Priority Health - Transition of Care for New Priority Health Medicaid Members

May 27, 2021

What’s changing?

Per MDHHS guidance, we’ve updated our policy in 2021 for Medicaid plans to allow members a 90-day Transition of Care window. Providers can submit for Transition of Care authorizations on our website.

 

What is Transition of Care?

If a Medicaid member is new to Priority Health and their provider or medication isn’t covered, Transition of Care may allow them to temporarily continue receiving coverage of services with an established out-of-network provider and/or approved medication within the first 90 days of eligibility if their health would be put at serious risk if they go without care. Members, their appointed representative or providers may request Transition of Care authorizations.

 

What you need to know

You’ll have the ability to submit a Transition of Care request on behalf of a new member to Priority Health Choice. This will only apply for members new to Priority Health Choice who have an established relationship with an out-of-network provider and/or history with a maintenance medication (with 30-day supply filled within 90 days prior to enrollment), and when in the absence of continued access to necessary services, the member would suffer serious detriment to their health or be at risk of hospitalization.