Section 210-RICR-30-05-2.30 - Primary Care Providers (PCPs)A. The MCO has written policies and procedures allowing every member to select a primary care provider (PCP). If a member does not select a PCP during enrollment, the MCO shall make an automatic assignment, taking into consideration such factors as current provider relationships, language needs, and the relative proximity of the PCP to the member's area of residence. The MCO must notify the member in a timely manner of his/her PCP's name, location, and office telephone number, and how to change PCPs, if desired. The PCP serves as the member's initial and most important point of interaction with the health plan network. In addition to performing primary care services, the PCP coordinates referrals and specialty care. As such, PCP responsibilities include at a minimum: 1. Serving as the member's primary care provider;2. Ensuring that members receive all recommended preventive and screening care appropriate for their age group and risk factors;3. Referring for specialty care and other medically necessary services both in and out-of-plan;4. Maintaining a current medical record for the member; andB. In addition, the MCO retains responsibility for monitoring PCP actions to ensure they comply with health plan and Medicaid program policies.210 R.I. Code R. 210-RICR-30-05-2.30
Amended effective 12/12/2023
Amended effective 3/17/2024