Unitedhealthcare Community Plan-Books Download

UnitedHealthcare Community Plan

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program is designed to provide critical long term care support services, in the community setting of choice for beneficiaries that would otherwise require institutionalization in an intermediate care facility for an ICF-ID (intermediate care facility for intellectual disabilities).




Important Telephone Numbers, Member Services and Care Coordination. 8 a m to 6 p m CST Monday through Friday 1 877 542 9238. TTY Hard of hearing 711, Fax 1 913 451 1297, 24 7 NurseLineSM 1 855 575 0136. available 24 hours a day 7 days a week , TTY 711, Mental Health and. Substance Use Disorder Services 1 855 802 7095, LogistiCare Transportation Services. Non Emergency Transportation 1 877 796 5847, Where s My Ride Hotline 1 877 796 5848.
Website myuhc com communityplan, UnitedHealthcare Community Plan. Address 10895 Grandview Dr Suite 200, Overland Park KS 66210. Your Health Providers, My Care Coordinator , Phone Email . My Targeted Case Manager , Phone Email , Name Phone . Name Phone , Emergency Room Phone , Pharmacy Phone .
If you have questions about your health plan please call us . Our toll free Member Services number is 1 877 542 9238 TTY 711 for the hard of hearing . NurseLineSM is a service mark of UnitedHealth Group Inc . Health plan coverage provided by UnitedHealthcare of the Midwest Inc . 2 UnitedHealthcare Community Plan Intellectually Developmentally Disabled Supplement. Contents, KanCare Transportation 10, Intellectually Developmentally. Disabled Benefits 4 Additional Information 11, Eligible Program Services 5 Self Advocacy 11. Guiding Principles for Money Follows the Person 12. UnitedHealthcare Community, Plan I DD Program 6 Kansas Department of Aging. and Disability Services 12, Care Coordination 7, KanCare Ombudsman 13. The Role of the Care Coordinator 7, Grievances Appeals and.
Examples of How UnitedHealthcare State Fair Hearings 14. Community Plan Can Help 7, What if I Have a Problem 7 Member Rights. and Responsibilities 16, Additional ID DD Benefits 8. Value Added Benefits VAB for, UnitedHealthcare Community Plan. of Kansas Members 8, Person Centered Support Plan 8. Guardianship 9,Kansas 3, KanCare Intellectually Developmentally.
Disabled Benefits, This information is directed at the member UnitedHealthcare Community Plan is also aware of the. important role of the member s support team Family guardians or representatives can be a big help in. getting the right services and can use this information to assist in supporting the member . The Home and Community Based Services Intellectual Developmental Disability HCBS I DD . program is designed to provide critical long term care support services in the community setting. of choice for beneficiaries that would otherwise require institutionalization in an intermediate. care facility for an ICF ID intermediate care facility for intellectual disabilities The KanCare. HCBS I DD program is administered by the Kansas Department of Aging and Disability. Services KDADS , Consistent with the Developmental Disabilities Reform Act of 1995 DDRA the goals and. objectives of the program center around the policy of the State to provide persons who have. intellectual and or developmental disabilities access to services and supports which allow for these. persons opportunities for choice that increase their independence productivity integration and. inclusion in the community Further this range of supports and services will be appropriate to. each person and will be provided in a manner that affords the same dignity and respect to persons. with intellectual or developmental disabilities that would be afforded to any person who does not. have a disability , HCBS I DD goals conform to the Developmental Disabilities Reform Act of 1995 DDRA . The policy is to provide access to services that allow persons to be more independent It is to help. people with disabilities be a part of the community It is to help them be more productive This. help is tailored to each person It is given with dignity and respect . Kancare UnitedHealthcare Community Plan is managing your HCBS I DD services You will be. able to keep your same community providers including your Targeted Case Manager There are. 13 services under the I DD program You may be getting some or all of them They are . Assistive Services Sleep Cycle Support, Day Supports Specialized Medical Care. Financial Management Service FMS Supported Employment. Medical Alert Supportive Home Care SHC , Overnight Respite Wellness Monitoring.
