Transition of Care Requirements for New Members. The MCP shall follow the transition of care requirements as outlined below for any new member, regardless of if the individual is transitioning from FFS or another MCP.
Transition of Care Requirements for New Members. Effective January 1, 2019, the MCP shall follow the transition of care requirements as outlined below for any new member, regardless of if the individual is transitioning from FFS or another MCP. Upon notification from a member and/or provider of a need to continue services, the MCP shall allow a member transitioning from another MCP to continue to receive services from network and out-of- network providers when the member could suffer detriment to their health or be at risk for hospitalization or institutionalization in the absence of continued services. Upon request from the enrolling MCP, the disenrolling MCP shall provide historical utilization and prior authorization data for the disenrolled member as expeditiously as the situation warrants. The MCP may prior authorize these services or assist the member to access services through a network provider when any of the following occur: the member’s condition stabilizes and the MCP can ensure no interruption to services; the member chooses to change to a network provider; the member’s needs change to warrant a change in service; or quality concerns are identified with the provider.
