Sexually Transmitted. Diseases (STDs) and Human Immunodeficiency Virus (HIV)
Sexually Transmitted. DISEASES (STDS) AND HUMAN IMMUNODEFICIENCY --------------------------------------------------------------- VIRUS (HIV) ----------- HMO must provide STD services that include STD/HIV prevention, screening, counseling, diagnosis, and treatment. HMO is responsible for implementing procedures to ensure that Members have prompt access to appropriate services for STDs, including HIV.
6.15.1 HMO must allow Members access to STD services and HIV diagnosis services without prior authorization or referral by PCP. HMO must comply with Texas Family Code ss.32.003, relating to consent to treatment by a child.
6.15.2 HMO must provide all covered services required to form the basis for a diagnosis and treatment plan for STD/HIV by the provider.
6.15.3 HMO must consult with TDH regional public health authority to ensure that Members receiving clinical care of STDs, including HIV, are managed according to a protocol which has been approved by TDH (see Article
7.16.1 relating to cooperative agreements with public health authorities). El Paso Service Area HMO Contract
6.15.4 HMO must make education available to providers and Members on the prevention, detection and effective treatment of STDs, including HIV.
6.15.5 HMO must require providers to report all confirmed cases of STDs, including HIV, to the local or regional health authority according to 25 Texas Administrative Code, Sections 97.131 - 97.134, using the required forms and procedures for reporting STDs.
6.15.6 HMO must coordinate with the TDH regional health authority to ensure that Members with confirmed cases of syphilis, chancroid, gonorrhea, chlamydia and HIV receive risk reduction and partner elicitation/notification counseling. Coordination must be included in the subcontract required by Article 7.16.
1. HMO may contract with local or regional health authorities to perform any of the covered services required in Article 6.15.
6.15.7 HMO's PCPs may enter into contracts or agreements with traditional HIV service providers in the service area to provide services such as case management, psychosocial support and other services. If the service provided is a covered service under this contract, the contract or agreement must include payment provisions.
6.15.8 The subcontract with the respective TDH regional offices and city and county health departments, as described in Article 7.16.1, must include, but not be limited to, the following topics:
Sexually Transmitted. DISEASES (STDs) The Contractor will provide access to STD services without Prior Authorization to all Members both within and outside its provider network. The reimbursement of out-of-plan STD services is limited to one office visit per disease episode for the purposes of: (1) diagnosis and treatment of vaginal discharge and urethral discharge, (2) those STDs that are amenable to immediate diagnosis and treatment, and this includes syphilis, gonorrhea, chlamydia, herpes simplex, chancroid, Trichomoniasis, human papilloma virus, non-gonococcal urethritis, lymphogranuloma venereum and granuloma inguinale and (3) evaluation and treatment of Pelvic Inflammatory Disease (PID). The Contractor will provide follow-up care. The Contractor will reimburse STD providers at the Medi-Cal Fee-For-Service (FFS) rate, unless otherwise negotiated, and the Contractor will provide reimbursement only if STD treatment providers provide treatment records or documentation of the Member's refusal to release Medical Records to the Contractor along with billing information.
Sexually Transmitted. Diseases (STD); services, for the disease episode, as defined by DHS for each STD, including diagnosis and treatment of the following STDs: syphilis, gonorrhea, chlamydia, herpes simplex, chancriod trichomoniasis, human papilloma virus, non-gonococcal urethritis, lymphogranuloma venereum and granuloma inguinale;
