Common use of Choice of a Health Care Professional Clause in Contracts

Choice of a Health Care Professional. ‌ The Contractor shall offer each Member the opportunity to choose from at least two (2) network PCPs. The Contractor shall encourage Members to select a PCP to serve as a Medical Home. If the Member does not voluntarily choose a PCP, the Contractor may assign the Member a PCP. A Member who has received Prior Authorization from the Contractor for referral to a specialist shall be allowed to choose from among all the available specialists and hospitals within the Contractor’s network to the extent possible, reasonable, and appropriate. The Contractor must place Member PCP on all Member cards. If the Contractor elects to assign Members to a PCP, it must have written policies and procedures for assigning Members to PCPs. The Contractor must submit PCP assignment policies and procedures to the Division for review and approval thirty (30) calendar days after Contract execution and must submit any significant updates. Any changes or modifications to these policies and procedures must be submitted by the Contractor to the Division at least thirty (30) calendar days prior to implementation and must be approved by the Division. These policies and procedures shall include the features listed below:

Choice of a Health Care Professional. ‌ The Contractor shall offer each Member the opportunity to choose from at least two (2) network PCPs. The Contractor shall encourage Members to select a PCP to serve as a Medical Home. If the Member does not voluntarily choose a PCP, the Contractor may assign the Member a PCP. A Member who has received Prior Authorization from the Contractor for referral to a specialist shall be allowed to choose from among all the available specialists and hospitals within the Contractor’s network to the extent possible, reasonable, and appropriate. The Contractor must place Member PCP on all Member cards. If the Contractor elects to assign Members to a PCP, it must have written policies and procedures for assigning Members to PCPs. The Contractor must submit PCP assignment policies and procedures to the Division for review and approval thirty (30) calendar days after Contract execution and must submit any significant updates. Any changes or modifications to these policies and procedures must be submitted by the Contractor to the Division at least thirty (30) calendar days prior to implementation and must be approved by the Division. These policies and procedures shall include the features listed below: