Page 25
2.12 Scope of Provider Networks A. The MCO must maintain provider networks in locations that are geographically accessible to the populations to be served, comprised of hospitals, physicians, advanced practice practitioners, mental health providers, substance use disorder providers, pharmacies, transportation services, dentists, school based health centers, etc. in sufficient numbers to make available all services in a timely manner. 2.13 Mainstreaming/Selective Contracting A. The mainstreaming of Medicaid beneficiaries into the broader health delivery system is an important objective of the Medicaid program. The MCO must ensure that all of its network providers accept RIte Care members for treatment. The MCO also must accept responsibility for ensuring that network providers do not intentionally segregate RIte Care members in any way from other persons receiving services. B. Health plans may develop selective contracting arrangements with certain providers for the purpose of cost containment, but must still adhere to the access standards as defined in the health plan contracts. 2.14 Primary Care Providers (PCPs) A. The MCO has written policies and procedures allowing every member to select a primary care provider (PCP). If a member does not select a PCP during enrollment, the MCO shall make an automatic assignment, taking into consideration such factors as current provider relationships, language needs, and the relative proximity of the PCP to the member’s area of residence. The health plan must notify the member in a timely manner of his/her PCP’s name, location, and office telephone number, and how to change PCPs, if desired. The PCP serves as the member's initial and most important point of interaction with the MCO network. In addition to performing primary care services, the PCP coordinates referrals and specialty care. As such, PCP responsibilities include at a minimum: 1. Serving as the member's primary care provider; 2. Ensuring that members receive all recommended preventive and screening care appropriate for their age group and risk factors; 3. Referring for specialty care and other medically necessary services both in and out-of-plan; 4. Maintaining a current medical record for the member; and