Member Services

Call center operator Our Senior Care Options Program (HMO SNP) allows your primary care physician (PCP) to coordinate a comprehensive range of health care, health-related, and social support services tailored to fit your individual needs. Your PCP is dedicated to providing a personalized approach to your care so that you, your family, and network providers are able to work together on your behalf. Commonwealth Care Alliance provides access to nurses, services, and information on a 24-hour basis, 7 days a week.

If you have any questions or concerns, please call our Member Services team at 1-866-610-2273 (TTY users please dial 1-866-322-7357). We are available 24 hours a day, 7 days a week.

Unique Features of Senior Care Options Program (HMO SNP)

Commonwealth Care Alliance will work in partnership with you, your family, and your PCP to coordinate all appropriate services. All covered services are provided through Commonwealth Care Alliance's extensive contracted network, including specialists, hospitals, community-based home care providers, and skilled nursing facilities. Your PCP will arrange hospital and nursing home care through our contracted facilities.

Commonwealth Care Alliance only contracts with physicians who have considerable experience in caring for seniors. Your PCP is responsible for coordinating your medical care, and calling upon additional specialists, if necessary. Commonwealth Care Alliance contracts with community based health centers that are experienced in serving the elder populations.

If your care requires it, you will be assigned a primary care team (PCT). Your PCT will work together with your PCP to coordinate medical support service needs. Your PCT will include a geriatric support services coordinator (GSSC), as well as a nurse practitioner, registered nurse, or physician's assistant. Each member of the PCT will have experience in caring for seniors.

Your PCP and PCT will work together with you and anybody you choose, such as family members or caregivers, to construct a comprehensive Individual Care Plan (ICP), designed for your specific needs. Your ICP includes all health care, health-related, or social support services that your PCP or PCT has authorized or recommended that you receive. Your PCP will coordinate these services. In order to ensure the most appropriate services, your PCP will review and approve any changes to the ICP, whether adding, altering, or discontinuing a service. Your PCP will personally reassess your needs at least every six months, or more frequently, if necessary.

Thanks to Commonwealth Care Alliance's unique relationship with CMS and MassHealth, members have the privilege of receiving all of Medicare and Medicaid's coverage and services, in addition to benefits and services not traditionally covered by these programs.

Other advantages to participating in the Senior Care Options Program (HMO SNP) include:

A centralized record of your health and medical information
Comprehensive coverage for health care services, including pharmacy, in-home care, and long term care support
Free transportation to and from appointments
Flexibility to remain at home with needed care and support rather than being admitted to a hospital or nursing home
Assistance for family caregivers
Providers who speak your language
Providers from your community
Coordinated care 24 hours a day, 7 days a week, 365 days a year
Health care professionals from various disciplines, including physicians, nurses, nurse practitioners, and social workers, all of whom are experienced in providing care to elders
Friendly and knowledgeable member services representatives

Member Responsibilities

Select a primary care physician from our list of participating doctors
Agree to receive all services through providers linked to the doctor you have enrolled with (except for emergency and out of area urgent care services)
Agree to receive services within our contracted provider network (except for emergency and out of area urgent care)

Member Rights to Exceptions and Appeals

At Commonwealth Care Alliance, we are committed to ensuring that you are satisfied with the care you receive. You have the right to voice a complaint if you ever have a problem or concern with your care, your provider of care, your prescription program or coverage, or any aspect of the Senior Care Options Program (HMO SNP). You also have the right to appeal any decision or our failure to approve, arrange, or provide any services that you believe are necessary. If you would like to file a complaint or appeal, please call our Member Services team at 1-866-610-2273 (TTY users please dial 1-866-322-7357). We are available 24 hours a day, 7 days a week.

You may also fax your written complaint to: (617) 426-3097 or mail your written complaint to this address:

Commonwealth Care Alliance

Member Services
30 Winter Street
Boston, MA 02108

*Filing a complaint will not negatively affect your membership or coverage.

You may also utilize your MassHealth Appeal Rights

You may request a fair hearing from MassHealth no later than 30 calendar days from the date you received your written denial notice from Commonwealth Care Alliance Senior Care Options Program (HMO SNP). The request must contain:

your name
your address and phone number
your MassHealth ID number or Social Security number
your reason for appeal
if you would like your hearing to be scheduled as soon as possible
if you need an interpreter to be provided, and
if you would like to name a representative to appeal on your behalf

The request must be signed and sent to:

Executive Office of Health and Human Services
Board of Hearings
100 Hancock Street, 6th Floor
Quincy, MA 02171

Or faxed to (617) 847-1204

Please keep one copy of the fair hearing request for your information.

If you do not agree with the fair hearing decision, you will have further appeal rights under MassHealth. You will be notified of those appeal rights if this happens.

For more information about your appeal rights, call our Member Services team toll-free at 1-866-610-2273 or see your Evidence of Coverage (TTY users please call 1-866-322-7357). We are available 24 hours a day, 7 days a week.

If you are a member, or are interested in becoming a member, you may request a report from Commonwealth Care Alliance on the total number of complaints (grievances), appeals, and exceptions file with the plan. To request this report, call our Member Services team at 1-866-610-2273 (TTY users please dial 1-866-322-7357). We are available 24 hours a day, 7 days a week.

Last Updated 1/1/12