Presentation Overview. Overview of Medicaid Coverage Policies for Perinatal Care. Medicaid Births. Medicaid Births.

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Presentation Overview. Overview of Medicaid Coverage Policies for Perinatal Care. Medicaid Births. Medicaid Births."

Transcription

1 Presentation Overview Overview of Medicaid Coverage Policies for Perinatal Care Rachel Currans-Henry, MPP Director, Bureau of Benefits Management Division of Medicaid Services April 23, Importance of perinatal coverage policies to Medicaid 2. Who is eligible 3. What benefits are available 4. Additional HMO responsibilities and programs 5. Resources Division of Medicaid Services 2 Medicaid Births Year Wisconsin Medicaid Percent ,493 32, ,595 33, ,119 32, ,004 31, ,593 30, Medicaid Births In calendar year 2016, Wisconsin Medicaid covered 30,750 (46.2%) state births. The majority of these births were to women enrolled in a managed care organization (MCO). o MCO births: 19,837 (64.5%) o Fee-for-service (FFS) births: 10,913 (35.5%) Division of Medicaid Services 3 Division of Medicaid Services 4 Medicaid Births 2016 Wisconsin Medicaid Non-Medicaid Number of Births 66,593 30,750 (46.2%) 35,843 (53.8%) Adequate Prenatal Care 47,634 (71.5%) 18,882 (61.4%) 28,752 (80.2%) Premature ( 36 weeks) 6,373 (9.6%) 3,561 (11.6%) 2,812 (7.8%) Low Birth Weight (< 5.5.lbs) 4,938 (7.4%) 3,051 (9.9%) 1,887 (5.3%) Eligibility Pregnant Women Wisconsin Medicaid covers pregnant women with incomes up to 300 % of the federal poverty level (FPL). Per federal law, there is no asset test for pregnant women. Medicaid eligibility can be backdated to the first of the month up to three months prior to the month of application. Division of Medicaid Services 5 Division of Medicaid Services 6 1

2 Pregnant women are eligible for coverage through the end of the month in which the 60 th post-partum day occurs. Other health insurance coverage does not preclude Medicaid coverage, as Medicaid pays last. Pregnant women are generally eligible for the duration of the pregnancy. Division of Medicaid Services 7 After the 60-day postpartum period ends, the eligibility system determines if her eligibility can continue under another health care category, for example: parents or caretakers. Division of Medicaid Services 8 Women are not automatically evaluated for Family Planning Only Services (FPOS) eligibility, but can submit an application. FPOS income limit is at 300% FPL. Household size is always one (the applicant). Individuals may apply: Online at access.wisconsin.gov. By phone. In person at their local income maintenance agency. By completing a paper application and mailing it to the local agency. Division of Medicaid Services 9 Division of Medicaid Services 10 Pregnant women are allowed immediate access to health care coverage through presumptive eligibility (PE). Coverage determined by health care providers Income limit same as for continuous coverage Women covered for ambulatory services only (no inpatient care) The PE period begins on the day eligibility is determined and continues through the end of the following month. One PE period per pregnancy Services delivered FFS during the PE period Division of Medicaid Services 11 Division of Medicaid Services 12 2

3 Eligibility Newborn Mothers must report the newborn within 10 days of the birth, and Medicaid will add coverage for the infant as soon as we are notified. In many cases the hospital or HMO reports the birth. Physicians and other obstetric care providers report if the baby is born outside of hospital setting. Eligibility Newborn, continued Babies born to Medicaid mothers: Are Medicaid-eligible for the first 12 months with no limit on income. Are referred to as continuously eligible newborns (CENs). Division of Medicaid Services 13 Division of Medicaid Services 14 Eligibility Newborn, continued Babies born to non-medicaid mothers do not meet the criteria for CENs but the mother may apply for Medicaid coverage for the newborn. The hospital (or other health care provider) can make a PE determination for the baby. PE cannot be backdated; it begins on the eligibility determination date. Division of Medicaid Services 15 Eligibility Newborn, continued When applying for ongoing coverage, the mother can request retroactive coverage for the baby to include the date of birth, if necessary. Division of Medicaid Services 16 Eligibility Newborn, continued Babies are assigned their own Medicaid ID and are issued a ForwardHealth card. If mother is in an HMO, the baby is enrolled in the same HMO. The HMO provides outreach and care coordination for the mother and baby. The HMO assists with identifying a primary care provider for the newborn, if necessary. BadgerCare Plus Prenatal Program Covers pregnant women who meet BadgerCare Plus eligibility criteria but who do not qualify because of their immigration or citizenship status or who are in prison or jail. PE not an option for these women. All Medicaid-covered services are allowed, including prenatal care, prenatal vitamins and other prescription drugs, and hospital stay. Division of Medicaid Services 17 Division of Medicaid Services 18 3

4 Emergency Medicaid Non-qualifying aliens who do not apply for the BadgerCarePlus Prenatal Program are covered for labor and delivery only. The mother s prenatal and post-partum care are not covered. Newborns born to these mothers are eligible for continuous eligibility coverage. Division of Medicaid Services 19 Medicaid and BadgerCare Plus Benefits Wisconsin Medicaid covers all services allowed under Federal Medicaid laws. Federal law mandates coverage of certain services, while making others optional. For example, coverage of hospital services is mandatory, but coverage of prescription drugs is optional. Comprehensive preventive and pregnancy-related services are covered with no copays. Division of Medicaid Services 20 Preventive and Pregnancy -Related Services Prenatal Vitamins Prenatal vitamins o Covered for females of childbearing age o Prior to May 2015, covered only for pregnant and lactating women Iron (ferrous gluconate/ferrous sulfate) o Covered for adults and children o No diagnosis or age restrictions Preventive and Pregnancy -Related Services Prenatal Vitamins, continued Folic acid for women of childbearing age with no prior authorization or diagnosis restriction Makena and 17-P (compound) injections o Providers must attest that the member meets the clinical criteria for administration of the injection. o Medical professional must administer these as pharmacies are not reimbursed. o Medicaid covers both on a FFS basis. Division of Medicaid Services 21 Division of Medicaid Services 22 Drug Utilization ForwardHealth prospective drug utilization review system: Alerts pharmacists if a drug is contraindicated for pregnant women. Allows pharmacists to make a professional judgement on whether to proceed with dispensing the drug. Division of Medicaid Services 23 Tobacco Tobacco cessation drugs and counseling Tobacco cessation drugs, over-the-counter (OTC) and prescription o Includes nicotine gum, patches, or lozenges o All products, including OTC require a written prescription Diagnosis restriction applies Medication therapy management covered o Pharmacist can talk about available options Division of Medicaid Services 24 4

