§ 56286. Continuity of Care.

(a) Each PCCM plan shall designate a primary care physician to supervise and coordinate each member's health care. Any member dissatisfied with the primary care physician shall be allowed to select another if more than one is available. Any PCCM plan physician dissatisfied with the professional relationship with any PCCM plan member may request that another primary care physician be substituted to supervise the member's care.

(b) Each PCCM plan shall establish and operate a case management system, which shall assure continuity of care through appropriate referral of members needing specialty health services, documentation of referral services in member's medical records, monitoring of members with ongoing medical conditions, documentation in the member's medical records of emergency medical encounters with appropriate follow-up as medically indicated, and coordinated hospital discharge planning including necessary post-discharge care.

HISTORY

1. New section filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed on 7-9-90.

2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90, No. 35). A Certificate of Compliance must be transmitted to OAL within 120 days or emergency language will be repealed by operation of law on 11-6-90.

3. Request to readopt section on an emergency basis pursuant to Government Code section 11346.1 granted and filed 11-6-90 as an emergency; operative 11-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL by 3-6-91 or emergency language will be repealed by operation of law on the following day.

4. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91; disapproved by OAL on 3-25-91 (Register 91, No. 18).

5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91 or emergency language will be repealed by operation of law on the following day.

6. Certificate of Compliance as to 3-25-91 order transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92, No. 1).

Note

Note: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions Code. Reference: Section 14088.16, Welfare and Institutions Code.