Current through 2024-38, September 18, 2024
30.06-1
Professional and Other Qualified Staff
A. Physicians employed by a family planning
agency may provide family planning medical and counseling services by virtue of
possession of a current license to practice medicine in the State or Province
in which the services are performed.
Each agency shall employ a physician to provide medical
direction for the agency's health care activities and counseling and for
medical supervision of the health care staff.
B. A physician assistant may provide family
planning, medical and counseling services when he or she has obtained Full or
Temporary Licensure from the Board of Licensure in Medicine or Osteopathy,
which must be renewed bi-annually in accordance with Board rules. Such services
may be performed only when delegated by a physician in accordance with the
rules and regulations governing physician assistants.
C. A family planning nurse practitioner or
certified nurse-midwife may provide family planning, medical and counseling
services which are supported by written protocols when he or she is a graduate
of a certified nurse practitioner program with specialization in Family
Planning, Obstetrics-Gynecology, Women's Health Care or its equivalent and when
he or she holds a current nurse practitioner or nurse-midwife license to
practice in the State or Province in which services are provided.
D. A licensed dietitian may provide dietary
counseling, dietary instruction and other nutritional services when employed by
a family planning agency and when he or she is licensed by the Board of
Licensing of Dietetic Practice in the State or Province in which services are
provided.
E. A family planning
specialist may provide counseling, instruction, and other support services
under the coordination and oversight of a family planning nurse practitioner,
certified nurse-midwife, physician or physician assistant when he or she has
had at least 1 year of experience in a related setting, or at least 1 year of
education in a relevant field.
In addition, there must be documentation of successful
completion of a family planning agency's formal training and orientation
program in each family planning specialist's record. Those family planning
specialists employed by a family planning agency prior to June 1, 1987, shall
be deemed qualified to provide services if, for such persons, documentation of
related training and prior experience is present.
30.06-2
Member's Records
There shall be a specific record for each member which
shall include, but not necessarily be limited to:
A. The member's name, address, and birthdate;
B. The member's medical and social
history, including immunization records, as appropriate;
C. A description of the findings from the
physical examination;
D. Long and
short range medical goals, as appropriate;
E. A description of any tests ordered and
performed and their results;
F. A
description of treatment, counseling, or follow-up care provided and the dates
scheduled for revisits;
G. Notation
of any medications and/or supplies dispensed or prescribed;
H. Recommendations for and referral to other
sources of care;
I. The dates on
which all services were provided; and
J. Written progress notes, which shall
identify the services provided.
Other qualified staff (woman's specialists, educators,
etc.) may sign record entries relative to history taking and up-dates,
instruction, and pregnancy testing and results.
Entries are required for each date of service billed and
must include the name, title, and signature of the service provider.
30.06-3
Program
Integrity
A. Program Integrity monitors
the medical services provided and determines the appropriateness and necessity
of the services
B. The Department
and its professional advisors regard the maintenance of adequate clinical
records as essential for the delivery of quality care. In addition, providers
should be aware that clinical records are key documents for post-payment audit.
In the absence of proper and complete clinical records, no payment will be
made, and payments previously made may be recovered in accordance with Chapter
I of this manual.
C. Upon request,
the provider will furnish to the Department, without additional charge, the
clinical records, or copies thereof, corresponding to and substantiating
services billed by that provider.
D. The Department requires that clinical
records (originals or copies) and other pertinent information will be
transferred, upon request and with the member's signed release of information,
to other clinicians involved in the member's
care.
