Blues introduce mandatory case management pilot program for UAW Retiree Medical Benefits Trust members

UAW Retiree Medical Benefits Trust members identified as having complex medical needs with high utilization patterns and a history of poor case management compliance will be required to participate in a mandatory pilot case management program.

Starting Jan. 1, 2013, the UAW Retiree Medical Benefits Trust, working through BCBSM, may require a member to work with a case manager to ensure coverage for certain conditions that are complex, severe or rare. The program was first offered Oct. 22, 2012.

If the member refuses to participate or cooperate in case management, the plan’s portion of the financial obligation for all medical services, treatments, situations, prescription drugs or other services related to the condition may not be covered. For members enrolled in Medicare Parts A and B, Medicare will continue to cover its portion of the financial obligation in those cases, since case management is not required by Medicare.

The pilot program intervention will include:

• BCBSM nurse case managers dedicated to the URMBT mandatory case management program will work with members.
• Members will be required to participate in regularly scheduled calls with the assigned nurse case manager and work to meet their established health care goals.
• All mandatory case management cases will be reviewed by the BCBSM physician consultant in conjunction with the nurse case manager and the member’s health care providers.
• Lack of member participation in or completion of the mandatory case management program may result in nonpayment of claims.

Members identified for the pilot will receive a certified introduction letter explaining the mandatory program and member participation requirements. Physicians will receive an introduction letter notifying them of their members who have been selected for mandatory case management. A BCBSM physician consultant will contact the member’s primary care physician or specialist to identify barriers or gaps that prevent medical stability, provide coordination of care and develop a plan of action to meet the patient’s health care goals and reduce unnecessary utilization.

If you have any questions about the URMBT mandatory case management pilot program, contact your BCBSM provider consultant.