Section 405 IAC 14-2-60 - PMP selection and assignmentAuthority: IC 12-15-1-10; IC 12-15-21-2; IC 12-15-44.5-9; IC 12-17.6-2-11
Affected: IC 12-15-12; IC 12-15-44.5; IC 12-17.6-2
Sec. 60.
(a) After enrollment with an MCO, an enrollee shall have the right to choose a PMP of their choice from the eligible providers in the MCO's contracted network.(b) An MCO shall assist enrollees in choosing a PMP if the enrollee desires.(c) Unless an enrollee elects otherwise, an enrollee's PMP is located within thirty (30) miles from the enrollee's residence.(d) An enrollee who does not select a PMP shall be assigned to a PMP by the MCO within thirty (30) calendar days after the enrollee's MCO enrollment. This subsection does not apply to HCC.(e) MCOs are required to consider, at minimum, any earlier provider relationships when making the enrollee's PMP assignment under subsection (d).(f) An MCO may use auto-assignment factor, as well as earlier provider relationships as required under subsection (e), when assigning an enrollee a PMP. These additional factors must be reviewed by the office before to implementation.(g) After an MCO assigns an enrollee to a PMP, the MCO shall notify the enrollee of the assignment in writing, including the:(2) enrollee's right to change the PMP; and(3) way the enrollee may change the PMP.Office of the Secretary of Family and Social Services; 405 IAC 14-2-60; filed 8/30/2024, 11:42 a.m.: 20240925-IR-405240180FRA