Ala. Admin. Code r. 560-X-37-.02
Primary Care Case Management (PCCM)
Effective Jan 14, 2021Amended: May 16, 1991; April 15, 1992. Amended: Filed April 6, 1994; effective May 13, 1994. Amended: Filed August 12, 1994; effective September 17, 1994. Repealed and Replaced: Filed June 6, 1996; effective July 12, 1996. Amended: Filed December 8, 1997; effective January 12, 1998. Amended: Filed November 8, 2001; effective December 13, 2001. Amended: Filed May 12, 2003; effective June 16, 2003. Repealed: Filed April 9, 2004; effective May 14, 2004. New Rule: Filed August 11, 2004; effective September 15, 2004. Amended: Filed January 11, 2018; effective February 25, 2018. Amended: Published November 30, 2020; effective January 14, 2021.Alabama Medicaid Agency
(1) Under this model of managed care, each patient/recipient is assigned to a primary medical provider (PMP) who is a physician who is responsible for managing the recipient's health care needs. This management function neither reduces nor expands the scope of covered services.
- (a) PCCM services means case management related services that include location, coordination, and monitoring of primary health care services; and are provided under a contract between Medicaid and the PMP or the OMP group.
- (b) PCCM services may be offered by the state as a mandatory option under the Medicaid state plan; with the exception of beneficiaries who are dually eligible for Medicare and Medicaid, American Indians/Alaska Natives, or children with special health care needs.
- (2) Primary Medical Providers (PMP). PMPs are generally family practitioners, general practitioners, internists or pediatricians. If a patient's condition warrants, PMPs of another specialty may be assigned if he/she is willing to meet all contractual requirements. Patients may be assigned to the individual physician. Patients may be assigned to a group of physicians, if approved by the Medical Director.
Author: Latonda Cunningham, Associate Director, Patient 1st Program
Statutory Authority: Sections 1915(b)(1)(2)(3), (4); Sections 1902(a)(i), (10), (23) of the Social Security Act, 42 C.F.R. 431.55, 438.2, 440.168.
History: Amended: May 16, 1991; April 15, 1992. Amended: Filed April 6, 1994; effective May 13, 1994. Amended: Filed August 12, 1994; effective September 17, 1994. Repealed and Replaced: Filed June 6, 1996; effective July 12, 1996. Amended: Filed December 8, 1997; effective January 12, 1998. Amended: Filed November 8, 2001; effective December 13, 2001. Amended: Filed May 12, 2003; effective June 16, 2003. Repealed: Filed April 9, 2004; effective May 14, 2004. New Rule: Filed August 11, 2004; effective September 15, 2004. Amended: Filed January 11, 2018; effective February 25, 2018. Amended: Published November 30, 2020; effective January 14, 2021.