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ACCESS Plus Fact Sheet
What is ACCESS Plus?
Pennsylvania’s Enhanced Primary Care Case Management (EPCCM)
program that will operate in the 42 counties where HealthChoices
is not operational by the Department of Public Welfare.
Most Medical Assistance (MA) recipients who reside in the 42 county
service area and who are not enrolled in a voluntary managed care
organization will receive health care through ACCESS Plus.
All MA recipients including both children and adults who are enrolled
in ACCESS Plus will be under the care of a Primary Care Practitioner
(PCP). Enrollees of ACCESS Plus will have the opportunity to select
their PCP, however, if they choose not to do so, they will be assigned
to one.
What are the components of ACCESS Plus?
Physical Health Services – provided, coordinated and managed
by PCPs.
Disease Management Services – provided by the ACCESS Plus
contractor and will include the following conditions:
- Asthma
- Diabetes
- Chronic Obstructive Pulmonary Disease
- Coronary Artery Disease
- Congestive Heart Failure
- Case Management Services – provided by the ACCESS Plus
contractor
- Enrollment Assistance Services – provided by the Enrollment
Assistance Program contractor
What services can be self-referred?
Enrollees may receive some services without a referral from the
PCP including behavioral health services coordinated by county Mental
Health/Mental Retardation programs, Single County Authority administrators,
and school-based services, chiropractic, vision care, dental care,
if it is included in their benefit package, Family Planning Services
and OB/GYN services, provided the Enrollee obtains the services
from Providers enrolled in the MA program.
What is the role of the PCP?
The PCP will coordinate, monitor and provide primary physical
health MA covered services to ACCESS Plus enrollees.
The PCP will coordinate access to and support of disease management
and case management services.
The PCP will refer ACCESS Plus enrollees to specialist providers
when they cannot provide the necessary service.
What are the Enhancements?
Fee increases for primary care
Provider call center
Coordinated disease and case management services
Provider and enrollee education, outreach and input
What are the requirements for provider participation?
PCPs can be any of the specific physicians or physician groups:
pediatricians, internists, OB/GYNs, family practitioners, general
practitioners, certified registered nurse practitioners (CRNPs),
physician’s assistants, certified nurse midwives, Federally
Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs) or
Specialists on a case by case basis, operating under the scope of
his or her licensure and who are responsible for supervising, prescribing
and providing primary care and PCCM services for the ACCESS Plus
program.
PCPs will be required to enroll in the Medical Assistance Program
and sign an ACCESS Plus Supplemental Provider Agreement.
Access Plus
Web Site – This web site contains information about Access
Plus, Pennsylvania’s Enhanced Primary Care Case Management
Program.
Last modified on: October 27, 2005
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