Continuity of Care (CoC)
| Date: | December 29, 2023 |
| To: | Health Plan Network and Non-Contracted Providers |
| Type: | Regulatory |
| Subject: | Continuity of Care (CoC) |
| Business: | Medi-Cal Managed Care |
In accordance with All Plan Letter (APL) 23-018 Medi-Cal Managed Care Plan Transition Policy Guide, HPSJ and Medi-Cal Managed Care Plans (MCP) will be required to engage in specific continuity of care and member support activities for incoming members due to the MCP transitions effective January 1, 2024.
Three changes beginning on January 1, 2024 will drive member transitions from MCPs exiting a given county service area to other MCPs that will continue to operate in the county service area, or to MCPs newly entering the county service area.
DHCS has issued the 2024 Medi-Cal Managed Care Plan Transition Policy Guide, which describes the operational requirements and guidelines for MCPs in facilitating the transition of those members leading up to and during the January 2024 MCP transition.
The Continuity of Care (CoC) Policy for the 2024 Transition includes three key protections for Medi-Cal members:
- Continuity of Care for Providers: A member may continue seeing a provider with whom they have a Pre-Existing Relationship, even if the provider is out of network (OON) with the Receiving MCP.
- Continuity of Care for Covered Services: A member may continue an Active Course of Treatment as well as receive services previously authorized by the Previous MCP.
- Continuity of Care Coordination and Management Information: The Previous MCP and the Receiving MCP must work together to share supportive information important for members’ care coordination and management.
Continuity of Care (CoC) for Providers enables transitioning members to continue receiving care from their existing providers for 12 months (exceptions are explained in the Policy Guide) if certain requirements are met.
For eligible provider types that CoC can be requested for, please see the Policy Guide, which also describes those ineligible provider types for CoC requests. Please be aware that providers must be Medi-Cal enrolled to be eligible for CoC requests.
The following links can provide you with additional information regarding APL 23-
018 and the 2024 MCP Transition Policy Guide, Version 5:
- https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2023/APL23-018.pdf
- https://www.dhcs.ca.gov/Documents/Managed_Care_Plan_Transition_Policy_Guide.pdf
Please also utilize information provided on Health Plan’s Continuity of Care
PowerPoint Presentation for Providers found by accessing the following link,
https://www.hpsj.com/continuity-of-care-information-for-providers/ .
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj.com/