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Pleasant Point Health Center
Pleasant Point Health Center
This Patient Handbook is dedicated to the memory
of Mrs. Hazel R. Dana, RN. Table of Contents Part 1 - Our Mission of Quality of Care
Part 6 - Programs & Services Offered
Part 7 - Medical Services
Part 9 - Policies & Procedures
Appendices
PART 1 - OUR MISSION OF QUALITY OF CARE The mission of the Pleasant Point Health Center is to provide the highest quality of health care available to the community we serve. We are funded through a contract with the Federal Indian Health Services. The Pleasant Point Health Center operates as a local comprehensive Health Care Delivery System under the “P.L. 638, Indian Self Determination Act.” Our primary contracting office is located in Nashville, Tennessee.Alternate Resources, such as payment from Medicaid, Medicare, Veterans’ Benefits, and Private insurance, provide additional funding to provide essential services to our community. We rely heavily on income from third party payers, as the level of funding that we receive from Indian Health Services is limited. The Contract Health Service Delivery Area (CHSDA) is defined as all of the area in Washington County, Maine described as: South of Route Nine (9) from Milbridge in the Southwest section to Calais in the Northeast section. Eligibility Criteria for Passamaquoddy Tribal Members is determined by the Congress of the United States and published in the Federal Register. It is our hope that the information contained in the following pages is helpful to you. It has been assembled to assist you in accessing services available at the Pleasant Point Health Center. We may not be able to answer all of your questions, but we hope that this information has been helpful to you in learning about your health clinic and the types of services that we can offer to you, the patient. We look forward to continuing to provide a wide range of services designed to help Passamaquoddy People live longer and stronger. If you have any questions, or would like to discuss any aspect of health care delivery, feel free to call us at (207) 853-0644. PART 2 - PATIENT BILL OF RIGHTS All Patients at the Pleasant Point Health Center are entitled to Respect and dignity - The right to health care that is considerate, respectful, and sensitive to his or her culture and beliefs.
The Pleasant Point Health Center offers a wide range of services ranging from Dental to Mental Health. The hours these services are provided are listed below:
The Pleasant Point Health Center is pleased to have 24-hour Emergency Medical Services as part of their team. For all of your emergency services, please call the Sipayik Ambulance at (207) 853-2551 or 4811. In addition to regular services, the Sipayik Ambulance also has paramedic coverage on weekends. Please note that the Pleasant Point Health Center is not able to pay for transportation by any service other than the Sipayik Ambulance. If the Sipayik Ambulance is unavailable, they will dispatch another service for you, which will be paid by the Pleasant Point Health Center. If you have an emergency during non-working hours, be sure to call the Receptionist at the Pleasant Point Health Center within 72-hours to notify. Failure to make notification within 72-hours will result in non-payment of any bill associated with the emergency. PART 4 - ELIGIBILITY REQUIREMENTS - Contract Health Services Enrolled Members of the Passamaquoddy Tribe at Pleasant Point are eligible for Direct (on-site) Medical Services. This includes members who reside within and outside of the Contract Health Service Delivery Area. (CHSDA) Enrolled Members of the Passamaquoddy Tribe at Pleasant Point shall be given resident status and deemed eligible for Contract Health Care (off-site services) once all requirements for eligibility have been met. Health care coverage will continue for a period of six (6) months after the eligible member has left the Service Area. However, if a person leaves the Service Area prior to establishing residency, they will be considered a non-resident and therefore ineligible for Contract Health Care. If moving from one reservation to another, no residency period is required. To be eligible for Contract Health Services(CHS), members must:
Enrolled members of the Passamaquoddy Tribe at Pleasant
Point who are students or serving in the U.S Military shall not lose their
resident status or eligibility for Contract Health Services while
attending school or serving in the military full-time. However, if they
elect to remain outside the Service Area, an eligibility period of six (6)
months coverage will start on the date of:
Indian children residing in the Service Area, who have been adopted by or are in the foster care of: Non-Tribal Members, shall be eligible for services through the Pleasant Point Health Center if they are a Non-Indian Child who has been adopted or a Non-Indian women seeking prenatal care when pregnant with an Indian child. A Non-Indian Child who is adopted by an Enrolled Member of the Passamaquoddy Tribe at Pleasant Point is eligible for Direct (on-site) Health Services until they have reached the age of nineteen (19). First generation descendants of Enrolled Tribal Members shall be eligible for Direct Services until the age of nineteen (19). Pre-Natal Care is available to a Non-Indian Mother pregnant with the child of an Enrolled Member of the Passamaquoddy Tribe at Pleasant Point. Health Care Services are for the duration of the pregnancy and for a period of six (6) weeks Post-Partum. Notarized acknowledgement of paternity is required if not married. Also, she must comply with CHS Guidelines and apply for any alternative resources available. PART 5 - SUPPORT SERVICES Patient Registration Once a patient has checked in with the Receptionist, they report to the Patient Registration Office. Our Patient Registration Office is in the lobby area for your convenience. All new patients must report to the Patient Registration Office to be signed up for services. The process of registering at the Pleasant Point Health Center takes just a few minutes. Please come early for your appointment so that we may have the opportunity to complete your file. Stop by the Patient Registration office to report any changes to your file. We request that the Patient Registration form to be updated quarterly. Our Patient Registration staff is willing and able to assist you with your application for Medicaid. We have application forms at the clinic so there is no need to request these forms from DHS. In addition, Patient Registration staff can assist with your application for SSI and Disability Benefits, Food Stamps, and Social Security Cards for you and your family. Also, we offer Medicaid mileage through WHCA. (You must give provide one week in advance to process the paperwork.) Parents must also register minor children for services. An adult must accompany all underage patients to be seen at the clinic. Please do not leave children unattended in the health center.
