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Heading: Providers Primary Care Case Management (PCCM)  
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   As of March 1, 2012, the PCCM Program is no longer available. Medicaid clients who were covered by PCCM have been assigned to Medicaid managed care organizations (MCOs). Click here to go to the Medicaid Managed Care web page.

 PCCM Program Information

Primary Care Case Management (PCCM) Overview

PCCM is a primary care provider network where providers contract directly with HHSC. PCCM clients receive health care services through a primary care provider. PCCM enlists primary care providers to provide a medical home, where clients receive the majority of their primary care and obtain referrals for specialty care. For providing a medical home to enrolled clients, participating primary care providers are paid traditional fee-for-service rates plus an additional $3.90 per patient, per month for those who selected them as their primary care provider. Providers who do not wish to be a primary care provider are not required to sign a primary care provider agreement.

PCCM is a network of Medicaid primary care providers and hospitals—not a health maintenance organization (HMO). PCCM improves the provision of primary and preventive care services to Medicaid clients while ensuring the efficient use of limited Medicaid resources.

Who Can Be a Primary Care Provider

PCCM enlists primary care providers to provide a medical home, where clients receive the majority of their primary care and obtain referrals to specialty care. Although clients are required to receive services and referrals through their primary care provider, referrals may be made to any Medicaid-enrolled provider. In addition, primary care providers are responsible for hospital admissions and obtaining prior authorization for elective inpatient and outpatient procedures. OB/GYN, Texas Health Steps (THSteps), vision services, and behavioral health providers may continue to see Medicaid clients without a primary care provider referral. However, coordination with the patient's primary care provider is encouraged. A primary care provider can be a:

  • Physician (general practice, family practice, internal medicine)
  • Physician assistant
  • Pediatrician
  • Obstetrician/gynecologist (OB/GYN)
  • Federally qualified health center (FQHC)
  • Rural health clinic (RHC)
  • Advanced practice registered nurse (i.e., nurse practitioner, clinical nurse specialist, certified nurse midwife)
  • Specialist who would like to serve as a primary care provider for patients with special needs (e.g., oncologist, pulmonologist)

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Resources on the TMHP website:

Contact Information

  • PCCM Provider Helpline: 1-888-834-7226
  • PCCM Client Helpline: 1-888 302-6688
  • Community Health Services (CHS): 1-888-276-0702
  • PCCM Prior Authorization Department: 1-888-302-6167

 
   
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