Commonwealth Coordinated Care Plus Program Effective .
community.Welcome to theCommonwealth of VirginiaDepartment of Medical Assistance ServicesCommonwealth Coordinated Care Plus ProgramEffective January 1, 2020CSVA20MC4763151 000
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Where to Find InformationImportant Phone Numbers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Help in Other Languages or Alternate Formats . . . . . . . . . . . . . . . . . . . . . . . . . 101. Commonwealth Coordinated Care Plus (CCC Plus) . .Welcome to UnitedHealthcare Community Plan . . . . . . .How to Use This Handbook . . . . . . . . . . . . . . . . . . . . . .Getting Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other Information We Will Send to You . . . . . . . . . . . . . .UnitedHealthcare Community Plan Member ID Card .Provider and Pharmacy Directory . . . . . . . . . . . . . . . 13. 13. 13. 14. 15. 15. 162. What Is Commonwealth Coordinated Care Plus . . . . . . . . . . . . . . .What Makes You Eligible to be a CCC Plus Member . . . . . . . . . . . . . .CCC Plus Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Reasons You Would Not be Eligible to Participate in CCC Plus . . . .What if I Am Pregnant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Coverage for Newborns Born to Moms Covered Under CCC Plus .Medicaid Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Choosing or Changing Your Health Plan . . . . . . . . . . . . . . . . . . . . . . .Health Plan Assignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .You Can Change Your Health Plan Through the CCC Plus HelplineAutomatic Re-Enrollment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UnitedHealthcare Community Plan’s Service Area . . . . . . . . . . . . .If You Have Medicare and Medicaid . . . . . . . . . . . . . . . . . . . . . . . . . .You Can Choose the Same Health Plan for Medicare and MedicaidHow to Contact the Medicare State Health InsuranceAssistance Program (SHIP). . . . . . . . . . . . . . . . . . . . . . . . . . 17. 17. 18. 18. 18. 19. 19. 20. 20. 20. 21. 21. 22. 23. . . . . . . . . 233. How CCC Plus Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .What are the Advantages of CCC Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . .What are the Advantages of Choosing UnitedHealthcare Community Plan .Transition of Care Policy: Continuity of Care Period . . . . . . . . . . . . . . . . . . .If You Have Other Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24. 24. 25. 26. 26CSVA20MC4763159 0001-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.3
Where to Find Information (continued)4. Your Care Coordinator . . . . . . . . . . . .How Your Care Coordinator Can Help .Transportation Contacts . . . . . . . . . . . .What Is a Health Screening . . . . . . . . . .What Is a Health Risk Assessment . . . .What Is a Care Plan. . . . . . . . . . . . . . . .How to Contact Your Care Coordinator . 27. 27. 28. 29. 29. 30. 305. Help from Member Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .How to Contact UnitedHealthcare Community Plan Member Services . . . . .How Member Services Can Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Medical Advice Line Available 24 Hours a Day, 7 Days a Week . . . . . . . . . . .Behavioral Health Crisis Line Available 24 Hours a Day, 7 Days a Week . . . .Addiction and Recovery Treatment Services (ARTS) Advice LineAvailable 24 Hours a Day, 7 Days a Week . . . . . . . . . . . . . . . . . . . .If You Do Not Speak English . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If You Have a Disability and Need Assistance in Understanding Informationor Working with Your Care Coordinator . . . . . . . . . . . . . . . . . . . . . .If You Have Questions About Your Medicaid Eligibility . . . . . . . . . . . . . . . . . 31. 31. 32. 33. 346. How to Get Care and Services . . . . . . . . . . . . . . .How to Get Care from Your Primary Care PhysicianYour Primary Care Physician . . . . . . . . . . . . . . .Choosing Your PCP . . . . . . . . . . . . . . . . . . . . .If You have Medicare, Tell us About Your PCP . .If Your Current PCP is not in Our Network . . . . .Changing Your PCP . . . . . . . . . . . . . . . . . . . . .Getting an Appointment with Your PCP . . . . . . .Appointment Standards . . . . . . . . . . . . . . . . . .How to Get Care from Network Providers . . . . . . . .Travel Time and Distance Standards . . . . . . . . .Accessibility . . . . . . . . . . . . . . . . . . . . . . . . . . .Provider Incentive Plan . . . . . . . . . . . . . . . . . . .What are “Network Providers” . . . . . . . . . . . . . .Learn more about network doctors . . . . . . . . . .What are “Network Pharmacies” . . . . . . . . . . . .What are Specialists . . . . . . . . . . . . . . . . . . . . .4.1-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free. . . . 35. . . . 35. . . . 36. . . . 36. 37. 37. 37. 37. 38. 38. 39. 39. 39. 40. 40. 41. 41. 41. 41. 42. 42
