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New Network of Skilled Nursing Facilities for Medicare Advantage Plans

New Network of Skilled Nursing Facilities for Medicare Advantage Plans

Effective November 1, 2016, we will be implementing a new Medicare Advantage network of skilled nursing facilities. Members in our Medicare Advantage plans (Medicare HMO Blue® and Medicare PPO Blue) who need skilled nursing facility services should use this new network for in-network care.

The new network will replace our current Medicare Advantage network of skilled nursing facilities. By collaborating more closely with a smaller network of skilled nursing facilities, we hope to improve quality of care and reduce overall costs for Medicare Advantage members.

Member impact

As of November 1, a Medicare Advantage member getting care in a facility that is terminating will be able to continue to get their treatment for that episode. For a new episode of care, members will need to use a participating skilled nursing facility for in-network care. Medicare PPO Blue and Medicare HMO Blue FlexRx members may choose to get out-of-network care, but will pay significantly more for these services.

Criteria for Network Participation

  • Ability to provide high-quality, cost-effective care. Factors considered include, but are not limited to, reducing readmission rates and lengths of stay, and Massachusetts Department of Public Health Performance Survey scores
  • Geographic location

We will regularly review the network to make sure all the skilled nursing facilities meet these criteria. We'll have Blue Cross case managers assigned to work directly with the Medicare Advantage network of facilities on discharge planning, transitions of care, and health plan and community resources available to our members.

If you have any questions, please contact your Account Executive.

Blue Cross Blue Shield of Massachusetts

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