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«Member Handbook: Integrated Health Services For Physical and Behavioral Health Services Amerigroup Louisiana LA-MHB-0018-16 05.16 1-800-600-4441 (TTY ...»

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Member Handbook:

Integrated Health Services

For Physical and Behavioral Health Services

Amerigroup Louisiana

LA-MHB-0018-16 05.16

1-800-600-4441 (TTY 711)

www.myamerigroup.com/la

www.myamerigroup.com

A Member Handbook Update

We want to tell you about a few changes to your health plan. Please keep this update with your

handbook.

Bayou Health is now Healthy Louisiana

The name of the Medicaid program in Louisiana changed from Bayou Health to Healthy

Louisiana. Here’s what you need to know about the change:

 The program still offers the same benefits and services  You might still get letters, postcards, handbooks or other materials with the Bayou Health name or logo on it while we update materials  The new website for Healthy Louisiana is www.healthy.la.gov Resources to help you live a healthy life Your current handbook tells you about mental and substance use services. We want to let you know we also have resources to help you quit smoking and get help if you have a gambling problem.

 Quit with Us, LA — this is a website that can give you the tools you need to break the habit.

Visit www.quitwithusla.org or call 1-800-Quit-Us.

 If you have a gambling problem, you can contact a Department of Health and Hospitals (DHH) Office of Behavioral Health near you. You get the services you need at no cost to you.

Visit http://new.dhh.louisiana.gov/index.cfm/page/2253 for more information.

Healthy Louisiana program enrollees Medicaid is expanding. This means Mediciad now covers more adults than ever. You might be

eligible for benefits if you:

 Are 19 to 64 years old  Meet citizenship requirements  Don’t already qualify for Medicaid or Medicare  Have a household income less than 138% of the federal poverty level New immunizations (shots) available Talk with your primary care provider to see if you’re due for any of these shots.

For members age 19-20:

• Pneumococcal 13 • Meningococcal B • Haemophilus influenza B (Hib) LA-MHI-0005-16

For members age 21 and up:

• Tdap • Varicella • Zoster • MMR • Pneumococcal 13 • Hepatitis A • Hepatitis B • Meningococcal B • Meningococcal 4 valent • Haemophilus influenza B (Hib) Medical appeals Your current handbook tells you how to file a medical appeal. We want to let you know more about this process.

 You have the option to be present while your appeal is reviewed. We’ll make a decision and mail you a letter to tell you the decision of your appeal. You’ll be able to check this option on the Request for Appeal form. Someone will contact you to schedule your in-person appeal.

 You can give us information about your appeal in person or in writing.

 You and your representative can look at your case file before and during your appeal. Your case file includes medical records and any other documents and records needed for your appeal.

Please keep this update with your handbook. You can also find your member handbook at www.myamerigroup.com/LA.

Have questions? Call Member Services at 1-800-600-4441 (TTY 711), Monday through Friday from 7 a.m. to 7 p.m.

For members who do not speak English, we offer oral interpretation services for all languages.

These services are free of charge. If you need these services, call Member Services toll free at 1-800-600-4441.

Para miembros que no hablan inglés, ofrecemos servicios de interpretación oral para todos los idiomas. Estos servicios son gratuitos. Si necesita estos servicios, llame a la línea gratuita de Servicios al Miembro al 1-800-600-4441.

–  –  –

Dear Member:

Welcome to Amerigroup Louisiana! We’re pleased to help you get your health care benefits for you and your family.

This member handbook tells you how Amerigroup works and how to keep your family healthy. It also explains how to get health care when you need it. You have a right to receive a member welcome packet at least once a year if you need it.

You will get your Amerigroup member ID card and more information from us in a separate mailing.

Your ID card tells you when your Amerigroup membership starts. Please check your ID card right away.

If any other information is not right, please call us at 1-800-600-4441. We will send you a new ID card with the correct information.

If you need to reach us, you can call Member Services at 1-800-600-4441 (TTY 711).

You can talk to a Member Services representative about your benefits or visit our website at www.myamerigroup.com/LA. Or if you need medical advice and wish to speak with a registered nurse, call Amerigroup On Call at 1-866-864-2544.

