TMHP: Providers Can Serve Both PCCM and HMO Clients

Texas Medicaid Healthcare Partnership, the state’s contractor for Medicaid services, recently posted an alert on its Web site to update physicians on the repeal of Primary Care Case Management in the Medicaid STAR areas of Bexar, Dallas, El Paso, Harris and Lubbock. What follows is the text from that July 28 Web posting:

“In recent months, you have received information about upcoming Medicaid managed care program changes affecting PCCM clients in the STAR Medicaid program. Effective December 1, 2006, PCCM Medicaid clients (except SSI-related clients) living in the STAR program service areas of Bexar, Dallas, El Paso, Harris, Harris Expansion, and Lubbock will no longer have PCCM as an option for Medicaid covered health care services. The Health and Human Services Commission mailed out initial notification letters and enrollment kits to affected clients in July 2006.

“Although PCCM clients in these service areas will be moving to an HMO, PCCM still needs primary care providers. By remaining enrolled in PCCM, providers ensure continuity of care for each PCCM client in those STAR metropolitan areas as they transition to an HMO. Providers should remember that choosing an HMO does not require that providers terminate their contracts with PCCM. Providers may contract simultaneously with an HMO(s) as well as with PCCM.

“PCCM providers in the STAR metropolitan areas are encouraged to continue to provide ongoing health care services to PCCM clients who live in contiguous areas not affected by the changes. There may be instances where PCCM clients may choose a PCCM primary care provider in a metropolitan (STAR) service area.

For more information about STAR Medicaid program changes and the affected service areas, please refer to July/August 2006 Texas Medicaid Bulletin, No. 197 and look for more information in the upcoming September/October 2006 Texas Medicaid Bulletin, No. 198.”