Our plan will help you find the right mix of care and services to live the life you choose.
Selecting a Primary Care Provider (PCP)
Each PHP Care Complete FIDA-IDD Plan participant is required to select and maintain an ongoing relationship with a primary care provider (PCP) within PHP’s network. A PCP is typically a physician, such as a family or internal medicine practitioner who is trained to treat a wide variety of health-related problems. Nurse practitioners may also serve as PCPs, as can specialists under certain circumstances (e.g., chronic illness). PHP’s Provider and Pharmacy Directory lists all available network PCPs and their location, contact information, languages spoken, and other important information. If desired, PHP’s Care Management Teams or Participant Services staff will be happy to assist you in selecting a PCP that can best meet your needs and preferences. If you already have a relationship with a PCP who participates in Medicaid but is not in PHP’s network, PHP’s staff will make a reasonable effort to recruit that provider into our network.
Primary care physicians and practitioners serve as the participant’s “medical home” and are responsible for:
- Providing primary and preventive care services
- Assisting in the development of participant Life Plans
- Facilitating referrals for all medically necessary specialist services and long-term services and supports
- Coordinating the participant’s care in collaboration with PHP’s care management team, the Interdisciplinary Team, and other professionals
- Maintaining participants’ medical records in accordance with contractual requirements and all applicable state and federal rules and regulations
Participants or their authorized representatives may request a change in PCP at any time and for any reason simply by contacting PHP. PHP’s Care Management Teams will provide any needed assistance in selecting a new PCP and ensuring a smooth transition. PHP will also help with the transfer of medical records and other documents.
A PCP might leave PHP’s network for reasons such as retirement, relocation, death, or because of a disagreement between PHP and the PCP. If this occurs, PHP will assist participants in making a new PCP selection and ensuring a seamless transition.
Under certain circumstances, PHP may also allow a participant to continue to see his or her PCP for a temporary period if he or she is receiving active treatment for a complex medical condition or undergoing prenatal care. PHP must review and approve the request and the PCP must agree to:
- Share information regarding the participant’s treatment plan with PHP
- Continue to follow PHP’s Utilization Management policies and procedures
- Accept payment based on the current Medicare or Medicaid fee schedule, as applicable