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April 2022 policy and protocol updates overview - UHCprovider.com

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.

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