Contract Health Care Contract Health Services are those services that are provided by outside agencies for eligible members of the Passamaquoddy Tribe at Pleasant Point. The referral for these types of services arises when the patient’s provider sees the need for more specialized services in order to maintain the health of the patient. Funds for these services are provided as part of our contract from Indian Health Services. In order to receive a referral for services outside of the clinic, a patient must:
We require 72-hour notification for any Emergency Room visits. Failure to provide proper notice will result in non-payment of any bills associated with the Emergency Room Visit. If you have been denied payment for services, you may appeal the decision by submitting, in writing, a letter explaining why you feel it should be paid and any supporting documentation. Any appeal must be done within 30-days of the receipt of a denial letter. All requests for appeal are reviewed by the Quality Assurance Team to ensure that a correct decision has been made. ALL PATIENTS MUST BE REFERRED BY THE HEALTH CENTER TO
ENSURE PAYMENT.
Third party Billing The Pleasant Point Health Center, through payment for services from third party payers, has established a budget that is commonly known as the “ Third Party Budget.” The Authorization to create this funding is authorized by the Indian Health Services through their Nashville Area Office. The Third Party money pays for wages of some employees at the Pleasant Point Health Center, but a majority of the funds collected go back into direct services to our community. Many of the services offered are paid for by Third Party, They include, but are not limited to:
These are just some of the reasons why it is so important for us to have your health insurance information. When we bill for services provided at the clinic, all of the money collected comes back to our community in the form of additional programs and services. Medical Records The Medical Records Department houses the files of all medical patients at the Pleasant Point Health Center (PPHC). We are open Monday through Friday from 8:00 AM – 4:30 PM. We adhere to the Policies and Procedures set forth by Indian Health Services and work diligently to protect the CONFIDENTIALITY of all patients. If a patient requires information, please note the following:
The Medical Records Department is unable to accept “ verbal” results from outside providers. Also, we cannot give patients results over the telephone. PART 6 - PROGRAMS AND SERVICES OFFERED The Pleasant Point Health Center is proud to offer a wide variety of services that is continuing to grow with our community.
Our Programs and Services Dental ServicesThe Dental Program at the Pleasant Point Health Center offers a wide range of patient services to the Pleasant Point Community. On-site we are able to provide the following
Referrals to outside specialists are done only as necessary and in accordance with the Dental Priority System set forth by Indian Health Services. Pharmacy A registered Pharmacist is available to fill prescriptions form Monday through Friday, 8:00 AM to 4:30 PM. Emergency prescriptions may be filled after hours, on weekends, or holidays, at Havey & Wilson (Eastport), and Rite-Aid (Calais), and Treworgy Rexall (Calais), provided that you notify the Pleasant Point Health Center within 72 hours (3 days). Failure to notify us will result in your prescription cost not being covered by the Pleasant Point Health Center. Emergency Medical Services The Pleasant Point Ambulance Corps is a group of top-rated, professional persons that offers emergency medical services to the injured and sick of the Pleasant Point as well as surrounding communities. We have two new ambulances stocked with the latest “high-tech” medical equipment on board. With our new ambulances, we are able to respond quickly to your emergency and make prompt transport to the nearest emergency medical facility. A core of dedicated medical technicians and experienced paramedics now offers basic and advanced life support services 24 hours a day. The staff is state certified to respond to medical emergencies including, but not limited to, trauma, cardiovascular and psychiatric needs. Paramedic services are offered on weekends and holidays. We have been classified by the National Indian Health Services as “ Superior” in meeting the needs of our patients. The Pleasant Point Ambulance Corps is proud of this ranking, and will continue to work hard to meet the needs of our community. We are pleased to offer complete paramedic coverage on the weekends. Wolipomawsu Program The Wolipomawsu Program offers general psychiatric, psychological and substance abuse services. These services cover the full range of child and adolescent treatment through to adult and geriatric age groups. We are open Monday through Friday from 8:00 AM until 4:30 PM. The hour of 1:00 PM – 2:00 PM is reserved for emergency walk-in visits every day. Our specialties include:
