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Updates to UHC Community Plans Coming September 1

Thursday, August 29, 2019   (0 Comments)
Posted by: APTANJ
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On September 1, UHCCP will implement a new policy concerning authorization for outpatient physical, occupational and speech therapy with a particular focus on site of care. Below are some key concerns with the policy.

•        It is unclear which freestanding outpatient PT/OT providers are able to serve children with special needs.  Access to care concerns are arising, specifically for this population especially in Newark, Jersey City, New Brunswick, Toms River where there are no or limited freestanding locations accepting managed Medicaid reimbursement.  To date, UHCCP has not provided a list of in-network providers that will be able to care for these children.

•        The documentation burden on therapists and physicians is unreasonable and unnecessary to achieve the goal of improved overall management of the therapy benefit.  This paperwork burden will be a barrier to access by having a chilling effect on referrals.  Therapists are highly trained and skilled professionals who evaluate and design plans of care for thousands of patients every day.  Forcing them into an additional step with the referring physician will only serve to delay care for patients. National data on utilization of these services compared to New Jersey only tell part of the story and cannot account for the diversity of population, social determinants affecting health status and other local issues affecting our communities.

•         Under the Medicaid Managed Care contract, a readiness review is required for changes in service authorization policy. UHCCP has acknowledged that the questions raised during their Aug. 23rd education session will require them to produce further guidance.  It is not productive to incrementally add guidance because it adds confusion to the process.  The policy implementation should be delayed until UHCCP can demonstrate readiness and has engaged in more robust provider education.


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