DualAccess Plans Provider Training Information about MVP’s Dual Special Needs Program

CY 2025
©2024 MVP Health Care
Information about MVP’s Dual Special Needs Program
(D-SNP) Plans
DualAccess Plans
Provider Training

This training is designed to inform Providers how MVP
serves Members dually eligible for Medicare and
Medicaid.
It is intended to give Providers the information
needed to successfully treat these Members,
including:
• Introduction to MVP DualAccess Plans
• Overview of Program Benefits, Goals, and Objectives
• Review the Four Elements of the Model of Care (MOC)
– Description of the D-SNP Population
– DualAccess Model of Care Overview
– DualAccess Provider Network
– DualAccess Quality Measurement and Performance
Improvement Plan
Overview
CMS Mandated Training
CMS requires Providers to complete an
annual D-SNP training and attest to its
completion.
The network team at MVP appreciates
your time and dedication to treating this
special population of patients.
MVP's D-SNP Plans are
known as the
DualAccess Plans

• Special Needs Plans (SNPs) are a type of Medicare
Advantage (MA) plan designed for individuals with
special needs focusing on intensive care coordination.
• SNPs are offered by Medicare Advantage Organizations
(MAOs) that enroll individuals dually eligible for Medicare
and Medicaid (D-SNP).
• Medicare Advantage Plans must have existing, executed
contract(s) with the State Medicaid Agency (SMA).
• D-SNPs must coordinate all services, including:
– Enrollment
– Mandatory benefits
– Enhanced Care Coordination (Model of Care)
– Long-term care services
– Grievance and Appeals
What is a D-SNP?

MVP D-SNP Plans
MVP DualAccess
(HMO D-SNP)
Non-Integrated
• Medicare coverage through MVP D-SNP
• Medicaid is generally Fee-For-Service or another
carrier
• Limited coordination of benefits
• Plan required to notify NYS when a high-risk dual
has been admitted to a hospital or Skilled Nursing
Facility (SNF)
• MVP began offering this plan January 1, 2022
MVP DualAccess Complete
(HMO D-SNP)
Integrated Benefit Plan (IBP)
• Medicare coverage through MVP D-SNP
• Medicaid coverage through MVP Mainstream
Medicaid or MVP HARP plan
• Operates as one plan for the Member with all
integrated services
• Members do not require long term support
services (LTSS) more than 120 days
• MVP began offering this plan August 1, 2023

©2024 MVP Health Care 5
Target Population
• Full dual-eligible individuals age 65+
• Capital District & Hudson Valley has
approximately 58,000 D-SNP enrollees*
Service Area
• Both plans offered in 14 counties
in NY
Network
• Existing network of providers that participate in
the MVP Medicare Advantage network and MVP
Medicaid Managed Care network, plus Long-
Term Care Services (LTCS) and Skilled Nursing
Facilities (SNF) providers
*CMS, Monthly Enrollment of CPSC

MVP DualAccess 2025 Plan Benefits
Supplemental Benefits
• NEW for 2025! $150 per
month flex benefit that
can be used for over-the-
counter items, grocery
items, and utility bills
• $200 Eyewear Allowance
• $0 Co-pay Preventive
and comprehensive
Dental
care
• Transportation to
Medical Care
• Post-Discharge Meal
Delivery
• Joint Replacement
Recovery Care Kit
Part A Benefits
• Inpatient Hospitalization
• Skilled Nursing Facility & Rehabilitation Facility Services
• Imaging and Laboratory Services
• Home Health Care and Hospice
• Hospital Care, Including Emergency Services
Part B Benefits
• Routine Physicals and Vaccinations
• Physician Services
• Durable Medical Equipment
• Ambulance Services
• Mental Health and SUD Treatment
• Specialty Health Visits (i.e., Dental, Podiatry, Physical Therapy)
• Specialty Diagnostic Services (i.e., Audiology, Optometry)
Part C Benefits
• Fitness Membership
• Telehealth Services
• Health Promotions Programming