PART 7 - MEDICAL SERVICES The Pleasant Point Health Center is pleased to have a professional staff, able and willing to provide a wide range of services to all patients in our community. All providers are accessible via the walk-in clinic, which runs from 10:45 AM through 12:00 PM Monday through Friday. In addition to specialty clinics, patients can access the following:
Laboratory Services:
Nursing Services:
Home Health Care Services:
PART 8 - SPECIALTY CLINICS Through funds provided by Third Party Revenue, the Pleasant Point Health Center is able to offer certain specialty services on-site. Chiropractic Care This clinic provides spinal manipulation to restore normal joint movement and reduce pressure on the nerve, joint and muscles in the affected area; Deep-muscle Accupressure therapy to improve muscle movement and reduce pain; and care for chronic pain (low back, upper back, neck and headaches) Appointments are available from 8:00 AM through 4:00 PM on the second and fourth Wednesday of each month. Optometry This clinic provides eye examinations as well as screening for glaucoma. Special emphasis is placed on the elderly and diabetic population of our community; however, appointments for eye exams for the general population can be made with the Receptionist. The Pleasant Point Health Center utilizes some of the most modern up to date equipment to provide a full and professional service. The optometrist is available twice a month from 8:00 AM through 4:00 PM. As the days vary, please call the set an appointment. Podiatric MedicineThis clinic provides services related to the foot, ankle, and lower leg. This includes but is not limited to the following conditions Achilles tendonitis, ankle and foot injuries, bunions, corns and calluses, plantar warts, rheumatoid arthritis and skin cancer. Special emphasis is placed on the elderly and diabetic population of our community; however, appointments for the general population can be made with the Receptionist. Appointments are available from 8:00 AM through 4:00 PM on the second and fourth Monday of each month. Pulmonology This clinic provides services related to lung health. This includes but is not limited to colds, asthma, bronchitis, lung cancer, chronic cough, and tuberculosis. Appointments are limited to those patients with pulmonary function problems. This clinic is on the second and fourth Monday of each month available from 8:00 AM through 4:00 PM. Call the Receptionist to schedule an appointment. Pediatrics Clinic Pleasant Point Health Center is now pleased to be able to offer a Pediatrics Clinic and now many babies and families within the community will be afforded professional healthcare without having to drive long distances. Dr. Lichauco, who began practicing in Machias in July 2001, provides this service and brings with him several years of experience. Men’s ClinicA range of professional services are offered in the men’s clinic dealing with prevention and early detection of a range of health issues that are of particular concern to men. The men’s clinic is offered once a month and the date and times can be obtained by calling the Health Center receptionist. Office of Environmental HealthThe OEH Program is funded by the Pleasant Point Health Center through Third Party Funds. Our OEH Technician is trained to provide the following services from 8:00 AM - 4:30 PM Monday –Friday:
WIC & Nutrition Services The Pleasant Point Health Center’s WIC Program offers assistance with food and nutrition services for Pregnant Women, Infants and Children up to age five. We are open from 8:00 AM - 4: 30 PM Monday - Friday. In addition to the WIC Program, we offer the Car Seat Loan Program. This program provides car seats for infants and children up to 60 pounds. This program operates during the same hours as the WIC Program. Also, Pleasant Point also offers the Farmers Market Nutrition Program. A licensed provider, through the State of Maine, offers nutrition services and is available Thursday and Friday from 8:00 AM - 4:30 PM. The Pleasant Point Health Center’s Nutrition Program offers the following services to our community:
Fitness Center Our wellness facility has recently undergone a considerable re-development with a new building and significant investment in new high quality equipment. The fitness room is open from Monday through Friday and offers free weights, universals, as well as treadmills, a stair master, recumbent bike and other equipment for total fitness activities. There are no dues or fees to use our fitness center. Special sessions are offered for elderly, diabetics, youth, men, and women. All users are asked to get clearance from their doctor before beginning a program of physical fitness. You must also have a physical and have all your forms signed before you can utilize the fitness center. A parent or legal guardian must accompany all persons under the age of sixteen (16) at all times. Open for special groups or persons. Nighttime hours are open for all unless specified on the schedule, if there is a volunteer. Please call for available times or scheduled times. Schedule is subject to change without notice. If you would like to volunteer to open the center, please call the Fitness Coordinator at the Pleasant Point Health Center at 853-0644 ext 335.