5 Opioids Wisconsin Medicaid covers all FDA-approved medications for the treatment of opioid use disorders Buprenorphine tablets o Covered for pregnant women ages 16 and older o Prior authorization required Counseling Wisconsin covers substance abuse counseling. The reimbursement rate increased on January 1, Division of Medicaid Services 25 Division of Medicaid Services 26 Weight Management Services Covered as an evaluation and management visit Five visits per calendar year, then prior authorization Prescription drugs, with prior authorization Screenings Screening services, including depression screening, pap tests, mammograms, and other medically necessary screenings identified by the health care provider. Division of Medicaid Services 27 Division of Medicaid Services 28 Obstetric Care Services Full coverage of obstetric care services, including prenatal care, labor and delivery, ultra-sound, and labs Elective cesarean sections reimbursement same as vaginal delivery Contraceptives and Supplies Immediate postpartum long-acting reversible contraceptives (LARCs) o LARC methods include intrauterine devices or systems and contraceptive implants o Additional payment to hospitals Breastfeeding supplies, including breast pumps Division of Medicaid Services 29 Division of Medicaid Services 30 5

6 Obstetric Care Services Covered In addition to physicians, obstetric care services covered when provided by: Nurse practitioners. Nurse midwives. Licensed midwives (since January 1, 2017) with reimbursement limited to office, home or birthing center (no facility fee). Obstetric Care Services Covered, continued Many obstetric care procedure codes are eligible for an enhanced fee if provided in a Health Professional Shortage Area (HPSA): Newborn care Preventive medicine codes Office visits (new and established patients) Emergency department visits Division of Medicaid Services 31 Division of Medicaid Services 32 Care Coordination or Case Management Prenatal care coordination (PNCC) services Statewide benefit targeted to pregnant women at risk of having a poor birth outcome Include outreach, care coordination, health education, and nutritional counseling Providers required to administer an initial, comprehensive assessment using a standardized tool Division of Medicaid Services 33 Postpartum Period At least one face-to-face PNCC visit during the postpartum period is required. Mothers are encouraged to choose a primary health care provider for their baby. Visit addresses the importance of immunizations and regular well-child checkups (i.e., HealthChecks) for the baby. Division of Medicaid Services 34 Memorandum of Agreement PNCC providers must sign a memorandum of agreement (MOU) with HMOs. The HMO and PNCC agency must designate at least one individual as the key point of contact. If requested by the HMO, PNCC providers are required to share a copy of the completed Pregnancy Questionnaire within two days. Division of Medicaid Services 35 PNCC providers are required to make written contacts with Medicaid-enrolled primary care providers, including obstetric and pediatric care providers. PNCC services are reimbursed on a FFS-basis for women enrolled in a Medicaid HMO. Division of Medicaid Services 36 6

7 Care Coordination Child care coordination in Milwaukee County and the city of Racine does not provide direct services, just care coordination activities. Targeted case management is primarily a countybased program that does not provide direct services, just care coordination activities. Family Planning Drugs and supplies, including coverage of contraceptive methods from condoms and LARCs to sterilization, per the member s choice Counseling and education Sexually transmitted disease testing and treatment Related lab and radiology Division of Medicaid Services 37 Division of Medicaid Services 38 Screening Mental health and substance abuse screening for pregnant women: Includes screening for substance use, depression, and trauma. Requires no particular screening tool but tool must be evidence-based (e.g., AUDIT or PHQ-9). One screening is allowed per pregnancy and is billed using the procedure code H0002 with modifier HE or HF. Brief, preventive mental health counseling and substance abuse intervention are limited to four hours per pregnancy and are billed with procedure code H0004 with modifier HE or HF. Division of Medicaid Services 39 Division of Medicaid Services 40 A wide range of providers are allowed for the screening and brief intervention. Physicians and physician assistants Nurse practitioners Nurse midwives (not mental counseling) PNCC providers (not mental health counseling) Medicaid covers screening, brief intervention, and referral to treatment (SBIRT) services for all full-benefit members Limited to one every 12 months Brief intervention limited to four hours every 12 months Providers required to complete DHS training Division of Medicaid Services 41 Division of Medicaid Services 42 7

8 Licensed professionals require four hours of training that may be conducted in-person or online. On a case-by-case basis, DHS may exempt individuals with expertise in the field of substance abuse screening and motivational interviewing from this training. Unlicensed individuals must: Complete at least 60 hours of training with at least 30 hours of training completed in-person. Provide services under the supervision of a licensed health care professional. Follow written or electronic protocols for evidencebased practice. Division of Medicaid Services 43 Division of Medicaid Services 44 Wisconsin Medicaid reimburses SBIRT under the following CPT codes: H0049 (Alcohol and/or drug screening) H0050 (Alcohol and/or drug service, brief intervention, per 15 minutes) Division of Medicaid Services 45 Transportation Medicaid generally covers transportation for a member going to and from a Medicaid-covered service. Women identified with a high-risk pregnancy are not required to ride a bus and will use a common carrier. Mothers may bring her infant to postpartum visits as an additional passenger. Division of Medicaid Services 46 HMO Contract Requirements To ensure network adequacy, HMOs must: Ensure the delivery network is sufficient to meet the requirements of the contract. Include an adequate number of obstetric care and other primary care providers. Include access to licensed midwives. Division of Medicaid Services 47 HMOs must meet distance requirements for primary care providers and non-specialized hospitals, including: Primary care providers within a 20-mile radius (10 miles if Milwaukee, Kenosha, Racine, or Madison) Hospital within a 20-mile distance in Brown, Dane, Kenosha, Milwaukee, Ozaukee, Racine, Washington, and Waukesha counties Hospital within 35-mile distance in all other counties Division of Medicaid Services 48 8

9 HMOs must provide: Women with direct access to a women s health specialist for routine and preventive health care services. Prenatal care within two weeks of an appointment request, or three weeks if the request is for a specific HMO provider who is accepting new patients. Division of Medicaid Services 49 With the importance of interconceptioncare and early intervention for high-risk pregnancies, DHS shares data with HMOs about enrolled women at risk of a poor outcome. Some HMOs offer incentives to providers to notify the HMO of the confirmed pregnancy. Division of Medicaid Services 50 The Obstetric Medical Home initiative is a patient-centered model to provide enhanced care coordination. The goal is to improve birth outcomes and reduce birth disparities for high-risk pregnant women. The approach to care is comprehensive and teamoriented. Obstetric medical homes are available in Dane, Kenosha, Milwaukee, Ozaukee, Racine, Rock, Washington, and Waukesha counties. Obstetric medial homes identify not only the medical care needs, but social factors that could have a negative impact on the pregnancy outcome or newborn s health. Care coordinators track and follow-up on test results and referrals. The medical home actively supports and promotes patient self-care and adherence to treatment recommendations. Division of Medicaid Services 51 Division of Medicaid Services 52 Transition plan requirements, regardless of birth outcome, include: Collaboration with the HMO to ensure continuity of care for the mother and newborn. A primary care provider for both mother and newborn. An initial appointment for the newborn. If the birth outcome was poor, the HMO must: Ensure appropriate follow-up and ongoing contact with the mother. Provide interconception education and care specific to the mother s needs. Ensure preventive medicine visits for mother and baby. Assist with referral and follow-up on appointments. Division of Medicaid Services 53 Division of Medicaid Services 54 9

