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Developmentally Disabled (DD) Children's Rehabilitative Services (CRS) Program (DD-CRS) Glossary

A

  • Action

    The denial or limited authorization of a requested service including: 1) Denial of limited authorization of requested services, including the type or level of service; 2) The reduction, suspension, or termination of a previously authorized service; 3) The denial, in whole or in part, of payment for a service; 4) The failure to provide a service in a timely manner; or 5) The failure of a contractor to act within the timeframes required for standard and expedited resolution of appeals and standard disposition of grievances; and 6) Denial of a rural CRS recipient's request to obtain services outside the CRS Contractor's network under 42 C.F.R. § 438.52(b)(2)(ii), when the CRS Contractor and its subcontractors is the only Contractor in the rural area.

  • Administrative Hearing

    A hearing under A.R.S. Title 41, Chapter 6, Article 10 (also called State Fair Hearing).

  • Advance Directives

    A written instruction, such as a living will or durable power of attorney for health care, recognized under State law (whether statutory or as recognized by the courts of the State), relating to the provision of health care when the individual is incapacitated that clearly specifies how medical decisions affecting an individual are to be made if they are unable to make them or to authorize a specific person to make such decisions for them.

  • Ambulation Assistive Devices

    Means walkers, canes, and crutches.

  • Americans with Disabilities Act (ADA)

    A Public Law 101-336 enacted July 26, 1990. The ADA prohibits discrimination and ensures equal opportunity for persons with disabilities in employment, state and local government services, public accommodations, commercial facilities, and transportation.

  • Appeal (Expedited)

    An appeal where the CRS Contractor determines (for a request from the CRS recipient), or provider (in making the requests on the CRS recipient's behalf indicates) that the standard resolution timeframe could jeopardize the CRS recipient's life or health or ability to attain, maintain, or regain maximum function. The CRS Contractor shall resolve all expedited appeals not later than three (3) business days from the date the CRS Contractor receives the appeal (unless an extension is in effect) and shall make reasonable efforts to provide oral notice to a CRS recipient regarding an expedited resolution appeal.

  • Appeal (Standard)

    An appeal which must be resolved no later than thirty (30) days from the date of receipt of the appeal unless an extension is in effect.

  • Applicant

    An individual who is requesting assistance from the agency.

  • Arizona Administrative Code (AAC)

    State regulations established pursuant to relevant statutes.

  • Arizona Health Care Cost Containment System (AHCCCS)

    AHCCCS is the system through which Arizona's Medicaid (Title XIX), KidsCare (Title XXI), and the Arizona Long Term Care System (ALTCS) programs are delivered. AHCCCS is the State agency that oversees the Title XIX and Title XXI programs.

  • Arizona Long Term Care System (ALTCS)

    A program under AHCCCS that delivers long term, acute, behavioral health care and case management services to eligible members, as authorized by ARS §36-2932 et seq.

C

  • Care Coordination Services

    Includes: 1. Coordination of CRS health care through multi-specialty, interdisciplinary approach to care, 2. Coordination of member health care needs through a Service Plan 3. Collaboration with providers, communities, agencies, service systems, members, and families; 4. Sharing information with other appropriate professionals, with the member's or family's consent; 5. Coordination, communication, and support services designed to manage the transition of care for a member.

  • Child Life Services

    Include organization of individual, family, or group activities designed to reduce the member's and family's fear of the nature of the illness, medical care, and procedures.

  • Children's Rehabilitative Services (CRS)

    A program that provides medical treatment, rehabilitation, and related support services to eligible individuals who have certain medical, disabling, or potentially disabling conditions, that have the potential for functional improvement through medical, surgical, or therapeutic modalities.

  • Coinsurance

    A percentage of the cost of a service that you must pay to the provider for that service.

  • Covered Services

    The general term we use to mean all of the health care, long-term services and supports, supplies, prescription and over-the-counter drugs, equipment, and other services covered by UnitedHealthcare Community Plan.

  • CRS Clinic or Multi-Specialty, Interdisciplinary Clinic or MSIC

    An established facility where specialists from multiple specialties meet with Recipients and their families for the purpose of providing interdisciplinary services to treat the Recipient's CRS condition.

