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24-722, Continuity of Care for Medi-Cal Members

Date: 07/15/24

Find out how to request continuity of care

Physicians or other providers who have a pre-existing relationship with the member, may request continuity of care on behalf of the member. To request a continuity of care, contact the Member Services number on the back of the member ID card.

Pre-existing relationship is defined as: The member has seen an out-of-network primary care physician, specialist, or select ancillary provider, including physical therapy, occupational therapy, respiratory therapy, behavioral health treatment, and speech therapy provider for a nonemergency visit in the medical office, at least once during the 12 months prior to the date of their initial enrollment in Health Net, unless otherwise specified in the
All Plan Letter (APL) 23-0221 (PDF).

Health Net will request that you provide medical records to validate a pre-existing relationship.

Continuity of care requirements

Continuity of care requirements include the provider:

  • Accepts Health Net’s contract rates or Medi-Cal fee-for-service rates;
  • Meets Health Net’s applicable professional standards and has no disqualifying quality of care issues; and
  • is a California State Plan approved provider.

An out-of-network provider should not refer the member to another out-of-network provider without authorization from Health Net. In such  cases, Health Net will make the referral, if medically necessary, if we do not have an appropriate provider within our network.

Additional information

Relevant sections of provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library.

If you have questions regarding the information contained in this update, contact the Health Net Medi-Cal Provider Services Center at 800-675-6110.

1www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2023/APL23-022.pdf

 

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary providers, Community Supports (CS) Providers, and Enhanced Care Management (ECM) Providers.

For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.

 



Last Updated: 07/11/2024