Jump to content
Insurance Agent Forum by NAAIP

UHC SCO in Massachussetts


NAAIP Admin
 Share

Recommended Posts

when can consumers eligible for unitedhealthcare sco plan enroll if the consumer has both medicaid and medicare?
answer: once per quarter during and during aep

while determining if carl is eligible for the UHC sco plan, anne learns that carl does not pay copayments when he goes to the pharmacy.
what that may indicate.

answer. carl may be enrrolled in pace. if that is confirmed carl should not enroll.


uhc sco is a fully integrated dual eligible fide (fide)snp offered in MA. the plan covers remibursed under medicare and masshealth, the ma state medicaid program.

the uhc sco plan also provides specialized geriatric elder support services and respite care for families and caregivers in addition to providing the medicare and medicaid benefits.


medicaid in ma is called masshealth
is combination medicaid and state childrens health inssurance plan (schip) in one program.


to be eligible for masshealth, must live in ma, have low to medium income and meet certain financial eligibilty requirements.

masshealth offers six coverage types of individuals, families and people with disablities.
masshealth standard
masshealth common health 
masshealth careplus
masshealth family assistance
masshealth premium assistance
masshealth limited

only individuals enrolled in masshealth standard who also meet the eligibility requirements
maybe enrolled in uhc sco

Pace is the program for the all-inclusive care for the elderly progrram covered by medicare and masshealth. in some areas it is referred b to as the elder service plan (esp)
special consideration should be given prior to enrolling a pace covered person in SCO. pace offers
coordinated care provided by health providers, additional covered services (meal delivery) and case management.


the purpose of a sco is to keep members as independant as possible, whether they live in the commnity or in an institution.

to achieve this goal, the plan offers benefits in addition to those covered by Original medicare and medicaid alone.

as a fully integrated plan, members  receive all their medicaid and medicare benefits through UHC.

sco plans are like health maintenance organizations hmo. and require each member to select and use 
an in-network pcp primary care physician. 

community service - adult day care, housekeeping, home delivered meals, transporrtantion, are covercovered if guidelines are met

other benefits and services, drugs - no copayments or out of pocket costs for covered drugs and for over the counter medications orded by the primary physician (unlike masshealth only coverage)

dental- routine exams, cleanings, fillings, dentures, implants, and more in addition to masshealth.

vision, annual eyeglasses and hearing benefits.
transportation to all medical benefits
hospice at in network hospice providers for masshealth standard recipients without medicare(original medicare still covers hospice for those with medicare)

masshealth - medicaid -standard sco members must be enrolled in masshealth... most will be covered by medicare, but it is not required for enrollment in uhc sco.

cms granted permission to the state executive office for health and human services eohhc to require that medicaid only individuals be included in the sco eligible eligible population.
sco plans contracted with MA are required to provide the same benefits to the medicaid only members as medicare  and medicare covered members.


care management team is responsible for care planning and service coordination of all medicare and masshealth standard covered services.

a health risk assessment tool is used to assess the level of each member's health care within 30 days of becoming a member. all members assessed at least twice a year, with more frail members being assessed more frequently.

 

care management proactively works to coordinate care and service as a seamless model of care.
this is a fundamental aspect of the UHC sco and is also a key selling point.


uhc sco care management provides recomendations for timely, medically necessary covered health care services in an appropriate setting.

uhc sco care management focuses on primary and preventative care. care managers share servics and care plan information with the member's Pcp. in addition. the uhc
sco clinical team has a healthcare service coordinator to help assist members get on boarded onto the plan and obtain preventative services they may need , such as flu and pneumonia vaccines.

uhc sco care management provides access to telephonic support 27/7. members are able to call toll free to reach health care professionals to ask questions and discuss concerns about their health care.

uhc sco care management seeks to optimize a members health and well being by helping the member obtain the medical and home/communitiy based services they need. such as personal care assistance, home health and adult day health.

