AmeriHealth Caritas Florida: Continuity of Care (COC)
If an enrollee was receiving a service, or has routine appointments scheduled prior to moving to AmeriHealth Caritas Florida, including those services previously authorized under the fee-for-service delivery system, AmeriHealth Caritas Florida must continue to provide that service for up to 60 days after enrollment or until:
- The enrollee’s primary care provider or behavioral health provider reviews the enrollee’s treatment plan.
In addition, the following services may extend beyond the 60-day COC period:
- Prenatal and postpartum care for the entire course of pregnancy including postpartum care (six weeks after birth).
- Transplant Services for one year post-transplant.
- Oncology services including radiation and/or chemotherapy services for the duration of the current round of treatment.
- Full course of treatment of therapy for Hepatitis C treatment drugs.
AmeriHealth Caritas Florida will not require authorization and cannot require that the services be provided by a participating (in-network) provider.
Statewide Medicaid Managed Care: Continuity of Care Provisions
The Agency for Health Care Administration (Agency) contracts with Medicaid health and dental plans to provide services to health plan enrollees in the Statewide Medicaid Managed Care (SMMC) program. The Agency recently entered into new contracts with health and dental plans. As part of those contracts, the Agency achieved program changes that greatly benefit enrollees and providers.
Health and dental plans are required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program. COC requirements ensure that when enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition. The Agency has instituted the following COC provisions:
- Health care providers should not cancel appointments with current patients. Health plans must honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the roll-out date in each region.
- Providers will be paid. Providers should continue providing any previously authorized services, regardless of whether the provider is participating in the plan’s network. Plans must pay for previously authorized services for up to 60 days after the roll-out date in each region, and must pay providers at the rate previously received for up to 30 days.
- Providers will be paid promptly. During the continuity of care period, plans are required to follow all timely claims payment contractual requirements. The Agency will monitor complaints to ensure that any issues with delays in payment are resolved.
- Prescriptions will be honored. Plans must allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after the roll-out date in each region, until their prescriptions can be transferred to a provider in the plan’s network.
More information about COC provisions are available in the COC program highlight document (PDF).