SecureBlue (MSHO) and Skilled Nursing Facility Service
|Member name: | |
|Member ID | |
|Effective Date | |
|Care Coordinator | |
|Contact information: |Phone: |
Skilled Nursing Facility Service
Blue Cross and Blue Shield of Minnesota and Blue Plus is participating in Minnesota Senior Health Options (MSHO) by offering SecureBlue. MSHO is a program with the Centers for Medicare & Medicaid Services (CMS) and the Minnesota Department of Human Services (DHS). It is for people ages 65 and older who are dually eligible for Medicare & Medicaid or eligible for Medicaid alone. SecureBlue enrollment is voluntary.
SecureBlue Nursing Facility Benefits
For SecureBlue members, Blue Plus is responsible for 180 days of care in a nursing facility for members entering the facility after their enrollment in MSHO, including both Medicare-covered and Medicaid-covered days. In addition, SecureBlue benefits include all Medicare-covered Skilled Nursing Facility (SNF) benefits for members currently residing in nursing facilities. A Care Coordinator works closely with individual SecureBlue members to assist them in achieving optimal medical and social stability; assist with transitions between care settings; and work with providers to manage member needs, answer health plan questions and support our members with health care decisions.
Nursing Facility Responsibilities
• Support and implement the resident’s care plan.
• Alert Care Coordinator of resident’s:
▪ Significant change in health status
▪ Admissions or discharge from any inpatient setting
▪ Enrollment in hospice
▪ Hospitalization
▪ Discharge from Nursing Home setting
▪ Death
▪ Care conference date/time so the Care Coordinator may attend as needed
• Work collaboratively with the Care Coordinator, physician, family, and health plan.
• Provide information for resident assessment.
• Assist the care coordinator for discharge planning to allow member to return to the community, if appropriate.
Billing Requirements
• All Medicare-covered days for SecureBlue members must be billed to Blue Plus. Complete the Minimum Data Set (MDS) in order to determine the rate to be billed.
• Bill Medicare rates for Medicare-covered days, and Medical Assistance rates for Medicaid-covered days.
• Services eligible under Medicare Part A or Part B should be submitted directly to Blue Plus.
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