|
The state's primary care case management (PCCM) train is rolling into a county near you in September and state officials are offering you a chance to get on board. Officials will begin a series of free workshops to explain how PCCM works for physicians throughout the state later this month.
The PCCM is not an HMO. It is a network of primary care physicians who treat Medicaid patients as part of the state's Medicaid managed care program. PCCM now operates in the Harris, Dallas, Bexar, El Paso, Lubbock and Southeast Texas service areas, but will expand to 197 counties Sept. 1. The affective counties are listed on the TMHP Web site (PDF).
TMA supports PCCM as a pragmatic approach to improving care for patients, while constraining Medicaid costs. TMA also is working closely with the Texas Health and Human Services Commission (HHSC) to address outstanding operational and policy issues that may unique to border and rural communities.
Legislation establishing an Integrated Care Management model (ICM) for Medicaid that passed by the Texas Legislature this year does not affect the PCCM expansion. ICM is an enhanced version of the PCCM program and will be tested in Dallas for patients with disabilities and the elderly. The ICM bill was stripped of language assuring that PCCM will be an option in existing service areas, like Dallas and San Antonio. The health and human services commissioner is free to eliminate it if he chooses. TMA supported creation of the ICM over state plans to impose HMOs on all Medicaid patients in and around urban counties. ICM will put more money into direct patient care, save state dollars, protect local taxpayers, and attract federal Medicaid funds back to Texas.
Enrollment in PCCM is mandatory for pregnant women, low-income families and children, and Supplemental Security Income (SSI) beneficiaries 21 and older who are on Medicaid. PCCM gives patients a medical home through primary care physicians who are responsible for providing and coordinating their care. SSI recipients under 21 can enroll voluntarily. Elderly patients and those who have disabilities and who live in nursing homes or are enrolled in community-based long-term care will remain in traditional Medicaid. Children in foster care, Medicare patients, and patients enrolled in the Medically Needy Program cannot be in PCCM.
PCCM physicians are paid Medicaid fee-for-service rates plus $2.93 per patient. General, family practice, and internal medicine physicians, obstetrician-gynecologists, and pediatricians can be a PCCM primary care physician. So can specialists, such as oncologists and pulmonologists, who would like to provide primary care for patients with special needs. PCCM primary care doctors provide or arrange for 24-hour-a-day, 7-day-a-week telephone access to necessary medical care, provide or coordinate all of the patients' health care needs, and document all medically necessary services.
The TMHP and THHSC-sponsored workshops begin June 21 in Temple and end July 28 in Nacogdoches. Other workshops will be held in Abilene, Alpine, Amarillo, Brenham, Childress, College Station, Cuero, Dalhart, Del Rio, Fredericksburg, Harlingen, Kerrville, Laredo, Longview, Lufkin, McAllen, Midland, Mineral Wells, Mount Pleasant, Odessa, Pampa, Paris, San Angelo, Texarkana, Tyler, Uvalde, Waco, Wharton, and Wichita Falls. A schedule of the hearings is posted on the TMHP Web site. Click on "PCCM Introductory Workshop." You may register online there.
The workshops will cover who can be a primary care physician, the role of physicians and hospitals, client eligibility guidelines, PCCM utilization management policies, and how to bill for covered services.
For more information, call (800) 925-9126.
Last Published: 6/13/2005 Print this page
|