For members who do not speak English, we offer oral interpretation services for all languages.

These services are free of charge. If you need these services, call Member Services toll free at 1-800-600-4441.

Para miembros que no hablan inglés, ofrecemos servicios de interpretación oral para todos los idiomas. Estos servicios son gratuitos. Si necesita estos servicios, llame a la línea gratuita de Servicios al Miembro al 1-800-600-4441.





Nếu quý vị cần thông tin này bằng tiếng Việt, hãy gọi tới đường dáy miễn phí của Dịch Vụ Thành Viên theo số 1-800-600-4441.

Thank you for being an Amerigroup member.

Sincerely,

–  –  –

When is it time for a wellness visit?

It is important for all Amerigroup members to have regular wellness visits. This way, your primary care provider (PCP) can help you stay healthy. When you become an Amerigroup member, call your PCP and make the first appointment for you and your Amerigroup family members before the end of 90 days.

–  –  –

After age 6, you and your child should keep going to your PCP every year for wellness visits.

What if I become pregnant?

If you think you are pregnant, call your PCP or OB-GYN right away. This can help you have a healthy baby.

If you have any questions or need help making an appointment with your PCP or OB-GYN, please call Amerigroup Member Services at 1-800-600-4441.

–  –  –

Welcome to Amerigroup Louisiana! You will get most of your health care services covered through Amerigroup. This member handbook will tell you how to use Amerigroup to get the health care you need.

Table of Contents

WELCOME TO AMERIGROUP LOUISIANA!

Information about your new health plan

How to get help

Amerigroup Member Services

Online and automated self-service features

Amerigroup On Call

24-hour Behavioral Health Crisis Line

Behavioral Health Warm Line

Language Assistance

Other important phone numbers

Personal disaster plan

Your Amerigroup member handbook

Your Amerigroup ID card

YOUR PROVIDERS

Picking a primary care provider

Second opinion

If you had a different primary care provider before you joined Amerigroup

/f your primary care provider’s office moves͕ closes or leaves the Amerigroup network.................. 10 How to change your primary care provider

If your primary care provider asks for you to be changed to another primary care provider............ 10 If you want to go to a doctor who is not your primary care provider

Picking an obstetrician or gynecologist

Specialists

GOING TO THE PRIMARY CARE PROVIDER

Your first primary care provider appointment

How to make an appointment

Wait times for appointments

What to bring when you go for your appointment

How to cancel an appointment

How to get to a doctor’s appointment or to the hospital

Disability access to Amerigroup network providers and hospitals

WHAT DOES MEDICALLY NECESSARY MEAN?

UTILIZATION MANAGEMENT NOTICE

YOUR HEALTH CARE BENEFITS

Your covered services

Extra Amerigroup benefits

BEHAVIORAL HEALTH SERVICES

What are behavioral health services?

Types of behavioral health providers and services

Your covered behavioral health services

Helpful Resources

SERVICES COVERED UNDER THE LOUISIANA STATE PLAN OR FEE-FOR-SERVICE MEDICAID............... 39 Coordinated System of Care

PRIOR AUTHORIZATIONS

NEW TECHNOLOGY

DIFFERENT TYPES OF HEALTH CARE

Routine, urgent and emergency care: What is the difference?

Routine care

Emergency care

How to get health care when your primary care provider’s office is closed

How to get health care when you are out of town

How to get health care when you cannot leave your home

WELLNESS CARE FOR CHILDREN AND ADULTS

Wellness care for children

Why well-child visits are important for children

When your child should get wellness visits

Blood lead screening

Vision screening

Hearing screening

Dental screening

Immunizations (shots)

Wellness care for adults

When you or your child misses one of your wellness visits

SPECIAL KINDS OF HEALTH CARE

Special care for pregnant members

When you become pregnant

When you have a new baby

After you have your baby

Disease Management Centralized Care Unit

Medicines

Copays

SPECIAL AMERIGROUP SERVICES FOR HEALTHY LIVING

Health information

Health education classes

Community events

Domestic violence

Minors

MAKING A LIVING WILL (ADVANCE DIRECTIVES)

