PMP Selection. The Contractor shall assure that each member has a PMP who is responsible for providing an ongoing source of primary care appropriate to the member’s needs. Following a member’s enrollment, the Contractor must assist the member in choosing a PMP. Unless the member elects otherwise, the member shall be assigned to a PMP within thirty (30) miles of the member’s residence. If a member fails to initially select a PMP, the Contractor shall assign the member to a PMP within thirty (30) calendar days of the member’s enrollment. The member must be assigned to a PMP within thirty (30) miles of the member’s residence, and the Contractor should consider any prior provider relationships when making the assignment. OMPP must approve the Contractor’s PMP auto- assignment process prior to implementation, and the process must comply with any guidelines set forth by OMPP. See the Hoosier Healthwise MCE Policies and Procedures Manual for further detail. The Contractor shall notify the member in writing of the auto-assigned provider, the member’s right to change PMP, as well as the process by which the member may change PMP. The Contractor shall have written policies and procedures for allowing members to select a new PMP, including PMP auto-assignment, and provide information on options for selecting a new PMP when it has been determined that a PMP is non-compliant with provider standards (i.e. quality of care) and is terminated from the MCE, or when a PMP change is ordered as part of the resolution to a grievance proceeding. The MCE shall allow the member to select another PMP. The notice shall include information on options for selection a new PMP. The Contractor’s written policies and procedures for PMP selection shall be approved by OMPP. Providers that may serve as PMPs include internal medicine physicians, general practitioners, family medicine physicians, pediatricians, obstetricians, gynecologists, endocrinologists (if primarily engaged in internal medicine), and physician extenders as outlined in BT 201584 and in BT 201743.
PMP Selection. The Contractor shall ensure that each member has a PMP who is responsible for coordinating the services accessed by the member and providing an ongoing source of primary care appropriate to the member’s needs in accordance with 42 CFR 438.208(b)(1). Following a member’s enrollment, the Contractor must assist the member in choosing a PMP and provide information to the member on how to contact their designated PMP or entity. Unless the member elects otherwise, the member shall be assigned to a PMP within thirty
PMP Selection. The Contractor shall assure that each member has a PMP who is responsible for PMP. Unless the member elects otherwise, the member shall be assigned to a PMP If a member fails to initially select a PMP, the Contractor shall assign the member to a should consider any prior provider relationships when making the assignment. OMPP -assignment process prior to implementation, and the process must comply with any guidelines set forth by OMPP. See the Hoosier Healthwise MCE Policies and Procedures Manual for further detail. The Contractor shall notify the member in writing of the auto- change PMP, as well as the process by which the member may change PMP. The Contractor shall have written policies and procedures for allowing members to select a new PMP, including PMP auto-assignment, and provide information on options for selecting a new PMP when it has been determined that a PMP is non-compliant with provider standards (i.e. quality of care) and is terminated from the MCE, or when a PMP change is ordered as part of the resolution to a grievance proceeding. The MCE shall allow the member to select another PMP within ten (10) business days of the postmark date of termination of a PMP notice to members. The notice shall include information on PMP selection shall be approved by OMPP. Providers that may serve as PMPs include internal medicine physicians, general practitioners, family medicine physicians, pediatricians, obstetricians, gynecologists, endocrinologists (if primarily engaged in internal medicine), and physician extenders as outlined in BT 201584 and in BT 201743.
