UnitedHealthcare Connected® for MyCare Ohio

Public Notice and Request for Comment

Pursuant to the provision of title 42 Sections 441.301 and 441.304 of the Code of Federal Regulations, public notices are required for any of the following: new 1915(c) waiver, new 1915(i) state plan amendment, renewal of a 1915(c) waiver, and any amendment to a 1915(c) waiver that includes one or more substantive changes.

Please open the link for additional information.

Draft HCBS Statewide Transition Plan

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Thursday, October 15, 2015

Comment End Date: Sunday, November 15, 2015

Purpose: The purpose of this posting is to provide public notice and receive public comments for consideration regarding the revisions made to the draft statewide transition plan following the Centers for Medicare and Medicaid Services' (CMS) initial review of the plan, submitted by the State on March 13, 2015.

Background: The U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) published regulations in the Federal Register on January 16, 2014, which became effective on March 17, 2014, implementing new requirements for Medicaid's 1915(c), 1915(1), and 1915(k) Home and Community-Based Services (HCBS) waivers. These regulations require states to submit a transition plan for all the states' 1915(c) waiver and 1915(i) HCBS state plan programs.

This plan sets forth the actions Ohio will take to operate all applicable HCBS programs in compliance with the final rules. The pertinent federal regulations are 42 CFR 441.301(c)(4)-(6). More information can be found on the CMS website.

Summary Draft HCBS Statewide Transition Plan

Detail HCBS Statewide Transition Plan

A non-electronic copy of the Draft HCBS Statewide Transition Plan may be obtained by calling (614) 466-6742.

Public Comment Submission

Comments must be submitted by midnight of the comment period end date using one of the following options:

E-mail: HCBSfeedback@medicaid.ohio.gov

Written comments sent to:

HCBS Statewide Transition Plan
Ohio Department of Medicaid
P.O. Box 182709, 5th Floor
Columbus OH 43218

FAX: (614) 466-6945 (please include Attn. HCBS Statewide Transition Plan in the subject line)

Calling toll-free to leave a voicemail message at 1 (800) 364-3153.

Courier or in-person submission to Attn: BLTCSS, Lazarus Building, 50 W. Town St., Columbus OH 43218.

Flu Shots

Influenza is a serious illness that can be easily prevented by a simple shot.

• The best time to get a flu shot is before flu season starts. Talk to your doctor about what is right for you. You may want to write down when you get your shot, and plan to get it at the same time each year.
• When you get your flu shot, it is covered by the terms of your plan. For help scheduling an appointment, call the toll-free number on the back of your member ID card. Health coaches are available daily from 8 a.m. – 8 p.m. to help you.

Don't have time to see the doctor for a flu shot? View a list of locations where you can get a flu shot.

UnitedHealthcare Care Managers for Member's Unique Needs

Every UnitedHealthcare MyCare Ohio member receives a personal representative. These Care Managers are licensed professionals providing education and coordination of UnitedHealthcare Connected^® for MyCare Ohio (Medicare Medicaid Plan) benefits, tailored for each member's unique needs.

Click here to watch a video on how these Care Managers are helping current members.

Important Update to Members (1/27/15)

We recently mailed you a letter that included some information on benefit changes. Some of the information did not pertain to members that only have their Medicaid covered benefits through our plan. Please disregard that letter. The letter also had an incorrect number for the Ohio Medicaid Hotline. The correct number for the Hotline is 1-800-324-8680. We are sorry for any confusion this may have caused you. Please view the Member Clarification Letter for additional information.

Use the documents below to learn more about each important health topic.

UnitedHealthcare Member Advisory Council and "Connected Advisors"

UnitedHealthcare Member Advisory Council and "Connected Advisors" is an advisory council to ensure that UnitedHealthcare actively engages consumers, families, advocacy groups, and other key stakeholders as partners in the program design and delivery system.

Who is involved?

