I.  PURPOSE
 

To establish policy and procedures regarding the Continuity of Care requirements for Medi-Cal members within the Los Angeles County Department of Mental Health (DMH) network of care.

Contracted agencies shall develop an internal policy and associated procedures that are consistent with their organizational practices and meet the requirements set forth in this policy.
 

II.  DEFINITIONS
 

Continuity of Care: The ability for a Medi-Cal member to continue receiving services for up to twelve months from their existing (current) provider after the member has moved to another county or has transitioned from a mental health plan to a Managed Care Plan (MCP) or vice versa.
 

Department of Mental Health (DMH): The local Mental Health Plan (MHP) for Los Angeles County. 
 

In-Network: DMH Directly operated and contracted Specialty Mental Health Service (SMHS) providers. 
 

Out-of-Network: SMHS providers under MHPs in other counties or not contracted with DMH. This includes providers who have voluntarily terminated their contract with DMH or were terminated by DMH. 
 

Pre-Existing Relationship: A relationship where a client has received at least one service by a provider, that is now out-of-network, in the twelve (12) months prior to:

• Establishing residence in the county;
• Referral by another MHP or MCP; and/or
• The MHP determining the Medi-Cal member meets medical necessity criteria for SMHS. 

Medi-Cal Member: An individual with Medi-Cal insurance previously referred to as Medi-Cal Beneficiary. 
 

III.  POLICY
 

Through Continuity of Care, the Medi-Cal member can continue receiving services, for a limited period of time, from a provider that has become Out-of-Network.

Continuity of Care is designed to allow a Medi-Cal member to complete treatment with an existing provider and/or support the smooth transition of services to a new provider.

At any time, Medi-Cal members may change their provider to an in-network provider whether or not a Continuity of Care relationship has been established. DMH must provide SMHS and/or refer Medi-Cal members to appropriate in-network providers without delay and within established appointment time standards. 
 

DMH is not required to provide Continuity of Care for services not covered by Medi-Cal. In addition, Continuity of Care does not apply to durable medical equipment, transportation, other ancillary services, or carved-out services. 
 

DMH is responsible for Continuity of Care requests when the client has LA County Medi-Cal and is requesting to remain with a provider that is out-of-network for DMH (e.g., provider that is in another county). 
 

For Continuity of Care requests when the Medi-Cal member requests to remain at a DMH in-network provider following a transfer of their Medi-Cal to another county of jurisdiction due to a change in residence, the Medi-Cal member must request Continuity of Care from their new County. 
 

IV.  PROCEDURES
 

Procedures - Continuity of Care
 

V.  AUTHORITIES
 

Code of Federal Regulations Title 42 Part 438.62 
California Code of Regulations Title 28, 1300.67.2.2 
Health and Safety (H&S) Code § 1373.96 
W&I Code §14185(b), W&I Code Sections (§§) 14132.03 and 14189
Department of Health Care Services MHSUDS Information Notices No.: 13-023, 18-011, 18-059, 18-60, 21-008, 22-011. 
 

VI.  ATTACHMENT
 

No attachments are associated with this policy.