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Care Improvement Plus
National Home › Providers › Plan Overview › Clinical Guidelines

For Providers

Today's complex health care system can put significant constraints on the time and resources of health care providers. Care Improvement Plus understands the challenges faced by health care providers, and offers services within its Medicare health plans to support provider efforts to manage their Medicare patients.

National Guidelines Used in Care Management Programs.

Within its Model of Care, health plan offerings and programs, Care Improvement Plus provides comprehensive care management services to support the health of Medicare beneficiaries. All interactions with members and providers are based on well-established, national clinical guidelines. Providers are encouraged to incorporate these guidelines into their practice and may access the Care Improvement Plus Model of Care training through our vendor training site.

In order to comply with all applicable laws, including requirements that we must ensure that all entities that provide health, prescription and administrative services meet annual education and training requirements related to compliance and fraud, waste and abuse (FWA), we have provided a slide presentation for health care providers that addresses the compliance requirements only. You may satisfy this requirement by completing the presentation provided on our vendor training site.

  • American Diabetes Association (ADA) Standards of Medical Care in Diabetes.
  • National Institute of Health, National Heart, Lung, Blood Institute (JNC7) (2004), JNC 8 12/2010, released Spring 2011.
  • National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults.
  • American Heart Association (AHA) AND American College of Cardiology (ACC) Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult.
  • Global Initiative for Chronic Obstructive Lung Disease (GOLD).
  • Coalition organizations American Academy of Hospice and Palliative Medicine (AAHPM), Center to Advance Palliative Care (CAPC), Hospice and Palliative Nurses Association (HPNA), National Hospice and Palliative Care Organization ( NHPCO) on Clinical Practice Guidelines for Quality Palliative Care.
  • The American Geriatric Society (AGS) guidelines on pharmacological management of persistent pain in older persons (2009).

Care Improvement Plus -- Specialized Care for Medicare Beneficiaries.

Care Improvement Plus offers unique Medicare Advantage plans designed to meet the specific needs of underserved Medicare beneficiaries and those living with chronic conditions such as diabetes and heart failure — people whose wellbeing can be very dependent on the good health decisions they make.

By contracting with Care Improvement Plus, providers can gain a partner dedicated to the needs of their Medicare patient’s health and committed to the support of their practice. The advantages of working with Care Improvement Plus include:

  • Open access network: Within most services areas, we offer our members the freedom to receive care from any Medicare-approved provider who accepts payment from our plan and Medicaid.
  • Limited authorization requirements: We’re easy to work with.
  • Provider relations team: We have experienced, locally-based provider relations representatives to work with you and address your questions.
  • Care management programs: Comprehensive support tailored to fit individual member health needs.


This page was last updated on: 9/29/2011 10:08:32 AM
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Copyright © 2006 - 2012 Care Improvement Plus
Y0072_OE12_4511 CMS Approved 11/15/2011

Care Improvement Plus is a Medicare Advantage organization with a Medicare contract. Care Improvement Plus is owned by XLHealth Corporation, a UnitedHealthcare company. The Care Improvement Plus contract with CMS is renewed annually and coverage availability beyond the end of the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information contact the plan. To be eligible for a Care Improvement Plus plan you must be a Medicare beneficiary living in Arkansas, Georgia, Missouri, South Carolina, Texas and select counties in Illinois, Iowa, Indiana, Maryland, New Mexico, New York, Wisconsin and have both Medicare Part A and Part B to enroll.

To be eligible for a Care Improvement Plus Chronic Conditions Special Needs Plan, you must have diabetes and/or heart failure. To be eligible for Care Improvement Plus Dual Advantage, you must be enrolled in state Medicaid and be a dual eligible beneficiary whom the State holds harmless for Part A and Part B cost sharing.

Members may enroll in the plan only during specific times of the year. Contact Care Improvement Plus for more information. If you have diabetes, heart failure, or Medicaid/Low Income Subsidy, you may qualify to enroll in a Care Improvement Plus Special Needs Plan ANYTIME of the year by exercising a “Special Election Period.

You must continue to pay your Medicare Part B premium. If you are a full benefit dual beneficiary and your Part B premium is paid for by the State, you will not be responsible for paying your Part B premium. Premiums, copays, coinsurance and deductibles may vary based on the level of help received. Limitations, copayments and restrictions may apply.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1–800–MEDICARE (1–800–633–4227). TTY users should call 1–877–486–2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1–800–772–1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1–800–325–0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for extra help to pay their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at 1–800–772–1213.TTY users should call 1–800–325–0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp. If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a part of this premium, we will bill you for the amount that Medicare doesn’t cover.

Premiums, copays, coinsurance, and deductibles may vary based on the level of help that beneficiaries may receive. Contact the plan for further details. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under nonroutine circumstances, and quantity and restrictions may apply. It may cost more to get care from out–of–network providers, except in an emergency. If there isn’t a network provider available for you to see, you can go to an out–of–network provider but still pay the in–network amounts except for members who live in our Maryland service areas. Those members can only use doctors, specialists, or hospitals in–network. The health providers in our network can change at any time.

Y0072_R3E12_4511 CMS Approved 02/09/2012