10 Participating providers receive $1,000 for each eligible woman that meets all criteria, and $2,000 if the woman had a good birth outcome. Since 2011, DHS has paid over $3 million in Obstetric Medical Home initiative payments, with the majority of women having good birth outcomes. The key to the Obstetric Medical Home initiative is enhanced care coordination of both medical and psychosocial needs. All BadgerCare Plus HMOs are required to meet quality benchmarks, and a portion of their capitation payment is at risk for financial incentive. Division of Medicaid Services 55 Division of Medicaid Services 56 Wisconsin Medicaid tracks the following quality measures related to pregnancy, birth, and the first year after birth. Prenatal and postpartum care (PPC) Healthcare Effectiveness Data and Information Set (HEDIS) o Timeliness of prenatal care (PPC-PC) o Post-partum (PPC-PP) visit within days of delivery W15 (HEDIS) o Collected beginning in 2016 o Well-child visits in the first 15 months of life Division of Medicaid Services % 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 2016 Wisconsin Medicaid HMO Data BadgerCare Plus and Wisconsin Medicaid Average 2016 PPC-PN and PPC-PP National 50 th 81.80% Percentile = 82.3% National 75 th PPC-PN Percentile = 67.5% 66.70% PPC-PP Wisconsin: Near 50 th percentile for PPC-PN; Near 75 th percentile for PPC-PP Division of Medicaid Services % 60.00% 50.00% 2016 Wisconsin Medicaid HMO Data BadgerCare Plus and Wisconsin Medicaid Average 2016 W15 (Well-Child Visits in First 15 Months of Life) -Six Visits or More National 50 th Percentile = 62% 60.9% Resources Wisconsin Medicaid and BadgerCarePlus: % 30.00% 20.00% 10.00% ForwardHealthPortal: % 6 Visits or more Wisconsin: Just below national 50 th percentile 59 Division of Medicaid Services 60 10

11 Resources ForwardHealth Portal includes: HMO contract Obstetric medical home guide and annual reports Provider handbooks and training information Member resources, including helpful fact sheets Enrollment data Fee schedules Resources Federal Medicaid and Children s Health Insurance Program: Division of Medicaid Services 61 Division of Medicaid Services 62 Legal Framework State Medicaid Law and Regulations Law o Wis. Stat. ch.49 Regulations o Wis. Admin. Code chs. DHS 101 to 109 Wis. Admin. Code ch. DHS 103 is Eligibility Wis. Admin. Code ch. DHS 107 is Covered Services Legal Framework Federal Law and Regulations: Law: o Social Security Act: Titles 19 (Medicaid) and 21 (CHIP) Regulations: 42 C.F.R Chapter IV Division of Medicaid Services 63 Division of Medicaid Services 64 Questions? Division of Medicaid Services 65 11

BadgerCare Plus Member Handbook

BadgerCare Plus Member Handbook BadgerCare Plus Member Handbook BadgerCare Plus Member Handbook Table of Contents A Ambulance...7 Making an Appointment With Your PCP...2 Missed Appointments...3 B If You Are Billed....6 When You May Be

More information

Florida Medicaid BIRTH CENTER AND LICENSED MIDWIFE SERVICES COVERAGE AND LIMITATIONS HANDBOOK

Florida Medicaid BIRTH CENTER AND LICENSED MIDWIFE SERVICES COVERAGE AND LIMITATIONS HANDBOOK Florida Medicaid BIRTH CENTER AND LICENSED MIDWIFE SERVICES COVERAGE AND LIMITATIONS HANDBOOK Agency for Health Care Administration May 2014 BIRTH CENTER AND LICENSED MIDWIFE SERVICES COVERAGE AND LIMITATIONS

More information

Part I. New York State Laws and Regulations PRENATAL CARE ASSISTANCE PROGRAM (i.e., implementing regs on newborn testing program)

Part I. New York State Laws and Regulations PRENATAL CARE ASSISTANCE PROGRAM (i.e., implementing regs on newborn testing program) Part I. New York State Laws and Regulations PRENATAL CARE ASSISTANCE PROGRAM (i.e., implementing regs on newborn testing program) (SEE NY Public Health Law 2500f for HIV testing of newborns FOR STATUTE)

More information

Benefits. Benefits Covered by UnitedHealthcare Community Plan

Benefits. Benefits Covered by UnitedHealthcare Community Plan Benefits Covered by UnitedHealthcare Community Plan UnitedHealthcare provides all medically necessary covered services under Medicaid SSI. Some services may require a prior authorization. Specific covered

More information

There are over 2 million Michigan Medicaid and CHIP Beneficiaries, more than ½ are children

There are over 2 million Michigan Medicaid and CHIP Beneficiaries, more than ½ are children April, 2015 There are over 2 million Michigan Medicaid and CHIP Beneficiaries, more than ½ are children (January, 2015). www.medicaid.gov/medicaid-chip-program- Information/By-State/michigan.html Signed

More information

The Healthy Michigan Plan Handbook

The Healthy Michigan Plan Handbook The Healthy Michigan Plan Handbook Introduction The Healthy Michigan Plan is a health care program through the Michigan Department of Community Health (MDCH). The Healthy Michigan Plan provides health

More information

HUSKY Health Benefits and Prior Authorization Requirements Grid* Clinic-Medical Effective: January 1, 2012

HUSKY Health Benefits and Prior Authorization Requirements Grid* Clinic-Medical Effective: January 1, 2012 Benefit HUSKY A, HUSKY C (ABD) HUSKY B HUSKY D (LIA) Health and Behavior Assessments (CPT 96150-96155) 100% covered under medical benefit for members with diagnoses outside the range of ICD-9 codes 291-316

More information

Covered Benefits Rhody Health Partners ACA Adult Expansion

Covered Benefits Rhody Health Partners ACA Adult Expansion Covered s Rhody Health Partners ACA Adult Expansion Abortion Services Adult Day Services AIDS Medical and Non-Medical Case Management Alcohol and Substance Abuse Treatment Cosmetic Surgery Dental Care

