FAQ - PHC08

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Clinical/Services

Billing/Eligibility

Administrative

 

Clinincal/Services

Q.
If you have a client that has health insurance but their insurance policy does not cover prescriptions, can you enroll this client for PHC - as supplemental for prescription services? (3/2008)

A.
As long as the client meets all PHC eligibility criteria, and documentation has been provided that verifies Rx coverage denial via private health insurance policy, a client may be certified for PHC supplemental benefits. [Applicable policy or rule: PHC Policy & Procedure Manual, Section II Chapter 1, Page II-12. TAC - Rule §3.8 (a).]

 

Billing/Eligibility

Q.
If all of the family's eligibility forms and documentation are kept in one folder for eligibility, is the agency required to run multiple copies of the Applicant's Rights so that there is one for each child? (10/2007)


Scenerio: An agency keeps separate client files for eligibility records and clinical records. For eligibility, the agency keeps all of the eligibility information and documentation for the entire family in one folder. In the event that several members of one family are determined to be eligible for services and are enrolling in the program, can you clarify if the forms listed below would meet the documentation requirements according to PHC and Title V MCH policy:

1) Copy of Screening & Eligibility Determination form that is signed by the husband & wife if both are enrolling in the program (a separate copy of the form for each family member with their name highlighted/circled)

2) Copy of Applicant's Rights signed by the husband

3) Copy of Applicant's Rights signed by the wife

A.
1) Yes, it is allowable to have a separate copy of the the Screening & Eligibility Determination form that is signed by the husband & wife if both are enrolling in the program for each family member with their name highlighted/circled.

2) Yes, the husband needs to sign his own Applicant's Rights.

3) Yes, the wife needs to sign her own Applicant's Rights.

If all of the family's eligibility forms & documentation are kept in one eligibility folder, it is allowable for the parent to sign only one Applicant's Rights for the family since the family is screened on the one screening and eligibility form.

 

 

Administrative

Q.
It has been a requirement since 1994 when I started as the PHC/Title V Coorinator that the contract required a functioning community advisory board that meets no less than on a quarterly basis. Has this requirement changed or can the CAC meet on a annual basis? (1/2008)

A.
1) The FY08 PHC Policy & Procedure Manual does not specify a required frequency of meetings by the CAC; however, the CAC by-laws and/or written policies should include the frequency of meetings. As part of the PHC monitoring requirement, the DSHS reviewer will read the agency's CAC bylaws/polices to ensure that the frequency of the CAC meetings is clearly stated.

 


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Last updated May 07, 2010