Md. Code Regs. 10.67.02.04

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.67.02.04 - Assignment to Primary Care Provider (PCP)

A. Within 10 days of the notification of enrollment of a new enrollee or within 10 days of any event that requires a change in an existing enrollee's PCP, an MCO shall notify the enrollee of the enrollee's PCP assignment.

B. A Program recipient with no previous affiliation with any of the providers on the MCO's primary care provider panel who:

(1) Indicates a preference for a participating PCP during the enrollment process shall be assigned to that PCP unless the MCO documents in writing, for good cause, its inability to assign the enrollee to that PCP; or

(2) Fails to make known any preference for a PCP shall be assigned to a PCP whose location satisfies the access standards specified in COMAR 10.67.66.06E.

C. Before changing an enrollee's PCP, the MCO shall obtain the Department's approval at least 60 days before the reassignment is effective unless:

(1) The PCP has decided to stop practicing;

(2) The PCP has terminated the relationship with an enrollee due to the enrollee's behavior;

(3) The change is requested by the enrollee; or

(4) The age limits of the PCP's practice no longer meet the needs of the enrollee.

Md. Code Regs. 10.67.02.04

Regulations .04 recodified from 10.09.63.04 effective 46:22 Md. R. 976, eff. 11/1/2019