More information

2013 Mommy Steps. Program Description. Our mission is to improve the health and quality of life of our members

2013 Mommy Steps. Program Description. Our mission is to improve the health and quality of life of our members 2013 Mommy Steps Program Description Our mission is to improve the health and quality of life of our members I. Purpose Passport Health Plan (PHP) has developed approaches to the management of members

More information

Covered Benefits Rhody Health Partners

Covered Benefits Rhody Health Partners Covered s Rhody Health Partners s Covered by UnitedHealthcare Community Plan As member of UnitedHealthcare Community Plan, you are covered for the following services. (Remember to always show your current

More information

Aetna Open Access POS II

Aetna Open Access POS II Aetna Open Access POS II The Aetna Open Access Point-of-Service (POS) II Options combine the advantages of managed healthcare with the freedom of traditional medical coverage. With the POS options, every

More information

Continuing Certain Medicaid Options Will Increase Costs, But Benefit Recipients and the State

Continuing Certain Medicaid Options Will Increase Costs, But Benefit Recipients and the State January 2005 Report No. 05-03 Continuing Certain Medicaid Options Will Increase Costs, But Benefit Recipients and the State at a glance Florida provides Medicaid services to several optional groups of

More information

ProviderReport. Managing complex care. Supporting member health.

ProviderReport. Managing complex care. Supporting member health. ProviderReport Supporting member health Managing complex care Do you have patients whose conditions need complex, coordinated care they may not be able to facilitate on their own? A care manager may be

More information

community. Welcome to the Wisconsin BadgerCare Plus 2017 United Healthcare Services, Inc. All rights reserved. CSEX17MC _003

community. Welcome to the Wisconsin BadgerCare Plus 2017 United Healthcare Services, Inc. All rights reserved. CSEX17MC _003 Welcome to the community. Wisconsin BadgerCare Plus 2017 United Healthcare Services, Inc. All rights reserved. CSEX17MC4032747_003 Welcome. Welcome to UnitedHealthcare Community Plan. Please take a few

More information

SECTION 4: CLIENT ELIGIBILITY TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1

SECTION 4: CLIENT ELIGIBILITY TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 SECTION 4: CLIENT ELIGIBILITY TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 FEBRUARY 2018 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 FEBRUARY 2018 SECTION 4: CLIENT ELIGIBILITY Table of Contents

More information

QUALITY, CHOICE, RESULTS PROVIDER REFERENCE MANUAL

QUALITY, CHOICE, RESULTS PROVIDER REFERENCE MANUAL QUALITY, CHOICE, RESULTS PROVIDER REFERENCE MANUAL Table of Contents I. INTRODUCTION...5 A. MISSION STATEMENT...5 B. COMPANY INFORMATION...5 C. INTEGRATED CARE MANAGEMENT MODEL...6 D. MODEL OF CARE...7

More information

SUMMARY OF THE STATE GRANT OPPORTUNITIES IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: H.R (May 24, 2010)

SUMMARY OF THE STATE GRANT OPPORTUNITIES IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: H.R (May 24, 2010) National Conference of State Legislatures 444 North Capitol Street, N.W., Suite 515 Washington, D.C. 20001 SUMMARY OF THE STATE GRANT OPPORTUNITIES IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT: H.R.

More information

Provider. Relations. Quality. Physician. PractitionerClaims. Standards. Experience. Benefits. Care4Kids. Children s Community Health Plan

Provider. Relations. Quality. Physician. PractitionerClaims. Standards. Experience. Benefits. Care4Kids. Children s Community Health Plan Provider PractitionerClaims Standards Relations Taxonomy Directory Portal Children s Community Health Plan Services BadgerCare Plus Benefits Experience Quality Physician Care4Kids Provider Tool Kit 2016

More information

B a d g e r C a r e P l u s M e m b e r s

B a d g e r C a r e P l u s M e m b e r s Member Handbook B a d g e r C a r e P l u s M e m b e r s 2 Table of Contents Welcome...3 Your Civil Rights...3 Member Rights...3 Important Physicians Plus Phone Numbers...3 Interpreter Services...4 Your

More information

Contracting Out Health Service Delivery in Afghanistan

Contracting Out Health Service Delivery in Afghanistan Contracting Out Health Service Delivery in Afghanistan Dr M.Nazir Rasuli General director Care of Afghan Families,CAF. Kathmando Nepal 12 Jun,2012 Outline 1. Background 2. BPHS 3. Contracting with NGOs,

More information

Community Grants Program for Idaho, Montana, North Dakota, South Dakota and Wyoming

Community Grants Program for Idaho, Montana, North Dakota, South Dakota and Wyoming March of Dimes Community Grants Program for Idaho, Montana, North Dakota, South Dakota and Wyoming Request for Proposals (RFP) March of Dimes Contact: Gina Legaz 206-452-6638 glegaz@marchofdimes.org 1

More information

Provider Administrative Guide

Provider Administrative Guide Provider Administrative Guide Effective Date 1-1-16 BadgerCare Plus and Medicaid SSI About Trilogy Trilogy Health Insurance, Inc., a Wisconsin insurance company ( Trilogy ) is contracted with the Wisconsin

More information

COVERED SERVICES FOR NHP MASSHEALTH MEMBERS

COVERED SERVICES FOR NHP MASSHEALTH MEMBERS COVERED SERVICES FOR NHP MASSHEALTH MEMBERS Neighborhood Health Plan Covered Services for MassHealth Standard & CommonHealth, Family Assistance, and CarePlus Issued and effective October 1, 2015 nhp.org/member

More information

The Heart and Vascular Disease Management Program

The Heart and Vascular Disease Management Program Element A: Program Content The Heart and Vascular Disease Management Program GHC-SCW is committed to helping members, and their practitioners, manage chronic illness by providing tools and resources to

More information

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:

KY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant

More information

1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS

1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS 1199SEIU Greater New York Benefit Fund OVERVIEW OF YOUR BENEFITS I HOSPITAL CARE This benefit is for the hospital s charge for the use of its facility only. Coverage for services rendered by doctors, labs,

More information

Washington Targeted Case Management and Traditional Medicaid Service

Washington Targeted Case Management and Traditional Medicaid Service APPENDIX B: MEDICAID AND HOME VISITING STATE CASE STUDIES Washington Targeted Case Management and Traditional Medicaid Service Established under the 1989 Maternity Care Access Act, Washington State s First

More information

Cover for pregnancy and childbirth

Cover for pregnancy and childbirth Cover for pregnancy and childbirth 2017 How we cover pregnancy and childbirth in 2017 The Maternity Benefit covers day-to-day and in-hospital medical expenses for expectant mothers and newborns. Overview

More information

Communicator. the JUST A THOUGHT. Ensuring HEDIS-Compliant Preventive Health Services. Provider Portal Features. Peer-to-Peer Review BY DR.

