Dual Eligibility Special Needs Plan (DSNP) Model of Care 1. To be eligible for the Security Health Plan DSNP program the member must meet the following requirements: Entitled to Medicare benefits under Part A: Entitled to Full Medicaid Benefits from the State of Wisconsin and reside in Wood County Entitled to Medicare benefits under Part A; Enrolled in Medicare Part B; Reside in the service area (Clark County, Lincoln County, Marathon County, Portage County and Wood County) Entitled to Medicare benefits under Part A; Enrolled in Medicare Part B; Entitled to Full Medicaid Benefits from the State of Wisconsin; Reside in the service area (Clark County, Lincoln County, Marathon County, Portage County and Wood County) Entitled to Full Medicaid Benefits from the State of Wisconsin; Reside in the service area (Clark County, Lincoln County, Marathon County, Portage County and Wood County)

Dual Eligibility Special Needs Plan (DSNP) Model of Care 2. The DSNP program values include the following: Improved access to only mental health service; improved access to affordable care; improved coordination of care; seamless transitions of care with the PCP; improving preventive health services; appropriate utilization of services and improved member outcomes Improved access to community services; improved access to affordable care; improved coordination of care; seamless transitions of care within the community; improving preventive health services, appropriate utilization of services and improved member outcomes Improved access to only medical care (PCP only); improved access to affordable care; improved coordination of care; seamless transitions of care within the community; improving preventive health services, appropriate utilization of services and improved member outcomes Improved access to care (medical, mental health and social services); improved access to affordable care; improved coordination of care; seamless transitions of care with the PCP; improving preventive health services; appropriate utilization of services and improved member outcomes

Dual Eligibility Special Needs Plan (DSNP) Model of Care Provider responsibilities for participation and collaboration with the Model of Care and the DSNP care team include: All contracted providers are required to complete initial and annual MOC training Assist with development of care plan; Returning signed member care plan to the DSNP care team Collaborating and actively communicating with the DSNP care team; accepting invitations to attend member’s care plan meetings whenever possible All of the above

Dual Eligibility Special Needs Plan (DSNP) Model of Care The Interdisciplinary Care Team role is: Analyze and incorporate the results of the initial and annual comprehensive health risk assessment; Collaborate to develop and annually update an individualized care plan for each enrollee; Manage the medical, cognitive, psychosocial and functional needs of the enrollee through collaboration and the development of a comprehensive care plan; Coordinate with the provider network and enrollee to deliver specialized services in a timely and quality way; Always respect the wishes of the enrollee; Be cognizant of any special communication need of the persons with disabilities Manage the medical, cognitive, psychosocial and functional needs of the enrollee through collaboration and the development of a comprehensive care plan; Coordinate with the provider network and enrollee to deliver specialized services in a timely and quality way Analyze and incorporate the results of the initial and annual comprehensive health risk assessment; Collaborate to develop and annually update an individualized care plan for each enrollee; Manage the medical, cognitive, psychosocial and functional needs of the enrollee through collaboration and the development of a comprehensive care plan Coordinate with the provider network and enrollee to deliver specialized services in a timely and quality way; Always respect the wishes of the enrollee