Ohio Department of Job and Family Services (ODJFS) Responds to AMCNO Concerns regarding Anthem transition

The AMCNO contacted ODJFS because of our concern about continuity of care issues as Anthem Blue Cross Blue Shield Partnership Plan (Anthem) exits from the Covered Families and Children (CFC) Managed Care program in the Northeast Ohio market. The AMCNO queried the ODJFS about how they planned to assure a smooth transition regarding the continuity of care for Anthem members, and more specifically how the ODJFS planned to respond when an Anthem member was seeing a physician(s) not currently a part of either of the remaining health plan's networks.

The ODJFS responded to the AMCNO that their department is aware of the need to assure the smooth transition of members from Anthem to the remaining CFC-participating plans in the Northeast Region, CareSource and Wellcare. In terms of continuity of care, the ODJFS informed that AMCNO that a number of things are happening to help with this transition. ODJFS stated that both CareSource and Wellcare are working to expand their healthcare networks to increase the overlap of network providers. ODJFS hopes that this activity will allay concerns about CFC consumers who may be seeing providers who are not currently in either of the networks. The ODJFS is hopeful that by the time the consumer is required to select a new plan, their provider of choice may be participating with one or more of the remaining health plans.

In addition, as the ODJFS begins the process of permitting CFC consumers to choose a new plan, the ODJFS has implemented an assignment algorithm that looks for previous experience with a primary care provider. In the event the CFC consumer does not make a new health plan choice and that person is then assigned to a new plan, the algorithm will make its best attempt to assign the consumer to health plan which includes in its network a primary care provider(s) with whom the member has had previous experience. 

Another step in the ODJFS continuity of care transfer process will occur once the enrollment transfer is complete. The ODJFS plans to share with Anthem information regarding those health plans to where their CFC membership is being transferred. Anthem will then be responsible for sharing with the new health plan information on outstanding scheduled treatments, prior authorizations for : a) private duty nursing; b) durable medical equipment; c) home care services; d) pharmacy; e) vision; f) dental; and g) prenatal care services for members in their third trimester of pregnancy, and those members who were under case management. The ODJFS expected that whenever possible, the Anthem information will identify the authorized provider for prior authorized services.

And finally the ODJFS has informed the AMCNO that as a consumer-driven fail safe mechanism, members will continue to have the right to change their health plan selection within the first 90 days of enrollment should they wish to do so. The ODJFS noted that they are confident that these activities and processes will help to assure a smooth transition of the Anthem members required to select a new health plan because of Anthem's business decision to exit the CFC managed care program. Providers should remember that Anthem will continue as a participating health plan in our ABD managed care program. 

The AMCNO will continue to monitor this situation for our members as the transition process moves ahead over the coming months. If AMCNO member have questions or concerns, contact the AMCNO and we will bring these issues to the attention of the ODJFS.