Common use of PCP Transfers Clause in Contracts

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one (1) time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances: 1. The enrollee requires specialized care for an acute or chronic condition, and the enrollee and MCO agree that reassignment to a different PCP is in the enrollee’s interest; 2. The enrollee’s PCP ceases to participate in the MCO’s network; 3. The enrollee’s behavior toward the PCP is disruptive, and the PCP has made all reasonable efforts (three (3) attempts within ninety (90) calendar days) to accommodate the enrollee; or 4. The enrollee has taken legal actions against the PCP.

PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees members to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one (1) time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances: 1. The enrollee requires specialized care for an acute or chronic condition, and the enrollee and MCO agree that reassignment to a different PCP is in the enrollee’s interest; 2. The enrollee’s PCP ceases to participate in the MCO’s network; 3. The enrollee’s behavior toward the PCP is disruptive, and the PCP has made all reasonable efforts (three (3) attempts within ninety (90) calendar days) to accommodate the enrollee; or 4. The enrollee has taken legal actions against the PCP.