2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Preventive Health Care GuidelinesEPSDT program is complete and timelyimmunizations (see the Vaccines for Childreninformation below). Presbyterian supports providersin coordinating these services.EPSDT benefits include comprehensive medicaland behavioral screening and treatment servicesavailable to all Presbyterian Centennial Carechildren from birth through age 21. The EPSDTWell-Child Checkups are also referred to as Tot-to-Teen health checks.EPSDT training for providers is available throughthe Provider Network Management department.ImmunizationsAll Presbyterian contracted PCPs are requested toprovide and document all immunizations accordingto the accepted immunization schedule. Theschedule can be accessed on the PresbyterianHealthcare Services website athttps://www.phs.org/providers/cliniciansresources/Pages/health-services.aspx.See thepreventive health care section on the webpage forimmunization information.The New Mexico Medicaid Managed Care programin the New Mexico Administrative Code8.305.6.12.A (5) requires PCPs contracted withPresbyterian Centennial Care to vaccinatemembers in their offices and not refer memberselsewhere for immunizations.Vaccines for ChildrenPresbyterian participates in the federal Vaccines forChildren (VFC) Program and supports the programgoals toImprove vaccine availability nationwide byproviding vaccines free of charge to VFCeligiblechildren through public and privateprovidersEnsure that no VFC-eligible child contracts avaccine-preventable disease because of his orher parent’s inability to pay for the vaccine orits administrationVFC-eligible children are those children from birththrough 18 years who meet one of the followingcriteria:Are eligible for MedicaidHave no health insuranceAre American Indian/Alaska NativeHave health insurance, but it does not coverimmunizations, and they go to a FederallyQualified Health CenterUnder the VFC program, New Mexico iscategorized as a Universal State, which is definedas a state that offers all vaccines as recommendedby the Advisory Committee on ImmunizationPractices to all health care providers to serve allchildren, including those who are fully insured.Presbyterian does not reimburse providers forvaccines that are available through the VFCprogram when they are given to Centennial Caremembers.Information regarding the VFC program may beobtained from the program director at 505-827-2898 or the immunization hotline at 1-888-231-2367. Additional VFC information is availablein the Presbyterian EPSDT Provider Manual, whichcan be accessed on the Presbyterian Healthcare5-42014 Practitioner and Provider Manual - Ver. 3