Ill. Admin. Code tit. 50, § 4520.60 - Transition of Services
a) Health care
plans shall notify new enrollees and current enrollees of the availability of
transitional services for conditions that require ongoing course of
treatment.
b) New enrollees must
request the option of transitional services in writing, within 15 days after
receiving notification of the availability of transitional services, through a
mechanism established by the health care plan.
c) Enrollees whose physician leaves the
health care plan's network of health care providers shall request the option of
transitional services in writing within 30 days after receipt of notification
of termination of the physician.
d)
Within 15 days after receiving such notification from the enrollee, the health
care plan shall notify the enrollee if a denial is issued for the enrollee's
request of transitional services based on the enrollee's physician refusing to
agree to accept the health care plan's reimbursement rates, adhere to the
health care plan's quality assurance requirements, provide the health care plan
with necessary medical information related to the enrollee's care, or otherwise
adhere to the health care plan's policies and procedures. The notification
shall be in writing and include the specific reason for such denial.
Notes
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