PCP Enrollee Panels Sample Clauses

The "PCP Enrollee Panels" clause defines how primary care providers (PCPs) are assigned groups of patients, known as panels, for whom they are responsible. Typically, this clause outlines the criteria for assigning enrollees to a PCP, such as geographic location, patient preference, or provider capacity, and may specify limits on the number of enrollees per panel. Its core function is to ensure an organized and manageable distribution of patients among providers, promoting continuity of care and efficient resource allocation within a healthcare network.
PCP Enrollee Panels. The MCO is expected to ensure that the MHT (Medicaid and WVCHIP) enrollee panel of any PCP in its network does not exceed two thousand (2,000) Medicaid enrollees. The two thousand (2,000) MHT enrollee limit applies to each PCP, not the average across all of the MCO’s PCPs. In the case of PCP teams (see below), this ratio may be adjusted. Exceptions to this limit may be made with the consent of the physician and BMS. Reasons for exceeding the limit may include: continuation of established care; assignment of a family unit; availability of mid-level clinicians in the practice that effectively expand the capacity of the physician; and inadequate numbers of providers in the geographic area. Recognizing that precise numerical ratios are not readily enforceable, the MCO must take measures to ensure compliance with this requirement such as monitoring PCPs’ panels and enrollees’ access to PCPs. BMS will monitor PCP panels across MCOs and notify each affected MCO if the total MHT enrollee panel of a PCP in its network exceeds two thousand (2,000) Medicaid and WVCHIP enrollees. MCOs must reduce the panel for PCPs with panels above two thousand (2,000) MHT enrollees across the program unless one (1) of the exceptions above is granted.
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