LOS ANGELES COUNTY
DEPARTMENT OF MENTAL HEALTH
  Policy 302.15 Continuity of Care
 
  PROCEDURES
  1. Any Medi-Cal member who wants to request Continuity of Care will be directed to the Quality Assurance (QA) Unit. The QA unit shall provide reasonable assistance to members in completing requests, including oral interpretation and auxiliary aids and services.
  2. The QA Unit shall establish if a Pre-Existing Relationship exists.
  3. Following identification of a Pre-Existing relationship, the QA Unit shall determine if the provider is an Out-of-Network provider. If the provider is an Out-of-Network provider, the QA Unit shall contact the provider and make a good faith effort to enter into a contract, letter of agreement, single-case agreement, or other form of relationship to establish a Continuity of Care agreement for the Medi-Cal member.
  4. Each Continuity of Care request must be completed within 30 calendar days from the date the QA Unit receives the request, or sooner if the Medi-Cal member’s medical condition requires more immediate attention.
    1. If the Medi-Cal member’s condition requires more immediate attention, such as upcoming appointments or other pressing care needs, it must be completed within 15 calendar days; or,
    2. If there is a risk of harm to the Medi-Cal member, it must be completed within three (3) calendar days.
  5. Upon approval of a Continuity of Care request, the QA Unit shall notify the Medi-Cal member and/or the member’s authorized representative in writing of the following:
    1. Department of Mental Health (DMH) approval of the Continuity of Care request;
    2. The duration of the Continuity of Care arrangement;
    3. The process that will occur to transition the member’s care at the end of the continuity of care period; and
    4. The member’s right to choose a different provider from an In-Network DMH provider.
  6. If a Continuity of Care request is denied, the QA Unit shall notify the Medi-Cal member and/or the member’s authorized representative in writing of the following:
    1. DMH denial of the member’s continuity of care request;
    2. A clear explanation of the reasons for the denial;
    3. The availability of In-Network Specialty Mental Health Services (SMHS);
    4. How and where to access SMHS from DMH;
    5. The member’s right to file an appeal based on the adverse benefit determination; and,
    6. DMH beneficiary handbook and provider directory.
  7.  A Continuity of Care request is considered complete when:
    1. ​​​​​​​The Medi-Cal member is informed of his or her right of continued access and approval of the Continuity of Care request;
    2. DMH and the Out-of-Network provider are unable to agree on a rate and the QA Unit has notified the Medi-Cal member that the request is denied;
    3. DMH has documented quality of care issues, offered the Medi-Cal member an In-Network alternative and notified the Medi-Cal member that the request is denied; or,
    4. ​​​​​​​DMH has made a good faith effort to contact the provider and the provider is non-responsive for 30 calendar days offered the Medi-Cal member an In-Network alternative and notified the Medi-Cal member that the request is denied.
  8. The QA Unit shall notify the Medi-Cal member and/or the member’s authorized representative, 30-calendar days before the end of the Continuity of Care period about the process that will occur to transition the member’s care at the end of the Continuity of Care period. After the member’s Continuity of Care period ends, the member must choose an In-Network DMH provider.