Personal Assistant Services PAS Targeted Case Management TCM . Residential Supports, 4 UnitedHealthcare Community Plan Intellectually Developmentally Disabled Supplement. Eligible Program Services home or in the community Some examples. are bathing grooming feeding mobility and, The following services are or may be offered exercise They can include shopping house. Assistive Services Something that cleaning chores meal preparation laundry. improves your health independence and help with managing money . productivity and inclusion in your community Residential Supports Services for someone. This can be wheelchair modifications ramps who lives in a residential setting and not with. lifts modifications to your bathroom and their family . kitchen This can also be assistive technology, to improve communication or mobility This Sleep Cycle Support Overnight help. can be to help you with daily activities at home for someone who lives with their family or. or at work does not live at a residential facility The. worker giving the service must be immediately, Day Supports Regular activities help you available for the member but can sleep when. take part in your community They include not needed The worker could . help in getting and keeping a job if you want, Call the doctor or hospital .
one Examples of day supports are seeing, others recreation transportation education Help in an emergency . and job skill training Help the member turn over in bed . Medical Alert A monitoring system to help Help the member use the bathroom . you if you have a medical emergency Help with taking medicine at night . Overnight Respite This is temporary care Specialized Medical Care This is long . for a member when the primary caregiver term nursing support for medically fragile and. needs time away technology dependent members The level of. care is care that would be given in a hospital if. Personal Assistant Services This is the nurse were not with the member . available to members who self direct all, or part of their services and Supported Employment Help to find and. Lives in an adult residential setting hold a job . Lives with family Supportive Home Care Help with, Is 5 to 21 years old and lives with daily living and care for a person living with. caregivers family or a child age 5 to 21 who does not live. with family , Lives with a caregiver who is not, a guardian Wellness Monitoring Evaluation of a. member s health by a nurse to make sure the, The Services are to help the person who.
member is getting the best care , could do the activity if they did not have. a disability The services can be provided at,Kansas 5. KanCare Intellectually Developmentally, Disabled Benefits cont . Financial Management Services Guiding Principles, FMS Provided for beneficiaries who. are aging or disabled and will be provided for UnitedHealthcare. within the scope of the Agency with Choice Community Plan. AWC model Within the self directed Intellectually Developmentally. model and Kansas state law K S A 39 7 100 , beneficiaries have the right to make decisions Disabled Program.
about direct the provisions of and control Providing person centered community. the attendant care services received by such support and services to members that. individuals including but not limited to would otherwise be institutionalized . selecting training managing paying and Recognize and value the importance to. dismissing of a direct support worker The collaborate with the member s current. beneficiary or beneficiary s representative support team which includes the CDDO . has decision making authority over certain CSP and TCM . services and takes direct responsibility to Commitment to support the member s. manage these services with the assistance preferred lifestyle . of a system of available supports FMS is, included in these supports You can still access services through the. Community Developmental Disability, Targeted Case Management TCM Organization CDDO Your CDDO will. Services Services that assist individuals in still determine your eligibility for the I DD. gaining access to medical social educational program each year You can keep your targeted. and other services These services may be case manager TCM You can use the. provided during a transitional phase from providers you want . institutional care with the exception of, transition from incarceration The primary Your Plan of Care will still be reviewed yearly. intent of TCM services should always be by your TCM It will be updated as your needs. related in some manner to the development change Any changes or reductions in the plan. implementation amendment and coordination of care have to be approved by the Kansas. and or monitoring of a service plan Department for Aging and Disability Services. KDADS , You will also keep all of your medical providers . 6 UnitedHealthcare Community Plan Intellectually Developmentally Disabled Supplement. Care Coordination, The Role of the Help to Develop .
Care Coordinator Person Centered Support Plan PCSP . Behavioral Support Plan BSP , You will get a Care Coordinator from. UnitedHealthcare Community Plan of Help to Find , Kansas The Care Coordinator will work Health plan resources . with your TCM on your plan of care You, Resources in the community . or your TCM will help make sure you have, the services you need Your Care Coordinator Help to Manage . will help you understand your KanCare Obtain supports to help meet Person. benefits He or she will assist with doctor Centered Support Plan goals . visits and find services He or she will also, Connect to community and health.
help with access to specialists If you do not, plan supports . have a care coordinator assigned already by, UnitedHealthcare one will be assigned for you Help with non medical issues . when you become an I DD program member Manage complex care needs . Help assess need for any assistive services , Our Care Coordinators including home modifications . Act as a resource to the TCM the member, Monitoring and Follow Up . and the support team , Help with on going needs , Evaluate the plan of care .
