General resources for Community Plans (2024)

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Last Update: January 1, 2024, 8:00 a.m. CT

Information contained in the topics below provides information, resources, and links to help practitioners support our Community and State members and our Quality programs.

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Appointment accessibility standards

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As a reminder, UnitedHealthcare Community Plan has appointment availability requirements for PCPs and specialists. The requirements apply to routine, urgent and after-hours care. For specific information, please refer to your provider administrative manual, which can be found at UHCprovider.com/en/admin-guides/cp-admin-manuals.html.

Care management

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The UnitedHealthcare Community Plan Case Management program is a holistic approach to care for members with complex needs, especially for those with chronic conditions. The goal is to keep our members in the community with the resources necessary to maintain the highest functional status possible.

What can the UnitedHealthcare Community Plan case manager provide for your patients?

  • Telephonic contact with members and facilitation of home visits
  • Health education and educational materials
  • A health assessment with stratification of diagnosis and severity of condition and
    psychosocial needs
  • Referral to community resources as needed
  • Assistance with medical transportation
  • Arrangements for durable medical equipment (DME) and ancillary services as needed or ordered by the physician
  • Outreach to members to promote assistance with keeping doctor's appointments
  • Work with members to identify and address barriers to seeking health care and following their medical treatment plan of care

How to refer
For more information or to make a referral, call our referral line at 877-542-9235.

Clinical guidelines

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UnitedHealthcare Community Plan has identified evidence-based clinical practice guidelines that are available as resources. The guidelines cover a variety of conditions, such as diabetes, asthma, depression, as well as preventive care. They can be found at UHCprovider.com/cpg or you may call 877-542-9235 for a copy.

Coordination of care between primary care practitioners and specialists

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UnitedHealthcare wants to underscore the importance of ongoing communication between primary care providers (PCP) and specialists. PCPs and specialists share responsibility for communicating essential patient information regarding consultations, treatment plans and referrals. Relevant information from the PCP should include the patient's history, diagnostic tests and results and the reason for the consultation. The specialist is responsible for timely communication of the results of the consultation and ongoing recommendations and treatment plans.

The information exchange between practitioners should be timely, relevant and accurate to facilitate ongoing patient management. The partnership between the PCP and specialist is based on the consistent exchange of clinical information and is a critical factor in providing quality patient care.
The provider administrative guide addresses coordination of care and expectations of our providers. For more information, please refer to the provider administrative guide for the applicable state at UHCprovider.com/en/admin-guides/cp-admin-manuals.html.

Member rights and responsibilities

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Just a reminder, the UnitedHealthcare Community Plan member rights and responsibilities can be found in the care provider manual. Member rights and responsibilities are distributed to new members upon enrollment. On an annual basis, members are referred to their handbook to review their member rights and responsibilities.

Pharmacy updates

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UnitedHealthcare Community Plan pharmacy updates are available at UHCprovider.com > Menu > Health Plans by State> select state > Medicaid (Community Plan) > Pharmacy Resources and Physician-Administered Drugs.

You can find this information online:

  • A list of covered pharmaceuticals, including restrictions and preferences
  • Pharmaceutical management procedures
  • Explanations on limits or quotas
  • How to submit and support special requests
  • Generic substitution, therapeutic interchange and step-therapy protocols

Call the pharmacy hotline at 800-922-1557.

