Date: April 13, 2018
To: All Medical Assistance Providers
Re: Continuity of Care Requirements for HealthChoice Illinois Managed Care Health Plans
This notice reminds providers of the requirements for health plans (MCOs) providing care to enrollees under the continuity of care provision in the HealthChoice Illinois contract.
Continuity of Care
Providers are reminded that MCOs must offer an initial 90-day transition period for enrollees new to a health plan, during which enrollees may maintain a current course of treatment with a provider who is not part of the health plan’s provider network. This applies to all providers, including those providing behavioral health services and long term services and supports.
Providers not in an MCO’s network that provide services, including those that provide behavioral health services and long term services and supports, will be paid the same rate the Department would pay for those services under current fee-for-service rates. Providers must adhere to the MCO’s policies and procedures regarding referrals and obtaining preauthorization for treatment.
This 90-day continuity of care period also allows additional time for providers to finalize contracting with the HealthChoice Illinois plans. Following the 90-day continuity of care period, MCOs have the option of transitioning the individual to a provider in their network or continuing to pay out of network fees.
Questions regarding this notice may be directed to the Department’s Bureau of Managed Care at 217-524-7478.
Felicia F. Norwood