Year 1 Budget Request - DHMH - Maryland.gov

notes including documentation of all contacts with patients and providers, BCCP data entry form
(Attachment K), consent form (Attachment L), recall tracking forms, and Case Management
Care Plans (Attachment J, if applicable).
2. The Contractor shall assure that all women receiving services through this program have signed a
consent/release of information form modeled after the form developed by the Department,
completed prior to receiving services (Attachment L).
B. The Contractor shall meet the program standards as listed below:
1. Perform the following services on-site within the same Calvert County medical
campus, if possible:
a. Mammography,
b. Clinical Breast Exam,
c. Initial pelvic examination for determination of existence of cervix and if so, the Contractor
shall perform Pap test collection.
At least one of the services must be provided on-site, however if a service is not provided on the
Contractor’s campus, it may be sub-contracted to another fee-for-service provider located within
Calvert County.
2. Assure that Pap tests, pelvic examinations, and clinical breast exams are performed by an
OB/GYN, Family Practitioner, Internist, General Practitioner, General Surgeon, nurse
practitioner, or physician assistant who has received specialized medical training to perform these
procedures.
3. Assure that the provisions of COMAR 10.27.07, Practice of the Nurse Practitioner are met.
4. Assure the provisions of COMAR 10.32.03, Delegation of Duties by a Licensed Physician-
Physician Assistant are met.
5. Assure that colposcopies are performed by board-certified or eligible gynecologists or health care
practitioners who meet the following guidelines:
a. Training
1. Training in colposcopy as a part of an OB/GYN residency program, or
2. Attendance at a physician or nurse colposcopy training program of at least three (3)
days in duration which included both didactic and clinical elements, and
b. Training Colposcopies
Performance of at least 50 colposcopies under the direct supervision of a preceptor who
has extensive experience in performing colposcopies.
6. Assure that the cytology laboratory adheres to the provisions of COMAR 10.10.05 and 10.10.06.
7. Have a Medical Case Manager for the program to accept responsibility and liability for medical
decisions regarding the care and follow-up of women screened through the program.
8. Have a Service Coordinator/Administrative Case Manager for the program to consult with the
Medical Case Manager to determine the need for follow-up and case management, and arrange
for the care and follow-up of women in this program.
9. Assure that any subcontract for interpretation of results (e.g. laboratory) entered into between the
Contractor and a clinical provider shall be modeled after and include the conditions in the
contracts developed by the Department (Select contracts can be found in Attachment M).
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