Section 508.12 - Continuing care providers.

508.12 Continuing care providers. (a) Continuing care providers must provide at least the following services to persons eligible for C/THP services formally enrolled with the provider:

(1) screening, diagnosis and treatment, and follow-up services in accordance with C/THP standards contained in section 508.8 of this Part;

(2) maintenance of a comprehensive health history, including information received from other medical or dental providers;

(3) direct provision of, or referral for, medically necessary services;

(4) direct provision of, or referral for, dental services, or referral to the local social services district for such services;

(5) assistance with transportation and/or scheduling assistance for medical or dental services, or referral to the local social services district for such services; and

(6) physician's services as needed by the recipient for acute, episodic or chronic illnesses or conditions.

(b) The agreement with the continuing care provider must specify:

(1) whether direct dental services or referral to dental services are provided. If the provider does not provide either service, then the provider must refer recipients to the local social services district for dental services;

(2) whether transportation to C/THP providers and/or assistance with the scheduling of appointments with C/THP providers will be furnished. If the provider does not furnish either service, the provider must refer recipients to the local social services district for such services; and

(3) that such provider will submit such reports to the department as are agreed to be submitted.

(c) To be formally enrolled with a continuing care provider, a person eligible for C/THP services or person legally responsible for such an eligible person must agree to use one continuing care provider as his/her regular source for the services described in subdivision (a) of this section for a specified period of time. Both the person eligible for C/THP services and the continuing care provider must agree in writing to their respective obligations under a continuing care arrangement.

(d) All agreements between local services districts and health-care maintenance organizations or other continuing care providers must require such organizations and providers to provide the services identified in this section and to comply with the requirements of this section. All such agreements must be approved by the department.

 

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