Ratio of PCPs to Enrollees. The MCO’s provider network must include a panel of primary care providers (PCPs) from which the enrollee may select a personal PCP. The MCO must maintain an adequate panel of available PCPs so that the ratio of PCPs to enrollees meets or exceeds the required ratio of one (1) PCP for every five hundered (500) adult enrollees who is accepting new patients and one (1) age appropriate PCP for every two hundred fifty (250) pediatric enrollees under twenty-one (21) who is accepting new patients as outlined in Appendix I. Only PCPs who have assigned MCO enrollees and are listed in the MCO’s provider directory as accepting new patients will count toward the provider-to-enrollee ratio. Specialists designated as PCPs for certain individuals will not count toward the standard, unless these providers are willing to serve as the PCP for other enrollees. The provider-to-enrollee ratio is distinct from the requirement in the MCO contract regarding the total assigned panel size for any individual PCP.
Ratio of PCPs to Enrollees. The MCO’s provider network must include a panel of primary care providers (PCPs) from which the enrollee may select a personal PCP. The MCO must maintain an adequate panel of available PCPs so that the ratio of PCPs to enrollees meets or exceeds the required ratio of one
