Essay on Community Plan For Children 's Health Insurance Plan
UnitedHealthcare, Community Plan (UHC) holds a contract with the state of Washington for the Apple Health (Medicaid) members. These include the Temporary Assistance for Needy Families (TANF), the Children’s Health Insurance Plan (CHIP), Aged, Blind and Disabled (ABD) and the new “Expansion” or Alternate Benefit Population (ABP) plans. Each of these subsets of the Apple Health (AH) population are treated the same when it comes to the state’s requirements to report out sentinel events, and quality of service (QOS) and quality of care (QOC) events; more commonly referred to as Grievances and Appeals (GAA).
Quality Assurance and Legal Departments
A sentinel event includes any suicidal or homicidal event in which a UHC AH member is involved, either they themselves are feeling suicidal or homicidal, or have been the victim of violence. In the event of a sentinel event notification to UHC, the information is sent to the Quality Assurance department and Compliance. This is an “as soon as possible” notification to allow for any appropriate intervention, on the part of the Health Care Authority (HCA). These “adverse events” are reported out by the HCA quarterly ("Adverse events," n.d.). This is a new requirement for the managed care organizations (MCOs) that are covering the AH population, effective January 1, 2015.
Other adverse events that the MCOs are responsible for reporting to the HCA quarterly are the QOC and QOS, grievances and appeals. A member may file a…