QUEST Integration – Continuity of Care

Original Effective Date:

02/01/2004

Current Effective Date:

01/01/2015

HMSA promotes continuity of patient care by encouraging physicians to share appropriate confidential patient medical information with other providers. HMSA also is committed to ensuring that members continue to receive quality healthcare when a provider terminates his or her HMSA Participating Physician Agreement.

Sharing Medical Information

Physicians are encouraged to provide copies of medical information when:

• The physician refers a member to another provider
• The member requests information be sent to another provider, or
• Another provider who is treating the member requests information

Sharing medical information with other medical professionals involved with the patient’s care helps to ensure continuity of care and reduce duplication of services. When transferring a patient’s medical information, providers must maintain patient record confidentiality and comply with pertinent state and federal laws governing such transfers.

Note: Providers may not share medical information when the member specifically asks that it not be shared except as required by law or Department of Human Services or other State or Federal agencies require information. See QUEST Integration – Provider Participation Requirements for confidentiality of records.

Continued Care When a Physician Ceases Participation in the Network

If a contracted physician terminates his or her contract with HMSA, the physician must notify his or her HMSA members not less than 30 days prior to the termination date.

If a PCP ceases participation in the Network, HMSA will send written notice to the members who have chosen the provider as their PCP or were seen on a regular basis by the provider within 15 calendar days after receipt or issuance of the termination notice, to each member who received his or her primary care from, or was seen on a regular basis by, the terminated provider.

For patients who are in their second or third trimester of pregnancy, the physician is obligated to provide or arrange for continued care through the postpartum period. The physician also is required to offer continued care for up to 90 days to patients receiving an active course of treatment or until the active course of treatment is completed or until the member’s care has been successfully and adequately transferred to a new provider. An active course of treatment is one in which discontinuity of care would cause a recurrence or worsening of the condition and interfere with anticipated outcomes.

A physician who voluntarily terminates his or her Participating Physician Agreement must give HMSA 60 calendar days’ written notice before the date of termination.

Revision History