Support for Language Services

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UnitedHealthcare Community Plan serves a diverse group of individuals. Each state within UnitedHealthcare Community Plan has unique membership that has its own cultural and language needs. Information about our membership is collected and analyzed in order to provide our members with healthcare services that meet their individual cultural and language needs. An example of some of our diverse membership by state can be found in the table below:

State

2nd language

3rd language

4th language

5th language

6th language

7th language

Arizona

Spanish

Vietnamese

Arabic

Chinese

Persian

-

Florida

Spanish

Creole

-

-

-

-

Hawaii

Chinese

Ilocano (Filipino)

Korean

Vietnamese

Tagalog

-

Indiana

Spanish

-

-

-

-

-

Kansas

Spanish

-

-

-

-

-

Kentucky

Spanish

-

-

-

-

-

Louisiana

Spanish

Vietnamese

Arabic

-

-

-

Maryland

Spanish

Vietnamese

-

-

-

-

Michigan

Arabic

Spanish

Bengali

-

-

-

Minnesota

Spanish

Hmong

Karen

Somali

--

Mississippi

Spanish

-

-

-

-

Missouri

Spanish

-

-

-

-

-

Nebraska

Spanish

Arabic

Vietnamese

-

-

-

New Jersey

Spanish

Korean

Arabic

-

-

-

New York

Spanish

Chinese

Russian

Korean

French

Haida

North Carolina

Spanish

Arabic

RussianVietnamese--

Ohio

Spanish

Nepali

Arabic

Somali

Swahili

Burmese

Pennsylvania

Spanish

Arabic

Cambodian

Russian

-

-

Rhode Island

Spanish

Portuguese

-

-

-

-

Tennessee

Spanish

-

-

-

-

Texas

Spanish

Vietnamese

-

-

-

-

Virginia

Spanish

Arabic

Vietnamese

Amharic

Persian

Urdu

Washington

Spanish

Russian

Vietnamese

Ukrainian

Chinese

Korean

Wisconsin

Spanish

Hmong

Arabic

Burmese

Somali

Chinese

UnitedHealthcare supports our practitioners in their efforts to provide culturally appropriate care by providing cultural competency training and language services to effectively communicate with our members. Language assistance is available to help providers communicate with members. Services include a telephone language line, in-person interpreters, and video services. We also have tools to promote cultural awareness and assist practitioners in recognizing and treating health disparities.

VisitUHCprovider.com/en/resource-library/patient-health-safety/cultural-competency.htmlto find our more information and to access the following tools:

  • Quick reference guide – Understanding Cultural Competency and the Americans with Disabilities Act
  • The Cross-Cultural Health Care program
  • Cultural Orientation Resource Center

You may also call877-542-9235to get more information on how to obtain language assistance and interpreter services for our members.

Utilization review

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UnitedHealthcare Community Plan staff performs concurrent reviews on inpatient stays in acute, rehabilitation and skilled nursing facilities, as well as prior authorization reviews of selected services. The Prior Authorization and Notification tool provides a listing of services that require prior authorization. You can learn more about the tool at UHCprovider.com/paan. Training is available in the Videos and Training section of the website. A physician reviews all cases in which the care does not appear to meet guidelines. Decisions regarding coverage are based on the appropriateness of care and service and existence of coverage. We do not provide financial or other rewards to our physicians for issuing denials of coverage or for underutilizing services.

If you have questions or would like specific utilization management criteria, you can talk to our staff. Call toll-free at 877-542-9235. Staff is available 8 hours per day from 9 a.m.–5 p.m. ET.

General resources for Community Plans (2024)

FAQs

What are the elements of community based planning? ›

Like other forms of community action, the process of community-based planning typically includes the five common stages of (1) initiation, (2) organization of sponsorship, (3) visioning, goal setting and strategy formation, (4) recruitment and (5) implementation [b].

How do you create a community plan? ›

Sound Community Planning Process Based on Six Steps
  1. Gather up information, called data, and maps. ...
  2. Analyze the planning information you have collected. ...
  3. Set some tentative community goals. ...
  4. Make a written plan! ...
  5. Think through the plan implementation and whether it should be divided into phases.
Mar 22, 2023

How often are general plans updated in California? ›

While there is no requirement for how often to update the General Plan, the planning period has traditionally been every 15–20 years. The Housing Element is the only chapter of the General Plan that is required to be updated every eight years by HCD.