• Any members, or a member's representative, are eligible to participate.
• There are no term limits for participation.
• Representatives from member stakeholder or advocacy organizations.
• Representation reflects the diversity of the member population including: race, ethnicity, religion, sexual orientation, gender, disability (physical or mental), age, parental status, or genetic information.

They will advise and guide the UnitedHealthcare Community Plan of Ohio on:

• Clinical design and delivery
• Strategies to support members in the community
• Abuse and neglect initiatives
• Promote member-centric culture
• Provide input regarding research and best practices

How is it organized?

• One statewide council
• Three local groups of "Connected Advisors" with representation in the Northeast (Cuyahoga, Geauga, Lake, Lorain, and Medina counties); Northeast Central (Columbiana, Mahoning, and Trumbull counties); and East Central (Portage, Stark, Summit, and Wayne counties) MyCare Ohio regions.

What will they do?

• Participate in quarterly conference calls
• Receive electronic or printed newsletter(s).
• Attend three in-person, regional meetings held annually (UnitedHealthcare will provide a travel stipend at the request of a member. The amount of the stipend will follow the guidelines of the appropriate state governing rules and guidelines).
• There is no cost for participation.
• Decisions of the Member Council and Connected Advisors will be made by simple majority vote of members present.
• One member will be appointed/elected to participate in UnitedHealthcare's National Peer Ambassador program. The goal of a peer ambassador program is to elevate and empower members through meaningful dialogue, information exchange, and inclusion in the development of best practices, innovations, and delivery/design in promotion of a member-centered culture. The Community and National Peer Ambassadors connect virtually (via conference or web-based technology) to share experiences and insights regarding opportunities to better the quality of life and experience of the populations we serve. We leverage recommendations and insights shared by the Ambassadors to support improved outcomes and experiences in the promotion of a member-centered culture. The Ambassadors do not receive compensation for service in the ambassador role.

To learn more about UnitedHealthcare's Member Advisory Council and "Connected Advisors," or get involved, get information at www.myuhc.com/communityplan or call Member Services at 1-877-542-9236 (TTY 711).

Fraud, Waste and Abuse

Healthcare fraud, waste and abuse affects everyone. Combating it begins with awareness.

Fraud is committed when a dishonest provider or consumer intentionally submits, or causes someone else to submit, false or misleading information for use in determining the amount of health care benefits.

Waste is the over-utilization of services not caused by criminally negligent actions and the misuse of resources. 

Abuse is provider practices that are inconsistent with professional standards of care: medical necessity, or sound fiscal, business, or medical practices and provider or beneficiary practices that result in unnecessary costs to the healthcare program.

What is provider fraud, waste and abuse?

• Billing for services not rendered
• Upcoding (billing for more expensive services or procedures than were actually provided or performed)
• Soliciting, offering or receiving kickbacks
• Improper or sloppy billing practices
• Failure to maintain adequate records
• Routine waiver of coinsurance and deductible

What is member fraud, waste and abuse?

• Loaning or using another person's insurance card
• Forging or selling prescription drugs
• Providing false information when applying for program benefits

UnitedHealthcare Community Plan is committed to combating fraud, waste and abuse. If you suspect health care fraud, waste and abuse, you may report via the following methods:

• Anonymous fraud, waste and abuse hotline: 1-877-766-3844

Clinical Care Guidelines

Perinatal Care

American Academy of Pediatrics and The American College of Obstetricians and Gynecologists, Sixth Edition, Guidelines for Perinatal Care

Preventive Pediatric Health Care Screening

2009 Recommendations for Preventive Pediatric Health Care screening guidelines (periodicity schedule) from the American Academy of Pediatrics

American Academy of Pediatrics

Preventive Services Guideline

2010-2011 Guide to Clinical Preventive Services – US Preventive Services Task Force (USPSTF)

Agency for Healthcare Research and Quality

For a description of the UnitedHealthcare practice guidelines, please write to:

UnitedHealthcare Community Plan Quality Improvement
9200 Worthington Road, 3rd Floor
Westerville, Ohio 43082