Continuity of Care. CareMore is required to follow all continuity of care requirements.
- For Medi-Cal services, you can request to the plan to provide access to out-of-network providers, for up to 12 months., This does not apply to ancillary service providers
- For Medicare services, you may continue receiving services from an existing out of-network Medicare provider for primary and specialty care services for six months if all required criteria are met
Notification and Enrollment Processes. CareMore will provide you with meaningfull information about your enrollment rights and care options. The plan will also engage in community outreach and education activities to inform beneficiaries about their options.
CareMore will provide communication and services to dual eligible beneficiaries in alternative formats that are culturally, linguistically, and physically appropriate through means including, but not limited to assistive listening systems, sign language interpreters, captioning, written communication, plain language, and written translations.
Care Coordination. CareMore will provide care coordination and management activities that reflect a member-centered, outcome-based approach, and provides seamless access to the full continuum of necessary services.
Self-Directed Care. You will continue having the choice to self-direct your care. You will be able to hire, fire, and supervise you In-Home Support Services (IHSS) provider, as currently allowed in California’s IHSS program.
Health-Risk Assessment. Every CareMore member will have access to a health risk assessment. This assessment will include an evaluation of your medical, long-term care, and behavioral health needs.
Network Adequacy. As a CareMore member, you will have a choice of providers among a broad network of primary care providers, behavioral health providers, specialists, ancillary providers, hospitals, pharmacists, and providers of LTSS.
Appeals and Grievances . You will receive information on appeals rights in a format and language that is understandable and accessible. Our grievance and appeal processes comply with the Medicare and Medi-Cal requirements.
Quality Monitoring. CareMore complies with Quality Monitoring programs which tracks our health plans’ performance and accountability for providing you with seamless access to medically necessary services.