Common use of Choice of Primary Care Physician (PCP) Clause in Contracts

Choice of Primary Care Physician (PCP). The CRS contractor is required to assure that members have a choice of PCPs. Specifically, beneficiaries will have a choice of at least two primary care providers, and may request change of primary care provider at least at the times described in 42 CFR 438.56(c). In addition, the CRS contractor will offer contracts to primary and specialist physicians who have established relationships with beneficiaries including specialists who may also serve as PCPs to encourage continuity of provider. For children who have an established relationship with a PCP that does not participate in the CRS contractor’s provider network, the CRS contractor will provide, at a minimum, a 90-day transition period in which the child may continue to seek care from their established PCP while the child and child’s parents and/or guardian, the CRS contractor, and/or case manager finds an alternative PCP within the CRS contractor’s provider network.