Ala. Admin. Code r. 560-X-37-.02
Current through Register Vol. 43, No. 1, October 31, 2024
Section 560-X-37-.02 - Primary Care Case Management (PCCM)(1) Under this model of managed care, each patient/recipient is assigned to a primary medical provider (PMP) who is a physician who is responsible for managing the recipient's health care needs. This management function neither reduces nor expands the scope of covered services.(a) PCCM services means case management related services that include location, coordination, and monitoring of primary health care services; and are provided under a contract between Medicaid and the PMP or the OMP group.(b) PCCM services may be offered by the state as a mandatory option under the Medicaid state plan; with the exception of beneficiaries who are dually eligible for Medicare and Medicaid, American Indians/Alaska Natives, or children with special health care needs.(2) Primary Medical Providers (PMP). PMPs are generally family practitioners, general practitioners, internists or pediatricians. If a patient's condition warrants, PMPs of another specialty may be assigned if he/she is willing to meet all contractual requirements. Patients may be assigned to the individual physician. Patients may be assigned to a group of physicians, if approved by the Medical Director.Ala. Admin. Code r. 560-X-37-.02
Amended: May 16, 1991; April 15, 1992. Amended: Filed April 6, 1994; effective May 13, 1994. Amended: Filed August 12, 1994; effective September 17, 1994. Repealed and Replaced: Filed June 6, 1996; effective July 12, 1996. Amended: Filed December 8, 1997; effective January 12, 1998. Amended: Filed November 8, 2001; effective December 13, 2001. Amended: Filed May 12, 2003; effective June 16, 2003. Repealed: Filed April 9, 2004; effective May 14, 2004. New Rule: Filed August 11, 2004; effective September 15, 2004.Amended by Alabama Administrative Monthly Volume XXXVI, Issue No. 04, January 31, 2018, eff. 2/25/2018.Amended by Alabama Administrative Monthly Volume XXXIX, Issue No. 02, November 30, 2020, eff. 1/14/2021.Author: Latonda Cunningham, Associate Director, Patient 1st Program
Statutory Authority: Sections 1915(b)(1)(2)(3), (4); Sections 1902(a)(i), (10), (23) of the Social Security Act, 42 C.F.R. 431.55, 438.2, 440.168.