to enroll in uhc sco plan, what level of medicaid must the consumer have. answer enrolled in masshealth standard.

what is NOT a component of care management?  providing community services is not specifically a function of care management. the other choices were.


eligibility to uhc sco plan. - prefacing. best practice to not be intrusive ,, asking in a nice way personal questions. .. ask for approval to continue. 


is the consumer 65 or older?
is the consumer enrolled in masshealth standard
does the consumer live in the plans service area
does the consumer have esrd
does the consumer only have masshealth and live in a hospice that is outside the plans netowkr.
does the consumer qualify for masshealth standard through frail elder waiver - few


consumers must have a valid election period to enroll or disenroll in uhc sco plan.
medicare and medicade can enroll during the Medicare initial enrollment period - iep - and the annual election period aep, the medicare advantage open enrollment period oep and available special election period sep. 
consumer with medicare and medicaid can use the sep for dual/lis maintainting once per calendar quarter from january till september


medicaid only consumer are not restricted by cms election rules and can enroll/disenroll monthly.
the plans effective date depends on the election period used by the consumer. when sep/lis maintaining is used the plan effective date is the first day of the month following the receipt of the enrollment application.
the date the agent signs the enrollment application is considered the reciept date.

pace stands for program for all inclusive care for the elderly
pace is unique benefit under medicare and medicaid that focuses on frail seniors who meet the states standards for nursing home care.
it features comprehensiv medical and social services at an adult day health center. - in home and or in patient facility. for most participants , the comprehensive care allows them to remain in their home while receiving care, rather than be institutionalized. 
a team of doctors, nurses and other health care professionals assess a participants needs, develops care plans and delivers all services under one integrated plan.

PACE is available in states like MA that have offered to it through their medicaid program. 

pace and other sco plans. when consider enrolling consumers in uhc sco, be sure to determin whether the consumer is enrolled in pace. unless their is a compelling reason, it is generally nor appropriate to enroll pace members in uhc sco. these members are very frail and moving to sco may require changing providers.

these maybe the reason to change to sco.... that the pace member moved out of the pace service area.
that the member does want to stay with her pcp and wants to use a pcp with uhc sco netork.

there are numerous pace sites in MA. see online.

there are six uhc sco plans in ma.if consumer is not happy with providers may change, but ussually not
 by seeing the insurance card one is able to know if with plan already.
if consumer states that pays no copayment for drugs then agent must seek confirmation that not with pace or sco.
if on adult day care - then cross reference the pace centers. which is comparible to benefits of sco.

marketing.. be complient... agent must take and pass the events basic module. take the module to present the plan.
only enroll if good for consumer..

signed and dated by agent, review medicare card for accuracy..

provider directory for their area, pharmacy formulary will be mailed in welcome kit. if want provider directory for additional area they may request and it will be mailed at no cost.
agents should use online directory  and formulary.. and encourage members to contact customer service or online to confirm up to date provider status.

agents should look up online the doctor status... 

jarvis,uhc toolkit, uhc sco promo materials, phd, jarvis wrap, search tools, uhc toolkit,, additional sales tools


be knowledgable about medicaid eligibility requirements and masshealth benefits, scope of appt

review current health coverage, verify if have masshealth standard. 
look up consumers providers, pcp, if in network. must be willing to change pcp if not in network.
explain how to access doctors. confirm understanding of plan. explain, review the sco enrollment guide.
explain costs, details. pcp name.

enrollment guide to rules about enrollment, cancelation, disenrollment ... 
consumer may cancel before effective date....
cancelations in writing .,. and effective till end of month..
effective till ineligilbe .. they are in service area and in masshealth standard.

venues to sell should be accessable to wheelchair.. and public transportation.. if inquire about eligibility refer to eohhc]

agents must make available to uhc sco, upon request, all schedules of selling and activity to sell.


consumers should have upon request.. relevant info..

