Idaho Admin. Code r. 16.03.09.562

Current through September 2, 2024
Section 16.03.09.562 - HEALTHY CONNECTIONS: PRIMARY CARE SERVICES
01.Eligible Services. Participants enrolled with a primary care provider (PCP) are eligible to receive:
a. Basic care management and care coordination;
b. Timely access to routine primary care;
c. A patient-centered health care decision making process;
d. Twenty-four (24) hour, seven (7) days per week access to an on-call medical professional; and
e. Referral to other medically necessary services as specified in Section 210 of these rules, based on the clinical judgment of their primary care provider.
02.Selection or Change in Primary Care Provider. Participants may select or change their primary care provider as follows:
a. When they become eligible for Idaho Medicaid benefits, or after a break in their eligibility for Idaho Medicaid benefits;
b. For cause at any time ("for cause" reasons are listed in the Idaho Medicaid Provider Handbook).
c. Without cause:
i. During the ninety (90) days following the effective date of the participants enrollment with a PCP.
ii. At least once every twelve (12) months thereafter during the open enrollment period.
d. All approved PCP change requests will be effective the first of the following month.

Idaho Admin. Code r. 16.03.09.562

Effective March 17, 2022