Common use of Primary Care Dentist (PCD) Assignment Clause in Contracts

Primary Care Dentist (PCD) Assignment. (A) If the Contractor elects to deliver services using a dental home model, the Contractor shall allow Enrollees to select a PCD or change a PCD assignment at any time. Assignment of a PCD shall take effect immediately when needed to ensure there is no interruption in access or continuity of care. The Contractor shall ensure that Family Members are assigned to the same PCD, unless the Enrollees specifically request otherwise. (B) The Contractor shall pay for Covered Services rendered prior to the effective date of PCD assignment when: (1) the Enrollee receives Covered Services by a Non-Network Provider and the requirements in 3.5.3 (A) and (B) above are met; or (2) the Enrollee receives Covered Services by a Network Provider. (C) The Contractor is not required to pay for the services rendered after the effective date of PCD assignment unless: (1) the requirements in 3.5.4(A) above are met; or (2) otherwise requested by the Department on a case by case basis. (D) Enrollees who are Indians are not required to select a PCD and may receive Covered Services from any Indian Health Care Provider without referral.