  • CRS Condition

    A disease, disorder or condition that qualifies for CRS coverage as identified in A.A.C. Title 9, Chapter 7, Article 2.

  • CRS Medical Director

    The physician appointed by the CRS Contractor to make medical decisions about the medical eligibility of applicants and the medical care provided to recipients assigned to the CRS Contractor. The Medical Director also may provide medical advice and counsel to CRSA and to the CRS Contractor and interface with medical directors of other agencies and health plans on care coordination issues.

  • CRS Provider

    A CRS Contractor or its subcontractor who provide CRS covered services to a recipient.

  • CRS Recipient (Recipient)

    An individual who meets CRS eligibility requirements and is enrolled in CRS.

D

  • Diagnosis

    A determination or identification of a disease or condition that is confirmed by a physician.

  • Disabling

    Physical impairments that limit one or more major life activities such as: caring for oneself; performing manual tasks; walking; seeing; hearing; speaking; breathing; learning; and working.

  • Durable Medical Equipment (DME)

    Adaptive aids and devices, adaptive wheelchairs and ambulation assistive devices.

  • Durable Medical Equipment (DME), Customized

    Equipment that has been altered or built to specifications unique to a recipient's medical needs and which, most likely, cannot be used or reused to meet the needs of another individual.

E

  • Eligible

    Any individual determined by the CRS Medical Director or his or her designee to have a CRS covered condition, and meets residency, age, and citizenship requirements.

  • Enrolled

    An enrolled recipient is an individual who has been determined eligible and has been granted entry to the CRS program.

  • Ex-Recipient or Disenrolled Recipient

    An individual who is no longer enrolled in the CRS Program.

F

  • Field Clinic

    A "clinic" consisting of single specialty health care providers who travel to health care delivery settings closer to Members and their families than the MSICs to provide a specific set of services including evaluation, monitoring, and treatment for CRS related conditions on a periodic basis.

  • Fraud

    The intentional deception or misrepresentation made by a person or persons with the knowledge that the deception could result in some unauthorized benefit to him/her or some other person. It includes any act that constitutes fraud under applicable Federal or State law.

G

  • Grievance

    An expression of dissatisfaction about any matter other than an action. Possible subjects for grievances include, but are not limited to: 1) The quality of care or services provided; and 2) Aspects of interpersonal relationships such as rudeness of a provider or employee or failure to respect the enrollee's rights. Grievances do not include "action(s)" as defined in Arizona Administrative Code Title 9, Chapter 34 (9 A.A.C. 34).

H

  • Health Insurance Portability and Accountability Act of 1996 (HIPAA)

    A federal law that gives patients greater access to personal medical records and more control over how personally identifiable health information is used. The regulation also addresses the obligations of healthcare providers and health plans to protect health information.

I

  • Interdisciplinary Team

    Physician and non-physician professionals, the recipient, and family members who collaborate in planning, delivering, and evaluating health care services.

L

  • Limited English Proficiency (LEP)

    A description of an individual's ability to speak and understand the English language when communication is difficult through spoken and written English.

M

  • Minor

    An individual who is: 1) Under the age of 18 years; 2) Incompetent as determined by a court of competent jurisdiction; or 3) Incapable of giving consent for medical services due to a limitation in the individual's cognitive function as determined by a physician.

  • Multi-Specialty

    The use of more than one specialty physician or dentist in the treatment of a Recipient.

  • Multi-Specialty, Interdisciplinary Clinic (MSIC)

    An established facility where specialists from multiple specialties meet with Recipients and their families for the purpose of providing interdisciplinary services to treat the Recipient's CRS condition.

N

  • Notice of Action

    Written notification to the Title XIX/XXI recipient/ representative of an action that the CRS Contractor has taken or intends to take.

  • Notice of Appeal Resolution

    Written notification to the recipient/ representative and other parties of the decision made by the CRS Contractor of an appeal.

  • Notice of Eligibility Determination

    Also called Recipient Status Decision. Written notice to the applicant/ representative of the decision of the CRS Program to deny enrollment or disenroll a recipient.

O

  • Out-of-Network

    Care provided by health care providers that are not a part of the CRS Contractor's provider network.

