Sharp Health Plan to partner with Magellan

On mental health and substance use disorder services in 2024.

At Sharp Health Plan, we are committed to providing best-in-class mental health and substance use disorder services to our members that align with The Sharp Experience, and are rooted in integration, quality, and innovation. As such, we are pleased to announce that we are partnering with Magellan Healthcare, Inc¹. Magellan will manage Sharp Health Plan’s mental health and substance use disorder services for all lines of business with an anticipated effective date of Jan. 1, 2024².

Magellan is a trusted leader in the mental health and substance use disorder industry with over 50 years of experience providing innovative, impactful services to people around the country. This exciting new partnership will significantly increase the mental health and substance use disorder provider network for our members, and connect them with 24/7 access to personalized, evidence-based digital tools, wellness resources, and much more.

For your convenience, we’ve put together an FAQ with additional information. If you have questions that aren’t answered below, please feel free to reach out to your dedicated account management executive.

When will the partnership with Magellan be effective?

The scheduled effective date for this partnership is Jan. 1, 2024².

Will this change be applicable to all benefit plans?

Magellan will be providing mental health and substance use disorder services for all Sharp Health Plan members, across all benefit plans, including our employer group plans (HMO/POS), individual and family plans, and Medicare Advantage plans.

Will members’ mental health and substance use disorder benefits change? What about their copays?

No. Members’ plan benefits for mental health and substance use disorder services will not change, and their costs for accessing these services will remain the same.

Will this change impact members’ pharmacy benefits for mental health and substance use disorder medications?

No. If they are enrolled in a plan with pharmacy benefits through Sharp Health Plan, there will be no impact to their pharmacy benefits for mental health and substance use disorder medications.

Will members need a new member ID card?

No. They will not need a new member ID card.

Will members be able to keep their current mental health and substance use disorder providers?

To receive plan benefits, members must see an in network mental health and substance use disorder provider³. If a member’s current provider is part of the Magellan network, they will be able to continue seeing their provider. If a member’s provider is not part of the Magellan network, Magellan will give that provider an opportunity to join their network. If the provider chooses to join the Magellan network, the member will be able to continue seeing them. If the provider chooses not to join the Magellan network, the member can contact Magellan at 1-866-512-6190 beginning Dec. 15, 2023², to request continuity of care or choose a new provider that is in the Magellan network.

What is continuity of care?

To receive their plan benefits, members must see an in network mental health and substance use disorder provider³. If a member’s provider chooses not to join the Magellan network, they can contact Magellan at 1-866-512-6190 beginning Dec. 15, 2023², to request continuity of care. This means they may be able to continue seeing their provider until their care is completed or can be safely transferred to a provider in the Magellan network. Continuity of care may be provided for the completion of care when a member is in an active course of treatment for one of the following conditions:

The member’s requested mental health and substance use disorder provider must agree to provide continued services to them, subject to the same terms and conditions and similar payment rates to other similar health care providers contracted with Magellan. If the member’s provider does not agree, Sharp Health Plan is not required to provide continuity of care. Magellan must approve continuity of care prior to the member receiving such services.

If members are approved for continuity of care, will they need to reset any authorizations, especially Rx?

If a member has an existing mental health and substance use disorder authorization, Magellan will honor it through the end of the authorization period. Following the transition, members may contact Magellan to speak with an appropriate clinical representative for mental health and substance use disorder authorizations. Pharmacy benefits will not change, and existing authorizations for medication will remain in effect for the authorization period. Sharp Health Plan will continue to be responsible for medication authorizations.

Can members select a new mental health and substance use disorder provider?

Yes. Beginning in January², they can search Magellan’s online provider directory. Members will be able to filter by specialty, location and more to find the best fit for them.

Will a referral for mental health and substance use disorder services be needed before accessing care?

No. You don’t need a referral or prior authorization to access outpatient therapy from a provider in the Magellan network. Some services, such as partial hospitalization, intensive outpatient, applied behavior analysis (ABA), electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) and psychological and neuropsychological testing will require a referral and prior authorization. Magellan will honor existing prior authorizations for the duration of the authorization period for dates of service beginning Jan. 1, 2024².

How will Sharp Health Plan communicate this to members?

We will send a letter to members who accessed mental health and substance use disorder services in 2023. The letter will let them know if their provider is currently in or out of the Magellan network. If their provider is out of the Magellan network, we will share additional information with them, like how to request continuity of care and/or search for a new provider who is in Magellan’s network. We will do another member mailing in December confirming the effective date of our Magellan partnership, and whether their provider is in or out of the Magellan network.

Since Magellan manages a national network of providers, will Sharp Health Plan members have access to mental health and substance use disorder providers beyond Sharp’s service area?

All members, across all benefit plans, will have access to Magellan’s in network mental health and substance use disorder providers throughout the state of California. POS members will have access to Magellan in network mental health and substance use disorder providers nationwide on Tier 2. POS members will also have access to non-contracted providers on Tier 3.

Is telehealth available with all providers in the Magellan network? How can members see if a provider offers telehealth?

Telehealth is available with most providers in the Magellan network. Their online provider directory indicates if a provider offers telehealth services.

Who should members contact with questions?

Members should contact Customer Care at 1-844-483-9013 with questions.