What is SSBCI (Special Supplemental Benefits for the Chronically Ill)?

Special Supplemental Benefits for Chronically Ill Enrollees (SSBCI) Eligibility Criteria

• Determination of eligibility for the SSBCI
  • Documentation must include that the member has completed a Health Risk Assessment and
  • Has one or more complex chronic conditions including:
    • Cardiovascular disorders limited to:
      • Cardiac arrhythmias
      • coronary artery disease
      • Peripheral vascular disease
      • Chronic venous thromboembolic disorder
    • Chronic heart failure
    • Chronic and disabling mental health conditions limited to:
      • Bipolar disorders
      • Major depressive disorders
      • Paranoid disorder
      • Schizophrenia
      • Schizoaffective disorder
    • Chronic lung disorders limited to:
      • Asthma
      • Chronic bronchitis
      • Emphysema
      • Pulmonary fibrosis
      • Pulmonary hypertension
    • Dementia
    • Diabetes
    • End-stage liver disease
    • End-stage renal disease (ESRD)
    • HIV/AIDS
    • Neurologic disorders limited to:
      • Amyotrophic lateral sclerosis (ALS)
      • Epilepsy
      • Extensive paralysis such as:
        • Hemiplegia
        • Quadriplegia
        • Paraplegia
        • Monoplegia
      • Huntington’s disease
      • Multiple sclerosis
      • Parkinson’s disease
      • Polyneuropathy
      • Spinal stenosis
      • Stroke-related neurologic deficit
    • Stroke
  • The member is at high-risk for hospitalization or adverse health outcomes. UM Coordinator will request records from Primary Care Provider (PCP) to verify chronic condition(s).
  • The member is participating in the case management program:
    • C-SNP case management as defined in the Model of Care
    • Non – C-SNP case management, including:
      • The member receives a copy of their SSBCI care plan, and the case manager follows up as needed throughout the year.
• The UM Coordinator will proceed with processing the SSBCI request following the SSBCI Request Workflow.