Vol. 1, Issue 1, Spring 2019 STAY WELL GET CARE, A newsletter for Participants of Keystone First Community HealthChoices Welcome, Keystone First CHC Participants! 2 We need your help! 3 If you have long-term services and supports (LTSS), additional supports are available to you! 4 Formulary 5 Have you checked out our website? 5 Important numbers 6 Physical and behavioral health: We can help you get the care you need 7 An update from our advisory committees 7 Have a healthy mouth for life 8 Do you also have Medicare? 9 Keystone First Community HealthChoices (CHC) would like to welcome all our new Participants!
Transcript
Vol. 1, Issue 1, Spring 2019
STAY WELLGET CARE, A newsletter for
Participants of Keystone First Community HealthChoices
Welcome, Keystone First CHC Participants! 2We need your help! 3If you have long-term services and supports (LTSS), additional supports are available to you! 4Formulary 5Have you checked out our website? 5Important numbers 6Physical and behavioral health: We can help you get the care you need 7An update from our advisory committees 7Have a healthy mouth for life 8Do you also have Medicare? 9
Keystone First Community HealthChoices (CHC) would like to welcome all our new Participants!
Welcome, Keystone First CHC Participants!
Keystone First CHC would like to welcome all our new Participants! At Keystone First CHC, we understand that health care is personal and local. That’s why our employees live and serve in your community. We call this area home, too. We have experience that helps us understand your needs so you get the care and services you need.
Your roots are here. So are ours.
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We need your help!
Participants can help Keystone First CHC uncover provider fraud, waste, and abuse. You should keep track of the following things: • Who provided your health care. • What services you received during the
visit and any additional tests or visits the doctor ordered.
• When you got a health care service. • Where the service took place.
Call Keystone First CHC if you think the provider may have billed incorrectly or offered a service you didn’t think you needed. Please remember, do not: • Give your ID card or numbers to anyone
other than your doctor, clinic, hospital, or other health care provider.
• Ask your doctor or any other health care provider for medical services or supplies that you don’t need.
• Sign your name to a blank form. • Share your medical records with anyone
other than your doctor, clinic, hospital, or other health care professional.
Keystone First CHC has a team that works hard to identify and prevent fraud, waste, and abuse. But we still need all Participants to report possible fraud, waste, and abuse.
Please call the Fraud Hotline at 1-866-833-9718 (TTY 711). You can remain anonymous at all times.
If you have long-term services and supports (LTSS), additional supports are available for you!
Participants who have LTSS will have a Person-Centered Planning Team and a Service Coordinator.
What is a Person-Centered Planning Team?
The Person-Centered Planning Team focuses on you and what your life can be. Your team is led by you. Your Service Coordinator is there to help you.
The goal of having a team is to have open communication. Important information is shared with you and with those who support you, with your consent.
What is the role of your Service Coordinator?
Your Service Coordinator will meet with you in person. Your Service Coordinator will:• Go over and document your health care
needs and goals.• Coordinate your care with other health
and service providers, like Personal Assistance agencies and your primary care practitioner (PCP).
• Schedule your team meetings.• Help you develop your Person-Centered
Service Plan.• Update your plan as needed.• Guide you and your team through the
CHC program.
Remember, you are the most important person on your team. It will be important for you to share your needs and concerns with your team. This will help keep you as independent as possible.
What is a Person-Centered Service Plan?
The Person-Centered Service Plan is your plan of care. We will put your plan in writing for you. Here are some things your plan will include:• What you need, including your:
◦ Health care needs. ◦ LTSS needs. ◦ Wellness goals.
• All of the covered services that were approved for you. Also, the community resources you will get in order to reach your goals.
• Your health conditions and current medicines.
Have questions? We are here to help. We want to help you get the care and services you need. Just call our Personal Care Connection Team at 1-855-349-6280 (TTY 711). We are here Monday through Friday, 8:30 a.m. to 5 p.m.
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Formulary
The Keystone First CHC drug formulary is a list of medicines covered by Keystone First CHC. For the most up-to-date formulary list, visit www.keystonefirstchc.com. You can also call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976).
Have you checked out our website?
Visit www.keystonefirstchc.com for more information about your health care as a Keystone First CHC Participant!
Medical Assistance Transportation Program (MATP): Call your county number for more information. MATP phone numbers may change. Visit http://matp.pa.gov for the most up-to-date phone numbers.
County MATP services phone numbersBucks 1-215-794-5554 or 1-888-795-0740Chester 1-877-873-8415Delaware 1-610-490-3960 Montgomery 1-215-542-7433Philadelphia 1-877-835-7412
Behavioral health treatment contact numbers: Call your county number for more information.
County Behavioral health treatment contact numberBucks 1-877-769-9784Chester 1-866-622-4228Delaware 1-888-207-2911Montgomery 1-877-769-9782Philadelphia 1-888-545-2600
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Physical and behavioral health: We can help you get the care you need
Keystone First CHC cares about the whole you.
The health of your mind (your mental health) is a very important part of being healthy. According to the Centers for Disease Control and Prevention (CDC), about half of all Americans have been diagnosed with some sort of mental health illness or disorder. If you need treatment, don’t forget: You are not alone, and there are ways Keystone First CHC can help you.
Here are 2 terms that will help you understand how we can help:
1. You get physical health services for the health of your body through a Community HealthChoices managed care organization (MCO).
2. You get behavioral health services for the health of your mind through a behavioral health managed care organization (BH-MCO).
