Assignment of Primary Care Provider. The MCO must inform each enrollee about the full panel of participating providers. To the extent possible and appropriate, the MCO must offer each enrollee covered under this Contract the opportunity to choose among participating providers at the time of enrollment. This does not preclude the MCO from assigning a primary care provider to an enrollee who does not choose one. The MCO may assign an enrollee to a primary care provider when a recipient fails to choose one after being notified to do so. The MCO must set a period of time during which an enrollee may select a PCP, not to exceed ten (10) days after enrollment. Upon expiration of this time period, the MCO must assign the enrollee to a PCP. The assignment must be appropriate to the enrollee’s age, sex, and residence. The enrollee must be notified of this assignment and of the procedures for changing the designated provider. In the event that a primary care provider ceases to be affiliated with the MCO, the MCO’s procedures must provide for notice to affected enrollees at least 30 days before the termination date and promptly assist enrollees in obtaining a new primary care provider.
Assignment of Primary Care Provider. The MCO must inform each enrollee about the full panel of participating providers. To the extent possible and appropriate, the MCO must offer each enrollee covered under this contract the opportunity to choose among participating providers at the time of enrollment. This does not preclude the MCO from assigning a primary care provider to an enrollee who does not choose one. The MCO may assign an enrollee to a primary care provider when a recipient fails to choose one after being notified to do so. The MCO must set a period of time during which an enrollee may select a PCP, not to exceed 10 days after enrollment. Upon expiration of this time period, the MCO must assign the enrollee to a PCP. The assignment must be appropriate to the enrollee’s age, sex, and residence. The enrollee must be notified of this assignment and of the procedures for changing the designated provider. In the event that a primary care provider ceases to be affiliated with the MCO, the MCO’s procedures must provide for notice to affected enrollees at least 30 days before the termination date and promptly assist enrollees in obtaining a new primary care provider. Enrollment Limits BMS may establish a maximum Medicaid enrollment level for Medicaid beneficiaries for the MCO on a county-specific basis dependent on BMS’ evaluation of the capacity of the MCO’s network. Subsequent to the establishment of this limit, if the MCO wishes to change its maximum enrollment level, it must gain BMS’ approval. The MCO must notify BMS 45 days prior to the desired effective date of the change. BMS will issue its approval or disapproval in 30 days, subject to BMS’ timely receipt of all necessary information from the MCO to make the determination. If the change is an increase, the MCO must demonstrate its capability to serve additional enrollees. An increase will be effective the first of the month after BMS confirms additional capacity exists. If capacity is decreased because of a reduction in the number of participating providers available to Medicaid enrollees, then BMS will give the patients of those providers leaving the network the option to voluntarily disenroll from the plan.
Assignment of Primary Care Provider. (PCP) If a PARTICIPANT does not choose a PCP, or the PCP is no longer available, the CONTRACTOR assigns a PCP, notifies the PARTICIPANT in writing, and provides instructions for changing the assigned PCP. (See Section 210.) As needed