P

  • Parent Action Council (PAC)

    A local, parent-driven council consisting of members including parents of a child who is or has been a CRS recipient, adults, who are or were CRS recipients, and the CRS Contractor. PAC members may also include professionals and members of advocacy groups.

  • Protected Health Information (PHI)

    Under HIPAA, this refers to individually identifiable health information transmitted or maintained in any form.

  • Provider

    A person or entity that subcontracts with a CRS Contractor to provide CRS covered services directly to recipients.

  • Provider Network

    A person or entity who agrees to the terms specified in the contract with the CRS Contractor.

Q

  • Qualified

    An individual meets the conditions, criteria, or requirements for enrollment in the CRS Program.

R

  • Resident

    An individual who is living in Arizona and can provide proof of residency.

S

  • Service Plan

    A document that is developed consistent with applicable practice guidelines, which combines the various elements of multiple treatment plans with needed family support services and care coordination activities to provide a map of the steps to be taken for each recipient in achieving treatment and quality of life goals.

  • Social Work Services

    Iinclude: information and referral, support and counseling, screening and assessment, and documentation and coordination of services.

  • Special Health Care Needs

    Serious and chronic physical, developmental, or behavioral conditions that require medically necessary health and related services of a type or amount beyond that required by children generally. All CRS recipients are considered to be recipients with special health care needs.

  • Specialty Physician

    A physician who is specially trained in a certain branch of medicine related to specific services or procedures, certain age categories of patients, certain body systems, or certain types of diseases.

  • Stop loss insurance

    Coverage purchased by employers in order to limit their exposure under Self Insurance medical plans.

T

  • TDD

    means Telecommunications Device for the Deaf.

  • Treatment Plan

    A written plan of services and therapeutic interventions based on a comprehensive assessment of a recipient's developmental and health status, strengths, and needs that are designed and periodically updated by the interdisciplinary team.

U

  • UnitedHealthcare Community Plan

    UnitedHealthcare Community Plan is the contracted provider administering the CRS program.

V

  • Virtual Clinics

    Integrated services provided in community settings through the use of innovative strategies for care coordination such as Telemedicine, integrated medical records and virtual interdisciplinary treatment team meetings.

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Developmentally Disabled (DD) Children's Rehabilitative Services (CRS) Program (DD-CRS)

Individual & Family ACA Marketplace Plans Disclaimer
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Medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization Incorporated in CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of Texas, Inc.; and UnitedHealthcare of Oregon, Inc. in WA.  Administrative services provided by United HealthCare Services, Inc. or its affiliates.

1. The benefits described may not be offered in all plans or in all states. Some plans may require copayments, deductibles and/or coinsurance for these benefits. This policy has exclusions, limitations, reductions of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Plan specifics and benefits vary by coverage area and by plan category. Please review plan details to learn more. This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, call or write your insurance agent or the company, whichever is applicable. By responding to this offer, you agree that a representative may contact you.

2. Virtual visits conducted by telephone or video chat with a doctor are not an insurance product, health care provider or a health plan. Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Data rates may apply. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members, and visit limits may apply. Check your benefit plan to determine if these services are available.

3. Walgreens discount valid until 12/31/23. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the United Healthcare discount program. Discount cannot be used online. For full list of Walgreens brand health and wellness products, please visit www.walgreens.com/Smartsavings.  Offer not available on the following items: photo orders, prescriptions, tobacco, dairy, alcohol, liquor departments, phone/prepaid/gift cards, money orders/transfers, transportation passes, lottery tickets, charitable donations, pseudoephedrine or ephedrine products, newspapers, magazines, stamps, home medical equipment and durable medical equipment products, pharmacy items and services, Prescriptions Savings Club membership fee, and items or services submitted to insurance for reimbursement or where otherwise limited by law. Walgreens reserves the right to discontinue the offer at its discretion.

4 CO specific: $3 copays for Preferred generic drugs or something similar. 

Last Updated: 11.17.2020 at 02:57 AM CST

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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call 1-800-905-8671 TTY 711, or use your preferred relay service for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the nearest emergency room. The information provided through this service is for informational purposes only. The nurses cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health information is kept confidential in accordance with the law. The service is not an insurance program and may be discontinued at any time.

