2024 CCA Senior Care Options & One Care Provider Manual – Massachusetts
Chronic Condition Provider Attestation Form
Member Chronic Condition Coverage Request Form (CA)
Our members with certain health conditions or adverse health outcomes may be eligible for additional benefits under the Special Supplemental Benefits for the Chronically Ill (SSBCI). This form should be used by members to request that CCA determine eligibility for SSBCI benefits.
Member Chronic Condition Coverage Request Form (RI)
Our members with certain health conditions or adverse health outcomes may be eligible for additional benefits under the Special Supplemental Benefits for the Chronically Ill (SSBCI). This form should be used by members to request that CCA determine eligibility for SSBCI benefits.
Member Chronic Condition Coverage Request Form (MI)
Our members with certain health conditions or adverse health outcomes may be eligible for additional benefits under the Special Supplemental Benefits for the Chronically Ill (SSBCI). This form should be used by members to request that CCA determine eligibility for SSBCI benefits.
CCA Health (RI) – Comprehensive Needs Assessment Form
If you prefer to print and mail it, please send to:
Commonwealth Care Alliance
101 Wason Ave, 3rd floor
Springfield, MA 01107
Commonwealth Care Alliance
101 Wason Ave, 3rd floor
Springfield, MA 01107