Information for Physicians and their Staff

Project Access Dallas is a physician-led, community effort to provide health care for low-income, working but uninsured Dallas County residents—those people trying to get ahead through hard work. It is managed by the Dallas County Medical Society, and funded through grants and donations to DCMS’ foundation, the Dallas Academy of Medicine. The backbone of PAD is the volunteer physicians who donate just one to three office visits each month.

PAD volunteer physicians demonstrate their commitment to the ideals of their profession in an organized, efficient, and rewarding way. PAD was designed to make physicians’ volunteer work easier for them and less of a burden on his office staff. Instead of the physician being responsible for coordinating further care, a Care Coordination Team provides support services, including case management, low-cost pharmaceuticals, transportation and translation.

The following steps will help volunteer PAD physicians and their practices, when accepting a PAD patient.

1. The PAD Physician Network Director will provide an orientation for you and your staff before any patients are assigned to the physician. You may want to designate a person in your office for us to contact when we schedule appointments for a PAD patient.
   
   
2. When a patient is enrolled in the program, an Enrollment Coordinator will call to schedule the patient’s initial appointment with your office (unless your office already is the patient’s medical home). After the initial appointment, the patient, rather than the Enrollment Coordinator, can make all PCP appointments.
   
   
3. A PAD patient should have the same experience in your office as does an insured patient. Schedule a PAD patient as you would any other patient.
   
   
4. A PAD patient must show a current PAD identification card at each office visit (see front of card for expiration date). If the patient does not have a current PAD ID card, you can call a PAD staff member from 9 a.m. and 5 p.m. Monday through Friday at DCMS to verify enrollment (214-413-1439).
   
   
5. Submitting Claims—Do not bill a PAD patient for services—your physician has agreed to provide these services as a donation. Instead, submit a standard 1500 Claim Form each time your physician provides services to a PAD patient. We use the claim form to validate the physician’s uncompensated charity care provided to the program throughout the year. Each year, we provide your physician documentation listing the total value of donated care and public recognition for the generous care provided based on the claims submitted. Mail the standard 1500 Claim Form for services provided to:

   Project Access Dallas Claims
   6119 Greenville Ave. #326
   Dallas, TX 75206
   

6. If your practice is required to pay a business tax, your physician may qualify to deduct as an allowable business expense the total value of charity services provided as a PAD volunteer. You must be able to validate that the care you provided to Project Access Dallas truly was charity care and not bad debt. To validate your physician’s uncompensated charity care deductions, we suggest:
   
   1. When a patient is scheduled for an appointment, he should be identified in the system upfront as charity care. To do this, physicians may need to revise their record-keeping processes.
      
   2. Physicians cannot receive payment of any kind from the patient for the charity services they provide.
      
      
7. At checkout give the patient a PAD Patient Donation Form (see Section 8 Forms) instead of requesting a co-pay, and tell him to mail the payment to the address on the form. For each office visit, a PAD patient is asked to contribute $5, which goes directly to the pharmacy program. Your office is not responsible for collecting this money. For additional PAD Donation Forms, you can make your own copies (see Section 8, Forms) or call 214-413-1440.
   
   
8. To report NO SHOWS or patient noncompliance, contact Sharka Jones, Project Access Dallas Hospital and Ancillary Director, at 214-413-1439 or via email at sharka@dallas-cms.org.
   

MEDICATION
PAD patients are given a PAD Caremark pharmacy card, which is honored at any of the 40,000 U.S. retail pharmacies that accepts Caremark. The card is valid as long as enrollment in PAD has not expired (expiration date is shown on the PAD ID card). The physician must complete the PAD DEA/NPI form in order for his name to be recognized in the PAD Caremark system (see Section 8 Forms).

To maximize the patient’s pharmacy benefits, Project Access Dallas has an all-generic formulary. Although most medical PAD services are donated, the pharmacy portion of the program is not. This facet of the program is tremendously expensive. The formulary rejects all brand single/multisource medications and allows only generics to be processed. The exception to the generic-only formulary is for brand insulin (which includes brand insulin/insulin cartridges used in pen-devices/insulin prefilled syringes). If a brand-name drug medication does not have a generic alternative or the physician believes the brand-name medication is therapeutically necessary, he must complete a Brand Over Generic Request (see Section 8 Forms) and fax it to 214-941-3351.

