Compliance
Compliance
Compliance
Hispanic Physicians is dedicated to maintaining the highest of standards in patient and provider confidentiality, ethical business practices and governmental regulations. We are constantly and consistently updating our practices and standards to stay at the forefront of the medical industry.
The Hispanic Physicians compliance team is lead by the Compliance and Privacy Officer, Angel Marrero, and the Security and Information Officer, Jose Carbajal. To reach them directly regarding any compliance related matters, please email complianceteam@hpipa.net, call 213.739.0157 or by mail to Hispanic Physicians, Attn: Compliance, PO Box 869139, Plano, TX 75086.
Affirmative Statement About Incentives
The organization distributes a statement affirming that UM decision making is based only on appropriateness of care, service, and existence of coverage; the organization does not specifically reward practitioners or other individuals for issuing denials of coverage or service care; financial incentives for UM decision makers do not encourage decisions that result in under-utilization.
- Practitioners (NCQA definition – A licensed or certified professional who provides medical care of behavioral healthcare services.)
- Providers (NCQA definition – An institution or organization that provides services, such as a hospital, residential treatment center, home health agency or rehabilitation facility.)
- Employees
- Members
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Staff Training & Education P&P:
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Fraud, Waste and Abuse:
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Compliance Program:
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BEHAVIORAL HEALTH TREATMENT (Carve-Out)
BHT is the design, implementation and evaluation of environmental modifications using behavioral stimuli and consequences to produce socially significant improvement in human behavior, including the direct observation, measurement and functional analysis of the relations between environment and behavior. BHT services teach skills through the use of behavioral observation and reinforcement or through prompting to teach each step of targeted behavior. BHT services are designed to be delivered primarily in the home and in other community settings.
BHT services are a Medi-Cal covered benefit for members under 21 years of age when medically necessary, based upon the recommendation of a licensed physician, surgeon or a licensed psychologist after a diagnosis of autism spectrum disorder (ASD)
BHT services are a Medi-Cal covered benefit for members under 21 years of age when medically necessary, based upon the recommendation of a licensed physician, surgeon or a licensed psychologist after a diagnosis of autism spectrum disorder (ASD)
End of Life Services (Carve Out)
Terminally ill members, age 18 or older with the capacity to make medical decisions are permitted to request & receive prescriptions for aid-in-dying medications if certain conditions are met. Provision of these services by health care providers is voluntary and refusal to provide these services will not place any physician at risk for civil, criminal or professional penalties. End of Life Services include consultations and the prescription of an aid-in-dying drug. EOL services are a carve out for Medi-Cal Managed Care Health Plans (MCPs) and are covered by Medi-Cal FFS. Members are responsible for finding a Medi-Cal FFS Physician for all aspects of the EOL+benefit.
Pallatative Care (Carve-Out)
Palliative care consists of patient-and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. The provision of palliative care does not result in the elimination or reduction of any covered benefits or services under the MCP contracts and does not affect a members eligibility to receive any services, including home health services, for which the member would have been eligible in the absence of receiving palliative care. Unlike hospice, palliative care does not require the member to have a life expectancy of six months or less, and palliative care may be provided concurrently with curative care. A member 21 years of age or older may not be concurrently enrolled in hospice care and palliative care. A member under 21 years of age may be eligible for palliative care and hospice services concurrently with curative care.
Health Homes (Carve-Out)
Medicaid health homes was created to coordinate the full range of physical health care services, behavioral health services, and community-based long term services and supports (LTSS) needed by members with chronic conditions. MCP is responsible for providing the following six core HHP services to eligible Medi-Cal members: comprehensive care management, care coordination, health promotion, comprehensive transitional care, individual and family support, and referral to community and social support services.