MVP DualAccess Complete 2025 Plan Benefits
Supplemental Benefits
• NEW for 2025! $175 per
month flex benefit that
can be used for over-
the-counter items,
grocery items, and utility
bills
• $200 Eyewear Allowance
• $0 Co-pay Preventive
and comprehensive
Dental care
• Transportation to
Medical Care
• Post-Discharge Meal
Delivery
• Joint Replacement
Recovery Care Kit
Part A Benefits
• Inpatient Hospitalization
• Skilled Nursing Facility & Rehabilitation Facility Services
• Imaging and Laboratory Services
• Home Health Care and Hospice
• Hospital Care, Including Emergency Services
Part B Benefits
• Routine Physicals and Vaccinations
• Physician Services
• Durable Medical Equipment
• Ambulance Services
• Mental Health and SUD Treatment
• Specialty Health Visits (i.e., Dental, Podiatry, Physical Therapy)
• Specialty Diagnostic Services (i.e., Audiology, Optometry)
Part C Benefits
• Fitness Membership
• Telehealth Services
• Health Promotions Programming

Applies to all Covered Part D
Formulary Drugs
for DualAccess and DualAccess
Complete
✓All Members in DualAccess and
DualAccess Complete are eligible
✓No deductibles
✓No copays or coinsurance
Part D Prescription Benefits

Sample Member ID Cards
DualAccess Member ID Card DualAccess Complete Member ID Card
Member also has a Medicaid card
Member does not have a
separate Medicaid card

• Providers cannot collect any cost share from DualAccess Members, except:
• Eyewear allowance benefit could result in a Member cost share if the allowance is exceeded
• Members who see a non-participating dentist will be 100% responsible for services
• Bill and send prescriptions to the pharmacy using the Member Medicare ID card
• Submit prior authorization requests using the Member Medicare ID card
• Follow Medicare billing and coverage practices, including billing for immunizations through the
Part D benefit where applicable
• Submit in-office administered vaccine claims through TransactRx Part D Vaccine Manager
Special Considerations - DualAccess
As a reminder, Providers must participate in both the MVP Medicare Advantage
network and MVP Medicaid Managed Care network to care for DualAccess and
DualAccess Complete Members. Some exceptions exist for Providers who offer
Medicaid-only services.

• When submitting claims, be sure to follow all applicable CMS and NYS billing guidance for the
services provided, including billing for immunizations through the Part D benefit where applicable
• Submit in-office administered vaccine claims through TransactRx Part D Vaccine Manager
• Providers cannot collect any cost share from DualAccess Complete Members, except:
• Eyewear allowance benefit could result in a Member cost share if the allowance is exceeded
• Members who see a non-participating dentist will be 100% responsible for services
• Some medications may be covered under both Medicare (MVP) and Medicaid (NYRx)
• Patients need to present both their MVP DualAccess Complete card and their state issued
Medicaid card at the pharmacy
Special Considerations – DualAccess Complete
As a reminder, Providers must participate in both the MVP Medicare Advantage
network and MVP Medicaid Managed Care network to care for DualAccess and
DualAccess Complete Members. Some exceptions exist for Providers who offer
Medicaid-only services.

DualAccess
Provider
Network
Care
Coordination
Model of Care
Description of
D-SNP
Population
Model of Care
Four Pillars of the Model of Care
12

Population Overview
• Designed for individuals with special needs focusing on intensive care coordination
• To be eligible for MVP D-SNP plans, the Member must be fully dually eligible for Medicare
and Medicaid
MVP’s DualAccess Plans are Designed to Support this Specialty Population
• MVP DualAccess and DualAccess Complete Members have access to necessary specialized
services, including:
– Geriatric Medicine
– Habilitation
– Specialists with expertise in treating this population
– Programs and other resources designed to improve and enhance health
• MVP coordinates care for DualAccess and DualAccess Complete Members between PCPs and
specialists, including behavioral health providers
Description of the D-SNP Population

• Enhance Member experience
• Support quality outcomes
• Maximize benefits and resources
administration
• Streamline membership opportunities and
transitions of care from Medicaid eligible to
Dual eligible
• Enhance and integrate use of technology
• Promote delivery system innovation
MVP D-SNP Goals

Model of Care Overview
• Care Management Team
• Member Health Risk
Assessment (HRA)
• Individual Care Plan (ICP)
• Integrated Interdisciplinary Care
Management
Team (IICMT)
• Transition of Care (TOC) Process

