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Clinical Tips for Providers In the next few months, Humana will be sending important information to members about their health conditions. For this information to be most effective and help lead to better disease control, we encourage our network physicians and other health care providers to discuss the following with their patients: In June, and throughout the year, Humana will send messages to parents of children 18 months old regarding immunizations their children may, or will, need throughout their childhood years. Physicians may want to proactively communicate to parents about the overall safety and efficacy of vaccines to help them understand what vaccines their children will need at each visit. Also in June, Humana is reminding members that the American Academy of Pediatrics supports the recommendation that over-the-counter cough and cold medications not be given to infants and children under 2 years old because of the risk of life-threatening side effects. Parents are urged to seek safer ways to soothe infants and young children suffering from colds and coughs. Humana also directs members with children to review a list of toys recalled by the U.S. Consumer Product Safety Commission at http://www.cpsc.gov/cpscpub/prerel/category/toy.html. In July, Humana members will be reminded that HumanaFirst, Humana’s 24-hour-a-day nurse advice line, is available to help answer GI related questions and determine appropriate levels of care when their physician is not available. The phone number is 1-800-622-9529. Humana Offers Special Needs Humana now offers a specialized Medicare Advantage plan for older or disabled adults with osteoarthritis. This plan is available as a Humana Medicare Advantage regional PPO plan across the country and as a Humana Gold Plus® Medicare Advantage HMO plan in Florida. The osteoarthritis Special Needs Plan (SNP) is one example of the Chronic Condition Special Needs Plans recently outlined by the Centers for Medicare & Medicaid Services (CMS). These new plans are designed to help meet the needs of Medicare beneficiaries with specialized health care requirements, such as the institutionalized, those eligible for both Medicare and Medicaid, and those with severe or disabling chronic conditions. To utilize the osteoarthritis SNP, members must be eligible for Medicare A and B, and have a diagnosis of osteoarthritis (ICD-9-CM codes 715.0 through 715.9). Specifically, the eligible diagnoses are as follows:
An interdisciplinary team works with enrolled members to support their physician’s plan of care, offer self-care guidance, educate members on when to seek medical care and assist with prevention of unnecessary hospital stays and emergency room visits. Upon enrollment, members’ osteoarthritis symptoms are assessed using an osteoarthritis health risk assessment and acuity risk stratification tool, which helps Humana provide services customized to each member’s needs. Members of the plan have access to specialized benefits, including enhanced coverage for some over-the-counter osteoarthritis supplements and referrals for home safety evaluations and home meal delivery as appropriate, based upon the individual health needs of the member. Humana Gold Plus Medicare Advantage HMO members can also take advantage of a massage therapy benefit. Acupuncture and chiropractic benefits are available for Humana PPO Medicare Advantage members. Additionally, members who are found to have moderate to high acuity osteoarthritis have access to a Humana case manager. The member’s case manager will work closely with him or her to reinforce the physician’s plan of care, support adherence to the physician’s prescribed medication regimen and encourage routine preventative and follow-up medical care. The case manager will also help the member establish goals for positive lifestyle changes, including nutrition, weight loss and physical activity. Enrolled members also receive educational materials, discounts on durable medical equipment and invitations to informational seminars. Plus, all members can take advantage of the many benefits of Humana Active OutlookSM, a life enrichment program for Medicare-eligible members that addresses healthy aging through its physical, mental, psychological, spiritual, emotional and financial dimensions. Individuals who are interested in enrolling in the osteoarthritis SNP must first complete a special enrollment application and a prequalification form. The member will receive a “Verification of Chronic Condition” form, which the member should give to his or her primary care physician (PCP). The PCP should complete the form to substantiate that the applicant has an appropriate diagnosis for participation in the plan and return it to Humana. Members and health care providers can learn more about the osteoarthritis SNP and obtain enrollment information by calling Humana Medicare Advantage customer service at (800) 372-2147.
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