Help with wrap around plans , Review member status and visit the. member in their home or other setting Help prevent crises . Help develop an integrated plan of care The UnitedHealthcare Community Plan care. Participate in Person Centered Support coordination model is not limited to these. Plan meeting or provide input before and items We work with current I DD services. after meeting and supports to improve the outcomes We. Arrange access to services and supports want to be a resource to the service system We. try to build strong ties with the I DD system , Arrange transitions of care . We will continue to learn about various roles, and how we can help . Examples of How, UnitedHealthcare What if I Have a Problem . Community Plan Can Help You can always call your TCM community. service providers CDDO or UnitedHealthcare, Help to Assess Community Plan of Kansas Care Coordinator .
Do a Health Risk Assessment , If you cannot resolve your concerns . Help to identify needs , you can call the KanCare Ombudsman. Identify behavioral health needs at 1 855 643 8180 . Kansas 7, Additional ID DD Benefits, Value Added Benefits VAB You will still get Targeted Case Management. from your current TCM This service has not, for UnitedHealthcare changed It is detailed below Your TCM will. Community Plan of Kansas still to be your primary contact You and your. Members TCM can also contact the Care Coordinator. for help The Care Coordinator can help you, Value added benefits are services that navigate the UnitedHealthcare Community.
are not covered by KanCare but are Plan He or she can help you understand your. offered by UnitedHealthcare Community KanCare benefits . Plan In addition to these VAB I DD, services members can access the VAB s Definition of Services . for all UnitedHealthcare Community, Care Coordination services are to help the. Plan members , member get medical social educational and. Respite Care The member must other needed services . have a direct service worker either, Personal Attendant Services or supported Targeted Case Management Includes . home care The member is eligible 1 Assessment , for a maximum of 40 hours per year .
2 Making a support care plan , You can choose from current I DD. respite providers The service does 3 Referral and related activities . not need to be approved by the CDDO 4 Monitoring and follow up activities . Your Care Coordinator can help you, access this benefit Person Centered. Transportation to Job Related, Activities Members on the I DD. Support Plan, program can get six 6 one way or three Will I Still Have a Person Centered. 3 round trip rides a year to a job interview Support Plan PCSP . or to a job This is to fill the gap with the Yes your Targeted Case Manager will meet. member s transport plan The ride will be with you and your support team yearly to. from the current transportation network discuss your goals Your Care Coordinator. You can reach them by calling the number would like to be invited to the PCSP meeting. on the back of your card to get to know you better Even if your Care. Coordinator does not go to the meeting , they can be a resource before and after the.
meeting They can help make sure your needs, are being met . 8 UnitedHealthcare Community Plan Intellectually Developmentally Disabled Supplement. The Person Centered Support Plan PCSP is Can My Guardian or Parent Talk to. to help you get the support you need to have the MCO About My Services or Care . the lifestyle you want The PCSP helps put the If you are a minor under the age of 18 your. choice in your hands The PSCP is made up of parent or legal guardian is your main contact. 1 A planning team Your TCM helps you for the MCO If you are an adult with a legal. decide who needs to be on your team guardian we may need to verify our ability. This can be family members people in to speak with them If you want someone. the community your Care Coordinator other than a legal guardian to speak with the. and other people you want involved MCO you must sign a release Let your Care. 2 A Person Centered Plan Your plan Coordinator know of anyone you want to talk. reflects your needs and lifestyle choices with your MCO Your TCM and service. The plan is built around your wishes It providers do not need a release to talk to us . respects your hopes dreams and fears The guardian should coordinate with the. When you help make up your plan you State of Kansas at 1 866 305 5147 to ensure. will need fewer supports they are listed as the responsible person on the. 3 A plan that takes all the time needed to member s enrollment file UnitedHealthcare. make sure it is right for you Community Plan does require the guardian. to mail their certification to P O Box 8208 , Kingston NY 12402 In urgent situations . Guardianship we could also provide the member with. Some individuals with I DD services a fax number to a supervisor Once on. have a court appointed or legal guardian file there should be no need to update. We recognize that your guardian is a vital the document annually . part of your support team If you have a, guardian they . Must approve all services and medical care , Have the right to make decisions for you. with your input ,Kansas 9, Transportation, Transportation Before You Are Picked Up.