Where to Find Information (continued)If Your Provider Leaves Our Plan . . . . . . . . . . . . . . . . . . . . . .How to Get Care from Out-of-Network Providers . . . . . . . . . . . . .Care from Out-of-State Providers . . . . . . . . . . . . . . . . . . . . . .Network Providers Cannot Bill You Directly . . . . . . . . . . . . . .If You Receive a Bill for Covered Services . . . . . . . . . . . . . . . .If You Receive Care from Providers Outside of the United States. 42. 43. 44. 44. 44. 447. How to Get Care for Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . .What Is an Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .What to do in an Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .What Is a Medical Emergency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .What Is a Behavioral Health Emergency . . . . . . . . . . . . . . . . . . . . . . .Examples of Non-Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If You Have an Emergency when Away from Home . . . . . . . . . . . . . . .What Is Covered if You Have an Emergency . . . . . . . . . . . . . . . . . . . .Notifying UnitedHealthcare Community Plan About Your Emergency.After an Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Hospital Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If You Are Hospitalized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If it Wasn’t a Medical Emergency . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45. 45. 45. 45. 46. 46. 46. 46. 47. 47. 47. 48. 488. How to Get Urgently Needed Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49What Is Urgently Needed Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499. How to Get Your Prescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . .Rules for UnitedHealthcare Community Plan’s Outpatient Drug Coverage .Getting Your Prescriptions Filled . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .You can start using your pharmacy benefit right away . . . . . . . . . . . . . . . . .Copays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .List of Covered Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Limits for Coverage of Some Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Getting Approval in Advance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Prior Authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Trying a Different Drug First . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Quantity Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Emergency Supply . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free. 50. 50. 51. 52. 54. 54. 55. 55. 55. 56. 56. 565
Where to Find Information (continued)Non-Covered Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Changing Pharmacies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .What if You Need a Specialized Pharmacy . . . . . . . . . . . . . . . . . . . . . . . .Can You Use Mail-Order Services to Get Your Drugs . . . . . . . . . . . . . . . .Can You Get a Long-Term Supply of Drugs . . . . . . . . . . . . . . . . . . . . . . . .Can You Use a Pharmacy that is Not inUnitedHealthcare Community Plan’s Network . . . . . . . . . . . . . .What Is the Patient Utilization Management and Safety (PUMS) Program .Over-the-Counter (OTC) Medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10. How to Access Your CCC Plus Benefits . . . . . . . . . . . . . . . . . . . . .CCC Plus Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .General Coverage Rules. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Benefits Covered Through UnitedHealthcare Community Plan . . . .Extra Benefits We Provide that are not Covered by Medicaid . . . . . .Clinical Practice Guidelines and New Technology . . . . . . . . . . . . . .New Technology Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . .How to Access Early and Periodic Screening, Diagnostic,and Treatment Services . . . . . . . . . . . . . . . . . . . . . . . . . . .What Is EPSDT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Getting EPSDT Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Getting Early Intervention Services . . . . . . . . . . . . . . . . . . . . . . .How to Access Behavioral Health Services . . . . . . . . . . . . . . . . . . . .How to Access Addiction and Recovery Treatment Services (ARTS)How to Access Long-Term Services and Supports (LTSS) . . . . . . . .Commonwealth Coordinated Care Plus Waiver . . . . . . . . . . . . . .How to Self-Direct Your Care . . . . . . . . . . . . . . . . . . . . . . . . . . . .Nursing Facility Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Screening for Long-Term Services and Supports . . . . . . . . . . . . .Freedom of Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .How to Get Services if You are in a Developmental Disability Waiver .How to Get Non-Emergency Transportation Services . . . . . . . . . . . .Non-Emergency Transportation Services Covered byUnitedHealthcare Community Plan. . . . . . . . . . . . . . . . . . . . . .Transportation to and from DD Waiver Services . . . . . . . . . . . . . .6. 57. 57. 58. 58. 58. . . . . . 59. . . . . . 59. . . . . . 60. 61. 61. 61. 62. 66. 68. 68. 69. 69. 69. 69. 70. 71. 71. 72. 73. 73. 74. 74. 75. 76. . . . . . . . . . 76. . . . . . . . . . 771-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.
