Choice of Health Care Professional. The MCO must allow an Enrollee to choose his or her Health Care Professional to the extent possible and appropriate. “To the extent possible and appropriate” includes limiting the selection of a Primary Care Provider to participants in the MCO’s network, unless the Primary Care Provider was already at capacity, and other instances discussed in the “Provisions of the Proposed Rule and Analysis of and Response to Public Comments” to 42 CFR § 438.6(m), Volume 67, Number 115, column 3 of page 41,006 and column 1 of page 41,007 of the Federal Register, June 14, 2002.
Choice of Health Care Professional. The HMO must offer each enrollee covered under this Contract the opportunity to choose a primary health care professional affiliated with the HMO, to the extent possible and appropriate. If the HMO assigns recipients to primary care providers, then the HMO must notify recipients of the assignment. HMOs must permit Medicaid and BadgerCare enrollees to change primary providers at least twice in any calendar year, and to change primary providers more often than that for just cause, just cause being defined as lack of access to quality, culturally appropriate, health care. Such just cause will be handled as a formal grievance. If the HMO has reason to lock in an enrollee to one primary provider and/or pharmacy in cases of difficult case management, the HMO must submit a written request in advance of such lock-in to the Department’s Contract Specialist. Culturally appropriate care in this section means care by a provider who can relate to the enrollee and who can provide care with sensitivity, understanding, and respect for the enrollee’s culture.
Choice of Health Care Professional. The HMO must offer each member covered under this Contract the opportunity to choose a primary health care professional affiliated with the HMO, to the extent possible and appropriate. If the HMO assigns members to primary care providers, then the HMO must notify members of the assignment. The HMO must permit members to change primary providers at least twice in any year, and to change primary providers more often than that for just cause, just cause being defined as lack of access to quality, culturally appropriate, health care. Such just cause will be handled as a formal grievance. If the HMO has reason to lock in a member to one primary provider in cases of difficult case management, the HMO must submit a written request in advance of such lock-in to the Department’s Office of Inspector General. Culturally appropriate care in this section means care by a provider who can relate to the member and who can provide care with sensitivity, understanding, and respect for the member’s culture.
Choice of Health Care Professional. The HMO must offer each enrollee covered under this Contract the opportunity to choose a primary health care professional affiliated with the HMO, to the extent possible and appropriate. If the HMO assigns members to primary care providers, then the HMO must notify members of the assignment. The HMO must permit enrollees to change primary providers at least twice in any year, and to change primary providers more often than that for just cause, just cause being defined as lack of access to quality, culturally appropriate, health care. Such just cause will be handled as a formal grievance. If the HMO has reason to lock in an enrollee to one primary provider in cases of difficult case management, the HMO must submit a written request in advance of such lock-in to the Department’s Bureau of Fiscal Management. Culturally appropriate care in this section means care by a provider who can relate to the enrollee and who can provide care with sensitivity, understanding, and respect for the enrollee’s culture.
Choice of Health Care Professional. The PIHP must offer each member covered under this Contract the opportunity to choose a primary health care professional affiliated with the PIHP, to the extent possible and appropriate. If the PIHP assigns members to primary care providers, then the PIHP must notify enrollees of the assignment. The PIHP must permit FCMH members to change primary providers at least twice in any year, and to change primary providers more often than that for just cause, just cause being defined as lack of access to quality, culturally appropriate, health care. Such just cause will be handled as a formal grievance. If the PIHP has reason to lock in an enrollee to one primary provider in cases of difficultcare coordination, the PIHP must submit a written request in advance of such lock-in to the Bureau of Benefits Management Culturally appropriate care in this section means care by a provider who can relate to the member and who can provide care with sensitivity, understanding, and respect for the member’s culture.
