Refugee Health Programs
- Participating Physician Groups (PPG)
- Los Angeles
- San Diego
- San Joaquin
The Department of Health Care Services (DHCS) administers the Refugee Medical Assistance program for California. Using county-level refugee health coordinators and programs, the DHCS Local Assistance Branch Refugee Health Section ensures that every refugee, on initial entry into California, is given a complete health assessment and screening and, if needed, follow-up treatment and care. Services available through the Refugee Medical Assistance program are excluded from Health Net's coverage responsibilities under the health plan.
Members requiring refugee health services are identified through:
- Community-based organizations (CBOs)
- Initial health assessments (IHAs)
- Inpatient admissions (concurrent review)
- Primary care physicians (PCPs) and specialists
- Care management services
- Emergency room and urgent care usage information
- Health Net's Medi-Cal Public Programs Coordination Department, Medi-Cal Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties), Health Education Department , Provider Relations Department, or Medi-Cal Provider Services Department or CalViva Health Medi-Cal Provider Services Department .
- Authorization data
- Claims and encounter data
- PM 160 INF forms
- School-based clinics
- Out-of-network providers
Due to the importance of timely identification of newly arrived refugees, especially for the reporting of communicable diseases, Health Net collaborates with local refugee health programs to identify refugees who are candidates for local refugee health clinic services.
If a member is seen by a nonparticipating provider or the local health department (LHD), and calls the Health Net Medi-Cal Member Services Department or CalViva Health Medi-Cal Member Services Department (for Fresno, Kings and Madera counties), the representative gives the nonparticipating provider or the LHD claims submission instructions and instructs the nonparticipating provider or LHD on how to send the report to the member's primary care physician (PCP).
The primary care physician (PCP) coordinates referrals for specialty health services. Upon identification of a refugee, the PCP should refer the member to the local refugee health clinic. The PCP must submit required reporting information to the local health department (LHD) within the timetable in California statutes Title 17, Section 2500, "Reporting to the Local Health Authority." Information reportable to the LHD includes:
- Member demographics (name, age, address, home telephone, date of birth, sex, ethnicity, and marital status).
- Locating information (employer, work address and telephone number).
- Disease information (diseases diagnosed, date of onset, symptoms, laboratory results, and medications prescribed).
- Documentation regarding preventive care health education provided at the time of a routine exam for all members with high-risk behaviors for sexually transmitted infections (STI) or tuberculosis (TB). PCPs may refer members to LHD clinics for receipt of tuberculosis care.
The PCP must also ensure that the documentation is placed in the member's medical record.
Health Net's public programs administrators maintain regular contact with the Refugee Medical Assistance program. The Health Net Medi-Cal Health Services staff is available to provide assistance with coordination of care if indicated by the member's condition or requested by the primary care physician (PCP) or the Health Net public programs administrator.