Common use of Choice of Primary Care Clause in Contracts

Choice of Primary Care. Physician (PCP). The PIHP 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 PIHP, through the Regional Behavioral Health Authorities (RBHA), 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 individuals who have an established relationship with a PCP that does not participate in the PIHP/RBHA’s provider network, the PIHP will provide, at a minimum, a 90-day transition period in which the individual may continue to seek care from their established PCP while the individual, the PIHP, RBHA and/or case manager finds an alternative PCP within the PIHP/RBHA’s provider network.