agents use approved materail,,,access used by uhc sco materials.... distribute that material by mail
promo material if less than 15 dollars

no incentives to enroll or refer.. no door to door, or unsolicited contacts..must only use approved scripts, etc.


select with group of individual might qualify for medicaid?
certain person and famililies with low income

 requirement of masshealth?
live in MA

which is the following compenents of uhc sco plan is considered its foundation
care management


which 2 are true about uhc sco care management program?

a health risk assessment tool is used to assess the level of each member's health care
care management team is responsible for care planning and service coordination of all medicare and masshealth standard covered services.

when will johns coverage begin - only medicaid- if sign up nov 10th?
december 1 and use current year app..


which of the question could you ask the consumer to determin if they have pace or another sco plan?
do you currently pay copays for drugs.

requirements of uhc sco plan.
resident of service area.


which of the following about esrd. and uhc sco?
may not enroll in plan unless has uhc or the ma plan that they have has terminated.


what is  best describe pace and why no good to enroll them in sco plan..
it is an optional benefit under medicaid and medicare that focuses on frail seniors who meet their states standards for nursing home care. pace features comprehensive care that allows members to remain in their homes while recieving care. enrolling in a sco plan would change their providers and care approach. 

mr javitz  saw his pcp is not in sco network.. and not willing to change his pcp. what should agent do.
agent should not enroll him.


health risk assessment .. statement is true.
it is used by the care management team to determine the members level of healthcare needs.

when presenting sco plan to consumer these 2 things agent must do
look up provideers in online directory confirm if doctors are in network.
explain that the doctor status can change the advise consumer to call the plan or look online to confirm before see dr.

coverage guidelines do not typically cover in community services?
pet grooming

if medicaid only which is true regarding enrollment in uhc sco/
enrollment can occur year round with continueous enrollment.

what is the reason to enroll a pace member in a uhc sco?
participant moves out of pace area.


 

Link to comment
Share on other sites

  • 1 year later...
Guest Jen

What are the components of the UnitedHealthcare SCO Plan is considered its foundation?

Link to comment
Share on other sites

  • 1 month later...
Guest foundation
On 10/15/2019 at 1:20 AM, NAAIP Admin said:

when can consumers eligible for unitedhealthcare sco plan enroll if the consumer has both medicaid and medicare?
answer: once per quarter during and during aep

while determining if carl is eligible for the UHC sco plan, anne learns that carl does not pay copayments when he goes to the pharmacy.
what that may indicate.

answer. carl may be enrrolled in pace. if that is confirmed carl should not enroll.


uhc sco is a fully integrated dual eligible fide (fide)snp offered in MA. the plan covers remibursed under medicare and masshealth, the ma state medicaid program.

the uhc sco plan also provides specialized geriatric elder support services and respite care for families and caregivers in addition to providing the medicare and medicaid benefits.


medicaid in ma is called masshealth
is combination medicaid and state childrens health inssurance plan (schip) in one program.


to be eligible for masshealth, must live in ma, have low to medium income and meet certain financial eligibilty requirements.

masshealth offers six coverage types of individuals, families and people with disablities.
masshealth standard
masshealth common health 
masshealth careplus
masshealth family assistance
masshealth premium assistance
masshealth limited

only individuals enrolled in masshealth standard who also meet the eligibility requirements
maybe enrolled in uhc sco

Pace is the program for the all-inclusive care for the elderly progrram covered by medicare and masshealth. in some areas it is referred b to as the elder service plan (esp)
special consideration should be given prior to enrolling a pace covered person in SCO. pace offers
coordinated care provided by health providers, additional covered services (meal delivery) and case management.


the purpose of a sco is to keep members as independant as possible, whether they live in the commnity or in an institution.

to achieve this goal, the plan offers benefits in addition to those covered by Original medicare and medicaid alone.

as a fully integrated plan, members  receive all their medicaid and medicare benefits through UHC.

