PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected members to select other PCPs or make a reassignment within 15 days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances:
PCP Transfers. The Contractor shall:
PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date.
PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must 7 Certified nurse midwives are required to practice in a collaborative relationship with a licensed physician (West Virginia Code §30-15-7). The MCO must ensure compliance with all relevant federal and state regulations related to certified nurse midwives.
PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date. 7 Certified nurse midwives are required to practice in a collaborative relationship with a licensed physician (West Virginia Code §30-15-7). The MCO must ensure compliance with all relevant federal and state regulations related to certified nurse midwives. 8 Nurse practitioners with prescriptive authority must practice in a collaborative relationship with a licensed physician (West Virginia Code §30-7-15a). The MCO must ensure compliance with all relevant federal and state regulations related to nurse practitioners. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances:
PCP Transfers. The MCO must have written policies and procedures for allowing Medicaid enrollees to select or be assigned to a new PCP when such a change is requested by the enrollee, when a primary care provider is terminated from the MCO, or when a PCP change is ordered as part of the resolution 8 Certified nurse midwives are required to practice in a collaborative relationship with a licensed physician (West Virginia Code §30-15-7). The MCO must ensure compliance with all relevant federal and state regulations related to certified nurse midwives. to a formal grievance proceeding. In cases where a PCP has been terminated, the MCO must allow affected enrollees to select other PCPs or make a reassignment within fifteen (15) calendar days of the termination effective date. Enrollees may initiate a PCP change at any time, for any reason. The request can be made in writing or over the phone. MCOs are permitted to limit PCP changes to one (1) time per month. The MCO may initiate a PCP change for a Medicaid enrollee under the following circumstances:
PCP Transfers. The Contractor shall: At the Enrollee’s request, allow the Enrollee to change his or her PCP with or without cause. Enrollment with the new PCP shall be effective the next business day; Monitor Enrollees’ voluntary changes in PCPs to identify PCPs with higher relative rates of Enrollee disenrollment, and identify and address any opportunities for Provider education, training, quality improvement, or sanction; and Annually report to EOHHS on the results of the monitoring efforts described in Section 2.4.E.3.b above and Section 2.7.E.8, and the actions taken by the Contractor. Involuntary Changes in PCPs
