5403.1 Each fee-for-service primary care provider shall provide each enrollee with high quality health care at locations that ensure reasonable availability and accessibility to enrollees.5403.2 Each fee-for-service primary care provider shall provide either directly or by referral, each service in the Medicaid managed care benefits package, including patient management and referrals and approvals.5403.3 Each fee-for-service primary care provider shall ensure that urgent and emergency medical care are available to AFDC and AFDC-related Medicaid enrollees on a twenty-four (24) hour basis, seven (7) days a week, either through the fee-for-service provider or through other appropriate facilities.5403.4 Each AFDC and AFDC-related Medicaid recipient shall receive the same services in the same facilities as the fee-for-service primary care provider's non-AFDC and AFDC-related Medicaid enrollees.5403.5 Each AFDC and AFDC-related Medicaid enrollee shall be fully integrated into the fee-for-service primary care provider's practice and shall not be treated in a manner different from non-AFDC or AFDC-related patients.5403.6 Each fee-for-service primary care provider shall provide health education programs for its enrollees in languages understood by the population being served. The education programs shall include, at a minimum, the following:1. Information regarding the importance and availability of preventive care;

2. Information regarding the importance and availability of childhood immunizations;

3. Information regarding the importance of and right to, and procedure for scheduling the Early Periodic Screening, Diagnosis and Treatment (EPSDT) screens for children covered by Medicaid;

4. Information on birth control and on the importance and availability of prenatal and well baby care;

5. Information regarding proper nutrition for pregnant women and children; and

6. Information regarding preventive and treatment measures for drug abuse and alcoholism.

5403.7 The fee-for-service primary care provider shall have a system of follow-up of patient care for enrollees with chronic and acute illnesses, including an appointment follow-up system for persons who do not appear for appointments.

5403.8 Waiting times for appointments for AFDC and AFDC-related Medicaid enrollees shall not exceed the waiting times for non-AFDC or AFDC-related patients of the fee-for-service primary care provider.

5403.9 Each fee-for-service primary care provider shall maintain a current, unified medical record on each enrollee.

SOURCE: Final Rulemaking published at 42 DCR 1566, 1590 (March 31, 1995).