Coordination of Services with School-Based Programs
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Health Net's policy on routine preventive, well-child screening services to children under age 21 is that they are provided principally by the member's primary care physician (PCP) for the following reasons:
- Services are the PCP's basic responsibility.
- All members have an assigned PCP who can provide these services.
- Provision of these services by the member's PCP provides for better continuity of care.
Recognizing the significance for improving both public and personal health outcomes and indicators, as well as health care access for school age Health Net members, Health Net has entered into contracts and agreements to provide and coordinate health care services where school-based clinics operate under the auspices of a Health Net participating physician group (PPG). Members who are identified at school sites as being in need of preventive and screening services receive these services from the participating school-based clinics within the required state and federal time frames. Health Net follows up and documents that preventive and screening services are provided to members. Health Net's participating school-based clinics and PCPs provide health assessments in accordance with the most recent American Academy of Pediatrics (AAP) Recommendations for Preventive Pediatric Health Care (PDF) for preventive health services.
All Health Net PPG-linked school-based clinics and PCPs must comply with the provisions of EPSTD/Medi-Cal for Kids & Teens. When a request is made for preventive and screening services by a member, the member's parent or guardian, an appointment must be made for the member to be examined within 14 days from the request if the child is deficient for EPSDT/Medi-Cal for Kids & Teens services. PCPs and PPG-linked school-based clinics must provide health assessments in accordance with the AAP Recommendations for Preventive Pediatric Health Care.
All members who are identified at school sites as being in need of preventive and screening services are to receive these services from their PCPs within the required state and federal time limits. If the member's PCP is unable to provide the needed exam within 14 days of the request when the exam is overdue, the PCP may refer the member to another Health Net provider, out-of-network provider, local health department, or PPG-linked school-based clinic.
Health Net's public programs administrators work with the PPG-linked school-based clinics to coordinate preventive and screening services to Medi-Cal members. School-based providers are required to:
- Coordinate with the child's PCP for identified follow-up care. The PCP's name and telephone number are listed on the child's Health Net member identification (ID) card.
- Notify the PCP of all needed services identified during the examination.