ADVANCE DIRECTIVE FOR MENTAL HEALTH TREATMENT

GRIEVANCES AND MEDICAL APPEALS

Grievances

Filing a grievance with Amerigroup

Medical appeals

Expedited appeals

Payment appeals

Continuation of benefits

State fair hearings

Continuation of benefits

OTHER INFORMATION

If you move

Renew your Medicaid or LaCHIP benefits on time

If you are no longer eligible for Medicaid or LaCHIP

How to disenroll from Amerigroup

Reasons why you can be disenrolled from Amerigroup

If you get a bill

If you have other health insurance (coordination of benefits)

Changes in your Amerigroup coverage

How to tell Amerigroup about changes you think we should make

How Amerigroup pays providers

YOUR RIGHTS AND RESPONSIBILITIES AS AN AMERIGROUP MEMBER

HOW TO REPORT SOMEONE WHO IS MISUSING THE MEDICAID OR LACHIP PROGRAM

HOW TO REPORT SOMEONE WHO HAS NOT FOLLOWED REQUIRED MARKETING GUIDELINES......... 66

HIPAA NOTICE OF PRIVACY PRACTICES

WELCOME TO AMERIGROUP LOUISIANA!

Information about your new health plan Welcome to Amerigroup Louisiana, Inc. Amerigroup is a Healthy Louisiana plan. We help people who are eligible for Medicaid or LaCHIP get health care coverage. As an Amerigroup member you are eligible for all covered services including physical health and mental health services.

Our goal is to offer eligible Medicaid and LaCHIP enrollees:

 A patient-centered medical home that supports continued care  Preventive care with a focus on self-managing care to help improve quality of life  Evidence-based information and resources to help enrollees and their providers manage the enrollees’ care Healthy Louisiana Program Mandatory Enrollees For some eligible Medicaid and LaCHIP enrollees, choosing a health plan through the Healthy Louisiana

Program is required. These groups include:

 Blind and disabled children under age 19  Children eligible for the Coordinated System of Care (CSoC) program  Eligible children under age 19 and certain groups of older children  Children with special health care needs  Foster care children who are receiving foster care or adoption assistance, are in foster care or are in an out-of-home placement  Native Americans who are members of federally recognized tribes  Eligible parents and caretaker relatives including those in:

o Parents and Caretaker Relatives Program o TANF Program o Regular Medically Needy Program  Pregnant women who are eligible due to pregnancy for pregnancy-related services only  Women without insurance under age 65 who are eligible for Medicaid and need treatment for breast and/or cervical cancer. Members will be identified through the Centers for Disease Control and Prevention National Breast and Cervical Cancer Early Detection Program  Aged, blind or disabled adults, age 19 or older Voluntary Opt-In Populations For these eligible Medicaid and LaCHIP enrollees, you are not automatically enrolled in a health plan

through the Healthy Louisiana program, but you may choose to enroll. These groups include:

 Individuals getting services through the following waivers:

o Adult Day Health Care (ADHC) o New Opportunities Waiver (NOW) o hildren’s hoice ;Ϳ o Residential Options Waiver (ROW)

–  –  –

How to get help If you’re having an emergency, call 911 or go to the nearest hospital. You can go to any hospital for emergency care even if it’s in a different city or state.

Here are other ways to get help when you need it͕ but don’t need the emergency room.

Amerigroup Member Services You can call our Member Services department at 1-800-600-4441 Monday through Friday, 7 a.m. to 7 p.m., except for holidays. If you call after 7 p.m., you can leave a voice mail message. One of our Member Services representatives will call you back the next working day. He or she can help with

questions about:

 This member handbook  Member ID cards  Your doctors and other providers, including names, specialties, addresses, phone numbers and professional qualifications  Provider visits  Health care benefits  Mental health services  Substance use treatment  Utilization or health care management processes  Wellness care  Special kinds of health care  Healthy living  Grievances, complaints and appeals  Rights and responsibilities

You can also call us:



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