The Plan of Care (POC) is completed for each child after the provider and family have collaboratively developed goals on the IFSP. These IFSP goals form the foundation of the POC, and the goals are automatically rolled to the POC. The POC also serves as a communication tool with the child’s primary care provider (PCP) and allows PIC to bill Medicaid and other insurance providers. A signed POC is not required for a child to receive services through PIC. However, not having a POC is considered a rare exception.
Alaska is a Direct Access State, meaning that under state licensure regulations, therapy services can be provided without a physician’s referral or a signed POC. However, reimbursement from Medicaid and most commercial insurances typically requires a PCP-signed POC.
In situations where a family does not have a PCP or declines to connect their child’s PCP with PIC, services will still be offered without restriction. Families will be informed that:
- Having a PCP is strongly recommended to ensure comprehensive care and support care coordination;
- Billing for services allows PIC to sustainably serve more children and families;
- If they are open to it, the family service coordinator (FSC) can assist with finding or reconnecting the child to a PCP and include this effort as a documented FSC goal.
In these rare instances where the family declines to share information with a PCP or does not have one, and no Release of Information (ROI) is on file for the child’s PCP, the following limitations apply:
- We do not bill
- Evaluations and POCs are not be sent to the child’s physician.
- If the physician originally referred the child, PIC may still confirm service engagement or provide referral feedback in alignment with what was shared at intake.
The same conditions that apply to families who have a PCP apply to parents who don’t have an established PCP:
- Providers will inform parents that all services that are available to them even without a POC.
- Providers request ROI for the child’s PCP at intake.
Parents can be given the option to release the POC only to the PCP, and attempt to secure provider’s signature on the POC however, the parent will need to sign a limited ROI (ie, only POC to be released).
Admin
- Add alert in Documents/Tasks --> Alerts section. You can even include unsigned forms for provider ease of access/information if ROI is waiting to be signed.
- Contact Admin or the HIT to remove/ensure no PCP is listed in the following places:
- Patient Demographics under the “Billing Referral”
- EACH case under the “Billing Referral”
