The Arc of New Jersey has been notified that New Jersey's United Healthcare Community Plan (UHCCP), one of NJ's Medicaid managed care organizations (MCOs), is ending its contract with the Children's Hospital of Philadelphia (CHOP) on December 1, 2020. In past years, there was talk of UHCCP ending its affiliation with CHOP, but, luckily, the contract between these two organizations remained intact in the past. However, this year is different, and we have been told that the contract will end on December 1st. Many families of children with I/DD and other significant healthcare needs are very concerned about this change in access to CHOP. Please see below for some frequently asked questions about the termination of the contract between UHCCP and CHOP. This information is accurate as of this date. We will provide additional updates as they become available.
1. CHOP has some primary care provider (PCP) offices in New Jersey. Will children enrolled with those CHOP-NJ PCP offices be able to continue to see those doctors at the NJ CHOP offices after December 1, 2020?
Yes, children enrolled with CHOP-NJ primary care provider (PCP) offices will be able to continue to see those doctors after December 1, 2020.
2. Does the December 1, 2020 contract termination between UHCCP and CHOP apply to all New Jersey children with intellectual and developmental disabilities (I/DD) and other significant healthcare needs who are enrolled with UHCCP?
The December 1, 2020 contract termination between UHCCP and CHOP applies to all New Jersey children enrolled in UHCCP. However, UHCCP and CHOP have agreed that certain services will continue to be available, as explained below. This is what families should know:
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Some children enrolled in UHCCP have been determined to have very complex medical needs, and they will be permitted to continue to receive medical care at CHOP after December 1, 2020. Every parent whose child is enrolled in UHCCP should have received a letter informing them of this contract change. However, if a family of a child who is enrolled in UHCCP and has been treated at CHOP did not receive a letter, it is suggested that they ask about their child’s status with CHOP as soon as possible by calling their UHCCP care manager or Member Services at 1-800-941-4647 or (TTY: 711).
- If parents have questions about how the decision was made regarding which children with very complex medical needs will be permitted to continue to receive care at CHOP and which were not, they should contact their care manager at UHCCP. If parents do not know how to reach their child’s care manager, they should call Member Services at 1-800-941-4647 or (TTY: 711) and ask to be connected to the child’s care manager.
3. If CHOP specialists have an affiliation with a New Jersey hospital or pediatric office, will UHCCP enrollees be able to see those doctors at the New Jersey location?
Parents may contact CHOP to inquire about the possibility of their child's CHOP doctors having an affiliation in New Jersey.
4. What about children with I/DD who have both private health insurance, and enrollment in NJ Medicaid's UHCCP is secondary? Can they continue to be seen at CHOP after December 1, 2020?
If UHCCP is the secondary insurance, it is the primary insurance that determines if CHOP is considered in- network. Therefore, as long as CHOP is in-network with the primary insurance coverage, the child can continue to be seen at CHOP.
5. How will continuity of care be provided for children with significant healthcare problems, enrolled in UHCCP, who have been receiving care from CHOP, if they are no longer able to receive that care, and if the CHOP doctors are not available at a New Jersey location?
UHCCP is required to provide needed care to members. Parents should call their child’s care manager or Member Services for help accessing care. If parents call the care manager and Member Services and are not getting the help they need, they should tell Member Services that they want to file a grievance. The phone number for UHCCP Member Services is 1-800-941-4647 or (TTY: 711). UHCCP is required to respond to grievances from members, and NJ Medicaid will monitor all grievances that are filed.
6. After December 1, 2020, will children who have an emergency medical problem be able to go to the CHOP emergency department?
Children in need of emergency medical care can access any hospital emergency department, including emergency care at CHOP. They will need to show their UHCCP identification card and they will not be charged for the care provided at any hospital emergency department.
7. After December 1, 2020, will children who are treated at the CHOP emergency department, and need hospitalization, be permitted to have hospitalization at CHOP?
Hospitalization will depend on medical necessity, which is determined on a case by case basis.
8. After December 1, 2020, where will children who are treated at the CHOP emergency department, and need outpatient, follow-up care, receive a level of medical care that is comparable to the medical care at CHOP?
UHCCP is required to provide needed care to members. Parents with questions regarding access to care after the child’s medical treatment in the emergency department should contact the child’s care manager or Member Services for help. The phone number for UHCCP Member Services is 1-800-941-4647 or (TTY: 711). See also the answer to #9 below.
9. What should parents do if they are not able to receive the level of care in New Jersey that is comparable to the care that the child had been receiving at CHOP?
UHCCP is required to provide needed care to members. Parents should call their child’s care manager or Member Services for help accessing care. If parents call the care manager and Member Services and are not getting the help they need, they should tell Member Services that they want to file a grievance. The phone number for UHCCP Member Services is 1-800-941-4647 or (TTY: 711). UHCCP is required to respond to grievances from members, and NJ Medicaid will monitor all grievances that are filed.
10. Will the December 1, 2020 contract termination between UHCCP and CHOP have any impact on New Jersey children enrolled in another Medicaid MCO who have received permission from that MCO to be treated by CHOP doctors?
All of the other four Medicaid MCOs have granted special, out-of-network permission for a small number of children with very significant medical problems to access care at CHOP, on a case-by-case basis. The termination of the contract between UHCCP and CHOP does not affect the special permission that has been granted by the other NJ Medicaid MCOs for medical care at CHOP.
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Thank you,
Bev
Beverly Roberts
Director, Mainstreaming Medical Care
The Arc of New Jersey
985 Livingston Avenue
North Brunswick, NJ 08902
Direct line and fax: 732.246.2567
