UHC Community Plan Update

• By: admin
• On: 12/08/2019 15:02:25
• In: Payment

Good afternoon,

APTA is aware of new prior authorization and site of service requirements for outpatient physical and occupational therapy under the UHC Community Plan. These changes are affecting a number of states and APTA is working with Chapter leadership in coordinating efforts with State Medicaid offices and Community Plan/UHC. The attached information targets Arizona, Hawaii, Maryland, Michigan, New Jersey, Ohio, Rhode Island, Virginia, Wisconsin, California, Kansas, Washington, Nebraska, and New York. Per the UHC alert, this policy does not apply to FL, LA, MA, MS, MO, PA, TN and TX. This information was previously sent to the chapters and posted on the HUB. Here is a link to the August Bulletin on the UM policy change for select states: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2019/network-bulletin/July-Network-Bulletin-2019.pdf (pages 45-46). While not on the original list, we are hearing NE is also impacted by the new prior auth policy.

748831407. is needed on why the UM change was implemented and how they plan to ensure patient access. With the number of roadblocks embedded into this prior auth (PA) program, access will surely be impeded. Plus coordinating with physician offices is extremely burdensome and not realistic. In reading the PA policy, not only is the physician having to get pre-authorization for the eval and re-eval, but the therapist still has to get authorization for the visits and the plan of care has to be signed by the physician. Plus during the eval visit no treatment can be rendered. Attached you'll find an undated letter to NJ providers that might be helpful in explaining the reasoning behind the proposed change- flawed as it may be.

We are beginning to hear of member concerns at the chapter and national level particularly on the physician eval and re-eval prior auth requirement. To that end, we are organizing a group chapter call on Wednesday, September 4^th from 12 noon to 1pm EST to discuss strategy. If you are unable to attend, please feel free to forward the invite to another chapter leader to engage on your behalf. The invite will arrive under separate cover.

In the interim, we suggest the following:

• Alert your members to the change and provide the templates referenced below.
• Contact your state Community Plan and request a meeting or a call at minimum.
• Get the physicians on board early.
  • The PTs who contract with this plan should contact their referring physicians to make sure they are aware of this new requirement and gauge their reaction. I assume they will not be happy.
  • At same time, conduct outreach to state medical society to ensure they are aware of the change.
  • Join with the other impacted associations, including AMA, to write a letter to the plan opposing the change arguing that this not only increases burden, but will significantly delay access to care.
  • Depending on the plan's reaction/response, or lack thereof, the state associations (PT, OT and AMA) could jointly contact the state Medicaid office.
• The chapter can tweak the Medicaid clinician template to direct it to the plan and have therapists and physicians oppose the change.
• The chapter can tweak our Medicaid consumer template to direct it to the plan and have the patients oppose this change.
• The advocacy resources/ templates referenced in the last 2 bullets are found here: https://www.apta.org/Payment/PrivateInsurance/TPAUtilizationMgmtReview/)

At the national level, we are looking for the right contact at UHC/ Community Plan. To date, the APTA commercial UHC contact has been unable to assist. As we continue the search, we plan to reach out to the UHC Chief Medical Officer that signed the NJ letter. If any of you have thoughts, please let us know.

Look forward to speaking soon.

Thanks in advance

Elise

Elise Latawiec, PT, MPH

Lead Specialist Practice Management

American Physical Therapy Association

1111 North Fairfax Street

Alexandria, VA 22314

703 706 3166

APTA.org