Where to Find Information (continued)11. Services Covered Through the DMAS MedicaidFee-For-Service Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Carved-Out Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Services that Will End Your CCC Plus Enrollment . . . . . . . . . . . . . . . . . . . . . . . . . 8012. Services Not Covered by CCC Plus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81If You Receive Non-Covered Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8213. Member Cost Sharing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83Member Patient Pay Towards Long-Term Services and Supports . . . . . . . . . . . . . 83Medicare Members and Part D Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8414. Service Authorization and Benefit Determination . . . . . . . . . . .Service Authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Service Authorizations and Continuity of Care . . . . . . . . . . . . . . .How to Submit a Service Authorization Request . . . . . . . . . . . . . .What Happens After We Get Your Service Authorization Request .Timeframes for Service Authorization Review . . . . . . . . . . . . . . . . 85. 85. 87. 87. 87. 8815. Appeals, State Fair Hearings, and Grievances. .Your Right to Appeal . . . . . . . . . . . . . . . . . . . . . . .Adverse Benefit Determination . . . . . . . . . . . .Authorized Representative . . . . . . . . . . . . . . .How to Submit Your Appeal . . . . . . . . . . . . . . .Continuation of Benefits . . . . . . . . . . . . . . . . .What Happens After We Get Your Appeal . . . .Timeframes for Appeals . . . . . . . . . . . . . . . . . .Written Notice of Appeal Decision . . . . . . . . . .Your Right to a State Fair Hearing . . . . . . . . . . . . .Standard or Expedited Review Requests . . . . .Authorized Representative . . . . . . . . . . . . . . .Where to Send the State Fair Hearing Request .After You File Your State Fair Hearing Appeal . .State Fair Hearing Timeframes . . . . . . . . . . . .If the State Fair Hearing Reverses the Denial . . 90. 90. 90. 90. 91. 91. 92. 92. 93. 94. 94. 94. 94. 95. 95. 96.1-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.7
Where to Find Information (continued)Your Right to File a Grievance . . . . . . . . . . . . . . . . .Timeframe for Grievances . . . . . . . . . . . . . . . . .What Kinds of Problems Should be Grievances .Grievances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .External Grievances . . . . . . . . . . . . . . . . . . . . . 101. 101. 103. 103. 104. 111. 11117. Member Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Your Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Advance Directives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Where to Get the Advance Directives Form . . . . . . . . . . . . . . . . . . . .Completing the Advance Directives Form . . . . . . . . . . . . . . . . . . . . .Share the Information with People You Want to Know About It . . . . . .We Can Help You Get or Understand Advance Directives DocumentsOther Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If Your Advance Directives Are Not Followed . . . . . . . . . . . . . . . . . . . 117. 117. 118. 119. 119. 119. 120. 120. 12016. Member Rights . . . . . . . . . . . . . . . . . . . . . . .Your Rights . . . . . . . . . . . . . . . . . . . . . . . . . . .Your Right to be Safe . . . . . . . . . . . . . . . . . . .Your Right to Confidentiality . . . . . . . . . . . . . .Health Plan Notices of Privacy Practices . . . .How to Join the Member Advisory CommitteeWe Follow Non-Discrimination Policies . . . . . . 96. 96. 97. 98. 9918. Fraud, Waste, and Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122What Is Fraud, Waste, and Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122How Do I Report Fraud, Waste, or Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12319. Other Important Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12420. Medicaid Expansion Addendum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12521. Important Words and Definitions Used in This Handbook . . . . . . . . . . . . . . . 12881-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.
