Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 5. Department of Health
Chapter 408. Certificate of Quality Assurance of Managed Care Health Insurance Plan Licensees

12VAC5-408-250. Continuity of care.

A. The MCHIP licensee shall provide, arrange, pay for, or reimburse the basic health care services it provides in such a way that:

1. Covered persons' individual needs are assessed on an ongoing basis through their physician or staff and matched with the appropriate level of medical, psychological, or medical social services care. The MCHIP licensee shall monitor the continuity and coordination of care a covered person receives with other facets of care;

2. Covered persons' transition through the system of care are facilitated by the MCHIP licensee and its components;

3. The MCHIP licensee does not impede covered persons' involvement in determining care and treatment;

4. Information necessary to support the provision of care from one plan component to another is provided in a timely manner to covered persons and providers to support the continuity of the covered person's care; and

5. The MCHIP licensee advises its physicians of their responsibility to share specific information with covered persons concerning their illness, condition or treatment, in order for the covered person to follow his plan of care and receive follow-up care when needed.

B. The MCHIP licensee shall assist with denial of care issues by providing adequate information for covered person and provider decisions regarding ongoing care, or if appropriate, discharge.

Statutory Authority

§ 32.1-137.1 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 16, Issue 7, eff. January 20, 2000; amended, Virginia Register Volume 18, Issue 8, eff. January 30, 2002.

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