Ky Dept. of Medicaid Services - PCP Letter of Intent

Auto Assignment and PCP Enrollment– The Department of Medicait plans to do the auto assignment of current recipients to one of the three Medicaid managed care organizations (MCOs) on August 18th. However, the MCOs have set internal deadlines of July 25th for physicians to sign letters of intent for initial listing in their network which will be used for the auto assignment process.

DMS clarified that specialist physicians are not prohibited from serving as a PCP, since some patients (ie., elderly, cancer patients) may be seeing a specialist as their primary care physician. Specialists desiring to serve as a PCP should submit letters of intent to that effect. PCPs are required to have admitting privileges at a hospital or formal referral agreement with a provider possessing admitting privileges, and agrees to provide 24/7 primary health care services to individuals. The MCO RFP also defined a PCP as including physician assistants, advanced practice registered nurse or a Rural Health Center.  Letter from Dept of Medicaid

If you want to continue providing Primary Care Services to Medicaid Patients outside of the Passport Region,  you will need to notify the managed care organizations of your interest in becoming a provider in their network!

There are three (3) Managed Care Organizations (MCOs) with whom the Cabinet has signed contracts to provide Medicaid services in a managed care environment are looking for Primary Care Providers with whom to contract. They are Centene – which is doing business in Kentucky as Kentucky Spirit Health Plans, Coventry Health Plan, and WellCare. After October 1, 2011 you will no longer to be able to provide Medicaid healthcare on a fee-for-service basis; you will need to be in a provider network with an MCO contract.

These 3 MCOs are authorized to provide Medicaid services in all counties of Kentucky with the exception of those for whom Passport has provided services over the past 10 years (Jefferson, Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington counties. Passport will continue to provide services in these counties.

The MCOs have been asked by the KY Cabinet for Health & Family Services to provide the names of Primary Care Providers by the first of August. If you are interested in pursuing a contract, the MCOs will need to hear from you by July 25^th, if possible.

You do not need to have a negotiated contract by that date, but you do need to let the MCOs know that you are interested in being a primary care provider in their network. We understand that all families receiving Medicaid services will be automatically assigned to one of the three MCOs. One factor in making this assignment will be the primary care provider…hence, the importance of maintaining your status as a Medicaid provider by having a contract – if possible – with each of the three MCOs so that you can be in their provider network!