GHP Family Provider Manual - Geisinger Health Plan

EPSDT ScreensAll under theage of 21PCP Appointments must be scheduled within 45days of enrollment unless the child isalready under the care of a PCP and currentwith screens.GHP Family’s appointment availability standards reflect minimum requirements. GHP Family routinely monitorsproviders for compliance with these standards. Noncompliance may result in the initiation of a corrective action plan orfurther corrective actions.PCP WAIT TIMESWaiting time standards for PCPs require that Members, on average, should not wait at a PCP office for more thanthirty (30) minutes for an appointment for routine care. On rare exceptions, if a physician encounters anunanticipated urgent visit or is treating a Member with a difficult medical need, the waiting time may beexpanded to one hour. GHP Family monitors compliance with appointment and waiting time standards and works withproviders to ensure that these standards are met.APPOINTMENT NOTIFICATION AND FOLLOW-UPThe PCP or SCP is required to conduct affirmative outreach whenever a Member misses an appointment and todocument this in the medical record. Such an effort shall be deemed to be reasonable if it includes three (3) attempts tocontact the Member. Such attempts may include, but are not limited to: written attempts, telephone calls and homevisits. At least one (1) such attempt must be a follow-up telephone call. Communications with the Member should takethe language and literacy capabilities of Members into consideration.EARLY PERIODIC SCREENING, DIAGNOSIS, and TREATMENT (EPSDT)Early Periodic Screening, Diagnosis, and Treatment (EPSDT) services are federally-mandated services intended toprovide preventive health care to children and young adults (under the age of 21 years) at periodic intervals which arebased on the recommendations of the American Academy of Pediatrics (AAP),and the Centers for Disease Control andPrevention (CDC). All PCPs who provide services to Members under age twenty-one (21) are required to providecomprehensive health care, screening and preventive services. GHP Family requires Network PCPs to provide all EPSDTservices in compliance with federal and state regulations and periodicity schedules.EPSDT screens for any new Member under the age of twenty-one (21) must be scheduled within forty-five (45) daysfrom the effective date of Enrollment unless the child is already under the care of a PCP and the child is current withscreens and immunizations. Members with suspected developmental delays under the age of five (5) are required to bereferred by their PCP through CONNECT [(800) 692-7288] for referral for local Early Intervention Program services.GHP Family will distribute quarterly lists to each PCP that identify Members who have not had an encounter during thefirst six (6) months of enrollment or Members who have not complied with EPSDT periodicity and immunizationschedules for children. PCPs shall be responsible to contact all Members who have not had an Encounter during theprevious twelve (12) months or within the MA appointment time frames. These EPSDT Member lists are also availableupon request from GHP Family.Please reference the most recent periodicity guidelines published on the Pennsylvania DPW Web site for theHealthChoices program at: http://services.dpw.state.pa.us/olddpw/bulletinsearch.aspx?BulletinDetailId=45612012 Recommended Childhood and Adolescent Immunization Schedules can be viewed at these links:19