Keystone First CHC is an MCO, but we can help connect you to your BH-MCO. You can call your BH-MCO 24 hours a day, 7 days a week. Find the number for the BH-MCO in your county on page 6 of this newsletter.
Keystone First CHC can help with your behavioral health needs in other ways, too. We can:• Help you get and manage your behavioral
health medicines. • Connect you with your PCP. Your PCP
and their staff can put you in touch with the right resources.
• Connect you to other behavioral health resources.
For more information, visit www.keystonefirstchc.com. You can also call Participant Services 24 hours a day, 7 days a week, at 1-855-332-0729 (TTY 1-855-235-4976).
An update from our advisory committees
Keystone First CHC has 2 advisory committees that come together throughout the year to talk about issues that matter to you:
1. Participant Advisory Committee (PAC).
2. Health Education Advisory Committee (HEAC).
Helping you understand your benefits and services is important to us. You can find more information about these committees and how to become a member at www.keystonefirstchc.com > Community. Be on the lookout for more highlights from the PAC and HEAC in upcoming newsletters!
Oral health is the health of your mouth, teeth, and gums. Some oral health problems become more common with age. But without the right care, these problems can happen earlier in life, too.
No matter what your age, there are ways to keep your mouth healthy.
1. Brush your teeth at least 2 times a day and floss every day. Regular brushing and flossing help keep bacteria away, which helps keep your teeth and gums strong and healthy. Talk with your dentist about how often you should brush and floss.
Having trouble remembering to brush and floss? Try setting an alarm or keeping your toothbrush and floss in plain sight to help you remember.
2. Use a mouthwash and toothpaste that have fluoride. Fluoride helps to:
• Prevent gum disease.• Reduce sensitivity.• Protect teeth from decay.
3. Keep your mouth moist. Saliva helps protect your mouth from gum disease and tooth decay. Drink plenty of water and use sugar-free mints, gum, or lozenges to increase your saliva.
4. If you smoke, now is the time to quit. Smoking can make your mouth dry and cause other oral health problems. Here’s how we can help you quit:
• As a Keystone First CHC Participant, you are eligible for counseling sessions to help you quit. Call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976) for more information. You may be eligible for medicines that can help you quit. Talk with your doctor about what medicine is best for you.
• Call the PA Free Quitline, 1-800-QUIT NOW (1-800-784-8669) or go to http://pa.quitlogix.org.
5. Eat healthy. Choosing the right food can help keep your teeth healthy.
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Try to eat:• Fresh fruits.• Vegetables.• Lean protein like chicken, beans,
and fish.
Try not to eat:• Sticky foods like caramels, raisins,
and gummy bears.• Lollipops and other hard candies.• Desserts like cookies, cakes, and
brownies.
• Sugar. This includes brown sugar, honey, and even molasses.
6. Visit your dentist. You should have a dental checkup 2 times a year. Regular checkups will help spot small problems before they become big ones.
If you have questions about your teeth, talk with your dentist. To find a dentist, visit www.keystonefirstchc.com and click Find a Provider or call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976).
Do you also have Medicare?
If you are a Keystone First CHC Participant and also have Medicare, your Medicare plan is your primary insurance. This means that in most cases, your Medicare plan will pay your health care providers before Keystone First CHC will pay.
Here are some important things to keep in mind for using your Medicare plan and your Keystone First CHC plan.• Call Participant Services 1-855-332-0729
(TTY 1-855-235-4976) to let us know that you have Medicare. Also, make sure to tell your County Assistance Office.
• Make sure to bring both your Medicare insurance card* and your Keystone First CHC ID card to all your doctor appointments and to the pharmacy.
• You can see the Medicare doctors of your choice. They do not need to be Keystone First CHC network doctors.
Have questions? You can call Keystone First CHC Participant Services 24 hours a day, 7 days a week, at 1-855-332-0729 (TTY 1-855-235-4976).
*If you have Medicare and you have chosen Keystone First VIP Choice as your Medicare plan and Keystone First CHC as your Community HealthChoices plan, you will get one ID card for both plans. Your ID card will show logos for both plans.
Keystone First Community HealthChoices complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation.
Keystone First Community HealthChoices does not exclude people or treat them differently because of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation.
Keystone First Community HealthChoices provides free aids and services to people with disabilities to communicate effectively with us, such as:
• Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats)
Keystone First Community HealthChoices provides free language services to people whose primary language is not English, such as:
• Qualified interpreters • Information written in other languages
If you need these services, contact Keystone First Community HealthChoices at 1-855-332-0729 (TTY 1-855-235-4976).
If you believe that Keystone First Community HealthChoices has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation, you can file a complaint with:
Keystone First Community HealthChoices, Participant Complaints Department, Attention: Participant Advocate, 200 Stevens Drive Philadelphia, PA 19113-1570 Phone: 1-855-332-0729, TTY 1-855-235-4976, Fax: 215-937-5367, or Email: [email protected]
The Bureau of Equal Opportunity, Room 223, Health and Welfare Building, P.O. Box 2675, Harrisburg, PA 17105-2675, Phone: (717) 787-1127, TTY/PA Relay 711, Fax: (717) 772-4366, or Email: [email protected]
You can file a complaint in person or by mail, fax, or email. If you need help filing a complaint, Keystone First Community HealthChoices and the Bureau of Equal Opportunity are available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Nondiscrimination Notice
www.keystonefirstchc.com
ATTENTION: If you speak English, language assistance services, free of charge, are available to you.
