Extension of care
Priority Health ensures continuity and coordination of care to its members by:
- Notifying members of the pending terminations of practitioners or practice sites
- Assisting members with selecting a new practitioner
- Offering patients of terminating providers extension of care when appropriate
- Providers have contractual obligations following termination of contracts
Providers will cooperate with extension of care
Providers will cooperate with a continuation of treatment based on the provider participation agreement.
- PCPs and specialists who are terminating their contract will cooperate with a continuation of treatment base on the provider participation agreement
- Extension of care may be necessary for patients in active treatment, such as pregnant patients past their first trimester
- Priority Health shall compensate physician for such service in accordance with their previously contracted fee schedule
When Priority Health offers extension of care to members
- The primary care physician or specialist chooses to terminate their contract with Priority Health and is willing to participate in extension of care
- Priority Health terminates the contract and approves the primary care physician or specialist to participate in extension of care
Priority Health will notify members about extension of care, if it is offered. Whenever possible, this will occur at least 30 calendar days prior to a provider termination. In addition, extension of care applies for both primary care physicians and specialists if the patient is in active treatment.
Timeline of extension of care period
Access to care is granted through the current period of active treatment or for up to 90 calendar days.
When the member is in the second or third trimester of pregnancy, access is granted through the postpartum period.
When extension of care does not apply
- A professional review action has occurred
- The primary care physician or specialist fails to meet applicable quality or licensure standards according to Michigan State Law.
- Medicare has sanctioned the primary care physician or specialist
- The primary care physician or specialist is staying in the service area and can still be selected as a participating primary care physician or specialist. The member can choose to stay with the provider and follow them to their new office location
- The practitioner does not agree to the terms of the extension of care based on the provider participation agreement