sco plans are like health maintenance organizations hmo. and require each member to select and use 
an in-network pcp primary care physician. 

community service - adult day care, housekeeping, home delivered meals, transporrtantion, are covercovered if guidelines are met

other benefits and services, drugs - no copayments or out of pocket costs for covered drugs and for over the counter medications orded by the primary physician (unlike masshealth only coverage)

dental- routine exams, cleanings, fillings, dentures, implants, and more in addition to masshealth.

vision, annual eyeglasses and hearing benefits.
transportation to all medical benefits
hospice at in network hospice providers for masshealth standard recipients without medicare(original medicare still covers hospice for those with medicare)

masshealth - medicaid -standard sco members must be enrolled in masshealth... most will be covered by medicare, but it is not required for enrollment in uhc sco.

cms granted permission to the state executive office for health and human services eohhc to require that medicaid only individuals be included in the sco eligible eligible population.
sco plans contracted with MA are required to provide the same benefits to the medicaid only members as medicare  and medicare covered members.


care management team is responsible for care planning and service coordination of all medicare and masshealth standard covered services.

a health risk assessment tool is used to assess the level of each member's health care within 30 days of becoming a member. all members assessed at least twice a year, with more frail members being assessed more frequently.

 

care management proactively works to coordinate care and service as a seamless model of care.
this is a fundamental aspect of the UHC sco and is also a key selling point.


uhc sco care management provides recomendations for timely, medically necessary covered health care services in an appropriate setting.

uhc sco care management focuses on primary and preventative care. care managers share servics and care plan information with the member's Pcp. in addition. the uhc
sco clinical team has a healthcare service coordinator to help assist members get on boarded onto the plan and obtain preventative services they may need , such as flu and pneumonia vaccines.

uhc sco care management provides access to telephonic support 27/7. members are able to call toll free to reach health care professionals to ask questions and discuss concerns about their health care.

uhc sco care management seeks to optimize a members health and well being by helping the member obtain the medical and home/communitiy based services they need. such as personal care assistance, home health and adult day health.

to enroll in uhc sco plan, what level of medicaid must the consumer have. answer enrolled in masshealth standard.

what is NOT a component of care management?  providing community services is not specifically a function of care management. the other choices were.


eligibility to uhc sco plan. - prefacing. best practice to not be intrusive ,, asking in a nice way personal questions. .. ask for approval to continue. 


is the consumer 65 or older?
is the consumer enrolled in masshealth standard
does the consumer live in the plans service area
does the consumer have esrd
does the consumer only have masshealth and live in a hospice that is outside the plans netowkr.
does the consumer qualify for masshealth standard through frail elder waiver - few


consumers must have a valid election period to enroll or disenroll in uhc sco plan.
medicare and medicade can enroll during the Medicare initial enrollment period - iep - and the annual election period aep, the medicare advantage open enrollment period oep and available special election period sep. 
consumer with medicare and medicaid can use the sep for dual/lis maintainting once per calendar quarter from january till september


medicaid only consumer are not restricted by cms election rules and can enroll/disenroll monthly.
the plans effective date depends on the election period used by the consumer. when sep/lis maintaining is used the plan effective date is the first day of the month following the receipt of the enrollment application.
the date the agent signs the enrollment application is considered the reciept date.

pace stands for program for all inclusive care for the elderly
pace is unique benefit under medicare and medicaid that focuses on frail seniors who meet the states standards for nursing home care.
it features comprehensiv medical and social services at an adult day health center. - in home and or in patient facility. for most participants , the comprehensive care allows them to remain in their home while receiving care, rather than be institutionalized. 
a team of doctors, nurses and other health care professionals assess a participants needs, develops care plans and delivers all services under one integrated plan.