Communicator. the JUST A THOUGHT. Ensuring HEDIS-Compliant Preventive Health Services. Provider Portal Features. Peer-to-Peer Review BY DR. WINTER 2016 MHS NEWSLETTER FOR PHYSICIANS Ensuring HEDIS-Compliant Preventive Health Services Here are a few best practice strategies for raising HEDIS and EPSDT onsite review scores, as demonstrated by

More information

Aetna Better Health of West Virginia

Aetna Better Health of West Virginia Provider Newsletter Summer 2017 Aetna Better Health of West Virginia Table of Contents Pharmacy Change... 1 Telehealth Services... 2 Continuity and Coordination of care... 2 Drug Screen Policy Update...

More information

SUMMARY OF BENEFITS. Hamilton County Department of Education Network Copay Plan. Connecticut General Life Insurance Co.

SUMMARY OF BENEFITS. Hamilton County Department of Education Network Copay Plan. Connecticut General Life Insurance Co. SUMMARY OF BENEFITS Connecticut General Life Insurance Co. Hamilton County Department of Education Annual deductibles and maximums Lifetime maximum Pre-Existing Condition Limitation (PCL) Coinsurance All

More information

Member Services: Authorizations: Option #2 Authorization Fax:

Member Services: Authorizations: Option #2 Authorization Fax: Allergy 100% covered Office visit $10 co-pay 100% covered Allergy injections no co-pay Immunotherapy or other therapy -no co-pay Cardiac Rehab 100% covered 100% covered 100% covered Contraceptives Covered

More information

Articles of Importance to Read: AmeriChoice Tennessee s Provider University. Spring 2010

Articles of Importance to Read: AmeriChoice Tennessee s Provider University. Spring 2010 Important information for physicians and other health care professionals and facilities serving AmeriChoice members Spring 2010 AmeriChoice Tennessee s Provider University AmeriChoice Tennessee s Provider

More information

Asthma Disease Management Program

Asthma Disease Management Program Asthma Disease Management Program A: Program Content GHC-SCW is committed to helping members, and their practitioners, manage chronic illness by providing tools and resources to empower members to self-manage

More information

CA Group Business 2-50 Employees

CA Group Business 2-50 Employees PLAN FEATURES Network Primary Care Physician Selection Deductible (per calendar year) Member Coinsurance Copay Maximum (per calendar year) Lifetime Maximum Referral Requirement PHYSICIAN SERVICES Primary

More information

WHAT DOES MEDICALLY NECESSARY MEAN?

WHAT DOES MEDICALLY NECESSARY MEAN? WHAT DOES MEDICALLY NECESSARY MEAN? Your Primary Care Provider (PCP) will help you get the services you need that are medically necessary as defined below. Medically Necessary means appropriate and necessary

More information

Date: Illinois Health Connect PCP 6/23/14 Page 1 of 8. Signature:

Date: Illinois Health Connect PCP 6/23/14 Page 1 of 8. Signature: Illinois Department of Healthcare and Family Services Illinois Health Connect Primary Care Provider Agreement This Agreement pertains only to the relationship between the Illinois Department of Healthcare

More information

BadgerCare Plus and Medicaid SSI

BadgerCare Plus and Medicaid SSI Provider Administrative Provider Directory Guide Based in the Milwaukee area, we have more than just a history here we are involved, invested and committed to serving you and your community. Effective

More information

MINUTEMAN HEALTH MY DOC HMO PLANS FOR INDIVIDUALS & FAMILIES MASSACHUSETTS 2017

MINUTEMAN HEALTH MY DOC HMO PLANS FOR INDIVIDUALS & FAMILIES MASSACHUSETTS 2017 MINUTEMAN HEALTH MY DOC HMO PLANS FOR INDIVIDUALS & FAMILIES MASSACHUSETTS 2017 Minuteman Health provides CHOICE, VALUE and, most importantly, QUALITY for Massachusetts individuals and families. CHOICE

More information

VOLUME II/MA, MT51 01/17 SECTION

VOLUME II/MA, MT51 01/17 SECTION 2054 POLICY STATEMENT Emergency Medical Assistance (EMA) provides medical coverage to individuals who meet all requirements for a Medicaid Class of Assistance (COA) except for citizenship/immigration status

More information

Appendix 5. PCSP PCMH 2014 Crosswalk

Appendix 5. PCSP PCMH 2014 Crosswalk Appendix 5 Crosswalk NCQA Patient-Centered Medical Home 2014 July 28, 2014 Appendix 5 Crosswalk 5-1 APPENDIX 5 Crosswalk The table compares NCQA s Patient-Centered Specialty Practice () standards with

More information

HPSM Medi-Cal Benefits A Guide on How to Get Your Health Care

HPSM Medi-Cal Benefits A Guide on How to Get Your Health Care HPSM Medi-Cal Benefits A Guide on How to Get Your Health Care Health care and insurance benefits can be difficult to understand. This guide introduces you to your basic Medi-Cal benefits, to the Health

More information

2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits

2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits 2018 CareOregon Advantage Plus (HMO-POS SNP) Summary of Benefits For Oregon counties: Clackamas, Clatsop, Columbia, Jackson, Josephine, Multnomah, Tillamook, Washington and Yamhill H5859_1099_CO_1018 CMS

More information

PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS

PLAN DESIGN AND BENEFITS - PA POS 4.2 with $5/$15/$30 RX PARTICIPATING PROVIDERS PLAN FEATURES Deductible (per calendar year) PHYSICIAN SERVICES Primary Care Physician Visits Specialist Office Visits Maternity OB Visits Allergy Treatment Allergy Testing PREVENTIVE CARE Routine Adult

More information

DEFINITION OF AN ENCOUNTER A billable encounter is defined as a face- to-face visit with a physician, physician assistant, midwife or nurse practition

DEFINITION OF AN ENCOUNTER A billable encounter is defined as a face- to-face visit with a physician, physician assistant, midwife or nurse practition ILLINOIS DEPARTMENT OF HEALTHCARE & FAMILY SERVICES Federally Qualified Health Centers (FQHC) Rural Health Centers (RHC) 09-28-11 DEFINITION OF AN ENCOUNTER A billable encounter is defined as a face- to-face

More information

From the Desk of the Medical Director Using Phone Triage to Meet Timely Access Regulations

From the Desk of the Medical Director Using Phone Triage to Meet Timely Access Regulations MD Health Plan of San Mateo Provider Newsletter Fall 2010 healthmatters From the Desk of the Medical Director Using Phone Triage to Meet Timely Access Regulations In our spring newsletter, we informed

