ACCESS Plus is Pennsylvania’s Enhance 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 are 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.

The following eligibles will be excluded for enrollment:

• Long Term Care Capitation (LTCCAP) enrollees,
• Nursing home residents,
• Health Insurance Premium Payment (HIPP) eligible members (HMO coverage only),
• Residents of state institutions, and
• Dual eligible Medicare/Medicaid members (over the age of 21 years).

ACCESS Plus consists of:

• Physical Health Services – provided, coordinated, and managed by PCPs.
• Disease Management Services – provided by the ACCESS Plus contractor and include 21conditions.
• Management Services – provided by the ACCESS Plus contractor.
• Enrollment Assistance Services – provided by the Enrollment Assistance Program contractor.

A comprehensive array of providers may serve as PCPs. PCP provider types include:

• Physicians,
• Physician Assistants*,
• Certified Registered Nurse Practitioners (CRNP)*,
• Obstetricians/Gynecologists,
• Nurse Midwives*,
• Federally Qualified Health Centers (FQHC),
• Rural Health Centers,
• Hospital Based Clinics, and
• Specialists.

* Operating under the scope of their licensure.

• 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 disease management and case management services.
• The PCP will refer ACCESS Plus Enrollees to specialist providers when they cannot provide the necessary service.

To enroll in the ACCESS Plus Program as a PCP you must:

• Be enrolled in Pennsylvania’s Medical Assistance Program. If you are not, please access DPW’s website for the appropriate enrollment forms or contact your Field Representative for assistance.
• Be appropriately licensed or certified in your specialty in the Commonwealth of Pennsylvania.
• Be a physician, certified registered nurse practitioner (CRNP) or a physician assistant (PA) practicing within the scope of your license, certified nurse midwife, Hospital Outpatient Clinic, Independent Medical Clinic, Rural Health Clinic (RHC) or a Federally Qualified Health Center (FQHC).
• Be an eligible physician, which includes family practitioners, general practitioners, pediatricians, internists, obstetricians/gynecologists or other physicians who provide primary care as well as specialists when approved by the Department of Public Welfare on a case by case basis.
• If the designated PCP is a Hospital Outpatient Clinic, Independent Medical Clinic, Rural Health Clinic or Federally Qualified Health Clinic:Primary care treatment must be provided by a family practitioner, general practitioner or other physicians who provide primary care and who are under contract or agreement with the clinic or center to provide service to Medical Assistance enrollees at their sites.
• Review the requirements of the ACCESS Plus Supplemental Provider Agreement.
• Complete and sign the Supplemental Agreement Enrollment Certificate.

The intent of this Quick Guide is to describe the support services available to participating ACCESS Plus providers and provide a brief overview of how to enroll as an ACCESS Plus provider.

Enrollees may receive some services without a referral from the PCP, including:

• Behavioral health services coordinated by county MH/MR Programs or Single County Authority administrators; School-based services;
• School-based services;
• Vision care and dental care(if it is included in their benefits package);
• Family planning services; and
• OB/GYN services.

This is provided the Enrollee obtains the services from Providers enrolled in the MA program.

No. The referral process has been simplified and is totally paperless.

Referral numbers consist of the PCP number for the recipient. This includes the MPI as well as the service location of the referring PCP. (Please check the PCP on file for each recipient).

Upon making a referral, the PCP will give his/her referral number to the specialist or provider to which the recipient is being referred.

ACCESS Plus offers support to providers:

• Over the phone via the Provider Helpline (1-800-543-7633). Provider Helpline hours of operation are Monday through Friday from 7:00 a.m. to 8:00 p.m. and Saturdays from 10:00 a.m. to 2:00 p.m.
• Face-to-face via field-based Field Representatives.
• For more information, visit the Department Of Public Welfare website.

You can find information about the Electronic Preventive Services Selector (ePSS) at: http://www.epss.ahrq.gov/