AB 75

 

CHDP Follow-up Treatment Program - Case Manager and Provider Information

 

For CHDP Case Managers

Patients eligible for the CHDPT are CHDP-screened children who are under 21 years of age and Medi-Cal eligible with a share of cost; or who are under 19 years of age, not covered by health insurance or any publicly-funded program, and whose family income is not more than 200% of the Federal poverty level.

CHDP follow-up treatment services are available from a network of CHDP screening and referral providers, expanded to include certain specialty services. The following is a description of service types and providers:

1. Inpatient hospital care - provided at San Francisco General Hospital (SFGH). In the unusual situation of a CHDP-screened child requiring inpatient care, most conditions would be reimbursable under the California Children's Services (CCS) program.
2. Outpatient specialty care - outpatient specialty physician and other care is provided mainly at SFGH and the health centers, with the backup availability of specialty physician care through the CHIP Physician program.
3. Pharmacy and lab services - primarily provided at SFGH and the health centers.
4. Dental services - provided through health center dental clinics and through the CHIP Physician program list of private dental providers.
5. Vision and hearing services - physician services in these areas are provided at SFGH. Free eyeglasses are also provided through SFGH.

The families of CHDP-screened children will be given a list of providers appropriate to the condition requiring follow-up treatment, first identified in the physical examination. The list shall include both "free" and "low cost" providers for the families to choose from. No payment or deductible is required from of any family of a CHDP-screened child for follow-up treatment services. The family may choose either a "free" provider if they determine that they cannot afford to pay for any portion of their care, or they may choose a "low cost" provider from the referral list.

The AB 75 Project administers the CHDPT in coordination with the local CHDP Program. Case managers wanting referral information should contact:

Sandra Gomez, Case Manager
Child Health Disability Prevention Follow-up Treatment Program (CHDPT)
30 Van Ness Avenue, Suite 210
San Francisco, CA 94102
(415) 575-5704

For CHDPT Treatment Providers

The CHDPT Case Manager plays a key role in assuring that treatment services are provided without cost to the family. She receives a copy of the child's CHDP Confidential Screening/Billing Report (PM-160) form which is used to track and authorize treatment services. The case management and referral procedures used to provide CHDPT services are as follows:

1. The CHDP screening provider may either provide follow-up treatment services directly or refer the child to a CHDPT provider. If the screening provider refers the child to a CHDPT provider, he or she must give a copy of the child's PM-160 form to the parent
2. The parent contacts the CHDPT provider to arrange for an appointment. The CHDPT Case Manager, using a copy of the PM-160 form, contacts the family to determine if the child has received services. The CHDPT Case Manager may assist the parent by contacting the CHDPT provider to assure that an appointment is made.
3. The parent must provide copy of the child's PM-160 form to the CHDPT provider in order to receive no cost treatment services. The form confirms the child's eligibility for treatment under the CHDPT Program.
4. The CHDPT provider provides the necessary follow-up treatment services to the child.

CHDPT providers do not bill patients for treatment services rendered. CHDPT providers may immediately submit claims to the CHIP Physician Program at any time, without a waiting period or without attempting to bill the patient or third-party payer. A patient's CHDP-eligible status is considered proof of indigency to meet the "third-party billing requirements" of the CHIP Program.

In addition to submitting a HCFA 1500 and supplemental information form, CHDPT providers must also submit a copy of the child's PM-160 which establishes the child's eligibility for CHDPT services. CHDPT dentists submit an ADA claim form, supplemental information form, and the PM-160 form.

CHDPT providers must enroll in the CHIP Physician/Dentists Program with a supplemental enrollment in the CHDPT Program. Providers interested in becoming a CHDPT Program provider should contact AmeriChoice, the CHIP fiscal intermediary, as described on this website.