Medical transportation is covered for LogistiCare will call to ask you if you still. some medical care If you have no other need a ride You will then know the name of. way to get to the doctor live in an area with the company that will be picking you up . no public transportation or cannot use public, When Your Ride Is Late. transportation due to a health condition or, disability call our Transportation Services Call 1 877 796 5848 if your ride is late . LogistiCare at 1 877 796 5847 Your ride, will be comfortable and safe If you need help . When You Need a Ride Home, you may bring someone to the appointment to. After Your Appointment, help you If you are a guardian or are assisting Call 1 877 796 5848 for a ride home if you.
the member you can also call to set up the did not set up a return time . ride Include this information when you call, for a ride If You Have a Complaint. If you have a complaint about the, How to Schedule a Ride transportation service call Member. 1 Call LogistiCare at 1 877 796 5847 Services at 1 877 542 9238 TTY 711 . Call at least 3 business days before your, appointment Urgent Care and same day LogistiCare also has a website that. rides are accepted Rides can be scheduled members can use to schedule rides . up to 30 days in advance https member logisticare com. 2 Call Monday to Friday from, 8 00 a m 8 00 p m , Remember to call 911 if you have. an emergency , 3 Give them this information , a The address of your medical.
provider appointment , b If you need a wheelchair lift or a. special vehicle , 4 They will ask you for , a Your ID number on your member. ID card , b Your first and last name, c The address of your appointment. d Your appointment time and location, e Your date of birth. 10 UnitedHealthcare Community Plan Intellectually Developmentally Disabled Supplement. Additional Information, Self Advocacy 4 Steps to Change.
Make a plan and take action , UnitedHealthcare Community Plan 1 What is the problem . Supports Your Right to Advocate, for Yourself 2 Who can fix it Who can make the. changes you want , This information is from the Self Advocate. Coalition of Kansas SACK 3 What should I do Ask for what you. want and get support for your idea , What Is a Self Advocate 4 Did I get the change I wanted If not . A person who speaks up for himself or herself make changes to your plan and get back. and lets others know what he or she thinks to work If you did get the changes you. wanted CELEBRATE , Being a Self Advocate Means , Advisors to Self Advocates.
Solving problems and making decisions, From the Self Advocate Coalition of Kansas. that affect you , Speaking for yourself If you are an advisor helping a person to be. a self advocate here are some tips , Knowing your rights and responsibilities . Contributing to your community You work for the self advocacy group . Changes that you or a friend need in your Your job is to support the decision of the. own services and supports self advocate , Allow the self advocate to try things for. Examples of Problems You Can themselves first They will ask for your help. Have a Voice in if they need it Everyone has the right to. You may need help with your money make mistakes , or banking .
When making plans check for, You or your friend do not like their job understanding from the self advocate . You are having trouble getting Help the person to understand their rights. around town and responsibilities , Your friend doesn t like where they live The advisor is a positive role model . The advisor helps provide information on, resources in the community . The advisor advises on how to run a, meeting with caregivers . Ask key questions to check for, understanding Use short words and.
sentences Make sure information is easy, to understand . Kansas 11, Additional Information cont , Give advice only when asked or when services you are not eligible for the. more information is needed to make MFP program , a good decision . All MFP services require prior authorization, Help the self advocate when asked or if PA Contact your Care Coordinator to. they need help to make a good decision learn more . A good advisor does not do it all , MFP beneficiaries must live in one of the.
Know Your Rights and Responsibilities following MFP Housing Options . From the Self Advocate Coalition of Kansas 1 Home owned or leased by the beneficiary. or beneficiary s relative , You have the right to speak out for yourself . 2 Leased apartment or home with, You have the responsibility to be involved. lockable egress The space must include, in making your support plan . separate living sleeping bathing and, You have the right to be treated with cooking areas . dignity and respect , 3 Community based residence for no.
You have the duty to treat others as you more than four unrelated individuals. want to be treated I DD only , You have the right to make decisions and. have responsibilities , Kansas Department, You are responsible for your actions . You have the right to be free from abuse , of Aging and Disability. neglect and exploitation Services, To report suspected abuse neglect or The KanCare HCBS I DD program is. exploitation call the Kansas Protection Report administered by the Kansas Department of. Center at 1 800 922 5330 Make sure to let Aging and Disability Services KDADS . your TCM know of any concerns you have, about your rights and responsibilities KDADS .
General Info 785 296 4986, Greg Wintle I DD Program Manager. Money Follows the Person 1 785 296 0935, The Money Follows the Person MFP Greg Wintle kdads ks gov. program provides MFP services to help a, person transition from an Intermediate Care KanCare www KanCare ks gov. Facility for Intellectual Disability ICF ID or I DD Program www kdads ks gov. a nursing facility back into the community The, people served by this grant include persons Visit our website often . with an Intellectual or Developmental We will post videos answer your questions . Disability This is a voluntary program for update information and share upcoming. persons living in institutional settings If you events and training sessions . are getting Home Community Based, 12 UnitedHealthcare Community Plan Intellectually Developmentally Disabled Supplement.