RN Care Manager (RNCM)
• MVP employee; Identifies the medical and psycho-social needs of designated Members
• Acts as a proactive partner
• Provides appropriate education, resources, and health care coaching telephonically or in person
• Engages individual Members and communicates with an established interdisciplinary team to create
an individualized person-centered care plan
Community Services Care Coordinator (CSCC)
• MVP employee who works directly with Members, members’ families and/or advocates, providers,
and community service organizations to ensure Members have access to the range of supportive
services needed to promote quality of life and the achievement of Member identified desired
outcomes
• Addresses the needs and wishes of the Member, and his or her family and/or advocate
• Supports changes as they affect the Member’s desired outcomes, quality of care and quality of life
• Collaboratives with the RNCM to implement the individual care plan (ICP) and assist Members in
reducing/resolving challenges or barriers so that the Member may achieve their optimal level of
health, independence, safety, and well-being
DualAccess Care Management Team

Integrated Interdisciplinary Care Management Team (IICMT)
• Responsible for developing the ICP based upon assessments, discussions with Member,
recommendations
by RNCM, and input from Primary Care Physician (PCP) and other providers treating the Member
• Ensures ICP includes measurable and clear goals and objectives, measurable outcomes, and all
appropriate services for the Member
• Member and their provider are at the center of the care team
• RNCM assists Member and Provider in achieving the goals outlined in the ICP and is responsible for:
– Documenting the draft ICP, informed by the HRA and available clinical data
– Reviewing the draft ICP with the Member and PCP
– Identifying team Members based on the Member’s needs, and Member and PCP requests, as indicated
from the HRA
and ICP
– Forming the IICMT and scheduling the IICMT meetings
– Updating the ICP to reflect their evaluation of Member’s progress toward ICP goals and changes
recommended by
the IICMT
– Distributing the ICP to the IICMT when changes occur and in advance of each IICMT meeting
DualAccess Care Management Team (cont’d)

IICMT
IICMT team members include but are not
limited to:
• Member, family and/or caregiver
• Medical Expert / PCP
• MVP Medical Director
• MVP RNCM
• MVP CSCC
• Social Services Expert (from MVP or the
community)
• Behavioral Health Specialist (from MVP or a
provider)
• Pharmacist (from MVP and/or the
community)
• Restorative Health Specialist
• Nutrition Specialist
• Disease Management Health Coach
Role of IICMT:
• Provides collaborative subject matter
expertise support and promotes
interdisciplinary dialogue to develop plan
of care for at-risk Members
• Team is convened at the request of the
RNCM and Medical Director
• MVP will make every effort to include the
Member and/or his or her caretaker in the
development of the ICP and IICMT
meetings
• IICMT meeting attendance is open to
Members, families, caregivers, PCP and/or
other Specialist, as appropriate and when
available and willing to participate in
meaningful discussion concerning the
Member

• Care team will conduct an initial and annual HRA for all
DualAccess
and DualAccess Complete Members
• HRA must be conducted within 90 days of enrollment,
readministered
annually, and administered upon change in health status
• HRA provides a holistic overview of each Member’s specific
needs:
– Medical
– Functional
– Cognitive
– Social
– Psychosocial
– Mental Health
• Information obtained via the HRA is used in developing ICP
Health Risk Assessment (HRA)

• HRA results inform the ICP
• Each ICP includes:
– Documentation of the Member’s current clinical,
social, and psychological needs
– Documentation of action plans to address the
Member’s current and anticipated needs
• The following individuals contribute to the
development of the ICP:
– Member, family, and/or caregiver
– Member’s PCP
– Specialty providers, as necessary
– RNCM
– CSCC
• Care plans managed frequently by RNCM and CSCC
ICP Development and Implementation

Transition of Care (TOC) Process
Focus on:
• Integrated care
coordination and
care transition
• Monitoring of
hospitalizations
and readmissions
Members transitioning
from one health care
setting to another will
be assured that:
• Their RNCM,CSCC,
IICMT Members,
and involved provider
are informed
• Safe and effective
protocols are followed
to facilitate a smooth
transition
Goal: Support the improved health care outcomes of our covered Members.
Successful transitions
are accomplished with:
• Timely and early
identification of the
Member’s need for care
setting transition
• A standardized and well-
documented process for
communication among
settings
• Related case
management and
IICMT
determinations and
actions
21

Network Requirements
& Resources

The MVP DualAccess network includes providers with expertise in treating this population, including but
not limited to gerontologists, habilitation specialists, and other specialists.
• MVP continuously evaluates our network to ensure Members have access to specialty care
Participation in IICMT Meetings
• Providers are expected to participate in IICMT meetings for DualAccess Members along with MVP’s Medical
Directors and RNCM to develop a Member specific care plan
Clinical Practice Guidelines
• As with all plans, Providers must follow MVP’s clinical practice guidelines
– Access MVP’s clinical guidelines at mvphealthcare.com/providers/quality-programs
– In the Provider Quality Improvement Clinical Guidelines and Supporting Resources section, select the desired
topic under View Guidelines and Documents
Unique Provider Network Requirements