Important Phone NumbersYour Care Coordinator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-622-7982, TTY 711UnitedHealthcare Community PlanMember Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-622-7982, TTY 711UnitedHealthcare Community Plan24/7 Medical/Behavioral Health Advice Line . . . . . . . . . . 1-866-622-7982, TTY 711UnitedHealthcare Community Plan24/7 Behavioral Health Crisis Line . . . . . . . . . . . . . . . . . . 1-866-622-7982, TTY 711UnitedHealthcare Community PlanAdult Dental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-622-7982, TTY 711UnitedHealthcare Community PlanNurseLine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-888-547-3674Smiles for Children through DentaQuest, DMAS Dental Benefits AdministratorFor questions or to find a dentist in your area,call Smiles for Children at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-888-912-3456Information is also available on the DMASwebsite at . . . . . . . . . . . . . . . . . http://www.dmas.virginia.gov/#/dentalservicesor the DentaQuest website at . . . . . . . . . . . . . . . . http://www.dentaquestgov.com/UnitedHealthcare Community Plan Transportation . . . . . . . . 1-866-622-7982, TTY 711DMAS Transportation Contractor for transportationto and from DD Waiver Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-866-386-8331TTY 1-866-288-3133Or dial 711 to reach a relay operatorCCC Plus Helpline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-844-374-9159TDD 1-800-817-6608or visit the website at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . cccplusva.comCoverVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-855-242-8282www.coverva.orgDepartment of Health and Human Services’ Office for Civil Rights . . . . . 1-800-368-1019or visit the website at . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . www.hhs.gov/ocrOffice of the State Long-Term Care Ombudsman . . . . . . . . . . . . . . . . . . 1-800-552-5019TTY 1-800-464-99501-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.9
Help in Other Languages or Alternate FormatsThis handbook is available for free in other languages and formatsincluding online, in large print, Braille or Audio CD. To request thehandbook in an alternate format and or language, please call ourMember Services staff at 1-866-622-7982, TTY 711.If you have any problems reading or understanding this information,please contact our Member Services staff at 1-866-622-7982,TTY 711 for help at no cost to you.We provide reasonable accommodations and communicationsaccess to persons with disabilities. Individuals who are deaf orhard of hearing or who are speech-impaired, who want to speak toa Member Services representative, and who have a TTY or otherassistive device can dial 711 to reach a relay operator. They willhelp you reach our Member Services staff.101-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.
1-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.11
121-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.
1. Commonwealth Coordinated Care Plus (CCC Plus)1. Commonwealth CoordinatedCare Plus (CCC Plus)Welcome to UnitedHealthcare Community PlanThank you for being a Member of UnitedHealthcare Community Plan, a CommonwealthCoordinated Care Plus (CCC Plus) plan. If you are a new Member, we will get in touch withyou in the next few weeks to go over some very important information with you. You can askus any questions you have, or get help making appointments. If you need to speak with usright away or before we contact you, call us at the number listed below.UnitedHealthcare Community Plan gives you access to many health care providers —doctors, hospitals and pharmacies — so you have access to all the health services you need.We cover preventive care, checkups and treatment services. We are dedicated to improvingyour health and well-being.We’re ready to answer any questions you may have. Just call Member Services at1-866-622-7982, TTY 711.You can also visit our website at myuhc.com/CommunityPlan.How to Use This HandbookThis handbook will help you understand your Commonwealth Coordinated Care Plus (CCCPlus) benefits and how you can get help from UnitedHealthcare Community Plan. Thishandbook is your guide to health services. It explains your health care, behavioral health,prescription drug, and long-term services and supports coverage under the CCC Plusprogram. It tells you the steps you can take to make your health plan work for you.Feel free to share this handbook with a family member or someone who knows your healthcare needs. When you have a question, check this handbook and call Member Services at1-866-622-7982, TTY 711.1-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.13
1. Commonwealth Coordinated Care Plus (CCC Plus)Getting StartedWe want you to get the most from your health plan right away. Start with these five easy steps:1234514Call your doctor and schedule a checkup.Regular checkups are important for good health. If you don’t know your PrimaryCare Provider (PCP) number, or if you need help finding a network doctor nearyou, call Member Services at 1-866-622-7982, TTY 711. We’re here to help.Take your Health Assessment.You will soon receive a welcome phone call from us to help you complete asurvey about your health. This is also called the initial health screening for newMembers. This survey helps us understand your needs so that we can serve youbetter. You can also fill out the survey online. See page 29 for details.Get to know your health plan.This Member handbook gives you general information about your health carecoverage, special programs, and rights and responsibilities. And be sure to keepthis booklet handy, for future reference.Discover your plan online.Go to myuhc.com/CommunityPlan to sign up for web access to your account.This secure website keeps all of your health information in one place. Take yourHealth Assessment, find answers to your questions about plan benefits, networkdoctors and more. In addition to plan details, the site includes useful tools thatcan help you. You can even print a copy of your Member ID card. Register today.Check your Member ID card.You should have received a Member ID card in the mail. The card has theUnitedHealthcare Community Plan logo on it. You should have a separateID card for each member of your family who is enrolled with us. If you did notget an ID card, or if the information on it is not correct, call Member Services.1-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.
