Transition of Care while you change plans
Some members who change OHP plans (CCOs) can still get the same services and see the same providers. That means care will not change when you switch CCO plans or move to/from OHP fee-for-service. If you have serious health issues, your new and old plans must work together to make sure you get the care and services you need.
This help is for members who have serious health issues, need hospital care, or inpatient mental health care. For example, members who need end-stage renal disease care, prenatal or postpartum care, transplant services, radiation, or chemotherapy services. We will honor your preapproved care and services for a time. This is to make sure you get the help you need.
If you need care while you change plans, please call Health Share Customer Service at 503-416-8090, or toll-free at 888-519-3845 (TTY/TDD 711). We will help you.
The following members are eligible for continued coverage:
- Medically Fragile Children
- Breast and Cervical Cancer Treatment program members
- Members receiving CareAssist assistance due to HIV/AIDS
- Members receiving services for end stage renal disease, prenatal or postpartum care, transplant services, radiation, or chemotherapy services
- Any members who, in the absence of continued access to services, may suffer serious detriment to their health or be at risk of hospitalization or institutionalization.
During the transition of care period, all eligible members will:
- Have continued access to care and Ride to Care, Non-Emergency Medical Transportation (NEMT)
- Continue receiving services from your previous provider, regardless of whether the provider participates in your new CCO’s network, until one of the following occurs:
- The minimum or authorized prescribed course of treatment has been completed
- The reviewing provider concludes the treatment is no longer medically necessary. For specialty care, treatment plans must be reviewed by a qualified provider.
While changing CCOs, you will have access to the following:
- Medically necessary covered services
- Prior authorized care
- Prescription Drugs
- Care Coordination Services
We will honor any documented written preapprovals (prior authorized) of ongoing covered services.
Your new CCO is required to cover the full course of treatment with your previous provider for the following services:
- Prenatal and postpartum care
- Transplant services through the first-year post-transplant
- Radiation or chemotherapy services for the current course of treatment
- Prescriptions with a defined minimum course of treatment that exceeds the transition of care period
Transition of Care means the period of time after you enroll with your new CCO, during which your old CCO must provide continued access to care. The transition of care period lasts for:
- Ninety days for members who are dually eligible for Medicaid and Medicare
- For other members, the shorter of:
- Thirty days for physical and oral health and 60 days for behavioral health
- Until the member’s new Primary Care Provider (oral or behavioral health provider, as applicable to medical care or behavioral health care services) reviews the member's treatment plan
After the transition of care period ends, your new CCO is responsible for care coordination and discharge planning activities.
New Members Who Need Services Immediately
If you’re a new Health Share member or new to Medicare you may need medical care, prescriptions (drugs) supplies, or other necessary items or services. If you need any of these during your first month of enrollment and can’t meet with a PCP, Primary Care Dentist (PDP) or other provider, we can help. Call Health Share Customer Service at 503-416-8090 or 888-519-3845 (TTY/TDD: 711). We will help you get any necessary (needed) health-related services you need right away. If you are new to Health Share or Medicare, we will help you and give you information. It is important to us that you have a smooth transition.