Continuity of Care
All new Medicaid members have a Continuity of Care (COC) period in which Sunshine Health can help transition members who have been receiving care through a non-participating Sunshine Health provider to a participating provider. Please review this Continuity of Care Q&A to help our new members successfully transition to Sunshine Health without experiencing any break in their care.
Continuity of Care Q&A
- Up to 120 days for our new Medicaid, Sunshine Health Pathway to Shine Specialty Plan (CW) and LTC members
No. Continuity of Care is provided for any new member, even after February 2019 when all regions are effective.
- Any previously prior authorized ongoing course of treatment, with any provider, including a provider who is not participating with Sunshine Health.
- Sunshine Health is responsible for continuing to cover the costs of the course of treatment, without any form of authorization, including:
- Prior existing orders
- Provider appointments
- Prescriptions
- Prior authorizations
- Treatment plan/plan of care
Yes. Services that can continue after the COC period for new members include:
- Prenatal and postpartum care – up to the postpartum visit
- Transplant services through the first year post-transplant
- Oncology (radiation and/or chemotherapy) for the current round of treatment
- Full course of Hepatitis C treatment drugs
Sunshine Health pays non-participating providers the rate they were receiving prior to the member transitioning to Sunshine Health, for a minimum of 30 days, unless the non-participating provider agrees to an alternative rate.
Providers with additional questions about Continuity and Coordination of Care or who need further assistance can call Sunshine Health’s Provider Services help line at 1-844-477-8313, from 8 a.m. to 8 p.m., Monday through Friday.