Welcome to the latest edition of Wellcare Insider, your source for important updates and reminders to help you provide excellent service and grow your business all year long.

Today’s edition has information on the following topics:

• New! PCP Changes – Enhanced service options for making PCP changes
• DST-SEP Updates – View our updated resource for pending & current SEPs
• 24/7 Nurse Advice – Connect your members to Wellcare’s care advice line
• Broker Resources – Bookmark these links for ongoing sales success

Set Your Members Up For Success!

New! PCP Changes Via Broker Support or Centene Workbench

We’ve recently expanded our service capabilities to accept PCP changes through Centene Workbench or by calling Broker Support, 866-822-1339.

Important Information

• For the PCP change to be processed, the requesting broker must reflect as the Broker of Record for the member’s active policy.
• Requests to retroactively change the PCP effective date should be directed to Member Services using the number on the back of your client’s member ID card.
• Approved PCP changes will be effective on the 1st of the following month from the date the ticket was resolved in Centene Workbench. The new provider must be in the member’s network and accepting new patients.

Please review the Member PCP Change Request resource for details on required information for initiating a request and instructions on submitting a PCP change through Centene Workbench.

Access Centene Workbench through your Single Sign-On portal.

DST-SEP Updates

As a reminder, an emergency or disaster Special Enrollment Period (DST-SEP) may be granted to individuals that reside in an affected service area where a Federal, State or Local Government Entity has declared a State of Emergency impacting individuals in a specific geographical area. The declaration allows for a one-time SEP in the event an individual was unable to make an election during another qualifying election period.

Stay up-to-date with all the developments pertaining to DST-SEP declarations in your service areas. Our updated Special Enrollment Period (SEP) – FEMA / State Declarations resource provides links to all active state and Federal declarations, details on DST-SEPs pending compliance review and a listing of declarations expired within the last six months.

DST-SEP Guidelines

Agents should keep in mind the DST-SEP should not be used as a marketing tool to promote Medicare Advantage (MA) or Prescription Drug Plan (PDP) sales. Agents should never actively market this special enrollment period. The opportunity for a SEP is ONLY available to beneficiaries who:

• Reside, or resided at the start of the SEP eligibility period, in an area for which a federal, state or local government entity has declared a disaster or other emergency, or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and
• Were eligible for another election period at the time of the SEP eligibility period, and;
• Did not make an election during that other valid election period due to the disaster or other emergency.

Should you have any questions regarding the DST-SEP application process, please reach out to your local Sales Leader. 

24/7 Nurse Advice Line

We understand that helping your members make informed health-care choices is an important part of being their trusted advisor. When members have questions about when, where or if they should seek care for a particular concern, connecting them with Wellcare’s 24/7 Nurse Advice Line is a safe and convenient resource for obtaining needed healthcare guidance.

Members may connect with nurse practitioners to discuss symptoms and get advice on what to do next, including:

• Answers to questions about their health
• Determining whether treatment from a doctor should be sought immediately

Members may call the Nurse Advice Line, 800-581-9952 (TTY: 711) anytime of the day or night. The number is also available on the back of the Member IDcard.

As a reminder, CMS guidelines permit a Special Election Period (SEP) for beneficiaries in qualified State Pharmaceutical Assistance Programs (SPAPs) under certain circumstances and in states where SPAPs are available. The chart below summarizes these qualifying SEP conditions:

Important Information & Recommendations

It is imperative that you take steps before enrolling a beneficiary using the SPAP SEP to confirm that the beneficiary meets the SPAP SEP’s eligibility requirements. The SPAP SEP is not available unless the beneficiary is enrolled in or is losing eligibility for coverage under a qualified SPAP.

We recommend that you take the following steps before enrolling a beneficiary using the SPAP SEP:

• Explain that a qualified SPAP is a program offered by certain states to provide financial assistance for pharmaceutical expenses to Part D eligible residents and that the beneficiary may be eligible for a SEP if the beneficiary is enrolled in a qualified SPAP or is losing eligibility for coverage in a qualified SPAP.
• Provide the beneficiary with the list of qualified SPAPs. See the list of qualified SPAPs below.
• Confirm that the beneficiary can attest to meeting the eligibility requirements based on the list of qualified SPAPs.
• If the beneficiary attests to meeting the eligibility requirements for an SPAP SEP, check that the beneficiary resides in one of the states listed below that have a qualified SPAP. In the event that the beneficiary does not reside in one of the states listed below with a qualified SPAP, check to see whether the beneficiary recently moved from one of the states listed below with a qualified SPAP and is therefore losing SPAP eligibility.

Qualified SPAPs

The following are qualified SPAPs:

• Delaware: Delaware Prescription Assistance Program
• Indiana: HoosierRx
• Maine: Maine Drugs for the Elderly and Disabled
• Maryland: Maryland Senior Drug Assistance Program
• Massachusetts: Prescription Advantage
• Missouri: MoRx
• New Jersey: NJ Pharmaceutical Assistance to the Aged & Disabled Program; NJ Senior Gold Discount Card Program
• New Mexico: New Mexico Medical Insurance Pool
• New York: Elderly Pharmaceutical Insurance Coverage Program (EPIC)
• Pennsylvania: Pharmaceutical Assistance for the Elderly
• Rhode Island: Rhode Island State Pharmaceutical Assistance to the Elderly (RIPAE)
• Texas: Texas Kidney Health Care Program
• Vermont: Vpharm
• Wisconsin: SeniorCare

Please refer to the SEP section in the CMS Enrollment and Disenrollment Guidance, Medicare Advantage (MA) (Section 30.4), for detailed descriptions of the various types of SEPs and their eligibility criteria.

April 1, 2024

To support quality improvement, retention, and effectuation initiatives, Wellcare will change its payment of all D-SNP and C-SNP Health Risk Assessments (HRAs) to effectuation versus submission effective April 1, 2024.

This change applies to D-SNP and C-SNP HRAs completed in both Ascend and Sunfire on or after April 1 and for members with an effective date of May 1 and forward. Additionally, Wellcare will update its administrative payment amounts effective on the same date.

Key Change Highlights 

WellCare’s new plan will change the current administrative payment amounts to:

• $150 for Special Needs Plans (D-SNPs and C-SNPs) HRA completion payments on effectuated members for 1099 partners.
• Removal of payment for non-SNP HRA completion.

HRAs can be completed up to 90 days after the application submission date. 

Learn More

For HRA program questions, please take a few moments to view our helpful HRA Announcement Video and Transcript and review the HRA Program Realignment FAQ.

If you have additional questions about this change, please contact your local Sales Leader.

This change applies to D-SNP and C-SNP HRAs completed in both Ascend and Sunfire on or after April 1, and for members with an effective date of May 1 and forward. Additionally, Wellcare will update its administrative payment amounts effective on the same date.

Key Change Highlights 

Wellcare’s new plan will change the current administrative payment amounts to:

• $150 for Special Needs Plans (D-SNPs and C-SNP) HRA completion payments on effectuated members for 1099 partners.
• Removal of payment for non-SNP HRA completion.

HRAs can be completed up to 90 days after the application submission date. 

For helpful HRA program questions, please review the HRA Program Realignment FAQ. If you have additional questions about this change, please contact your local Sales Leader.

As always, thank you for your valued partnership!