PACE is available in states like MA that have offered to it through their medicaid program. 

pace and other sco plans. when consider enrolling consumers in uhc sco, be sure to determin whether the consumer is enrolled in pace. unless their is a compelling reason, it is generally nor appropriate to enroll pace members in uhc sco. these members are very frail and moving to sco may require changing providers.

these maybe the reason to change to sco.... that the pace member moved out of the pace service area.
that the member does want to stay with her pcp and wants to use a pcp with uhc sco netork.

there are numerous pace sites in MA. see online.

there are six uhc sco plans in ma.if consumer is not happy with providers may change, but ussually not
 by seeing the insurance card one is able to know if with plan already.
if consumer states that pays no copayment for drugs then agent must seek confirmation that not with pace or sco.
if on adult day care - then cross reference the pace centers. which is comparible to benefits of sco.

marketing.. be complient... agent must take and pass the events basic module. take the module to present the plan.
only enroll if good for consumer..

signed and dated by agent, review medicare card for accuracy..

provider directory for their area, pharmacy formulary will be mailed in welcome kit. if want provider directory for additional area they may request and it will be mailed at no cost.
agents should use online directory  and formulary.. and encourage members to contact customer service or online to confirm up to date provider status.

agents should look up online the doctor status... 

jarvis,uhc toolkit, uhc sco promo materials, phd, jarvis wrap, search tools, uhc toolkit,, additional sales tools


be knowledgable about medicaid eligibility requirements and masshealth benefits, scope of appt

review current health coverage, verify if have masshealth standard. 
look up consumers providers, pcp, if in network. must be willing to change pcp if not in network.
explain how to access doctors. confirm understanding of plan. explain, review the sco enrollment guide.
explain costs, details. pcp name.

enrollment guide to rules about enrollment, cancelation, disenrollment ... 
consumer may cancel before effective date....
cancelations in writing .,. and effective till end of month..
effective till ineligilbe .. they are in service area and in masshealth standard.

venues to sell should be accessable to wheelchair.. and public transportation.. if inquire about eligibility refer to eohhc]

agents must make available to uhc sco, upon request, all schedules of selling and activity to sell.


consumers should have upon request.. relevant info..

agents use approved materail,,,access used by uhc sco materials.... distribute that material by mail
promo material if less than 15 dollars

no incentives to enroll or refer.. no door to door, or unsolicited contacts..must only use approved scripts, etc.


select with group of individual might qualify for medicaid?
certain person and famililies with low income

 requirement of masshealth?
live in MA

which is the following compenents of uhc sco plan is considered its foundation
care management


which 2 are true about uhc sco care management program?

a health risk assessment tool is used to assess the level of each member's health care
care management team is responsible for care planning and service coordination of all medicare and masshealth standard covered services.

when will johns coverage begin - only medicaid- if sign up nov 10th?
december 1 and use current year app..


which of the question could you ask the consumer to determin if they have pace or another sco plan?
do you currently pay copays for drugs.

requirements of uhc sco plan.
resident of service area.


which of the following about esrd. and uhc sco?
may not enroll in plan unless has uhc or the ma plan that they have has terminated.


what is  best describe pace and why no good to enroll them in sco plan..
it is an optional benefit under medicaid and medicare that focuses on frail seniors who meet their states standards for nursing home care. pace features comprehensive care that allows members to remain in their homes while recieving care. enrolling in a sco plan would change their providers and care approach. 

mr javitz  saw his pcp is not in sco network.. and not willing to change his pcp. what should agent do.
agent should not enroll him.


health risk assessment .. statement is true.
it is used by the care management team to determine the members level of healthcare needs.

when presenting sco plan to consumer these 2 things agent must do
look up provideers in online directory confirm if doctors are in network.
explain that the doctor status can change the advise consumer to call the plan or look online to confirm before see dr.

coverage guidelines do not typically cover in community services?
pet grooming

if medicaid only which is true regarding enrollment in uhc sco/
enrollment can occur year round with continueous enrollment.

what is the reason to enroll a pace member in a uhc sco?
participant moves out of pace area.

 

Link to comment
Share on other sites

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...