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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 29. PUBLIC WELFARE |
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Chapter 29-54. STANDARDS FOR MANAGED CARE PRIMARY CARE PROVIDERS THAT ARE PAID ON A FEE-FOR-SERVICE BASIS FOR SERVICES RENDERED TO AFDC AND AFDC-RELATED MEDICAID RECIPIENTS |
Section 29-5403. SERVICE DELIVERY AND QUALITY ASSURANCE REQUIREMENTS
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5403.1Each fee-for-service primary care provider shall provide each enrollee with high quality health care at locations that ensure reasonable availability and accessibility to enrollees.
5403.2Each fee-for-service primary care provider shall provide either directly or by referral, each service in the Medicaid managed care benefits package, including patient management and referrals and approvals.
5403.3Each fee-for-service primary care provider shall ensure that urgent and emergency medical care are available to AFDC and AFDC-related Medicaid enrollees on a twenty-four (24) hour basis, seven (7) days a week, either through the fee-for-service provider or through other appropriate facilities.
5403.4Each AFDC and AFDC-related Medicaid recipient shall receive the same services in the same facilities as the fee-for-service primary care provider’s non-AFDC and AFDC-related Medicaid enrollees.
5403.5Each AFDC and AFDC-related Medicaid enrollee shall be fully integrated into the fee-for-service primary care provider’s practice and shall not be treated in a manner different from non-AFDC or AFDC-related patients.
5403.6Each fee-for-service primary care provider shall provide health education programs for its enrollees in languages understood by the population being served. The education programs shall include, at a minimum, the following:
(a)Information regarding the importance and availability of preventive care;
(b)Information regarding the importance and availability of childhood immunizations;
(c)Information regarding the importance of and right to, and procedure for scheduling the Early Periodic Screening, Diagnosis and Treatment (EPSDT) screens for children covered by Medicaid;
(d)Information on birth control and on the importance and availability of prenatal and well baby care;
(e)Information regarding proper nutrition for pregnant women and children; and
(f)Information regarding preventive and treatment measures for drug abuse and alcoholism.
5403.7The fee-for-service primary care provider shall have a system of follow-up of patient care for enrollees with chronic and acute illnesses, including an appointment follow-up system for persons who do not appear for appointments.
5403.8Waiting times for appointments for AFDC and AFDC-related Medicaid enrollees shall not exceed the waiting times for non-AFDC or AFDC-related patients of the fee-for-service primary care provider.
5403.9Each fee-for-service primary care provider shall maintain a current, unified medical record on each enrollee.