PARKLAND HEALTHfirst - Parkland Community Health Plan, Inc.

HMO/Provider Coordination
PCHP will meet the program rules with the HHSC standards regarding care for persons with disabilities or
chronic and complex conditions.
PCHP will provide information, education and training programs to members, families, Primary Care Providers,
specialty doctors, and community agencies about the care and treatment available within Parkland Community
Health Plan for members with disabilities or chronic or complex conditions. Specialists can function as a
Primary Care Provider for treatment of members with chronic/complex conditions when approved by PCHP.
Federal and state laws prohibit unlawful discrimination in the treatment of patients on the basis of ethnicity, sex,
age, religion, color, mental or physical disability, national origin, marital status, sexual orientation, or health
status (including, but not limited to, chronic communicable diseases such as AIDS or HIV-positive status).
All participating doctors and health care professionals also have an obligation under the Federal Americans with
Disabilities Act to provide physical access to their offices and reasonable accommodations for patients and
employees with disabilities.
For each person with disabilities or chronic or complex conditions, the Primary Care Provider is required to
develop a plan of care that meets the special preventive, primary acute care and specialty care needs of the
member. The plan must be based on:
• Health needs
• Specialist recommendations
• Periodic reassessment of the member’s functional status and service delivery needs.
The Primary Care Provider must maintain an initial plan of care in the medical records of persons with
disabilities or chronic or complex conditions and that plan must be updated as often as the member’s needs
change, but at least once a year.
PCHP will ensure the members with special health care needs have adequate access to Primary Care Providers
and specialists skilled in treating persons with disabilities or chronic or complex conditions. Case Management
services are available to help members with special health care needs, their families, and health care providers
to facilitate access to care, continuity and coordination of services.
Obstetrician/Gynecologist Services
Females can seek obstetric and gynecological services from any participating OB/Gyn without a referral from
their Primary Care Provider. A female Parkland KIDSfirst member guardian can also pick an OB/Gyn as a
primary care provider for their child from the list of participating Parkland KIDSfirst providers. These care
Providers must perform services within the scope of their professional specialty practice. A properly
credentialed OB/Gyn must practice in accordance with Section 4, Article 21.53D of the Texas Insurance Code
and follow rules promulgated by the Texas Department of Insurance. This is not a benefit of Parkland CHIP
Perinate.
Health Plan Limits To Network
PCHP allows you to pick an OB/GYN but this doctor must be in the same network as your Primary Care
Provider.
Attention Female Members
You have the right to pick an OB/GYN without a referral from your Primary Care Provider. An OB/GYN can
give you:
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