rules and charge only the amount the plan
normally pays. This can happen if:
- The enrollee has a life-threatening disease or condition, or a degenerative and
disabling disease or condition including HIV; or
- The enrollee has reached the second trimester of pregnancy by the starting date
of enrollment. In this case, the transitional period will include care directly
related to the delivery for up to sixty days after the birth.
How long does my client have to wait to visit HIV SNP providers?
These first visits have to be made available to enrollees within the time periods
listed. (See Appendix III for time frames on other types of visits.) Your client can
call Member Services if he or she has any trouble getting these first appointments:
| Type of visit |
Appointment has to be available |
| First visit for enrollees with on-going treatment needs |
Within 7 days of request if medically necessary |
| First family planning visit |
Within 2 weeks of request |
| First prenatal visit |
Within 3 weeks during first trimester
Within 2 weeks during second trimester
Within 1 week during third trimester |
| First PCP office visit for newborns |
Within 48 hours of leaving the hospital |
SNiP Tip: Advise your client to do these things
at the first PCP visit:
- Bring a list of symptoms
- Bring a list of medications
- Take notes on what the PCP says
- Ask questions if anything is unclear
- Ask how the PCP will connect with other providers
- Ask how the PCP will work with the case manager
- Ask when the next appointment will be
|
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