In Lieu of Service (ILOS) Transition of Care Policy

In Lieu of Service (ILOS) Transition of Care Policy 

The health plan must ensure that an approved ILOS that was authorized for a member prior to the discontinuation of that specific ILOS is not disrupted by a change in ILOS offerings, either by completing the authorized service or by seamlessly transitioning the member into other medically necessary services or programs that meet the member’s needs. This transition plan must be provided to the state agency as part of the ILOS discontinuation process. The transition plan must identify the total number of members utilizing the ILOS through the discontinuation date and the alternative services that will be offered (either State Plan Services or other approved ILOS). At least forty-five (45) calendar days before discontinuing an ILOS, the health plan must notify affected members of the change and timing of the discontinuation and the procedures that will be used to ensure completion of the ILOS and transition into comparable medically appropriate service. The health plan shall not offer the ILOS after the date of discontinuation.

In the event the state agency, CMS, or both determine an ILOS not to be medically appropriate and/or cost-effective, the health plan will assist the state agency in preparing a transition plan to phase out the applicable ILOS while ensuring access for affected members to contractually required services with minimal disruption of care. The transition plan will include a process to notify members of the termination of the ILOS that they are currently receiving as expeditiously as required by the member’s health condition.

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