Primary Care Clinician (PCC) Plan for MassHealth Members

Learn about the MassHealth PCC Plan

The Primary Care Clinician (PCC) Plan is a managed care health plan for MassHealth members.


In the PCC Plan, primary care providers are called primary care clinicians (PCCs).


Members select or are assigned a PCC from a network of MassHealth providers. Members can use the MassHealth network of hospitals and specialists to receive care as coordinated with their PCC and can use the Massachusetts Behavioral Health Partnership (MBHP) behavioral health provider network for behavioral health services.

    PCC Plan overview

    In the PCC Plan, you

    • Choose a PCC from the MassHealth list, or one will be assigned to you
    • Can change your PCC at any time
    • Can change from the PCC Plan to an accountable care organization (ACO) or managed care organization (MCO) at any time


    PCPs who are part of an ACO will not be available as PCCs in the PCC Plan.

    Please note: If you have a high need for behavioral health or long-term services and supports (LTSS), ACOs and MCOs are now able to help more by providing you with support from a Community Partner (CP). Community Partners are not generally available in the PCC Plan, and care may not be as coordinated and integrated as in the ACOs or MCOs.

    Members who are eligible to join the PCC Plan

    Members under age 65 without third-party liability (TPL) in the following MassHealth coverage types are eligible to join the PCC Plan: 

    • Standard
    • CommonHealth
    • CarePlus
    • Family Assistance

    For more information about these coverage types, go to Learn about MassHealth coverage types for individuals, families, and people with disabilities

    Referrals in the PCC Plan

    For members of the Primary Care Clinician (PCC) Plan, all services need a referral from your PCC, unless the services were provided by your Primary Care Clinician, or are in the section below. 

    Services that do not need a referral in the PCC Plan

    Abortion services

    Services delivered by a dentist

    Annual gynecological exams

    Services delivered by a family planning service provider, for members of child-bearing age

    Clinical laboratory services

    Services delivered by a hospice provider

    Diabetic supplies

    Services delivered by a limited service clinic

    Durable medical equipment (items, supplies, and equipment)

    Services delivered in a nursing facility

    Fiscal intermediary services

    Services delivered by an anesthesiologist

    Fluoride varnish administered by a physician or other qualified medical professional

    Services delivered in an intermediate care facility–intellectual disability (ICF-ID)

    Functional skills training provided by a MassHealth personal care management agency

    Services delivered to a homeless member outside of the PCC office

    HIV pre- and post-test counseling services

    Services delivered to diagnose and treat sexually transmitted diseases

    HIV testing

    Services delivered to treat an emergency condition

    Hospitalization

    Services provided under a home- and community-based waiver

    • Elective admissions (All elective admissions are exempt from the PCC referral requirement and are subject to the MassHealth agency’s admission screening requirements at 130 CMR 450.208(A))

    Sterilization services when performed for family planning services

    • Non-elective admissions

    Surgical pathology services

    Obstetric services for pregnant and postpartum members (provided up to the end of the month in which the 60-day period following the termination of pregnancy ends)

    Tobacco-cessation counseling services

    Oxygen and respiratory therapy equipment

    Transportation to covered care

    Pharmacy services (prescription and over-the-counter drugs)

    Vision care in the following categories (see Subchapter 6 of the Vision Care Manual):

    • Visual analysis frames
    • Single-vision prescriptions
    • Bifocal prescriptions, and
    • Repairs

    Radiology and other imaging services with the exception of

    • Magnetic resonance imaging (MRI)
    • Computed tomography (CT) scans 
    • Positron emission tomography (PET) scans, and
    • Imaging services conducted at an independent diagnostic testing facility (IDTF)

    These all do require a referral.

     

    Services delivered by a behavioral health (mental health and addiction) provider, including inpatient and outpatient psychiatric services

     

    Call MassHealth at call (800) 841-2900 or TTY: (800) 497-4648 with questions about referral requirements.

    Finding a Provider in the PCC Plan

    To find primary care providers (called Primary Care Clinicans "PCCs"), specialists, and hospitals, you can use the MassHealth Provider Directory .   

    If you are seeking a behavioral health provider (mental health and addiction), you can use the MBHP provider directory.

    If you need help finding a provider, please call MassHealth at (800) 841-2900, TTY: (800) 497-4648).

    Additional Resources for Finding a Provider in the PCC Plan

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