Common use of Primary Care Providers Clause in Contracts

Primary Care Providers. 1. The Health Plan shall enter into agreements with a sufficient number of PCPs to ensure adequate accessibility for Enrollees of all ages. The Health Plan shall select and approve its PCPs. The Health Plan shall ensure its approved PCPs agree to the following: (a) The PCP’s agreement to accept the associated Case Management responsibilities. (b) The PCP’s agreement to provide or arrange for coverage of services, consultation or approval for referrals twenty four (24) hours per day, seven days per week by Medicaid enrolled providers who will accept Medicaid reimbursement. This coverage must consist of an answering service, call forwarding, provider call coverage or other customary means approved by the Agency. The chosen method of twenty four (24) hour coverage must connect the caller to someone who can render a clinical decision or reach the PCP for a clinical decision. The after hours coverage must be accessible using the medical office’s daytime telephone number. The PCP or covering medical professional must return the call within thirty (30) minutes of the initial contact. (c) The PCP’s agreement to arrange for coverage of primary care services during absences due to vacation, illness or other situations which require the PCP to be unable to provide services. Coverage must be provided by a Medicaid enrolled PCP. 2. The Health Plan shall provide the following: a. At least one (1) FTE PCP per county including, but not limited to, the following specialties: (1) Family Practice; (2) General Practice; (3) Obstetrics or Gynecology; (4) Pediatrics; and

Primary Care Providers. 1. The Health Plan shall enter into agreements Provider Contracts with a sufficient number of PCPs to ensure adequate accessibility for Enrollees of all ages. The Health Plan shall select and approve its PCPs. The Health Plan shall ensure its approved PCPs agree to PCP Provider Contracts provide for the following: (a) a. The PCP’s agreement to PCP shall accept the all associated Case Management responsibilities.; (b) b. The PCP’s agreement to provide PCP shall provide, or arrange for coverage of services, consultation or approval for referrals twenty four (24) hours per day, seven (7) days per week by Medicaid enrolled providers who will accept Medicaid reimbursement. This coverage must consist of an answering service, call forwarding, provider call coverage or other customary means approved by the Agency. The chosen method of twenty four (24) hour coverage must connect the caller to someone who can render a clinical decision or reach the PCP for a clinical decision. The after hours coverage must be accessible using the medical office’s daytime telephone number. The PCP or covering medical professional must return the call within thirty (30) minutes of the initial contact.; and (c) c. The PCP’s agreement to PCP shall arrange for coverage of primary care services during absences due to vacation, illness or other situations which require the PCP to be unable to provide services. Coverage must be provided by a Medicaid enrolled eligible PCP. 2. The Health Plan shall provide the following: a. At least one (1) FTE PCP per county Service Area including, but not limited to, the following specialties: (1) Family Practice; (2) General Practice; (3) Obstetrics or Gynecology; (4) Pediatrics; and