Learn more at mvphealthcare.com/providers/education/clinical
©2024 MVP Health Care 24
Integrated Health Services
MVP encourages integrating behavioral health and primary care.
Without Integration:
Mental illnesses go undetected & untreated
Mental illnesses & chronic health conditions often
co-occur (e.g., depression & heart disease)
Populations of color, children, adolescents, older
adults, uninsured, & low-income patients more often
receive inadequate health care services
BH & PCPs practice in different locations with similarly
trained providers & don’t coordinate well for patients
with multiple needs
Have little understanding of the interdependence of
behavioral & physical health functioning
According to the WHO,
integrated service delivery is
“the organization and
management of [all] health
services so that people get the
care they need, when
they need it, [with no wrong-
door for entry], in ways that
are user-friendly, achieve the
desired results, and provide
value for money.

The MVP QI/PIP is designed to improve the quality, safety, and efficiency of clinical care,
enhance satisfaction, and improve the health of MVP Members and the communities it
serves.
• Content of QI/PIP is established annually by the MVP Board of Directors, who is accountable for:
– Oversight of the quality of care and services provided to all Members
– Development, implementation, measurement, and outcome of the QI/PIP
• QI Program requires regular reporting (at least annually) and establishes mechanisms (HEDIS, CAHPS,
HOS) for monitoring and evaluating quality, utilization, and risk
• MVP continually monitors and analyzes data to measure performance against established benchmarks
and to identify and prioritize improvement opportunities
• Interventions are developed and implemented to improve performance and the effectiveness of each
intervention is measured at specific intervals, applicable to the intervention
Quality Measurement and Performance
Improvement Plan (QI/PIP)

MVP focuses monitoring efforts on the priority
performance measures that align with the mission
and goals outlined previously, as well as required
additional measures.
MVP reports all required measures in a timely,
complete, and accurate manner as necessary to
meet federal and state reporting requirements.
Quality Measures
Performance Measures
Includes all HEDIS measures required for the NCQA Health Plan Ratings and the
designated set of CMS Adult and Child Core measures, which are measured across six
domains of care:
1. Effectiveness of Care
2. Access and Availability of Care
3. Experience of Care
4. Utilization and Risk Adjusted Utilization
5. Health Plan Descriptive Information
6. Measures Collected Using Electronic Clinical Data Systems

MVP actively monitors:
• Member inquiries
• Complaints/grievances and appeals
• Member satisfaction surveys
• Member call center performance
• Direct feedback from Member focus groups
and other applicable committees
The Quality Improvement and Operations
departments analyze findings related to Member
experience and presents results to the QIC and
appropriate subcommittees.
CAHPS assesses patient experience in
receiving care:
CAHPS results are reviewed by the QIC and
applicable subcommittees, with specific
recommendations for performance improvement
interventions or actions. In addition to any
federal or state required CAHPS measures, MVP
focuses on the following measures required for
the NCQA Health Plan Ratings:
• Getting Care Quickly
• Getting Needed Care
• Coordination of Care
• Customer Service
• Rating of Health Plan
• Rating of All Health Care
• Rating of Personal Doctor
• Rating of Specialist Seen Most Often
Continuous Measurement of Member Experience

Health Outcome Surveys (HOS) are Member-reported
outcomes measures used in Medicare Star Ratings.
The goal of HOS is to gather valid, reliable, and clinically
meaningful health status data from Medicare beneficiaries.
HOS results are reviewed by the Medicare Quality Oversight
Committee and applicable subcommittees, with specific
recommendations for quality improvement activities,
pay for performance, program oversight, public
reporting, and to improve Members' health.
Five measures incorporated in the HOS survey:
1. Improving and Maintaining Physical Health
2. Improving and Maintaining Mental Health
3. Falls Risk Management
4. Managing Urinary Incontinence
5. Physical Activity in Older Adults
Continuous Measurement (cont’d.)

Thank you
Questions?
Please contact your Professional Relations Representative.

DualAccess Plans Provider Training Information about MVP’s Dual Special Needs Program

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