Common use of Assignment of PCP Clause in Contracts

Assignment of PCP. The MCO must have written policies and procedures for assigning each of its enrollees to a PCP. The MCO will assume responsibility for assisting the enrollee with PCP selection. MCOs must make a PCP assignment within five (5) calendar days after a Medicaid beneficiary is enrolled in the MCO. The process whereby MCOs assign PCPs to enrollees must take into consideration such known factors as current provider relationships, age, the child’s placement (physical location), claims history, and input by DHHR caseworker. The MCO then must notify the enrollee or his representative in writing of his or her PCP’s name, location and office telephone number, and the process for selecting a new PCP if the enrollee so desires. Enrollees with a disabling condition, chronic illness or who are SSI eligibles, must have a choice of specialist physician to serve as their PCP. The specialist physician must agree to perform all PCP duties required in the Contract and the PCP duties must be within the scope of the specialist’s license.