Primary Care Network Listing Serving Medical Assistance Special Needs Basiccare (SNBC) in Hennepin County October 2016 Through March 2017

DHS-6594Q-ENG 10-16 Primary Care Network Listing Serving Medical Assistance Special Needs BasicCare (SNBC) in Hennepin County October 2016 through March 2017 612-596-1507 This health plan may not cover all your health care costs. Read your contract (Evidence of Coverage) carefully to find out what is covered. DHS approved 8/1/2016 Hennepin Health 612-596-1507 This information is available in other forms to people ity in a local commission, or public assistance status. Hen- with disabilities by calling nepin Health shall not use any policy or practice that has the effect of such discrimination. • 612-596-1507 • 1-800-627-3529 (TDD) or 7-1-1 Enrolling in this health plan does not guarantee you can • Minnesota Relay direct access numbers at see a particular provider on this list. If you want to make 1-800-627-3529 (TTY, Voice, ASCII, hearing carry over), sure, you should call that provider to ask whether he or or 1-877-627-3848 (Speech to Speech relay services) she is still part of this health plan. You should also ask if he or she is accepting new patients. This health plan may American Indians can continue or begin to use tribal or not cover all your health care costs. Read your contract, or Indian Health Services (IHS) clinics. We will not require Evidence of Coverage carefully to find out what is covered. prior approval or impose any conditions for you to get services at these clinics. For enrollees age 65 years and older Hennepin Health this includes Elderly Waiver (EW) services accessed through Minneapolis Grain Exchange Building the tribe. If a doctor or other provider in a tribal or IHS 400 South Fourth Street, Suite 201 clinic refers you to a provider in our network, we will not Minneapolis, MN 55415 require you to see your primary care provider prior to the referral. Member Services Hennepin Health Hennepin Health will accept all eligible recipients who 612-596-1507 Fraud Hotline select or are assigned to Hennepin Health without regard (or toll-free: 1-888-562-8000) 1-844-440-3290 to physical or mental condition, health status, need for or (TTY: 1-800-627-3529) receipt of health care services, claims experience, medical history, genetic information, disability, marital status, age, Office Hours sex, sexual orientation, national origin, race, color, religion, 8 a.m.–4:30 p.m., Monday–Friday creed, political beliefs, familial status, membership or activ- www.hennepinhealth.org TABLE OF CONTENTS Introduction. II Program Description . II Important Information �� II Primary Care Clinics (PCC). 2 You have the option of choosing one of the clinics from the following list. While you are not required to choose a PCC, we encourage you to see one provider for most of your care. The provider could be a primary care provider or a specialist. If the clinic or provider that you would like to see is not included in this list, call Hennepin Health Member Services at 612-596-1507. Mental & Chemical Health Providers �� 26 Hospitals �� 31 Urgent Care �� 32 Eye Care Providers . 35 SNBC: Hennepin — October 2016 www.hennepinhealth.org I INTRODUCTION Program Description Special Needs BasicCare (SNBC) is a voluntary • have either Medicare Parts A & B or medical managed care program that covers health care for assistance only people with disabilities who: As of January 1, 2017, people in SNBC who turn • are ages 18 through 64*, and 65 will be mandated into a senior managed care • have Medical Assistance. program if they continue to meet the eligibility criteria to enroll in managed care. Important Information Clinics prescription filled. We will mail you a member packet The clinic information printed in this listing was and ID card. If you lose or misplace your ID card, call correct as of 7/1/2016. You may choose a primary Member Services to get a replacement card. care clinic when you enroll. Your primary care clinic Service Accessibility can provide most of the health care services you need, If you need special access to get services from a pro- and will help coordinate your care. Please confirm vider, you can obtain information by calling Member with Member Services that your clinic is still a Services at 612-596-1507 (TTY: 1-800-627-3529). provider with our health plan before signing up. You This could include, but is not limited to, access for may choose a clinic from the list on pages 2-23 to be services such as availability of flexible hours, your primary care clinic primary care clinic. Write wheelchair access or parking lot access. the clinic’s name and code in the space provided on the enrollment form , or call Member Services to Service Authorization update your primary care clinic choice at any time. Our approval is needed for some services to be You will still be able to see any provider within the covered. The approval must be obtained before Hennepin Health network for covered services. you get certain services or before we pay for Cost Sharing them. You do not need a referral or service authorization to see a specialist within the You may be required to pay an amount toward some Hennepin Health network or a contracted health care services. This is called cost sharing. Some Hennepin Health provider. The Hennepin Health examples of cost sharing are copays or deductibles provider network has a variety of specialists for certain services. You are responsible to pay your available. If your health care provider refers you cost sharing amount to your provider. Members will outside of the Hennepin Health network, get an Evidence of Coverage with more information authorization may be required. The out-of- about cost sharing. network specialist must be enrolled as a Minnesota Member Identification (ID) Cards Health Care Program (MHCP) provider, accept and Member Packet MHCP rates from Hennepin Health and be willing Members will get a health plan Member Identifica- to see Hennepin Health members. Members will tion (ID) card. You must show this card whenever receive an Evidence of Coverage with more you get health care services, including when you get a information about which services require authorization. II PRIMARY CARE NETWORK LISTING—SNBC INTRODUCTION Services dental benefits or your dental claims, please call Delta Dental of Minnesota (Delta Dental) at Care Coordination 651-406-5907 or 1-800-774-9049 (TTY: 711). Hennepin Health will assign you a Care Guide Delta Dental can also assist you with finding a who will work with you to develop a care plan dental provider, setting up your appointment, based on your health care and social services and arranging transportation or interpreter needs. You can get more information on care services if needed. coordination services by calling Member Services Durable Medical Equipment (DME) at 612-596-1507 (TTY: 1-800-627-3529). Durable Medical Equipment is any medical Chemical Dependency equipment you can use in the home to improve quality of living. It can also provide therapeutic Chemical Dependency services provide care and benefits to people with certain medical treatment for chemical substance abuse. abuse of conditions or illnesses. Examples are nebulizers, alcohol, narcotics or other drugs. This can include wheelchairs, crutches and many others. You can Hennepin Health provides chemical health get information on Durable Medical Equipment services through a network of providers that are by talking with your Care Guide, primary care listed on pages 24-29. If you prefer, you can use clinic, or by calling Member Services at any other licensed chemical dependency provider 612-596-1507 (TTY: 1-800-627-3529). in Minnesota who is enrolled as a MHCP provider, will accept MHCP rates and is willing to Eye Care see Hennepin Health members. Your Hennepin Hennepin Health provides eye care services, Health care team can help you choose a provider including eye exams and glasses. A list of eye based on the type of services you need and care providers is on pages 37-39. You can get location most convenient to you. If you need information on eye care services by calling chemical dependency services, talk to your Care Member Services at 612-596-1507 Guide, or call Member Services at 612-596-1507 (TTY: 1-800-627-3529). (TTY: 1-800-627-3529). Home and Community Based Waiver Services Chiropractic Care for People with Disabilities You may see any chiropractor who is enrolled as We do not cover Home and Community Based a MHCP provider, will accept MHCP rates from Waiver Services for people with disabilities who are Hennepin Health and is willing to see Hennepin members of our SNBC program. But you may be Health members. You can get information on eligible to get them through your county or tribe. chiropractic services by calling Member Services Call your county or tribe to apply for these and at 612-596-1507 (TTY: 1-800-627-3529). other waiver services under the following waiver programs: Community Alternatives for Disabled Dental Individuals (CADI), Brain Injury (BI), Community A list of dental providers is provided in your Alternative Care (CAC) or Developmental provider

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