If you are a newly enrolled participant that has been receiving treatment from an out-of-network provider for a service that is covered by PHP Care Complete FIDA-IDD Plan or PHP Care Preferred Medicaid Plan, you may continue to see your provider for at least 90 days following enrollment or until a comprehensive assessment has been completed (whichever is later) if all of the following criteria are met:

• You can demonstrate an existing relationship with the provider prior to enrollment (i.e., you visited the provider within the previous six months)
• The provider is willing to accept payment based on the current Medicare/Medicaid fee schedule, as applicable
• PHP would not otherwise exclude the provider from the network due to documented quality of care concerns

On an ongoing basis, PHP’s Provider Relations staff will make reasonable attempts (e.g., semi-annual telephone contacts, distribution of written materials about PHP, etc.) to recruit non-participating providers that have historically served PHP participants into our network.

Similarly, if you are a new PHP Care Complete FIDA-IDD Plan participant residing in an out-of-network Intermediate Care Facility, you will be allowed to remain in the facility as long as needed. PHP will also make a reasonable effort to recruit the facility into our network.