Common use of Number of Members to a PCP Clause in Contracts

Number of Members to a PCP. The MCO is expected to ensure that the Medicaid member caseload of any PCP in its network does not exceed 2,000 Medicaid members. The 2,000 Medicaid member limit applies to each PCP, not the average across all of the MCO’s PCPs. In the case of PCP teams (see below), this ratio may be adjusted. Exceptions to this limit may be made with the consent of the physician and BMS. Reasons for exceeding the limit may include: continuation of established care; assignment of a family unit; availability of mid-level clinicians in the practice that effectively expand the capacity of the physician; and inadequate numbers of providers in the geographic area. Recognizing that precise numerical ratios are not readily enforceable, the MCO must take measures to ensure compliance with this requirement such as monitoring PCPs’ caseloads and enrollees’ access to PCPs. BMS will monitor PCP caseloads across MCOs and notify each affected MCO if the total Medicaid member caseload of a PCP in its network exceeds 2,000 Medicaid members. MCOs must reduce the caseload for PCPs with panels above 2,000 Medicaid members across the program unless one of the exceptions above is granted.

Number of Members to a PCP. The MCO is expected to ensure that the Medicaid member caseload of any PCP in its network does not exceed 2,000 Medicaid members. The 2,000 Medicaid member limit applies to each PCP, not the average across all of the MCO’s PCPs. In the case of PCP teams (see below), this ratio may be adjusted. Exceptions to this limit may be made with the consent of the physician and BMSDHHR. Reasons for exceeding the limit may include: continuation of established care; assignment of a family unit; availability of mid-level clinicians in the practice that effectively expand the capacity of the physician; and inadequate numbers of providers in the geographic area. Recognizing that precise numerical ratios are not readily enforceable, the MCO must take measures to ensure compliance with this requirement such as monitoring PCPs’ caseloads and enrollees’ access to PCPs. BMS DHHR will monitor PCP caseloads across MCOs and notify each affected MCO if the total Medicaid member caseload of a PCP in its network exceeds 2,000 Medicaid members. MCOs must reduce the caseload for PCPs with panels above 2,000 Medicaid members across the program unless one of the exceptions above is granted.

Number of Members to a PCP. The MCO is expected to ensure that the Medicaid member caseload of any PCP in its network does not exceed 2,000 1,500 Medicaid members. The 2,000 1,500 Medicaid member limit applies to each PCP, not the average across all of the MCO’s PCPs. In the case of PCP teams (see below), this ratio may be adjusted. Exceptions to this limit may be made with the consent of the physician and BMS. Reasons for exceeding the limit may include: continuation of established care; assignment of a family unit; availability of mid-level clinicians in the practice that effectively expand the capacity of the physician; and inadequate numbers of providers in the geographic area. Recognizing that precise numerical ratios are not readily enforceable, the MCO must take measures to ensure compliance with this requirement such as monitoring PCPs’ caseloads and enrollees’ access to PCPs. BMS will monitor PCP caseloads across MCOs and notify each affected MCO if the total Medicaid member caseload of a PCP in its network exceeds 2,000 1,500 Medicaid members. MCOs must reduce the caseload for PCPs with panels above 2,000 1,500 Medicaid members across the program unless one of the exceptions above is granted.