February 01, 2022

February 2022 policy and protocol updates overview

Your notice of protocol and policy changes from UnitedHealthcare

Appendix Bulletins

Medical policy updates: February 2022
This month, you’ll find updates for Medicaid, Medicare Advantage, Exchange and commercial plans.

Reimbursement policy updates: February 2022
This month, you’ll find updates for commercial plans.

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


State News

New Jersey: Reimbursement changes to drug screening and testing
Effective April 1, 2021, we made changes to presumptive drug screening and definitive drug testing reimbursement and CPT® codes for the UnitedHealthcare Community Plan of New Jersey.

Washington Medicaid: Quality measures to help improve behavioral health outcomes
In 2022, Washington Medicaid is implementing 2 quality measures to help improve behavioral health outcomes for Medicaid beneficiaries.

New enrollment requirement for Louisiana Medicaid
All health care professionals who file claims with Louisiana Medicaid must now enroll in the new Medicaid Provider Enrollment Portal to continue being reimbursed. The enrollment deadline is March 31, 2022.

Kansas and Virgina: Injectable chemotherapy prior authorization update
Effective May 1, 2022, UnitedHealthcare will expand the existing prior authorization requirement for injectable chemotherapy drugs in an outpatient setting to UnitedHealthcare Community Plan members in Kansas and Virginia.

Maryland: Doula services now covered for Medicaid members
Starting Feb. 7, 2022, we’ll cover doula services for Maryland Medicaid members. The benefit includes 8 prenatal or postpartum services up to 60 minutes each and attendance during labor and delivery.

North Carolina: Non-routine newborn care requires notification effective immediately
Effective immediately, UnitedHealthcare Community Plan of North Carolina will enforce the process of requiring provider notification for newborns receiving non-routine newborn care.

100-day medication supply benefit in 22 states
A 100-day supply of medication is now available in 22 states for the same copay as a 90-day 


Digital updates

Prior authorization and clinical decision letters are going paperless for most plans
Beginning May 6, 2022, we will no longer mail prior authorization and clinical decision letters for most* UnitedHealthcare plans in the Central, Southeast and Northeast regions. Instead, you’ll be able to view them 24/7 through either the UnitedHealthcare Provider Portal or an Application Programming Interface (API) system-to-system data feed.

Starting Feb. 11, appeal decision letters won't be mailed
Beginning March 4, 2022, we will no longer mail appeal decision letters for Medicare Advantage and commercial plans. Instead, you’ll be able to view them digitally 24/7 starting on the day they’re generated.


Benefits, plan and program updates

Reimbursement changes to presumptive drug screening and definitive drug testing
Beginning May 6, 2022 we will no longer mail prior authorization and clinical decision letters for most* UnitedHealthcare plans in the Central, Southeast and Northeast regions. Instead, you’ll be able to view them 24/7 through either the UnitedHealthcare Provider Portal or an Application Programming Interface (API) system-to-system data feed.

Updates for Oxford policies, prior authorizations and claims
Effective May 1, 2022, Optum, an affiliate company of UnitedHealthcare, will start managing prior authorization requests for certain medical benefit medications for UnitedHealthcare Oxford plan members. This is currently in place for UnitedHealthcare commercial plan members.

Oxford specialty pharmacy requirement May 1, 2022
Effective for dates of service on or after May 1, 2022, we’re aligning the UnitedHealthcare Oxford health plan to the existing UnitedHealthcare commercial specialty pharmacy requirement.

Change in post-acute care management
Starting March 1, 2022, naviHealth will manage post-acute care for UnitedHealthcare Institutional-Equivalent Special Needs Plans (IE-SNP)/Assisted Living Health Plan members. This includes concurrent (continued stay) review and discharge planning for members transitioning to and receiving skilled care.

Updates to the 2022 Care Management and Quality Incentive Program
Effective Jan. 1, 2022, we have updated the 2022 Care Management and Quality Incentive Program. The program was designed with the goal of helping your patients who are UnitedHealthcare Community Plan members become more engaged with their preventive health care.


Education and training

Free CME opportunities: Buprenorphine and pregnancy
The Florida Perinatal Quality Collaborative (FPQC) offers 2 free on-demand continuing medical education (CME) training modules through Vanderbilt University Medical Center.

Learn more about our clinical tools and programs with these education courses

New online course on hospital quality care measures
Learn more about hospital measures with our new self-paced course Hospital Measures Overview.

New training course for providers treating patients with IDD
A new online course for providers who serve individuals with intellectual and developmental disabilities (IDD) is available: Providing Quality Care For Adults With Intellectual and Developmental Disabilities

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