Empowering Your Health Care 2021 Commonwealth Coordinated Care Plus Program (CCC Plus) Member Handbook VirginiaPremier.com Virginia Premier | Call Member Services at 1-800-727-7536 (TTY/TDD: 711), weekdays 8 am to 8 pm Page | 1 Commonwealth Coordinated Care Plus Program (CCC Plus) Member Handbook Effective July 1, 2021 Commonwealth of Virginia Department of Medical Assistance Services Virginia Premier | Call Member Services at 1-800-727-7536 (TTY/TDD:MLTSS_0121 711), weekdays-MHB 8-500024 am to 8 Approvedpm Page | 2 Table of Contents Help in Other Languages or Alternate Formats in Other ........................................................ 7 1. Commonwealth Coordinated Care Plus (CCC Plus) ............................................................. 9 Welcome to Virginia Premier Elite Plus .............................................................................................................................. 9 How to Use This Handbook ................................................................................................................................................. 9 Other Information We Will Send to You ............................................................................................................................. 9 Important Phone Numbers ............................................................................................................................................... 11 2. What is Commonwealth Coordinated Care Plus ............................................................... 12 What Makes You Eligible to be a CCC Plus Member ......................................................................................................... 12 Choosing or Changing Your Health Plan ........................................................................................................................... 14 If You Have Medicare and Medicaid ................................................................................................................................. 18 How to Contact the Medicare State Health Insurance Assistance Program (SHIP) .......................................................... 19 3. How CCC Plus Works ........................................................................................................ 19 What Are the Advantages of CCC Plus .............................................................................................................................. 19 What Are the Advantages of Choosing Virginia Premier .................................................................................................. 20 Transition of Care Policy: Continuity of Care Period ......................................................................................................... 20 If You Have Other Coverage .............................................................................................................................................. 20 4. Your Care Coordinator ..................................................................................................... 21 How Your Care Coordinator Can Help .............................................................................................................................. 21 What is a Health Screening ............................................................................................................................................... 21 What is a Health Risk Assessment .................................................................................................................................... 22 What is a Care Plan ........................................................................................................................................................... 22 How to Contact Your Care Coordinator ............................................................................................................................ 22 Chronic Care Management ............................................................................................................................................... 23 5. Help From Member Services ............................................................................................ 24 How Member Services Can Help ....................................................................................................................................... 24 Medical Advice Line Available 24 Hours a Day, 7 Days a Week ........................................................................................ 25 Behavioral Health Crisis Line Available 24 Hours a Day, 7 Days a Week .......................................................................... 25 Addiction and Recovery Treatment Services (ARTS) Advice Line Available 24 Hours a Day, 7 Days a Week ................... 26 If You Do Not Speak English .............................................................................................................................................. 26 If You Have a Disability and Need Assistance in Understanding Information or Working with Your Care Coordinator .. 26 Virginia Premier | Call Member Services at 1-800-727-7536 (TTY/TDD: 711), weekdays 8 am to 8 pm Page | 3 If You Have Questions About Your Medicaid Eligibility .................................................................................................... 26 6. How to Get Care and Services .......................................................................................... 26 How to Get Care from Your Primary Care Physician ......................................................................................................... 26 How to Get Care From Network Providers ....................................................................................................................... 28 How to Get Care From Out-of-Network Providers ........................................................................................................... 31 7. How to Get Care for Emergencies .................................................................................... 33 What is an Emergency ...................................................................................................................................................... 33 What to do in an Emergency............................................................................................................................................. 33 What is a Medical Emergency ........................................................................................................................................... 33 What is a Behavioral Health Emergency ........................................................................................................................... 33 Examples of Non-Emergencies ......................................................................................................................................... 34 If You Have an Emergency When Away from Home ......................................................................................................... 34 What is Covered if You Have an Emergency ..................................................................................................................... 34 Notifying Virginia Premier About Your Emergency ........................................................................................................... 34 After an Emergency .......................................................................................................................................................... 34 If You Are Hospitalized ...................................................................................................................................................... 34 If it Wasn’t a Medical Emergency ..................................................................................................................................... 34 8. How to Get Urgently Needed Care ................................................................................... 35 What is Urgently Needed Care ......................................................................................................................................... 35 9. How to Get Your Prescription Drugs ................................................................................ 35 Rules for Virginia Premier’s Outpatient Drug Coverage ................................................................................................... 35 Getting Your Prescriptions Filled ...................................................................................................................................... 36 List of Covered Drugs ........................................................................................................................................................ 36 Limits for Coverage of Some Drugs ................................................................................................................................... 36 Non-Covered Drugs ........................................................................................................................................................... 37 Changing Pharmacies ........................................................................................................................................................ 38 What if You Need a Specialized Pharmacy ....................................................................................................................... 38 Can You Use Mail-Order