Common use of Primary Care Provider for Enrollees With Special Needs Clause in Contracts

Primary Care Provider for Enrollees With Special Needs. (A) The Contractor shall have policies and procedures to inform caregivers, and when appropriate, Enrollees With Special Health Care Needs, about Primary Care Providers who have training in caring for such Enrollees. (B) The Contractor shall contract with Primary Care Providers with skills and experience to meet the needs of Enrollees with Special Health Care Needs. (C) For Enrollees determined to need a course of treatment or regular care monitoring, the Contractor shall have a mechanism in place to allow Enrollees to directly access a specialist (for example, through standing referral or an approved number of visits) as appropriate for the Enrollee’s condition and identified needs. The Contractor shall allow an appropriate specialist to be the Enrollee’s Primary Care Provider but only if the specialist has the skills to monitor the Enrollee’s preventative and primary care services.

Primary Care Provider for Enrollees With Special Needs. (A) The Contractor shall have policies and procedures to inform caregivers, and when appropriate, Enrollees With with Special Health Care Needs, about Primary Care Providers who have training in caring for such Enrollees. (B) The Contractor shall contract with Primary Care Providers with skills and experience to meet the needs of Enrollees with Special Health Care Needs. (C) For Enrollees determined to need a course of treatment or regular care monitoring, the Contractor shall have a mechanism in place to allow Enrollees to directly access a specialist (for example, through standing referral or an approved number of visits) as appropriate for the Enrollee’s condition and identified needs. The Contractor shall allow an appropriate specialist to be the Enrollee’s Primary Care Provider but only if the specialist has the skills to monitor the Enrollee’s preventative and primary care services.