April 01, 2022

April 2022 policy and protocol updates overview

Your notice of protocol and policy changes from UnitedHealthcare

Appendix Bulletins

Medical policy updates: April 2022
This month, you’ll find updates to our commercial, commercial affiliate, Exchange Plans, Community Plan, and Medicare Advantage medical policies.

Reimbursement policy updates: April 2022
See the latest updates for reimbursement policies.

Specialty Medical Injectable Drug program updates: April 2022
See the latest updates to requirements for Specialty Medical Injectable Drugs for UnitedHealthcare members.


Policy and protocol updates

Home health review process change for Alabama
Starting July 1, 2022, for UnitedHealthcare® Medicare Advantage and Dual Special Needs Plans (D-SNP) in Alabama, there will be a change in the process for requesting prior authorization for all visits after the start of care visit (SOC).

California Medicaid: Ensure compliance with blood lead screening requirements of young children
A list of UnitedHealthcare Community Plan members who have yet to receive a required blood screening is now included in the Patient Care Opportunity Report (PCOR).

Colorado, Kentucky and Tennessee: Access new home health review process
Starting July 1, 2022, for UnitedHealthcare® Medicare Advantage and Dual Special Needs Plans (D-SNP), you’ll need to request prior authorization for all visits after the start of care (SOC) visit.

Kentucky: Updating incarceration release dates in KYMMIS
Medicaid benefits are suspended for UnitedHealthcare Community Plan members when they’re incarcerated.

Louisiana: State policy on sinus procedures and surgery
The Louisiana Department of Health issued Information Bulletin 22-3 announcing its policy on sinus procedure balloon ostial dilation and functional endoscopic sinus surgery effective March 9, 2022.

Minnesota Medicaid: Injectable chemotherapy prior authorization update
Effective May 1, 2022, UnitedHealthcare will expand the existing prior authorization requirement for injectable chemotherapy drugs received in an outpatient setting to include the UnitedHealthcare Community Plan of Minnesota.

New York: Medicaid policy details for SD and ED prescriptions and treatments
New York State Medicaid does not cover prescription or physician-administered drugs used for the treatment of sexual dysfunction (SD) or erectile dysfunction (ED).

North Carolina: Avoid denials when submitting personal care services claims
There are several actions you can take to help avoid claim denials for personal care services.

Texas Medicaid: Prior authorization changes effective May 1, 2022
Effective May 1, 2022, prior authorization is required when prescribing drugs for UnitedHealthcare Community Plan of Texas members to treat certain conditions.

Veteran’s Affairs Community Care Network home health updates
The Centers for Medicare & Medicaid Services (CMS) recently announced changes to claim processing requirements that affect using Requests for Anticipated Payments (RAPs) for home health care claims, including changes to submission timelines and late penalties.

Specialty Pharmacy Requirement updates for certain medical benefit medications
Effective for dates of service on or after July 1, 2022, we will be revising our specialty pharmacy requirements for UnitedHealthcare and Oxford commercial plan members to simplify and streamline Medication Sourcing.

Updates to the oncology Specialty Pharmacy Requirement for commercial plan members
Effective for dates of service on or after March 18, 2022, the medication sourcing requirement for certain oncology supportive care medications will no longer apply for outpatient hospital providers.


State news

Arizona: Resources available to support family and caregivers of vulnerable individuals
To improve health care and create a safer environment for individuals with intellectual or development disabilities in Arizona, Governor Douglas Ducey formed the Abuse & Neglect Prevention Task Force in 2019

Arizona: Updated EPSDT clinical sample templates available now
Updated versions of Arizona Health Care Cost Containment System (AHCCCS) Early and Periodic Screening, Diagnostic and Treatment (EPSDT) clinical sample templates are now available.

Hawaii: CME training opportunity on vaccine hesitancy program now available
All Med-QUEST Health Plans are pleased to offer providers with a new CME eligible training: “Vaccine Hesitancy: How to Identify and Approach the “Movable Middle”.

Tennessee: See what's required for reportable events
As of Jan. 1, 2022, all TennCare CHOICES in Long Term Services (CHOICES) and Employment and Community First (ECF) providers must use the reportable event management (REM) process developed by the Department of Developmental Disabilities (DIDD) and TennCare.

Tennessee: What you need to know about EPSDT screenings
The early and periodic screening, diagnostic and treatment (EPSDT) screening benefit of UnitedHealthcare Community plan helps provide comprehensive and preventative health care services for children from birth through age 20.


Claims and payment updates

Important details about charging D-SNP members for non-covered services
The Centers for Medicare & Medicaid (CMS) requires all Medicare members, including Dual Eligible Special Needs Plan (D-SNP) members to know costs prior to receiving non-covered services.

New outpatient procedure grouper mapping exhibits for 2022
Effective July 1, 2022, we’re updating the outpatient procedure grouper (OPG) mapping exhibits to reflect the codes that are eligible for reimbursement for outpatient procedures and other services.


Other UnitedHealthcare news

Action required: 10-minute Model of Care training
The Centers for Medicare & Medicaid Services (CMS) requires all special needs plans (SNPs) to provide initial and annual Model of Care (MOC) training to health care professionals contracted to see SNP members and out-of-network providers who routinely see SNP members. 

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