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News & Press: Insurance/Provider

Alaska Medicaid Pilot Project

Wednesday, February 6, 2019   (0 Comments)
Posted by: Debbie Ryan
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Alaska Chiropractic Society

Update - Optum/UHC

OPTUM/UHC
MEDICAID PILOT PROJECT

Municipality of Anchorage + Matanuska-Susitna Borough

ACS has received many calls and emails regarding provider packets sent by Optum/UHC to chiropractic offices participating in Medicaid.  The cover letter invites offices to join the UnitedHealthCare Community Plan. It has also been reported that Optum/UHC is making phone calls to offices following up on the packets that have not been returned.  UHC  representatives have falsely indicated to chiropractic offices that these packets must be returned in order to continue to treat Medicaid patients.  

Here's some facts. The State of Alaska Medicaid Program is conducting a 3-year Pilot Project  with UnitedHealthCare (UHC) for the Anchorage and Mat-Su areas ONLY.  The pilot project with UHC has an initial three year contract with the option of three, one-year contract extensions.  Eligible beneficiaries for the pilot project in the Municipality of Anchorage and Matanuska-Susitna Borough areas include Medicaid eligible adults and children, Medicaid expansion recipients, Denali KidCare, Waiver program members (medical coverage only).  IHS beneficiaries within these populations are included on a voluntary basis.  Excluded individuals are dual eligible beneficiaries (Medicare & Medicaid) and Health Insurance Premium Payment (HIPP) program participants.  Participation by Medicaid beneficiaries is not mandatory, it is voluntary.  The state has indicated that they anticipate a majority of Medicaid recipients to be enrolled in the UHC managed care plan.  

  • The anticipated program go-live date has been delayed from 04/01/2019 to 07/01/2019.
  • Under this Medicaid pilot project, coverage for chiropractic services is NOT being expanded to include adults Chiropractic coverage will remain the same as they have always been under the Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT) benefit of Medicaid. The Alaska Medicaid program covers chiropractic services for children under age 21. Coverage is limited to 12 spinal manipulations and one chiropractic X-ray exam per recipient, per calendar year (January through December). If the recipient is under age 6, the chiropractor must get prior authorization before treating the child.  ACS is unsure why the state felt the need to include the limited chiropractic services available to a small section of the Medicaid population as part of this large scale managed care plan pilot project.  
  • Participation in UnitedHealthcare's managed care plan is NOT MANDATORY for providers.  Providers can choose not to join the UHC provider network and still be eligible to provide services to Alaska Medicaid/fee-for-service (FFS) patients and UHC members.  See next bullet point for services provided to UHC members.  
  • You can still provide services to UHC members as an out of network provider.  Prior authorization of services is required for out of network providers to provide UHC covered services to UHC members.  The state is currently working on designing and implementing two new initiatives to streamline and reduce the administrative burden of the prior authorization process for providers.  Prior Authorization Golden Ticket - providers who have had 99-100% prior authorization requests approved within the past year are eligible to receive a "golden ticket" for the following year's prior auth requests, which means that eligible providers will receive from DHSS a single prior auth number to use in lieu of making individual prior authorization requests.  
  • What services are included in the managed care program?  The covered services include but are not limited to disease management, dental, optical, transportation, ancillary services, audiology, telemedicine, chiropractic, hospital, surgical, DME, primary care, care coordination.  Excluded services are pharmacy, behavioral health services, home and community based waiver services, and long term services and supports.  
  • What are the reimbursement rates under UHC?  Rates for in-network providers will be based on the State fee schedule.  Rates for individual providers can be negotiated with UHC.  Providers will also have the option to participate in additional value based payment models through UHC.  For out of network providers, UHC will not pay less than 100% of the State's FFS schedule.  
  • Who do I submit claims to?  Alaska Medicaid claims (which may be referred to as fee-for-service claims (FFS) should be submitted to Conduent in the same way they are now.  FFS claims will include:  Individuals who are not eligible for the United Healthcare Managed Care program; Individuals who have opted out of the program, and; Services that are outside the scope of United Healthcare (e.g. behavioral health).  Claims for members of the United Healthcare Managed Care program should be submitted to United Healthcare.  
  • Individuals who become part of the managed care plan will have two separate ID cards, one for Alaska Medicaid services and a second one for UHC services.  It's recommended that each card be kept on file.  
  • PLEASE read all of the information in the packet you receive carefully.  In addition to the invitation to join the network with UHC for the Medicaid Pilot Project, the packet also includes opt-in forms for CorVel Workers' Compensation Plan network, CorVel Auto Liability Network, SmartComp, LLC (USC) Workers' Compensation Plan network, Align Networks, Inc. Workers' Compensation and Auto Liability, UnitedHeathCare Medicare Advantage, Prime Health Services, Inc. Auto Liability, Prime Health Services, Inc. Workers' Comp, Rockport Community Network, Inc., and TechHealth.  
  • If you have questions about United Healthcare, as always, I would advise that you do your homework.  Thoroughly read the contract.  Google Optum and United HealthCare on the internet to investigate the success of their business practices and relationships in other states.  As with any contract, have your attorney review them, and understand your rights and responsibilities.
  • Source:  Provider FAQs about UnitedHealthCare's Alaska Managed Care Plan
  • Source:  United HealthCare - Alaska Managed Care Plan

The Alaska Chiropractic Society, its Board or employees, cannot advise you whether or not to participate in the UHC network.  This is a business decision that you need to evaluate thoroughly for yourself.  I hope that this provides you with the information you need to make an informed choice.  

As you can see, more changes regarding the way healthcare operates in the state are coming. If you have not already become a part of SecureCare of Alaska (your very own IPA), there might never be a better time to join your fellow colleagues in building an independent physician association to work for better chiropractic care in Alaska.

If you have further questions, please feel free to call ACS at 907-903-1350.  

 



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Alaska Chiropractic Society, PO Box 111507, Anchorage, AK  99511-1507 
    
Phone: (907) 903-1350   Fax:  (907) 770-3790   Email:  info@akchiro.org