More information

IA Health Link and Amerigroup Iowa

IA Health Link and Amerigroup Iowa IA Health Link and Amerigroup Iowa Navigating the Transition to Amerigroup Foster Care Caretaker Orientation 1 Who is Amerigroup Iowa? A partner with the Iowa Department of Human Services (DHS), which

More information

PREFERRED CARE. combination of family members; however no single individual within the family will be subject to more than the individual

PREFERRED CARE. combination of family members; however no single individual within the family will be subject to more than the individual PLAN FEATURES Deductible (per plan year) $500 Individual $1,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. The family Deductible is a cumulative Deductible

More information

Table of Contents Managed Health Services Insurance Corp. All rights reserved. Member Services: (888)

Table of Contents Managed Health Services Insurance Corp. All rights reserved. Member Services: (888) Table of Contents Benefits summary... 3 Interpreter services... 4 Important Network Health phone numbers... 4 Welcome... 4 We want to hear from you... 4 Renew your health benefits... 4 Communications from

More information

Inova Fairfax Hospital Women s Center. Overview of Services

Inova Fairfax Hospital Women s Center. Overview of Services Inova Fairfax Hospital Women s Center Overview of Services Inova Fairfax Hospital Women s Center At Inova Fairfax Hospital Women s Center, our commitment to women s health is demonstrated in everything

More information

Kingsborough Community College The City University of New York Department of Nursing

Kingsborough Community College The City University of New York Department of Nursing Nursing 19 Family-Centered Maternity Nursing, page 1 of 12 Professor Catherine Olubummo RN, MSN, FNP Associate Professor Course Co-Coordinator Kingsborough Community College The City University of New

More information

Inventory of Biological Specimens, Registries, and Health Data and Databases REPORT TO THE LEGISLATURE

Inventory of Biological Specimens, Registries, and Health Data and Databases REPORT TO THE LEGISLATURE Inventory of Biological Specimens, Registries, and Health Data and Databases REPORT TO THE LEGISLATURE MARCH 2017 1 Inventory of Biological Specimens, Registries, and Health Data and Databases February

More information

Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY

Benefits are effective January 01, 2018 through December 31, 2018 PLAN DESIGN AND BENEFITS PROVIDED BY AETNA LIFE INSURANCE COMPANY PLAN FEATURES Annual Deductible The maximum out-of-pocket limit applies to all covered Medicare Part A and B benefits including deductible. Hearing aid reimbursement does not apply to the out-of-pocket

More information

Illinois Breastfeeding Blueprint: From Data to Strategy to Change

Illinois Breastfeeding Blueprint: From Data to Strategy to Change Illinois Breastfeeding Blueprint: From Data to Strategy to Change Sadie Wych, MPH Project Coordinator HealthConnect One 1 HealthConnect One is the national leader in advancing respectful, community-based,

More information

Comprehensive Community Services (CCS) File Review Checklist Comprehensive

Comprehensive Community Services (CCS) File Review Checklist Comprehensive This is a sample form developed by the "CCS Statewide QA/QI Work Group", and is available to CCS sites as a sample for consideration of use, modification, and customization. There is no implicit or explicit

More information

Welcome to Neighborhood Health Plan of Rhode Island!

Welcome to Neighborhood Health Plan of Rhode Island! [MEMBER NAME STREET CITY, RI ZIP] Welcome to Neighborhood Health Plan of Rhode Island! Thank you for choosing the Neighborhood ACCESS / RIte Care plan for women, pregnant women, families, children, and

More information

Two midwives will attend your birth. In certain circumstances, a senior midwifery student may attend your birth as the 2 nd midwife.

Two midwives will attend your birth. In certain circumstances, a senior midwifery student may attend your birth as the 2 nd midwife. Midwifery Care with Stratford Midwives What is a Midwife? A midwife is a registered health care professional who provides primary care to women during pregnancy, labour and birth, including conducting

More information

NORTH CAROLINA S PERINATAL HEALTH STRATEGIC PLAN:

NORTH CAROLINA S PERINATAL HEALTH STRATEGIC PLAN: NORTH CAROLINA S PERINATAL HEALTH STRATEGIC PLAN: 2016 2020 This plan is designed to address infant mortality, maternal health, maternal morbidity, and the health of men and women of childbearing age.

More information

Getting the most from your health plan

Getting the most from your health plan Getting the most from your health plan A Healthy Michigan Plan handbook and Certificate of Coverage We re here for you Call us Priority Health Choice, Inc. 888.975.8102 Hours: Monday Thursday 7:30 a.m.

More information

HANDBOOK FOR PROVIDERS OF SCHOOL BASED/ LINKED HEALTH CENTER SERVICES

HANDBOOK FOR PROVIDERS OF SCHOOL BASED/ LINKED HEALTH CENTER SERVICES HANDBOOK FOR PROVIDERS OF SCHOOL BASED/ LINKED HEALTH CENTER SERVICES CHAPTER S-200 POLICY AND PROCEDURES FOR SCHOOL BASED/ LINKED HEALTH CENTERS Illinois Department of Healthcare and Family Services CHAPTER

More information

FCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65

FCPS BENEFITS COMPARISON FOR PLAN YEAR 2018 Active Employees and Retirees Under 65 BENEFIT Medical Lifetime Maximum Unlimited Unlimited Unlimited Unlimited Unlimited Individual Annual Deductible $250 $500 $250 $500 None Family Annual Deductible $500 $1,000 $500 $1,000 None Medical Plan

More information

Organization Review Process Guide Perinatal Care Certification

Organization Review Process Guide Perinatal Care Certification Organization Review Process Guide Perinatal Care Certification 2016 Perinatal Care Certification Review Process Guide for Health Care Organizations 2016 What s New? Review process and contents of this

More information

Welcome to the Molina family.