1. Commonwealth Coordinated Care Plus (CCC Plus)Other Information We Will Send to YouYou should have already received your UnitedHealthcare Community Plan MemberID Card, and information on how to access a Provider and Pharmacy Directory, and a Listof Covered Drugs.UnitedHealthcare Community Plan Member ID Card.Show your UnitedHealthcare Community Plan ID card when you receive Medicaidservices, including when you get long-term services and supports, at doctor visits, andwhen you pick up prescriptions. You must show this card when you get any servicesor prescriptions. If you have Medicare and Medicaid, show your Medicare andUnitedHealthcare Community Plan ID card when you receive services. Below is a samplecard to show you what yours will look like:In case of emergency call 911 or go to nearest emergency room.Health Plan (80840)911-87726-04Member ID: 001500001Group Number:999999Member:Payer ID: 87726NEW M ENGLISHMedicaid ID:9999999991PCP Name:DOUGLAS GETWELLRx Bin:610494PCP Phone: (717)851-6816Rx GRP:Rx PCN:0501ACUVA4444UnitedHealthcare Community PlanAdministered by UnitedHealthcare Insurance CompanyPrinted: 12/11/17This card does not guarantee coverage. To verify benefits or to find a provider, visitthe website myUHC.com/CommunityPlan or call. Member Customer Service Hours8:00 am-8:00 pm local time.866-622-7982TTY 711Smiles for Children: 888-912-3456TTY 711NurseLine:888-547-3674TTY 711Care Coordination/Transportation: 866-622-7982 TTY 711For Providers:www.unitedhealthcareonline.com 877-843-4366Claims:PO Box 5270, Kingston, NY, 12402-5270Customer Service/Behavioral:Pharmacy Claims: OptumRX, PO Box 29044, Hot Springs, AR 71903For Pharmacists: 1-855-873-3493If you haven’t received your card, or if your card is damaged, lost, or stolen, call MemberServices at the number at the bottom of the page right away, and we will send you a new card.In addition to your UnitedHealthcare Community Plan ID card, keep your Commonwealth ofVirginia Medicaid ID card to access services that are covered by the State, under theMedicaid fee-for-service program. These services are described in Services Covered throughMedicaid Fee-For-Service, in Section 11 of this handbook.1-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.15
1. Commonwealth Coordinated Care Plus (CCC Plus)Provider and Pharmacy Directory.You can ask for an annual Provider and Pharmacy Directory by calling Member Servicesat 1-866-622-7982, TTY 711. You can also see the Provider and Pharmacy Directoryat myuhc.com/CommunityPlan.The Provider and Pharmacy Directory provides information on health care professionals(such as doctors, nurse practitioners, psychologists, etc.), facilities (hospitals, clinics, nursingfacilities, etc.), support providers (such as adult day health, home health providers, etc.), andpharmacies in the UnitedHealthcare Community Plan network. While you are a Member ofour plan, you generally must use one of our network providers and pharmacies to getcovered services. There are some exceptions, however, including: When you first join our plan (see Continuity of Care Period in Section 3 of this handbook), If you have Medicare (see How to Get Care from Your Primary Care Physician in Section6 of this handbook), and In several other circumstances (see How to Get Care from Out-of-Network Providersin Section 6 of this handbook).You can ask for a paper copy of the Provider and Pharmacy Directory or List ofCovered Drugs by calling Member Services at 1-866-622-7982, TTY 711. You canalso see the Provider and Pharmacy Directory and List of Covered Drugs atmyuhc.com/CommunityPlan or download it from this website. Refer to List ofCovered Drugs in Section 9 of this handbook.161-866-622-7982, TTY 711, 8:00 a.m. – 8:00 p.m., daily. The call is free.
