W. Va. Code R. § 114-100-5

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-100-5 - Coordination and Continuity of Care

5.1. A health carrier shall address its process for ensuring the coordination and continuity of care for its covered persons in the access plan for each network offered by the carrier.

5.2. The process for ensuring the coordination and continuity of care shall include, but is not limited to, the following:

5.2.1. The heath carrier's documented process for ensuring the coordination and continuity of care for covered persons referred to specialty providers;

5.2.2. The health carrier's documented process for ensuring the coordination and continuity of care for covered persons using ancillary services, including social services and other community resources;

5.2.3. The health carrier's documented process for ensuring appropriate discharge planning;

5.2.4. The health carrier's process for enabling covered persons to change primary care providers; and

5.2.5. The health carrier's proposed plan and process for providing continuity of care in the event of contract termination between the carrier and any of its participating providers or in the event of the carrier's insolvency or other inability to continue operations. The proposed plan and process shall include an explanation of how covered persons will be notified in the case of a provider contract termination, the health carrier's insolvency, or of any other cessation of operations, as well as how policyholders impacted by such events will be transferred to other providers in a timely manner.

W. Va. Code R. § 114-100-5