Code of Maine Rules
10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL
Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL)
Chapter VI
Section 144-101-VI-03 - Primary Care Plus
Subsection 144-101-VI-0305 - MEMBER ATTRIBUTION

Universal Citation: 144-101-VI-03 ME Code Rules ยง 144-101-VI-0305

Current through 2024-38, September 18, 2024

A. Attribution is the process of assigning members to a PCP panel. MaineCare members will be attributed to a PCP if all the following criteria are met:

1. The member is eligible for all MaineCare state plan services; and

2. The member has received at least one eligible Primary Care Service from a PCP during the Attribution Assessment Period or has contacted MaineCare Member Services to request assignment to a PCP.

B. The Department will attribute members to a PCP on a quarterly basis. Attribution will be based on where the member received a plurality of eligible Primary Care Services during the Attribution Assessment Period. In the case of a tie, the most recent visit determines attribution. Regardless of primary care service utilization, Members may contact MaineCare Member Services to select assignment to a PCP. If the Member does not receive at least one Primary Care Service from the PCP they selected for one (1) year from the selection date or does not receive a plurality of Primary Care Services from the selected PCP, the Department will verify that the selected PCP is still the Member's choice. If the Member does not respond, the Department will attribute the Member in accordance with the Primary Care Services-based methodology in the next quarterly attribution.

C. The Department will notify Members of which PCP they have been attributed to, how personal information will be used in PCPlus, and what financial incentives are included for their PCP. Members may seek care from any willing, qualified, and enrolled MaineCare provider. Member participation in PCPlus is voluntary and shall not restrict a Member's free choice of providers. In addition, enrolled providers shall not interfere with a Member's freedom of choice in seeking medical care from any willing and qualified MaineCare provider. Providers shall not limit Members' access to other MBM services, including primary care services, based on the Member's election to decline or accept PCPlus services. PCPlus services (3.04) are voluntary for Members. Members may opt out of the PCPlus program at any time by contacting MaineCare Member Services, and the Department shall remove the Member from attribution and no PCP shall receive PCPlus reimbursement for the Member.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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