Levels of Care Changes
An extended transition process is provided for circumstances involving level of care changes in which a beneficiary is changing from one treatment setting to another. An override for the refill too soon edit would be provided to allow appropriate coverage. Since there may exist some period of time in which beneficiaries with level of care changes have a temporary gap in coverage while going through the exception process, our transition policy would allow coverage of one fill with up to a 31-day supply of medication.
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