Special Needs Plan (SNP)

A Special Needs Plan (SNP) is available to PUP Members with Medicare and Medicaid. PUP partners with the Florida Agency for Health Care Administration (AHCA) to coordinate these benefits.

Model of Care

As a result of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), regulations were issued by The Centers for Medicare and Medicaid Services (CMS).

PUP has developed and implemented a SNP Model of Care that encourages early health status identification and an efficient, coordinated care system to improve the health and well-being of Members.

PUP’s SNP Model of Care includes the following elements:

  • Goals pertinent to the SNP members
  • Comprehensive Health Risk Assessment (HRA)
  • Coordinated care and case management
  • Specialized provider network and service delivery system
  • SNP training for network resources
  • Communication and accountability system (e.g., collaboration between provider and plan staff)
  • Performance measurement and improvement activities
  • Proactive outreach by PUP’s disease manager, case/care managers
  • Social worker services
  • 24-hour nurse hotline

All SNP Members receive an initial Health Risk Assessment within 90 days of enrollment. The SNP Model of Care requires an Individualized Care Plan (ICP) to be built for each Member following the HRA. As a part of PUP’s Patient-Centered Medical Home approach, the ICP is shared with the Member, their Primary Care Physician (PCP) and other involved care coordinators, including case managers or social workers.

Health Risk Assessment (HRA)

PUP’s standardized HRA evaluates the needs of the SNP Members, including physical, cognitive psychosocial and functional. The HRA process is as follows:

  • All new SNP Members are contacted telephonically within 90 days of enrollment to complete their initial HRA.
  • Call attempts that do not result in a completed HRA trigger written communication to the Member and the PCP to drive additional attempts to complete the assessment.
  • Existing SNP Members’ annual HRA renewal date is tracked electronically and the HRA completion process begins 30 days in advance of the renewal date.
  • Completion rates are electronically tracked and reported on a monthly basis.
  • Successfully completed HRAs are utilized to create the Members Individualized Care Plan (ICP) and shared with the Member’s PCP and PUP’s Interdisciplinary Care Team (ICT) as appropriate.

Individualized Care Plan (ICP)

PUP uses the results of the HRA to create Individualized Care Plans (ICP). By identifying specific problems, the care plans include short term and/or long term goals that best fit the Members’ health needs.