To enroll as PCPs, providers must be doctors, clinics, or health centers enrolled and taking part in the MA program as Early and Periodic Screening, Diagnosis and Treatment Program (EPSDT) providers if they serve individuals under 21. The types of EPSDT providers who can enroll include the following:
Physicians who provide primary care treatment.
Hospital outpatient clinics.
Independent medical clinics.
Rural health clinics.
Federally qualified health centers.
PCPs must sign supplemental provider agreements, in which they agree to do the following:
Provide primary and preventative medical services.
Provide referrals to specialists when an individual needs them.
Provide access 24 hours a day, 7 days a week.
Conduct EPSDT screens at required intervals.
Let individuals know when they need referrals to other services.
Help individuals get services from other providers and community agencies.
Refer individuals to Healthy Beginnings Plus, Woman, Infants and Children (WIC), Drug and Alcohol Programs,(D & A) Mental Health and Mental Retardation Programs (MHMR), Family Planning, and other Home and Community-Based Services (HCBS) when they are needed.
Contact school health staff when they are needed.
A PCP can agree to serve up to 1,000 individuals. PCPs with more than one doctor available at their practice site can agree to serve up to 5,000 clients (at 1,000 for each full-time-equivalent doctor). DPW can allow other limits in special situations.
Providers must be recruited and enrolled by the contractors who run the plans. Providers who are interested in enrolling as PCPs may be referred to the contractors at their toll-free numbers or to:
Office of Medical Assistance Programs
Division of Outpatient Programs
P.O. Box 8046, Harrisburg, PA 17105
See Chapter 338, Medical Assistance Benefits, Appendix J, Points of Contact.
Updated February 14, 2012, Replacing February 8, 2002