Alaska is a Direct Access State, meaning that under state licensure regulations, therapy services may be provided without a physician's referral or a signed Plan of Care (POC). However, reimbursement from Medicaid and most commercial insurance plans typically requires a PCP-signed POC.
In the uncommon situation where a family does not have a primary care provider (PCP) or declines to authorize communication with the child's PCP, services will continue without restriction.
Families will be informed that:
- The Plan of Care (POC) is a communication and care coordination tool that helps PIC providers and the child's PCP work together to support the child's development.
- The POC is developed from the IFSP outcomes established collaboratively by the family and provider and reflects the child's therapy plan. Sharing the POC with the child's PCP helps coordinate medical care by communicating the family's priorities and the child's developmental goals.
- Having a PCP is strongly recommended to promote comprehensive health care and care coordination.
- Billing insurance for eligible services helps PIC sustainably serve more children and families.
- If they are interested, the Family Service Coordinator (FSC) can assist with establishing or reconnecting the child with a PCP and may include this as an FSC outcome on the IFSP.
When a family does not have a PCP or declines to authorize communication with the PCP (no Release of Information is on file), the following limitations apply:
- PIC will not bill for services that require a PCP-signed POC.
- Evaluations and Plans of Care will not be sent to the child's PCP.
- If the physician originally referred the child to PIC, staff may acknowledge receipt of the referral, confirm that the family engaged with PIC, or provide referral outcome information consistent with what was communicated during the referral and intake process.
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”