Welcome to the Molina family. Welcome to the Molina family. Ohio Member Handbook Date of Issuance, July 2013 Table of Contents Member Handbook Welcome...3 Member Services...4 24-Hour Nurse Advice Line...5 Identification (ID) Cards...5

More information

Coast Guard Pregnancy and New Parent Resource Guide. Sponsored By:

Coast Guard Pregnancy and New Parent Resource Guide. Sponsored By: Coast Guard Pregnancy and New Parent Resource Guide Sponsored By: Coast Guard Pregnancy and New Parent Resource Guide If you are considering starting a family, expecting a baby, or have young children

More information

2009 Provider Office Manual

2009 Provider Office Manual 2009 Provider Office Manual Table of Contents Description Page Number Welcome...1 Current Contracts...2 IPN Partnerships/Programs/Value Added Services...3-4 Eligibility Verification...5 Referrals, Prior

More information

Advancing Preconception Wellness: Health System Learning Collaborative

Advancing Preconception Wellness: Health System Learning Collaborative Advancing Preconception Wellness: Health System Learning Collaborative Webinar #3 September 15, 2016 4PM EST Dial in : 1-800-371-9219 Participant Code: 6080761 Agenda Welcome and Introductions Learning

More information

Family Planning Services Clinical Coverage Policy No: 1E-7 Amended Date: April 1, Table of Contents

Family Planning Services Clinical Coverage Policy No: 1E-7 Amended Date: April 1, Table of Contents Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 1.1.1 Regular Medicaid Family Planning (Medicaid FP) and NCHC... 1 1.1.2 Be Smart Family Planning Medicaid

More information

Florida Medicaid Qualified Hospital (QH) Presumptive Eligibility. November 2016

Florida Medicaid Qualified Hospital (QH) Presumptive Eligibility. November 2016 Florida Medicaid Qualified Hospital (QH) Presumptive Eligibility November 2016 Presentation Outline 2 Presumptive Eligibility: Section 1 LEGAL BASIS 3 What is Presumptive Eligibility? Presumptive Eligibility

More information

Iowa Medicaid: Innovations & Initiatives

Iowa Medicaid: Innovations & Initiatives Iowa Medicaid: Innovations & Initiatives ICD-10 ACA Expansion Presumptive Eligibility Health Information Technology PERM DHS Initiatives Adult Quality Measures SIM CDAC Topics 2 ICD-10 3 1 ICD-10 Background

More information

Obesity and corporate America: one Wisconsin employer s innovative approach

Obesity and corporate America: one Wisconsin employer s innovative approach Focus On... Obesity Obesity and corporate America: one Wisconsin employer s innovative approach Amy Helwig, MD, MS; Dennis Schultz, MD, MSPH; Len Quadracci, MD Introduction The United States has an obesity

More information

Option Description & Impacts First Full Year Cost Option 1

Option Description & Impacts First Full Year Cost Option 1 Option 1 Grant coverage for nonemergency services to those adult undocumented immigrants who meet CMISP income and resource standards. Estimate for first year: This option reverses the December 2009 County

More information

Anthem Blue Cross HMO Plan

Anthem Blue Cross HMO Plan Anthem Blue Cross HMO Plan July 1, 2015 BENEFIT BOOKLET PLAN G-C This Anthem Blue Cross HMO booklet, called a Combined Evidence of Coverage and Disclosure Form, is made a part of the Healthcare, Insurance

More information

January 1, Your Anthem Blue Cross HMO Plan. RT Classic HMO Traditional (modified) Low Option (Retirees only)

January 1, Your Anthem Blue Cross HMO Plan. RT Classic HMO Traditional (modified) Low Option (Retirees only) January 1, 2014 Your Anthem Blue Cross HMO Plan RT276800-2 2014 Classic HMO Traditional (modified) Low Option (Retirees only) Combined Evidence of Coverage and Disclosure Form Anthem Blue Cross 21555 Oxnard

More information

Covered Benefits Matrix for Adults

Covered Benefits Matrix for Adults Medicaid Managed Care The matrix below lists the available for adults (age 21 and older) enrolled in the West Virginia Mountain Health Trust and s. Ambulance Ambulatory surgical center services Some services

More information

HMO Value & Quality Roadmap for Wisconsin Medicaid. Rachel Currans-Henry Director Medicaid Bureau of Benefits Management August 8, 2017

HMO Value & Quality Roadmap for Wisconsin Medicaid. Rachel Currans-Henry Director Medicaid Bureau of Benefits Management August 8, 2017 HMO Value & Quality Roadmap for Wisconsin Medicaid Rachel Currans-Henry Director Medicaid Bureau of Benefits Management August 8, 2017 1 Agenda A. Background B. Quality Roadmap C. 2018 SSI Managed Care

More information

5. COVERAGE, BENEFITS, SERVICES AND COPAYMENTS

5. COVERAGE, BENEFITS, SERVICES AND COPAYMENTS 5. COVERAGE, BENEFITS, SERVICES AND COPAYMENTS Coverage for adult members includes certain benefit limits, and copayments for some services. Copayments are your out-of-pocket cost, and are due at the time

More information

Idaho Perinatal Project Newsletter

Idaho Perinatal Project Newsletter Idaho Perinatal Project Newsletter In This Issue Idaho Perinatal Nurse Leadership Summit July/August 2014 2014/2015 March of Dimes Chapter Community Grant Application Helpful Resources PTSD, Depression

More information

Opioid Use in Pregnancy: Innovative Models to Improve Outcomes

Opioid Use in Pregnancy: Innovative Models to Improve Outcomes December 1, 2017 ML12 Opioid Use in Pregnancy: Innovative Models to Improve Outcomes Daisy Goodman, CNM, DNP, MPH Instructor, Dartmouth Medical School Tina Foster, MD, MPH Director of Education, Dartmouth

More information

COMPREHENSIVE QUALITY STRATEGY REPORT (CQS) 2017 Report Draft

COMPREHENSIVE QUALITY STRATEGY REPORT (CQS) 2017 Report Draft COMPREHENSIVE QUALITY STRATEGY REPORT (CQS) 2017 Report Draft CQS Report--Purpose Florida Medicaid is required to furnish a written quality strategy to the federal Centers for Medicare and Medicaid Services

More information

NOW, THEREFORE, be it resolved that DHS and HEALTH agree to perform the following in connection with this agreement: Purpose

NOW, THEREFORE, be it resolved that DHS and HEALTH agree to perform the following in connection with this agreement: Purpose COOPERATIVE AGREEMENT between NORTH DAKOTA DEPARTMENT OF HUMAN SERVICES and NORTH DAKOTA DEPARTMENT OF HEALTH and PRIMARY CARE OFFICE/PRIMARY CARE ASSOCIATION This agreement has been made and entered into

More information

Hong Kong College of Midwives

Hong Kong College of Midwives Hong Kong College of Midwives Curriculum and Syllabus for Membership Training of Advanced Practice Midwives Approved by Education Committee: 22 nd January 2016 Endorsed by Council of HKCMW: 17 th February

More information

Your Out-of-Pocket Type of Service

Your Out-of-Pocket Type of Service Calendar Year Deductible (CYD) 1 $0 single/ 3x family Out-of-Pocket Maximum - Deductibles, coinsurance and copays all accrue toward the outof-pocket maximum. With respect to family plans, an individual

More information

Blue Shield of California

Blue Shield of California An independent member of the Blue Shield Association City of San Jose Custom ASO PPO 100 90/70 Active Employees Benefit Summary (For groups of 300 and above) (Uniform Health Plan Benefits and Coverage