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid Plan) information, please contact our Member Services at 1-877-542-9236 (TTY 711,) from 7 a.m. to 8 p.m. Monday through Friday (voice mail available 24 hours a day/7 days a week) for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio (plan Medicare-Medicaid), comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al 1-877-542-9236 (TTY 711) de lunes a viernes de 7 a.m. a 8 p.m. (correo de voz disponible las 24 horas del día, los 7 días de la semana).

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays, and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

UnitedHealthcare Connected® (Medicare-Medicaid Plan)

UnitedHealthcare Connected® (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits and/or copayments may change on January 1 of each year.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al 1-800-256-6533, TTY 711, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes (correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro. Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. UnitedHealthcare Connected® for One Care (Medicare-Medicaid Plan)

es un plan de salud que tiene un contrato tanto con Medicare como con el programa MassHealth (Medicaid) para proporcionar los beneficios de ambos programas a sus miembros.

 

UnitedHealthcare Connected benefit disclaimer 

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits and/or copayments may change on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call 1-866-633-4454, TTY 711, 8 am - 8 pm., local time, Monday - Friday (voicemail available 24 hours a day/7 days a week). The call is free. You can call Member Engagement Center and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers. 

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al 1-866-633-4454, TTY 711, de 8am. a 8pm, hora local, de lunes a viernes (correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro. Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

UnitedHealthcare Connected® general benefit disclaimer

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.

You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. - 8 p.m., local time, Monday - Friday (voicemail available 24 hours a day/7 days a week). The call is free.

You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.

Language Line is available for all in-network providers.

Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.

Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.

Los servicios Language Line están disponibles para todos los proveedores dentro de la red.

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UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.

Availability of non-english disclaimer

ATTENTION: If you speak an alternative language, language assistance services, free of charge, are available to you. Call 1-800-905-8671 TTY 711, or use your preferred relay service.

ATENCIÓN: Si habla Español, hay servicios de asistencia lingüística disponibles para usted y que no tienen cargo. Llame al 1-800-905-8671 TTY 711, o utilice su servicio de retransmisión preferido

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Every year, Medicare evaluates plans based on a 5-Star rating system.

Formularies

The formulary, pharmacy network and provider network may change at any time. You will receive notice when necessary.

NCQA

UnitedHealthcare Connected® has a Model of Care approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2017 based on a review of UnitedHealthcare Connected’s Model of Care.

Important provider information

The Choice is Yours

We will provide you with information to help you make informed choices, such as physicians' and health care professionals' credentials. This information, however, is not an endorsement of a particular physician or health care professional's suitability for your needs.

The providers available through this application may not necessarily reflect the full extent of UnitedHealthcare's network of contracted providers. There may be providers or certain specialties that are not included in this application that are part of our network. If you don't find the provider you are searching for, you may contact the provider directly to verify participation status with UnitedHealthcare's network, or contact Customer Care at the toll-free number shown on your UnitedHealthcare ID card. We also recommend that, prior to seeing any physician, including any specialists, you call the physician's office to verify their participation status and availability.

Some network providers may have been added or removed from our network after this directory was updated. We do not guarantee that each provider is still accepting new members.

Out-of-network/non- contracted providers are under no obligation to treat UnitedHealthcare plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

American Disabilities Act notice

In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 ("ADA"), UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.

Referrals

Network providers help you and your covered family members get the care needed. Access to specialists may be coordinated by your primary care physician.

Paper directory requests

Paper copies of the network provider directory are available at no cost to members by calling the customer service number on the back of your ID card. Non-members may download and print search results from the online directory.

Inaccurate information

To report incorrect information, email provider_directory_invalid_issues@uhc.com. This email box is for members to report potential inaccuracies for demographic (address, phone, etc.) information in the online or paper directories. Reporting issues via this mail box will result in an outreach to the provider’s office to verify all directory demographic data, which can take approximately 30 days. Individuals can also report potential inaccuracies via phone. UnitedHealthcare Members should call the number on the back of their ID card, and non-UnitedHealthcare members can call 888-638-6613 TTY 711, or use your preferred relay service.

Declaration of Disaster or Emergency

If you’re affected by a disaster or emergency declaration by the President or a Governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non- contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
  • Where applicable, requirements for gatekeeper referrals are waived in full;
  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.

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