Common use of PCPs Clause in Contracts

PCPs. Providers who are PCPs shall comply with all additional requirements pertaining to PCPs under the applicable State Contract, including, but not limited to the following: (a) PCPs who serve Medical Assistance Covered Persons under the age of twenty-one (21) years are responsible for conducting all EPSDT screens for individuals on their panel under the age of twenty-one (21). If the PCP is unable to conduct the necessary EPSDT screens, the PCP must arrange to have the necessary EPSDT screens conducted by another Participating Provider and ensure that all relevant medical information, including the results of the EPSDT screens, is incorporated into the Covered Person’s PCP medical record. PCPs must report Encounter Data associated with EPSDT screens to Health Plan or Subcontractor, as directed, using a format approved by DPW, within ninety (90) days from the date of service. (b) PCPs who serve Medical Assistance Covered Persons under the age of twenty-one (21) years must contact those Covered Persons identified by Health Plan in quarterly Encounter lists as not complying with EPSDT periodicity and immunization schedules for children and shall identify to Health Plan or Subcontractor, as directed, any such Covered Persons who have not come into compliance with the EPSDT periodicity and immunization schedules within one (1) month of notification to the PCP by Health Plan or Subcontractor of noncompliance. PCPs shall document the reasons for noncompliance, where possible, and efforts made to bring the Covered Person’s care into compliance with the EPSDT standards. (c) PCPs shall contact: (i) new Medical Assistance Covered Persons identified by Health Plan in quarterly Encounter lists who have not had an Encounter during the first six (6) months of enrollment with Health Plan or who have not complied with the scheduling requirements under the Medical Assistance State Contract; and (ii) all Medical Assistance Covered Persons who have not had an Encounter during the previous twelve (12) months or within the time frames required under the Medical Assistance State Contract.

PCPs. Providers who are PCPs shall comply with all additional requirements pertaining to PCPs under the applicable State Contract, including, but not limited to the following: (ai) PCPs who serve Medical Assistance Covered Persons under the age of twenty-twenty- one (21) years are responsible for conducting all EPSDT screens for individuals on their panel under the age of twenty-one (21). If the PCP is unable to conduct the necessary EPSDT screens, the PCP must arrange to have the necessary EPSDT screens conducted by another Participating Provider and ensure that all relevant medical information, including the results of the EPSDT screens, is incorporated into the Covered Person’s PCP medical record. PCPs must report Encounter Data associated with EPSDT screens to Health Plan or Subcontractor, as directed, using a format approved by DPWDHS, within ninety (90) days from the date of service. (bii) PCPs who serve Medical Assistance Covered Persons under the age of twenty-twenty- one (21) years must contact those Covered Persons identified by Health Plan in quarterly Encounter lists as not complying with EPSDT periodicity and immunization schedules for children and shall identify to Health Plan or Subcontractor, as directed, any such Covered Persons who have not come into compliance with the EPSDT periodicity and immunization schedules within one (1) month of notification to the PCP by Health Plan or Subcontractor of noncompliance. PCPs shall document the reasons for noncompliance, where possible, and efforts made to bring the Covered Person’s care into compliance with the EPSDT standards. (ciii) PCPs shall contact: (ia) new Medical Assistance Covered Persons identified by Health Plan in quarterly Encounter lists who have not had an Encounter during the first six (6) months of enrollment with Health Plan or who have not complied with the scheduling requirements under the Medical Assistance State Contract; and (iib) all Medical Assistance Covered Persons who have not had an Encounter during the previous twelve (12) months or within the time frames required under the Medical Assistance State Contract.

PCPs. Providers who are PCPs shall comply with all additional requirements pertaining to PCPs under the applicable State Contract, including, but not limited to the following: (a) PCPs who serve Medical Assistance Covered Persons under the age of twenty-one (21) years are responsible for conducting all EPSDT screens for individuals on their panel under the age of twenty-one (21). If the PCP is unable to conduct the necessary EPSDT screens, the PCP must arrange to have the necessary EPSDT screens conducted by another Participating Provider and ensure that all relevant medical information, including the results of the EPSDT screens, is incorporated into the Covered Person’s PCP medical record. PCPs must report Encounter Data associated with EPSDT screens to Health Plan or Subcontractor, as directed, using a format approved by DPWDHS, within ninety (90) days from the date of service. (b) PCPs who serve Medical Assistance Covered Persons under the age of twenty-one (21) years must contact those Covered Persons identified by Health Plan in quarterly Encounter lists as not complying with EPSDT periodicity and immunization schedules for children and shall identify to Health Plan or Subcontractor, as directed, any such Covered Persons who have not come into compliance with the EPSDT periodicity and immunization schedules within one (1) month of notification to the PCP by Health Plan or Subcontractor of noncompliance. PCPs shall document the reasons for noncompliance, where possible, and efforts made to bring the Covered Person’s care into compliance with the EPSDT standards. (c) PCPs shall contact: (i) new Medical Assistance Covered Persons identified by Health Plan in quarterly Encounter lists who have not had an Encounter during the first six (6) months of enrollment with Health Plan or who have not complied with the scheduling requirements under the Medical Assistance State Contract; and (ii) all Medical Assistance Covered Persons who have not had an Encounter during the previous twelve (12) months or within the time frames required under the Medical Assistance State Contract.