Today, DHCS is issuing an updated continuity of care provider bulletin, which explains how current out-of-network physicians can continue seeing Cal MediConnect beneficiaries and the process for billing the correct entity for payment. It also provides information to help combat balance billing.
Earlier this year, DHCS announced that it would extend the continuity of care period for Medicare services from six months to 12 months to match the Medi-Cal continuity of care period, and modify requirements to just one visit with a specialist within the past 12 months, as is the case with primary care physicians. These policy changes will be effective starting October 1, 2016. DHCS has updated its Duals Plan Letter and this new provider bulletin also reflects these changes.
In order to ensure that beneficiary transitions into Cal MediConnect are smooth and do not result in disruptions in care, the Cal MediConnect continuity of care policy provides beneficiaries in Cal MediConnect plans with the right to continue seeing non-participating physicians for a limited period of time.