Common use of PCP Responsibilities Clause in Contracts

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing 24-hour, seven (7)-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: •  Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; •  Providing twenty-four (24-) hour, seven (7)-day-a-week access; •  Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; •  Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; •  Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and •  Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing 24twenty-hourfour (24)-hour, seven (7)-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing twenty-four (24-) hour, seven (7)-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and outout- of-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: •  Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; •  Providing 24twenty-hourfour (24)-hour, seven (7)-day-a-week access; •  Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; •  Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; •  Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and •  Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: •  Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; •  Providing 24twenty-hourfour (24)-hour, seven (7)-day-a-week access; •  Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; •  Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; •  Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and •  Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid and WVCHIP managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs The MCO may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care providerPCP; • Providing 24twenty-hourfour (24)-hour, seven (7)-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid and WVCHIP managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs The MCO may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing 24twenty-hourfour (24)-hour, seven (7)-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid and WVCHIP managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs The MCO may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: •  Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; •  Providing 24-hour, seven (7)-dayseven-day-a-week access; •  Making referrals for specialty care and other Medically Necessary covered medically necessary services, both in-in- network and out-of-network, consistent with the MCO’s utilization management policies; •  Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; •  Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and •  Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing twenty-four (24-) hour, seven (7)-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: •  Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; •  Providing 24-hour, seven (7)-day-a-week access; •  Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; •  Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; •  Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and •  Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing 24-hour, seven (7)-dayseven-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered medically necessary services, both in-in- network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule periodicity schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care providerPCP; • Providing twenty-four (24-) hour, seven (7)-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: •  Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; •  Providing 24-hour, seven (7)-dayseven-day-a-week access; •  Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; •  Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; •  Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and •  Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing 24-hour, seven (7)-dayseven-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered medically necessary services, both in-in- network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: •  Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; •  Providing 24-hour, seven (7)-dayseven-day-a-week access; •  Making referrals for specialty care and other Medically Necessary covered medically necessary services, both in-in- network and out-of-network, consistent with the MCO’s utilization management policies; •  Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; •  Adhering to the EPSDT Periodicity Schedule periodicity schedule for enrollees under age twenty-one (21); and •  Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.

PCP Responsibilities. The PCP will be the MCO enrollee’s initial and most important contact with the MCO. As such, PCPs must have at least the following responsibilities: • Maintaining continuity of each enrollee’s health care by serving as the enrollee’s primary care provider; • Providing 24-hour, seven (7)-dayseven-day-a-week access; • Making referrals for specialty care and other Medically Necessary covered services, both in-network and out-of-network, consistent with the MCO’s utilization management policies; • Maintaining a current medical record for the enrollee, including documentation of all services provided to the enrollee by the PCP, as well as any specialty or referral services; • Adhering to the EPSDT Periodicity Schedule for enrollees under age twenty-one (21); and • Following MCO-established procedures for coordination of in-network and out-of- network services for Medicaid enrollees. Although PCPs must be given responsibility for the above activities, the MCO must also retain responsibility for monitoring PCP actions to ensure they comply with MCO and West Virginia Medicaid managed care program policies. Additionally, the MCO must communicate with PCPs about the delivery of primary behavioral health services within their scope of practice, as well as the appropriate circumstances for making referrals to behavioral health providers. MCOs may provide this information through its provider manual, continuing education agendas, informal visits by provider representatives, or any other means. The MCO must ensure that PCPs are successfully identifying and referring patients to a behavioral health provider and provide education to PCPs who do not have training in this area.