§2194.5. Primary health care contracts of direct services

A. The secretary shall award contracts to eligible recipients for the provision of direct health care services as provided in this Section.

B. Eligible recipients for contracts shall include but not be limited to groups of physicians, primary health care centers, and hospital outpatient departments.

C. Contracts shall be awarded by the secretary, according to the recommendations of the council. Contracts shall be awarded in accordance with their priority of need and the availability of funds.

D. Contracts may be awarded to provide or arrange access to primary and preventive health services, to arrange referrals to specialty and inpatient care, and for prescription drugs, ancillary health services, health education, case finding and outreach to bring people into the health system. Contracts may not be used to subsidize inpatient services.

E. A community-based health care provider that demonstrates its capacity to provide an organized system of primary care shall be eligible to receive a contract subject to meeting the following criteria, where applicable:

(1) Arrangement for service for eight hours a day with extended hours when needed and on call twenty-four hours a day.

(2) Full hospital privileges for all primary care physicians or arrangements to refer patients for inpatient hospital care and specialist services. Arrangements shall be in writing or the provider shall be able to demonstrate that patients are being accepted and treated.

(3) Provision for follow-up care from the hospital or specialist to the patient's primary care provider.

(4) Access to ancillary services such as laboratory, pharmacy, and radiological facility.

(5) Accepts, without limitations, Medicaid patients and uninsured persons, and provides the public with notice of a sliding fee schedule.

(6) Maintains a medical records system with arrangements for transferring records between hospitals, specialists, and primary care physicians.

(7) Quality assurance procedures to evaluate the quality and appropriateness of patient care.

(8) Evidence of community input into the design and provision of health services to be funded by the contract.

(9) Linkage to the Women, Infants, and Children Special Supplemental Food Program of the United States Nutrition Act of 1966, nutritional counseling, social and other support systems.

F. The department shall monitor and evaluate each contract.

Acts 1991, No. 600, §1; Acts 1991, No. 658, §1.