PENNSYLVANIA DEPARTMENT OF HEALTH Policy and Procedure Number: 6.03 WIC State Agency USDA Approval Date: September 30, 2015 State Effective Date: January 27, 2016

POLICY AND PROCEDURE MANUAL

6. OUTREACH/REFERRAL

6.03. Referral Agreements for Health Care Services

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A. POLICY:

1. PA WIC shall provide access to appropriate health care services to all participants either by the direct provision of these services or by referral to providers of free or low cost health care in the community. Health care services are defined as ongoing routine prenatal obstetrical and pediatric care, and include routine examinations, diagnosis and treatment.

B. PROCEDURE:

1. The local agency shall develop and implement procedures to assure all participants access appropriate health care services and inform participants of the health services which are available to them.

2. If the local agency does not directly provide any or all of the necessary health care services, it shall enter into agreements with health care providers in the area to accept referral of participants for these services. Specifically:

a. Obtain written agreements with health care providers whenever possible and include sufficient information to identify the conditions of the agreement, such as terms of referral, limitations on provision of service, length of time the agreement will be in effect, and responsibilities of each party. (See Attachment 1 for Sample Agreement).

b. Retain copies of all written agreements and lists of provider names and addresses who have agreed to refer and accept referral of participants on file at the local agency.

c. A verbal agreement is acceptable when a health care provider is unwilling to sign a written agreement, but will provide services to participants. However, the local agency must have a plan for continued efforts to obtain a written agreement from the provider.

d. Review agreements, whether written or verbal, every two years and retain appropriate documentation of such reviews in accordance with the file retention policy (See Policy 3.00). Agreements may be terminated by either party.

PENNSYLVANIA DEPARTMENT OF HEALTH Policy and Procedure Number: 6.03 WIC State Agency USDA Approval Date: September 30, 2015 State Effective Date: January 27, 2016 POLICY AND PROCEDURE MANUAL 6. OUTREACH/REFERRAL 6.03. Referral Agreements for Health Care Services Page 2 of 2 e. Assure that information is used for eligibility and/or outreach and that information will not be shared with a third party. Attachment(s): 1. Sample Cooperative Referral Agreement for Health Care Services Reference(s): 1. WIC Regulations: 7 CFR part 246.6(b)(5). Policy and Procedure Status: 1. This P&P supersedes P&P Number 6.03, dated March 23, 2012.