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Case management & care coordination

One of the advantages of being a Santa Clara Family Health Plan DualConnect (Medicare-Medicaid Plan) (SCFHP DualConnect) member is having a case manager lead your care team. Your care team works with you to create and coordinate an individual care plan designed to meet your needs. Case management services are available to all SCFHP DualConnect members.

SCFHP DualConnect offers different types of case management programs. These programs can help you understand your covered medical, pharmacy, dental, and vision benefits, access health education classes, and connect you to community resources. We work with you to determine which program is best for you. You will be assigned to a case manager to help you work with your doctors to meet your personalized health goals.

SCFHP DualConnect members are eligible for these no-cost services upon enrollment. You can opt-out of these services at any time—just tell your case manager. Opting out does not affect your coverage or benefits. You can change your mind at any time.

Connect to a case manager by calling SCFHP Case Management toll-free at 1-877-590-8999 (TTY: 711), Monday - Friday, 8:30 a.m. to 5 p.m.

Frequently asked questions

What is a care coordinator?

When you enroll in SCFHP DualConnect, a care coordinator will be offered to help you. A care coordinator is a clinician or other highly trained person who works for your plan to provide care coordination services for you, especially during care transitions and hospital discharges. This is a person who will work with you and with your care team to create an ICP. For example, your care coordinator can help you:

  • Coordinate your health care (doctor visits, home health, behavioral health, therapy)
  • Get medical equipment and/or supplies
  • Coordinate your long-term services and supports (LTSS)
  • Schedule interpreters
  • Identify doctors and specialists within your network
  • Choose or change a doctor
  • Arrange transportation to and from medical appointments
  • Understand your health plan benefits
  • Get health care services that are covered by SCFHP
  • Find community resources and educational programs
  • Help with care transitions
  • Get any required prior authorization requests for care, equipment, or supplies
  • Understand the difference between “emergency” and “urgent care”
  • Schedule health screenings

To contact your case manager, call SCFHP care coordinator at 1-877-590-8999 (TTY: 711), Monday - Friday, 8:30 a.m. to 5 p.m.

What is a Care Team and a Care Plan?

Care Team
A care team consists of you, your primary care doctor, your care coordinator, and any other individual that supports your health; this may include family, friends, or other health professionals that you choose. A care team is led by your care coordinator and works together to create your care plan.

Care Plan
A care plan tells you and your doctors what services you need and how you will get them. It includes your medical, behavioral health, and LTSS needs. Your care team will work with you to come up with a care plan. Your care plan will be made just for you and your needs.

Your care plan will include:

  • Your personalized healthcare goals
  • A timeline for when you should get the services you need

Your care team meets with you after your health risk assessment (HRA). They talk to you about the services you need. They will also tell you about services you may want to think about getting. Your care plan will be based on your needs. Your care team will work with you to update your care plan at least yearly.

What are long-term services and supports (LTSS)?

LTSS are services that help improve a long-term medical condition. Most of these services help you stay in your home so you don’t have to go to a nursing home or hospital. LTSS includes the following:

  • Community-Based Adult Services (CBAS)
    • Health and social services provided at a licensed, community-based health center
  • Nursing Facility (NF)
    • A facility that provides care for people who cannot safely live at home but who do not need to be in the hospital

Your care coordinator will help you understand each program. To find out more about any of these programs, contact SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.

When you first join SCFHP— complete your Health Risk Assessment (HRA)

When you first join the plan, you will get an HRA form in your new member packet. It will come with a postage paid envelope so you can return it to SCFHP at no cost to you.

This HRA is a questionnaire you fill out according to your understanding of your health. It is the basis for developing your ICP. The HRA will include questions to identify benefits or services that you may need such as LTSS, and behavioral health and functional needs.

If you need help completing your HRA, call SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday through Friday, 8:30 a.m. to 5 p.m.

If you do not return your HRA, a care coordinator will reach out to you to complete the HRA. The HRA can be completed by an in-person visit, telephone call, or mail.

How do you request case management and care coordination?

Members or their doctors, family members, caregivers, hospital discharge planners, etc. may request case management and care coordination. To make a request, call SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday - Friday, 8:30 a.m. to 5 p.m.

How do you contact your care coordinator?

To contact your care coordinator, call SCFHP Case Management at 1-877-590-8999 (TTY: 711), Monday - Friday, 8:30 a.m. to 5 p.m. When a care coordinator is assigned to you, you will get a phone number to call them directly.

Accessibility

You can ask for published materials for free in other formats, such as large print, braille, or audio. Call SCFHP DualConnect Customer Service for help.

If you are more comfortable speaking a language other than English, Santa Clara Family Health Plan can help you. Whether you are contacting SCFHP or visiting a doctor, we have interpreters available. Tell your doctor you would like an interpreter for your visit.

Know your rights

  • You can get an in-person or telephone interpreter at no cost to you. This includes American Sign Language.
  • When you go to the doctor, interpreters are available 24-hours a day.
  • You can ask for SCFHP DualConnect materials written in other languages.

How can you get an interpreter?

Tell your doctor’s office you would like one. You can do this when you call to set up your next visit. You can also ask us for an interpreter or for translated materials.

Santa Clara Family Health Plan DualConnect is an HMO D-SNP with a Medicare and Medi-Cal contract. Enrollment in DualConnect depends on contract renewal.

Last updated 12/27/2022

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