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The Health and Human Services Commission (HHSC) recently mailed notices to primary care physicians along the Texas-Mexico border and rural counties informing them about the Primary Care Case Management (PCCM) expansion that will be effective Sept. 1, 2005.
Medicaid defines primary care physicians/providers as:
- FPs
- GPs
- Pediatricians
- Internists
- OBGyns (OBs can decide to be a PCP or a specialist)
- Rural Health Clinics
- FQHCs
- Advanced Practice Nurses
- Specialist who want to act as a PCP
- Certified Nurse Midwives
PCCM enrollment will be mandatory for Medicaid enrolled children, pregnant women, low-income adults, and disabled adults living in the community. Nursing home patients, foster children, and patients dually-eligible for Medicare/Medicaid are not included.
Key Points:
- PCCM is NOT an HMO. Physicians will be paid Medicaid fee for service. PCPs receive an additional $3 per patient per month for patients who select them as their PCP.
- Specialists do not need to enroll, unless they want to act as a PCP. PCPs can continue to refer to any specialist accepting Medicaid. There is not a restricted panel of specialists.
- Physicians are not required to accept a set number of patients. Physicians determine whether or not they will accept additional patients or just those currently in their practices.
HHSC will begin patient and provider education regarding PCCM in the spring and early summer. TMA will continue to strongly convey that patient and provider education must begin at least 3 months prior to implementation to assure that everyone understands the changes that will occur. TMA also will undertake educational initiatives together with local county medical societies and specialist.
PCCM Resources to Download
Last Published: 4/7/2005 Print this page
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