La. Admin. Code tit. 48 § V-5501

Current through Register Vol. 50, No. 11, November 20, 2024

Section V-5501 - Physician Services

A. Medical Staff Categories

1. Attending Physicians. CSHS attending physicians (also known as staff or contract physicians) are those physicians with whom CSHS has a signed contract for direct medical services. The CSHS attending physician provides the medical component of the multidisciplinary team care provided to CSHS patients. These medical services are primarily provided in CSHS clinics but may also involve provision of care in hospitals, clinics, private offices or other out-patient settings. The attending physician is the CSHS physician of record and is authorized to order medically necessary procedures such as lab, x-ray, rehabilitative therapy, hospitalization, medications, equipment and supplies as well as make referrals and requests for services from other agencies.

a. CSHS attending physicians receive no direct reimbursement from the Program for services to CSHS patients. Instead a limited number of honorariums are granted as they become available. Travel expenses for attending physicians are reimbursed as per Louisiana Division of Administration Policy and Procedure. CSHS attending physicians must also be willing to serve, if requested, on CSHS Regional Office Advisory Boards and/or Quality Assurance Committees.

2. Consulting Physicians. CSHS consulting physicians must meet the same qualifications of licensure, Board Certification and experience as attending physicians but are limited to providing consultation to CSHS attending physicians. The attending physician remains in charge of the case for CSHS purposes. Consulting physicians must agree to abide by CSHS policies and procedures and accept CSHS consultation fees. It is the responsibility of the CSHS attending physician to inform the consultant of these fees and to request preauthorization by CSHS for the consult.

B. Conditions of Employment

1. Clinician Profile Form/Employment Eligibility Verification. To apply to be a CSHS attending physician, a Clinician Profile Form and an Employment Eligibility Verification Form must be submitted to the CSHS Central Office through the Regional CSHS Office where services are to be provided. If a physician is not yet Board Certified, a copy of the residency certificate must also be submitted. After verification, a contract is initiated by the CSHS Central Office.

2. Contractual Agreement. CSHS attending physicians provide medical services to CSHS patients under a contractual agreement between the Office of Public Health (OPH) and the physician or the medical institution with which the physician is affiliated. The contract must name the individual physician providing medical services to CSHS patients in order to be covered by the State for medical malpractice liability. By signing the contract, the physician agrees to abide by OPH and CSHS policies and procedures.

3. Qualifications. All CSHS physicians both attending and consulting must hold a current unrestricted Louisiana medical license, Board of Medical Specialties Certification or Eligibility, and have experience in the examination and medical care of children (and/or young adults) in that specialty. They must have hospital privileges at hospitals with CSHS contracts. CSHS physicians are responsible to notify the CSHS Central Office of any change in licensure or board certification status, disciplinary actions or changes in hospital privileges.

4. Family Centered/Team Philosophy. All CSHS attending physicians must be willing to develop a working relationship with families, other CSHS physicians and allied health care personnel to provide patient care in a family centered, culturally competent, community based and coordinated fashion.

C. Physician Assignment to CSHS Clinics. CSHS attending physician assignments to CSHS Clinics are made only after the physician's application information is verified and a contract between the physician and the Office of Public Health has been signed and approved by the Division of Administration. Assigning a new physician to an existing clinic is done on the basis of documented need for continuation or expansion of that specific clinic. There also should be assurance that adequate CSHS staffing, clinic space and schedule time are available. Qualified physicians practicing in the CSHS Region are given priority in clinic assignments in keeping with the philosophy of the Program to support community based services whenever possible.

D. Physician Attendance. CSHS attending physicians are expected to assure adequate coverage of all scheduled CSHS clinics. Coverage must be by physicians having a contract with OPH for CSHS services.

E. Medical Resident Participation. Medical residents may participate in CSHS clinics only under the direction of CSHS attending physicians. Residents must dictate CSHS notes in the name of the attending physician and may not sign orders, prescriptions, etc. The number of residents participating in CSHS clinics may be limited at the discretion of the CSHS nursing supervisor.

F. Physician Billing. CSHS physicians must not bill the patient or family for CSHS services. Arrangements to bill Medicaid or any other funding source for services rendered at CSHS clinics are made only by CSHS. Medicaid or insurance may be billed directly by CSHS attending physicians for in-patient hospital care, office visits or other services provided when medically necessary and occurring between regularly scheduled CSHS clinic visits. It is the physician's responsibility to do the billing.

La. Admin. Code tit. 48, § V-5501

Promulgated by the Department of Health and Human Resources, Office of Preventive and Public Health Services. LR 13:246 (April 1987).1987), amended by the Department of Health and Hospitals, Office of Public Health, LR 22:362 (May 1996).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:31.2, and R.S. 40:1299.111-120.