Letter to CMS - Medicaid Managed Care Policies - Agency for ...

• Obtaining data from the health plan about its most vulnerable enrollees, such as high-
risk pregnancies, those in active behavioral health care, those in case management, and
those complex medication needs.
After the Transition:
All impacted beneficiaries are given 90 days after enrollment into the new health plan to select
another health plan without cause.
The Agency works with the new health plan(s) to provide information about high-risk OB
enrollees, special needs enrollees, enrollees in active behavioral health, enrollees currently on
psychotropic prescriptions, and enrollees in the hospital the day before the transition effective
date.
To further ensure continuity of care, health plans are contractually required to honor prior
authorization of ongoing covered services for a period of thirty (30) calendar days after the
effective date of enrollment in the new plan, or until the enrollee's PCP reviews the enrollee's
treatment plan, whichever comes first. Prearranged covered services could include provider
appointments, surgeries, and prescriptions. For covered behavioral health services, this policy
is extended for up to three months.
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