Continuity of Care

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CONTINUITY OF CARE

Effective July 1, 2018, Title 42 of the Code of Federal Regulations, part 438.62 requires the State to have in effect a transition of care policy to ensure continued access to services during a beneficiary’s transition from Medi-Cal fee-for-service (FFS) to a managed care program or transition from one managed care entity to another, when the beneficiary, in the absence of continued services, would suffer serious detriment to their health or be at risk of hospitalization or institutionalization

All eligible Medi-Cal beneficiaries who meet medical necessity criteria for SMHS have the right to request continuity of care. Beneficiaries with pre-existing provider relationships who make a continuity of care request to the county MHP must be given the option to continue treatment for up to 12 months with an out-of-network Medi-Cal provider or a terminated network provider (i.e., an employee of the MHP or a contracted organizational provider, provider group, or individual practitioner). SMHS shall continue to be provided, at the request of the beneficiary, for a period of time, not to exceed 12 months, necessary to complete a course of treatment and to arrange for a safe transfer to another provider as determined by the MHP, in consultation with the beneficiary and the provider, and consistent with good professional practice. This policy applies to all Medi-Cal beneficiaries who are transitioning as follows:

• The provider has voluntarily terminated employment or the contract with the MHP;

• The provider’s employment or contract has been terminated, for a reason other than issues related to quality of care or eligibility of the provider to participate in the Medi-Cal program;

• Transitioning from one county MHP to another county MHP due to a change in the beneficiary’s county of residence;

• Transitioning from an MCP to an MHP; or,

• Transitioning from Medi-Cal FFS to the MHP.

For more information, please contact the MHP at (559) 673-3508 or Toll Free at: (888) 275-9779. Fax (559) 661-2818 or mail to: P.O. Box 1288, Madera, Ca 93639.