Illinois MMAI
AETNA BETTER HEALTH
PREMIER PLAN
Explained
IDT Training
SM
Aetna Better HealthSM Premier Plan is a health plan that contracts
with both Medicare and Illinois Medicaid to provide benefits of
both programs to enrollees.
You can get this document in Spanish, or speak with someone
about this information in other languages for free. Call Member
Services at 1-866-600-2139 and TTY/TDD is 711, 24 hours a day,
7 days a week. The call is free.
Usted puede obtener este documento en español, o hablar gratuitamente
con una persona en otros idiomas sobre esta información. Llame a
Servicios al Miembro al 1-866-600-2139 y TTY/TDD al 711, 24 horas
al día, siete días de la semana. La llamada es gratis.
Limitations and restrictions may apply. For more information,
call Aetna Better HealthSM Premier Plan Member Services at
1-866-600-2139 or read the Aetna Better HealthSM Premier Plan
Member Handbook.
Benefits, List of Covered Drugs, pharmacy and provider networks
may change from time to time throughout the year and on
January 1 of each year.
www.aetnabetterhealth.com/illinois
©2014 Aetna Inc.
IL-14-03-02-ENG
CMS APPROVED
H2506_14_146
www.aetnabetterhealth.com/illinois
(Medicare-Medicaid
Alignment Initiative)
Cultural competency
Independence living and recovery
Cultural competency means relating effectively to individuals
with many cultures, beliefs, behaviors, needs, language and socioeconomic backgrounds. Developing cultural competency results
in an ability to understand, communicate with, and sensitively
interact with people across cultures.
The President’s New Freedom Commission in 2002 helped identify
and promote the use of community resources and providers to
support successful independent living in the community, for
persons living with a mental illness or emotional disturbance.
More than a decade later, the focus on independence and
recovery is even stronger. Recovery is self-directed, personcentered, rounded, supported by peers and allies, and part of the
range of improved health and wellness.
Wellness values
Wellness values is an active process that involves positive choices
that will improve their physical, knowledge, emotional, behavioral,
social, spiritual, and environmental health. The Interdisciplinary
Team can inspire and support the member in making these
positive choices. Wellness includes making healthy choices on
diet, reducing stress, exercising, taking their medications correctly,
going to the doctor and receiving their preventive care.
Person-centered planning process
Person-centered planning is a process designed to assist the
Interdisciplinary Team and member to plan medical, behavioral,
and physical care and supports to improve the member’s overall
well-being and independence.
Accessibility and accommodations
Accessibility and accommodation means that our members that
have a language barrier and/or disability have the same benefits
and rights that are available to a member without a language
barrier and/or disability. We have providers in our network that
serve members with disabilities by using special equipment and
offices. Aetna Better Health has the ability to order transportation
for members with disabilities, and offer language assistance to all
of our members, including interpretation services, sign language
and member materials in other languages, including Braille.
Recovery is the expectation, not the exception. Persons living
with an illness want to be at their highest level of functioning
with the most freedom to live in the community if possible.
Natural supports can support an individual’s ability to live in the
community rather than living in an institutional setting. These
natural supports include but are not limited to, supportive family
members, safe housing, and assistance with daily activities
when needed.
Americans with Disabilities Act
Prior authorization requirements
Americans with Disabilities Act (ADA) was passed in 1990 and
it protects individuals with disabilities against discrimination in
regards to employment, services, public housings, transportation
and telecommunication. Under the ADA, a person has a disability
if the individual has a physical or mental impairment that
substantially limits a major life activity. The ADA also protects
persons with a history of such a disability. At Aetna Better Health
we support and accommodate all individuals in our plan and who
work for us.
Aetna Better Health has identified services/and some durable
medical supplies that require approval before our members
receive them. This is called “prior authorization.” If the member’s
provider and/or IDT think the member needs one of these services/
procedures, they will ask us for prior authorization or ask the
member’s case manager to coordinate the request. Our medical
staff makes decisions about the care and services the member
needs. These decisions are based on three things:
• Member medical needs and conditions
• National clinical guidelines
• Information from the member’s provider and/or specialist
Being part of the Interdisciplinary Team means that we need to be
aware of what our member needs are, and to support the provider,
case manager and prior authorization staff in getting the right
information to make the right decisions for the member.
Coordination of behavioral health services
A member can get treatment for substance use disorders and
other behavioral health issues through the Aetna Better Health
provider network.
Self-referral is allowed; members do not need a referral from their
primary care provider to see a behavioral health provider that is
in our network. The provider, IDT and case manager can assist a
member in receiving services needed by the member.
If a member is having a behavioral health crisis, call the behavioral
health crisis line at 1-866-600-2139; then press option 9. Help
is available 24 hours a day, 7 days a week. If the member is on
the phone with the IDT or case manager, the call gets “warmtransferred” to the behavioral crisis line to be sure that the
member gets connected to someone who can immediately
assist them.
Being part of the Interdisciplinary Team (IDT)
I
Means that you are aware of what the member you are
representing needs, and you support those needs. You are
educated of the services and programs that may be needed to
maintain the good health and independence of the member.
Being an IDT representative, you need to take into consideration
the member’s language, religion, culture, and beliefs when
making a decision about their care. You are also aware of, and
sensitive to, the member’s special needs such as transportation,
an interpreter and or written materials in a different language or
different format.
certify as a member of the Interdisciplinary Team for
[your name]
[enrollee name]
have received instruction on:
• Cultural Competency
• Wellness Principles
• Person Centered Planning Process
• Accessibility and Accommodations
• The Americans with Disabilities Act
• Independence Living and Recovery
• Prior Authorization Requirements
• Coordination of Behavioral Health Services and
• Expectations as a Member of the Interdisciplinary Team
I agree that as a member of the Interdisciplinary team I will take
into consideration the member’s language, religion, culture, and
beliefs when making a decision about their care. I will be aware of,
and sensitive to, the
[enrollee name]
special needs such as transportation, an interpreter and or written
materials in a different language or different format.
If I have questions or concerns, I know I can contact the assigned
Care Manager or Member Services for assistance.
[signature]
[date]