Prescription Information

• $750 maximum pharmacy benefit per year, per patient.
• Co-pay is $10 per prescription. PAD pays the remaining amount of the pharmacy charge.
• When possible, please provide the patient with medication samples.
• Patients are encouraged to fill their prescriptions at Wal-Mart, Target, Kroger, & Tom Thumb because of their $4 drug program. Doing so will maximize the patient’s $750 pharmacy benefit.

Pharmacy Benefits Maximum
So we can serve as many Project Access Dallas patients as possible, we have a $750 per year maximum pharmacy benefit, per enrollee. PAD pharmacy benefits are managed on a calendar basis—from Jan. 1, 2009, through Dec. 31, 2009. That means that if the patient goes over the $750 maximum pharmacy benefit before Dec. 31, 2009, those benefits will not be reinstated until Jan. 1, 2010, and only if the patient’s enrollment in the program is still active. When the patient has exceeded the $750 per year maximum, he is sent a letter and given 30 days to fill and refill his prescriptions. The patient will remain enrolled in PAD until his six-month enrollment cycle ends. For the remainder of the six-month cycle, he will have access to the entire PAD network.

When a patient exceeds the limit, PAD sends him a letter advising him to seek alternate resources for prescription medication:

• Contact his neighborhood Parkland Health & Hospital System, Community Oriented Primary Care (COPC) health center, for help in caring for his medical needs, or
• Request sample drugs from his physician, or
• Contact the PAD Help Line at 214-563-2541 for assistance in contacting a pharmaceutical company’s patient assistance program.

HOSPITALIZATION
For hospitalization, prior approval from the hospital access services and authorization from the PAD medical director are required. To schedule hospitalization, complete a PAD Referral Request Form (see Section 8 Forms) and fax it to 214-941-3351.

LABS
Although physicians can donate lab services provided in their office to PAD patients, PAD has an agreement with LabCorp and CPL (Clinical Pathology Labs) to provide lab services for PAD patients. To order labs through LabCorp, PAD physicians must already have an Indigent Contract Agreement in effect. To order labs through CPL, you must be part of the Health Texas Provider Network. If neither of these applies to you, send PAD a Referral Request and we will set the lab draw up for the patient. Contact PAD at 214-413-1435 or 214-413-1439 for more information.

DIAGNOSTIC SERVICES/ANCILLARY SERVICES/ SPECIALTY REFERRALS
Physicians may donate diagnostic services provided in their office to PAD patients; however, PAD has relationships with various imaging centers and hospitals to provide services. To schedule services, the provider has two options: The physician can complete a Referral Request/Specialty Clinic Form and fax it to the hospital scheduling department where the physician has privileges, or the PAD staff can schedule the appointment upon receipt of the Referral Request/Specialty Clinic Form that should be faxed to 214-941-3351. If the physician chooses to schedule appointments directly with the hospital, he will be notified directly by the scheduling department of the appointment date and time, and the physicians’ office staff will be responsible for notifying the patient. If PAD staff schedules the appointment(s), your office will be notified by fax. The patient will be notified via telephone or mail.

COMMUNITY HEALTH NAVIGATION
During the patient enrollment process, an enrollment coordinator conducts a Health Risk Assessment to determine whether the patient should have his care navigated (if the patient needs individual assistance with accessing services). A patient assigned to the PAD Community Health Navigation program is assigned a Community Health Navigators who, under direction of a social worker, has been trained to assist the patient in navigating health care systems and other community resources independently, and will help the patient manage his chronic and acute illnesses. Health Navigation is also available to all PAD patients as needed to ensure access to medical care. Contact PAD at 214-413-1435 or 214-413-1439 for more information.

ENROLLING PATIENTS FROM YOUR PRACTICE
By signing up in the program as a volunteer, a Project Access Dallas physician can enroll a limited number of his practice’s patients who qualify for the program. These can be patients the physician already is treating for free, and the physician can get “credit” for seeing them. To refer a patient for enrollment, complete a PAD Patient Enrollment Request Form (see Section 8 Forms) and fax it to 214-941-3351.

PROGRAM CONCERNS OR QUESTIONS
Because your physician’s volunteer experience in Project Access Dallas is important to us, we send your office a PAD Physician/Staff Satisfaction Survey each quarter. Your physician’s comments and suggestions, along with yours, give us the chance to improve their volunteer experience to be as easy and stress-free as possible. At any time, feel free to contact Cheryl Prelow, VP Project Access Dallas, at 214-413-1435 or cheryl@dallas-cms.org.