DHCS issued a new letter to non-COHS health plans reminding MCPs to treat denied medical exemption requests (MERs) as an automatic request for continuity of care with an existing FFS or nonparticipating health plan provider. MCPs must make every effort to ensure that the beneficiary is allowed to continue to receive ongoing medical care through his or her FFS or nonparticipating health plan provider(s).
MCPs must process these requests within 5 working days from receipt of request. DHCS is also urging MCPs to allow non-contracted providers to continue a beneficiary’s treatment plan for other services that are not contracted. MCPs can provide more than the statutory 12-month continuity of care period if they so choose.
DHCS APL 17-007 (May 11, 2017)