Common use of PCP Responsibilities Clause in Contracts

PCP Responsibilities. If applicable, and Provider is a PCP, Provider shall comply with the following: 3.4.1 PCPs who serve Members under the age of nineteen (19) are responsible for conducting all Well- Baby and Well-Child Care services. Should the PCP be unable to conduct the necessary Well-Baby and Well-Child Care services screens, the PCP is responsible for arranging to have the necessary Well-Baby and Well-Child Care services screens conducted by another network provider and ensure that all relevant medical information, including the results of the Well-Baby and Well-Child Care services screens, are incorporated into the Member’s PCP Medical Record. 3.4.2 PCPs who serve Members under the age of nineteen (19) report encounter data associated with Well-Baby and Well-Child Care services, using a format approved by DOM, to Contractor within one hundred and eighty (180) calendar days from the date of service. 3.4.3 PCPs are responsible for contacting new Members identified in the quarterly encounter lists sent by Contractor that indicate who has not had an encounter during the first six (6) months of Enrollment. Contractor must require the PCP to: 3.4.3.1 Contact Members identified in the quarterly Encounter lists as not complying with Well-Baby, Well-Child Care, and immunization schedules for Children; 3.4.3.2 Identify to Contractor any such Members who have not come into compliance with Well-Baby, Well-Child Care, and immunization schedules within one (1) month of such notification to the site by Contractor; and 3.4.3.3 Document the reasons for noncompliance, where possible, and to document its efforts to bring the Member's care into compliance with the standards. 3.4.4 PCP shall provide the full range of Well-Baby, Well-Child Care, well-adolescent care and childhood and adolescent immunization services recommended by the Advisory Committee on Immunization Practices (ACIP) for all Members under the age of nineteen (19) as defined in, and in accordance with, the State Child Health Plan, 42 C.F.R. §457.495 and the provisions of Mississippi CHIP Contract, including periodic examinations for vision, dental, and hearing and all Medically Necessary services. The following minimum elements must be included in the periodic health screening assessment of children: a. Comprehensive health and development history (including assessment of both physical and mental development); b. Measurements (including head circumference for infants); c. Comprehensive unclothed physical examination; d. Immunizations appropriate to age and health history; e. Assessment of nutritional status; f. Laboratory tests (including tuberculosis screening and Federally required blood lead screenings); g. Vision Screening; h. Hearing Screening; i. Dental and Oral Health Assessment; j. Development Assessment; and, k. Health education and anticipatory guidance. If a suspected problem is detected by a screening examination, the child must be evaluated as necessary for further diagnosis. This diagnosis is used to determine treatment needs.