What is the purpose of a General Plan in California? ›

A general plan is each local government's blueprint for meeting the community's long-term vision for the future. The General Plan Guidelines serve as a resource to help jurisdictions draft and update their general plans.

What are the 5 core elements of a community? ›

  • Locus: a sense of place. ...
  • Sharing: common interests and perspectives. ...
  • Joint action: a source of cohesion and identity. ...
  • Social ties: the foundation for community. ...
  • Diversity: social complexity within communities.
Jun 29, 2001

What are the seven 7 elements of the community? ›

7 Elements of a Healthy Community
  • Arts & Culture. A healthy community encourages a wide variety of recreational, historical, and cultural opportunities.
  • Basic Needs. ...
  • Economy. ...
  • Education. ...
  • Environment. ...
  • Health. ...
  • Neighborhoods.

What are the 6 different parts of a community action plan? ›

The steps include: 1) Studying the community to understand issues; 2) Mapping out community actors and power relations; 3) Engaging stakeholders through interviews to deepen understanding; 4) Analyzing community strengths, weaknesses, opportunities and threats; 5) Mobilizing a specific project plan of action; and 6) ...

What is the first step in community planning? ›

The first step is to define the scope of the community development plan, which means identifying the target area or population, the purpose and objectives of the plan, and the time frame and resources available.

How to prepare a community action plan? ›

  1. Convene a planning group in your community to design your action plan. ...
  2. Develop an action plan composed of action steps that address all proposed changes. ...
  3. Review your completed action plan carefully to check for completeness. ...
  4. Follow through. ...
  5. Keep everyone informed about what's going on.

What are the optional elements of a California General Plan? ›

Optional Elements: In addition to the elements required by state law, a city or county may adopt other elements that relate to its growth over time. Common themes for optional elements include: recreation, air quality, historic preservation, community design, and economic development.

What is a General Plan amendment? ›

What is a General Plan Amendment? A General Plan Amendment is considered to be any change to the General Plan maps or text. State law provides that each mandatory General Plan element may be amended no more than four times per year.

What is a General Plan for a report or project? ›

A general plan is made up of text describing goals and objectives, principles, standards, and plan proposals, as well as a set of maps and diagrams. Together, these constituent parts paint a picture of the community's future development.

What are the seven elements of a general plan? ›

The seven (7) mandated elements are: Land Use, Open Space, Conservation, Housing, Circulation, Noise, and Safety. The general plan may be adopted in any form deemed appropriate or convenient by the legislative body of the county or city, including the combining of elements.

What is the difference between a general plan and a specific plan? ›

General plans cover all land in a jurisdiction. Specific plans cover smaller areas. They say what land uses can occur in the area. They set limits on how much building can go on sites (known as the "intensity" of development) and what structures will look like.

What is a general plan in urban planning? ›

A General Plan is a broad, long-range policy document that guides future development, conservation, and is a comprehensive collection of goals and policies related to a multitude of aspects of community life. In California, cities and counties are required by State law to have a General Plan.

What are the 4 elements of planning? ›

Here are 4 components of planning:

Vision casting, goal-setting, habit-building, and mindset. If you've struggled with not only enjoying the process of planning but also activating and achieving your goals, it might be because you didn't have all four of the necessary components to make planning effective.

What are the 4 elements of community? ›

The Sense of Community has four components: membership, influence, fulfillment of needs, and emotional connection. The Sense of Community is a key characteristic of successful communities, successful meaning active, engaged communities that people want to visit, and where members contribute on a regular basis.

What are key elements of a community action plan? ›

The plan describes what the community wants to achieve, what activities are required during a specified time period, what resources (money, people and materials) are needed to be successful. A community action plan becomes a framework for implementing the activities that are decided by the community itself.

What is community-based planning? ›

Community Based Planning is a form of participatory planning which is designed to promote community action. It is a convergence of planning and community participation targeted towards addressing mounting urban and social problems at the local level.

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