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See our Medicare Advantage pages (EmblemHealth | ConnectiCare) to see what will be changing in 2024.

Key things to know

EmblemHealth is modifying its Medicare plan portfolio. The following plans will not be offered in 2024:

• EmblemHealth VIP Essential (HMO).
• EmblemHealth VIP Reserve Classic (HMO).
• EmblemHealth VIP Dual (HMO D-SNP) will be closing and reintroduced under H5991 contract ID with revised benefits. Members enrolled in this plan in 2023, including IB-Duals, will be disenrolled on Dec. 31, 2023. Affected members will receive a non-renewal letter with instructions on how to select a new plan.

If Medicare-Medicaid dual-eligible individuals have their Part A and Part B cost-share fully covered by their Medicaid plan, or are Qualified Medicare Beneficiaries (QMB), they are not responsible for their Medicare Advantage cost-share for covered services. Please do not balance bill these members for any other costs. Any Medicare and Medicaid payments for services given to these members must be accepted as payment in full.  

For EmblemHealth members, you can use ePACES to check whether the member has full or partial Medicaid benefits. For more detail, see EmblemHealth Medicare Advantage Plans.  

For ConnectiCare members, you can visit the CT Department of Social Services or call 800-842-8440. For more detail, see ConnectiCare Medicare Advantage Plans.  

All hospitals and critical access hospitals are required by the Centers for Medicare & Medicaid Services (CMS) to provide Medicare beneficiaries, including Medicare Advantage enrollees, with the OMB-approved Medicare Outpatient Observation Notice (MOON). The MOON and instructions for completing it are available on CMS’ website.  

See our Commercial Networks and Benefit Plans pages (EmblemHealth | ConnectiCare) to see what will be changing in 2024.

Key things to know

In 2024, we will be making some changes to the networks our EmblemHealth individual and small group members will be able to use. The Select Care Network and Millennium Network will be offered based on where the member lives. Members may see all providers in these networks.

ConnectiCare members will have a new network option – the Value Network. This is a tailored network that only includes providers in Connecticut. There will be no reciprocity with EmblemHealth’s networks.  

If you are treating a member whose network is changing and you will not be in their network for 2024, there are some situations (e.g., pregnancy) that may qualify for an extension of their care. Affected members will be informed and instructed to have their providers contact our utilization management team to request authorization. Providers must agree to accept their current fee schedule and follow the plan’s policies and procedures.

The following preauthorization lists were updated:

• EmblemHealth Preauthorization List: See Notable Changes for updates.
• See revision histories for the updates to the following lists:
  • GHI PPO City of New York Preauthorization List.
  • ConnectiCare Commercial Preauthorization List.
  • ConnectiCare Medicare Preauthorization List.

EmblemHealth covers automatic blood pressure monitors for all lines of business—with no member cost-share or preauthorization requirement—for its members diagnosed with hypertension, provided they meet these coverage criteria:

• Member is age 11 or over.
• The cost of the device does not exceed $40.
• The member obtains the device through a contracted vendor.

We encourage you to prescribe a digital device for these members and discuss how self-monitoring at home may help them lower their blood pressure. Members can report their blood pressure verbally during a telehealth (telephone, e-visit, virtual) or office visit.

This is a HEDIS^® measure and this initiative can help support your blood pressure data capture, management of your patients, and improve your performance rate for the Quality measure: Controlling Blood Pressure.

Learn more about the recommended steps and the codes required for Quality care gap closure. The CDC offers educational materials for you to hand out to members to support Self-Measured Blood Pressure Monitoring | Million Hearts^®.

*This is an EmblemHealth benefit only for members diagnosed with hypertension. There is a limit of one unit every five years.

Each year, thousands of people in the United States die from flu, and many more are hospitalized. We encourage you to talk to your patients about getting a flu vaccine to help stop them from getting or spreading the flu.

The flu vaccine is a survey question for the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) evaluation.

The CAHPS survey evaluates how satisfied members are with their health plans and prescription drug services. Member satisfaction is impacted by experiences and interactions the member has with every part of their health plan, including you, the provider community. That’s why it’s so important for all of us to be focused on member satisfaction throughout the year.

Survey Question:

“Have you had a flu shot since July 1, 2023?” is one of the questions on the annual CAHPS survey.

Measure adherence is determined by member response via the CAHPS Health Plan Survey.

• Denominator = The number of members with a flu vaccination for adults ages 18–64 who responded “Yes” or “No” to the question: “Have you had either a flu shot or flu spray in the nose since July 1, YYYY?” on the CAHPS Health Plan Survey.
• Numerator = The number of members in the denominator who responded “Yes” to the question “Have you had either a flu shot or flu spray in the nose since July 1, YYYY?” on the CAHPS Health Plan Survey.  

Measure Description

The percentage of patients 65 years of age and older who received a flu vaccination between July 1 of the measurement year and the date when the CAHPS survey was completed.

How To Improve CAHPS Scores

Identify an “Immunization Champion” to lead and monitor flu vaccination efforts at the office.

• Institute a standing order program (SOP) to allow non-physician clinical staff to assess eligibility for vaccination and vaccinate patients and educate staff about the SOP.
• Turn on reminders/prompts for the flu vaccine if on electronic medical records (EMR). Review vaccine status in EMR.
• Flag the charts of all patients needing flu vaccine with a brightly colored sheet if not on EMR.
• Encourage staff vaccination (can also be used to show patients the importance of vaccination).
• Provide a list of pharmacy locations if you do not offer the flu vaccine.
• Address any hesitations the member may have about receiving the flu vaccine. (Examples: Flu vaccines do not cause flu. Flu vaccines aren’t safe.)
• Educate patients that the seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Each season requires a different vaccine.

Keep up to date with the CDC’s flu recommendations and educational resources.

On Jan. 1, 2024, Aspire Health will become Carelon Health. They will continue to manage in-home palliative care services as part of our case/care management programs under their new name for our eligible members. There isn’t anything for our providers or members to do. We’re sharing this in case your staff or your patients have questions.

ConnectiCare’s Medical Necessity Guidelines: Experimental, Investigational, or Unproven Services (Commercial & Medicare) policy changes are shown in the Revision History section.

The Hyperbaric Oxygen Therapy medical policy was revised for both EmblemHealth and ConnectiCare to:

• Add emergent anemia and intracranial abscess as covered indications with clinical criteria.
• Remove exceptional blood loss anemia from the Limitations and Exclusions section.