HHSC reinstates transition period for PCCM primary care provider selection

In answer to physician inquiries, the state’s contractor for Medicaid services has made it possible for a Medicaid patient in a Primary Care Case Management expansion area to see a physician who is not listed as their primary care provider. The Texas Medicaid Healthcare Partnership says the change, effective May 15, will remain in effect during an indeterminate transition period initiated by the Texas Health and Human Services Commission.

Under the transitional rules, when a patient presents to a physician who is not listed as their primary care provider on his Medicaid ID form, Form H3087, the patient can select that physician as their new designated primary care provider at the point of service. The physician must verify this selection on the Primary Care Provider Change List, available on the TMHP Web site. For more information and to link to the PCP Change List, go to the TMHP news bulletin.

In the announcement, TMHP also clarified referral questions regarding obstetrical and gynecological services. “ In this new transition period,” reads the TMHP announcement, “clients in PCCM Expansion Area s may also select any Medicaid enrolled OB/GYN, family practitioner, or internal medicine provider for the following services:

·      One well woman examination per year

·      Care related to pregnancy

·      Care for all active gynecological conditions and

·      Diagnosis, treatment, and referral to a Medicaid enrolled specialist for any disease or condition within the scope of the designated professional practice of a licensed obstetrician or gynecologist, including treatment of medical conditions concerning the breasts.”

Patients do not need a referral from their primary care provider to see a family physician, an OB/GYN or an internal medicine provider as long as the physician providing services is enrolled in Medicaid.