Primary Care Physician

Under the direction of the Institution/Facility CEO/CME or designee, the Temporary/Relief Primary Care Physician shall provide services as permitted within the scope of practice for Primary Care Physician services in accordance with Institution/Facility policies and procedures.

A. Standards of Obligation

To assist fin its exercise of its duty to provide and manage medical healthcare services for the patient/youth of the State of California, Temporary/Relief Primary Care Physicians shall provide high quality services, consistent with the terms and conditions under this Agreement and consistent with established and commonly accepted standards and principles of medical practice. Nothing in this Agreement shall supersede the common law rules for the interpretation of established and commonly accepted standards and principles of medical practice.

Temporary/Relief Primary Care Physicians shall adhere to the medical staff by-laws, rules, regulations, policies and procedures, and comply with universal infection control precautions.

B. Authorization

1. Authorization for Treatment

Temporary/Relief Primary Care Physician shall agree that, as required by law, excluding emergency and primary care services, prior authorization must be obtained in writing from the respective Institution/Facility CEO/CME or designee, in accordance with Utilization Management Plan. Temporary/Relief Primary Care Physician shall complete and return all forms required by regarding treatment of patient/youth. Authorization must be documented in the patient/youth medical record in all cases of essential services before considering any non-emergency specialty treatment, or any consultations by specialty Physicians, Physician Assistants, and/or Nurse Practitioners or diagnostic procedures not specifically stated in a prior authorization form.

2. Authorization for Transportation/Transfers

Temporary/Relief Primary Care Physician shall agree that, as required by law, retains full authority to determine the manner in which a patient/youth is transported to the Institutions/Facilities or transferred to other healthcare facilities, after the course of treatment or therapy has been implemented or completed.

Temporary/Relief Primary Care Physician shall not transfer a patient/youth to any Institution/Facility without prior written authorization from the appropriate Institution/Facility CEO/CME or designee.

 

4. Exclusions and Limitations

a. Temporary/Relief Primary Care Physician shall agree that no healthcare service or treatment shall be provided for those conditions specifically listed in California Code of Regulations (CCR), Title 15, Division 3, Chapter 1, Subchapter 4, Article 8, Section 3350.1. Physicians provided by the Vendor may request individual case exceptions for excluded or limited healthcare service or treatment by seeking prior approval of the Institution/Facility's CEO/CME or designee.

b. Temporary/Relief Primary Care Physician agree that any excluded healthcare service or treatment needed for pre-existing conditions shall be provided only in the event that the condition has become aggravated in such a manner that it poses a significant threat to the patient's/youth's current health and if not treated would result in morbidity and/or mortality. Temporary/Relief Primary Care Physician shall acknowledge that the appeal must be recognized as medically necessary.

c. The Medical Standards of Care shall be used as a reference when prior authorization is granted.

5. Clinical Reviews

At the request of the Institution/Facility's CEO/CME or designee, Temporary/Relief Primary Care Physician shall perform clinical reviews to determine the quality of clinical care delivered. This includes clinical reviews of index cases (deaths, adverse outcomes etc.) for the purposes of determining clinical quality. As part of the clinical review process, Temporary/Relief Primary Care Physician can also be required to participate in Professional Practice Committee activities and may be called as witnesses in Professional Practice activities. The process of clinical reviews may include the examination of written health records, discussion with Physicians, Physician Assistants, and/or Nurse Practitioners and supervisors and direct patient/youth examinations. The Temporary/Relief Primary Care Physicians who perform clinical reviews are required to be skilled in the preparation of written clinical review documents.

6. Provide a copy of the formulary to be kept on file by the Temporary/Relief Primary Care Physician. Temporary/Relief Primary Care Physician shall consult with physicians to assure that whenever possible only those medications which are on the formulary are prescribed unless prior authorization is given by the Institution/Facility's CEO/CME or designee for deviation.