KanCare Ombudsman, The KanCare consumer Ombudsman is. available to help consumers who receive long , term care and home and community based. services through KanCare with their rights and, responsibilities The Ombudsman can help you . When you need help with a concern or, filing a grievance . When you need help with a problem, you can t solve by speaking with your.
KanCare plan , When you do not think that you are. getting the care that you need , When you feel your rights are. being violated , Call this toll free number to reach the. KanCare Ombudsman 1 855 643 8180 ,Kansas 13, Grievances Appeals and. State Fair Hearings, What Is a Grievance We will review your grievance and send our.
decision within 30 days of getting your, A grievance is an expression of dissatisfaction grievance We will send you a letter with. about any matter other than an Action the decision . Examples include but are not limited to , You are unhappy with the quality of What Is an Appeal . your care An appeal is your request for a review of an. The doctor you want to see is not a Adverse Action An Action is when we . UnitedHealthcare Community Plan Deny or limit a service you want . doctor , Reduce suspend or terminate payment for, You are not able to receive culturally a service you are getting . competent care , Fail to authorize a service in the required. You got a bill from a provider for time or, a service that should be covered by.
Fail to respond to a grievance or appeal in, UnitedHealthcare Community Plan . the required time , Rights and dignity , Any other access to care issues . How Do I File an Appeal, What Should I Do if I With UnitedHealthcare. Have a Grievance Community Plan , You or someone acting for you can file. You or someone acting for you can file, an appeal by calling or writing to.
a grievance by calling or writing to, UnitedHealthcare Community Plan Call. UnitedHealthcare Community Plan , 1 877 542 9238 TTY 711 or write to . Call 1 877 542 9238 TTY 711 or write to , Grievance and Appeals. Grievance and Appeals, P O Box 31364, P O Box 31364. Salt Lake City UT 84131 0364, Salt Lake City UT 84131 0364.
You must file your appeal within 30 days, If you need help writing or filing a grievance . from the date you get a Notice of Action , call Member Services at 1 877 542 9238. If you need help writing or filing an appeal , TTY 711 . call Member Services at 1 877 542 9238, If someone else is going to file for you TTY 711 . we need your written permission If you, If you file an appeal we will send you a.
are a person with disabilities you may call, letter within 5 business days telling you that. UnitedHealthcare Community Plan at, we got your appeal . 1 877 542 9238 TTY 711 to file a grievance , 14 UnitedHealthcare Community Plan Intellectually Developmentally Disabled Supplement. We will review your appeal and send you How Do I File a State. a decision within 30 business days of getting, the appeal The letter will tell the reason for Fair Hearing Request . our decision We will tell you what to do if you If you disagree with an Action by. don t like the decision This letter will be a UnitedHealthcare Community Plan you. Notice of Action or someone acting for you can file for a State. Fair Hearing You file with the Kansas Office, of Administrative Hearings OAH .
Continuation of Care, You may file for a State Fair Hearing. You can ask for services to continue during the, at the same time that you appeal to. appeal However you may need to pay for the, UnitedHealthcare Community Plan . health service if you continue the service while, we are reviewing the appeal and we decide that For expedited appeals you must first. you should not have received the service exhaust UnitedHealthcare Community. Plan s appeal process before requesting, an expedited State Fair Hearing Or.
What Can I Do if I Need instead of appealing to UnitedHealthcare. Immediate Care Community Plan you may file for a State. If you or your doctor wants a fast decision Fair Hearing . because your health is at risk call Member You must file for a State Fair Hearing within. Services at 1 877 542 9238 TTY 711 30 days from the date you get a Notice of. for an expedited review UnitedHealthcare Action from UnitedHealthcare Community. Community Plan will call you with our Plan To request a State Fair Hearing write to . decision within 3 business days of getting Office of Administrative Hearings. your request for an expedited review This 1020 S Kansas Avenue. time may be extended up to 14 days if you Topeka KS 66612. ask for this or if we show a need for more, information and the delay is in your interest The State Fair Hearing request form. If we ask for an extension we will give you can be found online at. written notice of the reason www oah ks gov request htm . You will get a letter with our decision and the, reason for our decision We will tell you what How Do I Request. to do if you don t like the decision Disenrollment From. My Plan , You may choose to disenroll from our plan at. any time for cause If you have questions about, this process please call Member Services at.


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