More information

UTILIZATION MANAGEMENT AND CARE COORDINATION Section 8

UTILIZATION MANAGEMENT AND CARE COORDINATION Section 8 Overview The focus of WellCare s Utilization Management (UM) Program is to provide members access to quality care and to monitor the appropriate utilization of services. WellCare s UM Program has five

More information

Medi-Cal. Member Handbook. A helpful guide to getting services (Combined Evidence of Coverage and Disclosure Form)

Medi-Cal. Member Handbook. A helpful guide to getting services (Combined Evidence of Coverage and Disclosure Form) Medi-Cal Member Handbook A helpful guide to getting services (Combined Evidence of Coverage and Disclosure Form) Benefit Year 2016 AS A HEALTH NET COMMUNITY SOLUTIONS MEMBER, YOU HAVE THE RIGHT TO Respectful

More information

Quality Management Utilization Management

Quality Management Utilization Management Aetna Better Health Aetna Better Health Kids Quality Management Utilization Management 2015 Program Evaluation EXECUTIVE SUMMARY Aetna Better Health, a Medicaid Physical Health-Managed Care Organization

More information

UnitedHealthcare Community Plan Alliance Member Handbook

UnitedHealthcare Community Plan Alliance Member Handbook CAPITAL AREA UnitedHealthcare Community Plan Alliance Member Handbook 941-1057 8/11 Important Phone Numbers Member Services.... 1-800-701-7192 (8 a.m. 5:30 p.m., Monday Friday).... TTY: 711 NurseLine Services

More information

Mother and Child Health Program Family Medicine Enhanced Skills (Third Year) Curriculum and Objectives

Mother and Child Health Program Family Medicine Enhanced Skills (Third Year) Curriculum and Objectives Mother and Child Health Program Family Medicine Enhanced Skills (Third Year) Curriculum and Objectives Name of Institution: Department of Family Medicine McGill University Location: Accredited teaching

More information

Health plans for Maine small businesses Available through the Health Insurance Marketplace

Health plans for Maine small businesses Available through the Health Insurance Marketplace Health plans for Maine small businesses Available through the Health Insurance Marketplace Effective January 1, 2016 We can help you navigate the health care road We re here to help. In fact, for more

More information

community. Welcome to the Pennsylvania UnitedHealthcare Community Plan for Kids CHIP Member Handbook CSPA15MC _001

community. Welcome to the Pennsylvania UnitedHealthcare Community Plan for Kids CHIP Member Handbook  CSPA15MC _001 Welcome to the community. Pennsylvania UnitedHealthcare Community Plan for Kids CHIP Member Handbook CSPA15MC3673270_001 www.chipcoverspakids.com Telephone Numbers Member Services Monday Friday, 8:00 a.m.

More information

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived

Optional PREFERRED CARE. Covered 100%; deductible waived. Covered 100%; deductible waived PLAN FEATURES Deductible (per calendar year) $1,500 Individual $1,500 Individual $3,000 Family $3,000 Family All covered expenses, including prescription drugs, accumulate toward both the preferred and

More information

Prenatal Care Webinar. Luz Jimenez, RN, BSN VP Clinical Operations Erie Family Health Center

Prenatal Care Webinar. Luz Jimenez, RN, BSN VP Clinical Operations Erie Family Health Center Prenatal Care Webinar Luz Jimenez, RN, BSN VP Clinical Operations Erie Family Health Center National Center for Health in Public Housing The National Center for Health in Public Housing (NCHPH), a project

More information

Scripps Health Plan HMO Offered by Scripps Health Plan Services Combined Evidence of Coverage and Disclosure Form Effective January 1, 2017

Scripps Health Plan HMO Offered by Scripps Health Plan Services Combined Evidence of Coverage and Disclosure Form Effective January 1, 2017 Scripps Health Plan HMO Offered by Scripps Health Plan Services Combined Evidence of Coverage and Disclosure Form Effective January 1, 2017 Scripps Health Plan 0 Effective January 1, 2017 rev 7 7 2017

More information

Oklahoma Hospitals Work to Be Designated Baby-Friendly

Oklahoma Hospitals Work to Be Designated Baby-Friendly For Release: February 22, 2013 - Pamela Williams, Office of Communications - 405/271-5601 Oklahoma Hospitals Work to Be Designated Baby-Friendly More than 38,000 Oklahoma infants start out breastfeeding

More information

Request for Proposals (RFP) for CenteringPregnancy

Request for Proposals (RFP) for CenteringPregnancy March of Dimes State Community Grants Program Request for Proposals (RFP) for CenteringPregnancy March of Dimes Illinois 111 W. Jackson Blvd., Suite 1650 Chicago, IL 60604 (312) 765-9044 1 I. MARCH OF

More information

upscale: A digital health platform for effective health systems

upscale: A digital health platform for effective health systems República de Moçambique Ministério da Saúde Direcção Nacional de Saúde Pública upscale: A digital health platform for effective health systems From 2009 to 2016, Malaria Consortium tested a number of interventions

More information

MEMBER HANDBOOK. Western New York Medicaid. WNY-MHB

MEMBER HANDBOOK. Western New York Medicaid.  WNY-MHB MEMBER HANDBOOK Western New York Medicaid www.bcbswny.com/stateplans Western New York www.bcbswny.com/stateplans BLUECROSS BLUESHIELD OF WESTERN NEW YORK MEDICAID MANAGED CARE MEMBER HANDBOOK Revised March

More information

Amherst Central School District First Choice Health Plan. Non-First Choice Providers and Out-of-Network Providers

Amherst Central School District First Choice Health Plan. Non-First Choice Providers and Out-of-Network Providers Health: Hospital Services provided by First Choice Preferred Provider Network Medical Services Radiology, Ultrasounds 20% after $500 individual or Laboratory Testing 20% after $500 individual or MRI and

More information

Thank you for your interest in the community health benefits our hospital and community partnerships can provide to the region.

Thank you for your interest in the community health benefits our hospital and community partnerships can provide to the region. Marshfield Medical Center 611 N Saint Joseph Avenue Marshfield, WI 54449-1832 Dear patients, families and friends, Community health needs assessment and strategy implementation reports are completed every

More information

WI WH-FP/RH Program Site Manual for Developing Dual Protection Services

WI WH-FP/RH Program Site Manual for Developing Dual Protection Services WI WH-FP/RH Program Site Manual for Developing Dual Protection Services 1 Table of Contents SECTION I: UNDERSTANDING THE FULL SCOPE OF DUAL PROTECTION SERVICES... 5 A. INTRODUCTION TO DUAL PROTECTION SERVICES...

More information