2. What Is Commonwealth Coordinated Care Plus2. What Is CommonwealthCoordinated Care PlusThe Commonwealth Coordinated Care Plus (CCC Plus) program is a Medicaidmanaged care program through the Department of Medical Assistance Services (DMAS).UnitedHealthcare Community Plan was approved by DMAS to provide care coordination andhealth care services. Our goal is to help you improve your quality of care and quality of life.What Makes You Eligible to Bea CCC Plus MemberYou are eligible for CCC Plus when you have full Medicaid benefits, and meet one of thefollowing categories: You are age 65 and older, You are an adult or child with a disability, You reside in a nursing facility (NF), You receive services through the CCC Plus home and community based services waiver(formerly referred to as the Technology Assisted and Elderly or Disabled with ConsumerDirection [EDCD] Waivers), You receive services through any of the three waivers serving people with developmentaldisabilities (Building Independence, Family & Individual Supports, and CommunityLiving Waivers), also known as the DD Waivers.Medicaid expansion populations, which includes individuals that meet the following criteria: Adults ages nineteen (19) through sixty-four (64), Who are not already eligible for Medicare coverage, Who are not already
Commonwealth Coordinated Care Plus (CCC Plus) Welcome to UnitedHealthcare Community Plan Thank you for being a Member of UnitedHealthcare Community Plan, a Commonwealth Coordinated Care Plus (CCC Plus)
Commonwealth Coordinated Care Plus (Anthem CCC Plus) plan. We’re glad you’re our member. This interactive booklet will help you learn how to use your health plan for your Commonwealth Coordinated Care Plus (CCC Plus) benefits and services. Use the table of contents bel
Anthem Commonwealth Coordinated Care Plus (CCC Plus) 2 Understanding Anthem CCC Plus CCC Plus What is Medicaid? What is Medicare? Your care coordinator A safe place to live Food and meal . Remember your care coordinator can help! Make a reservation by calling SET
Commonwealth Coordinated Care Plus (CCC Plus) is Virginia’s mandatory Medicaid MLTSS program that was implemented in August 2017. CCC Plus is the successor to the Commonwealth Coordinated Care (CCC) program, Virginia’s voluntary program launched in 2014. Me
Overview of Commonwealth Coordinated Care Plus (CCC Plus) §New statewide Medicaid managed care program beginning Aug 2017 for over 216,000individuals §Participation is requiredfor qualifying populations §Integrated delivery model that includes m
COMMONWEALTH COORDINATED CARE PLUS CSA CONFERENCE MAY 2, 2018 Department of Medical Assistance Services . Agenda Slide 2 . Magellan Complete Care of Virginia (877)790-9472 All ages and all levels of servic
Aug 21, 2017 · Phase 1: Implemented Commonwealth Coordinated Care and Initiated transition of all non -dual waiver recipients into managed care . Phase 3: Implementing Commonwealth Coordinated Care Plus (CCC Plus) Results ; Medicaid Reforms . Accomplishme
Commonwealth Coordinated Care (CCC) Plus Phone Number Fax Number Web Portal United Healthcare (877) 843-4366 (855) 368-1542 www.providerexpress.com . BH1230_122017 Care Management decision-making is based only on the appropriateness of care as def
Artificial intelligence is a new digital frontier that will have a profound impact on the world, transforming the way we live and work. WIPO Director General, Francis Gurry. Preface 7 Foreword 8 About the contributors 10 Acknowl- edgments 12 Executive summary 13 1 Introduction The past, present and future of AI: what research and innovation trends can reveal; the data used in this report and .