PART 9 - POLICIES AND PROCEDURES Eyeglasses Policy When you are a patient at our clinic, we bill your insurance company to reimburse us for costs associated with your visit. We call the money that comes in, Third Party Income. Third Party income is used primarily to provide money for:
Each eligible Tribal member receives $100.00 toward the purchase of new eyeglasses. Due to the high demand for new prescriptions, we are unable to assist with replacements or repairs of eyeglasses. The eligibility for this service is two tiered. The first tier is eligible for assistance on an annual basis. Top priority is given to:
Once the top tier group has been taken care of, providing funding remains, the second tier eligible is:
Eye examinations are done at the clinic at no charge to the patient. Please see the Receptionist to schedule an appointment. Due to increased costs of health care, we can no longer afford to provide assistance to everyone who requests it. This policy will be in effect as of January 1, 2001. 72-Hour Notification All patients (or someone operating on their behalf) are required to notify the Pleasant Point Health Center within 72-hours of emergency room visit, unless a Medical Provider of the Pleasant Point Health Center has issued a referral. Failure to notify will result in the denial of payment for the service. (42 CFR 36.2). Health Services for Ineligible Persons [3(c)] The service may provide health services under this subsection to individuals who are not eligible for health services provided by the service under any other subsection of this section or under any other provision of law in order to:
Indian Health Services Description of Medical Priority Levels I. Emergency / Acutely Urgent Care Services DEFINITION: Diagnostic or therapeutic services which are necessary to prevent the immediate death or serious impairment of the health of the individual, and which, because of the threat to the life or health of the individual, necessitate the use of the most accessible health care available and capable of furnishing such services. Diagnosis and treatment of injuries or medical conditions that, if left untreated, would result in uncertain but potentially grave outcomes. Categories of Covered Services: (random order)
II. Preventative Care Services DEFINITION: Primary health care that is aimed at the prevention of disease or disability. This includes services proven effective in avoiding the occurrence of a disease (primary prevention) and services proven effective in mitigating the consequences of an illness or condition (secondary prevention). Level II services are available at most I.H.S facilities. Categories of Services included (random order)
III. Primary and Secondary Care Services DEFINITION: Inpatient and outpatient care services that involve the treatment of prevalent illnesses or conditions that have a significant impact on morbidity and mortality. This involves treatment for conditions that may be delayed without progressive loss of function or risk of life, limb, or senses. It includes services that may not be available at many I.H.S facilities and/or may require specialty consultation. Categories of Services Included (random order)
IV. Chronic Tertiary and Extended Care Services DEFINITION: Inpatient and outpatient care services that (1) are not essential for initial/emergent diagnosis or therapy, (2) have less impact on mortality than morbidity, or (3) are high cost, are elective, and often require tertiary care facilities. These services are not readily available from direct care I.H.S facilities. Careful case management by the service unit CHS committee is a requirement, as is monitoring by the Area Chief Medical Officer, or his/her designee. Depending on cost, the referral may require concurrence by the Chief Medical Officer. Categories of Services Included (random order)
V. Excluded Services DEFINITION: Services and procedures that are considered purely cosmetic in nature, experimental or investigation, or have no proven medical benefit.
The list of therapies and procedures classified as potentially cosmetic in nature, experimental, or excluded will be reviewed and updated on an annual basis. Categories of Excluded Services:
Appendix A - Organizational Chart Pleasant Point Health Center Passamaquoddy Tribe
Appendix B – Service Area Map
Pleasant Point Health Center P.O. Box 351 ¨ Perry ¨ ME 04667 Phone . (207) 853- 0644 ¨ Fax (207) 853 -2347 Registration Form - New Patient
I hereby certify that the information I have given is correct to the best of my ability. I authorize the Pleasant Point Health Center, or its agent to receive medical records information for the purposes of billing. I authorize the Pleasant Point Health Center or its agent, to access information regarding availability of alternate resource coverage on my behalf. The Pleasant Point Health Center is authorized to bill my insurance for covered services provided to me as a patient of its clinic. I further authorize payments to be made directly to: Pleasant Point Health Center Signature : Date:______________________
Pleasant Point Health Center P.O. Box 351 ¨ Perry ¨ ME 04667 Phone. (207) 853- 0644 ¨ Fax (207) 853- 2347 Registration Form - Established Patient
I hereby certify that the information I have given is correct to the best of my ability. I authorize the Pleasant Point Health Center, or its agent to receive medical records information for the purposes of billing. I authorize the Pleasant Point Health Center or its agent, to access information regarding availability of alternate resource coverage on my behalf. The Pleasant Point Health Center is authorized to bill my insurance for covered services provided to me as a patient of its clinic. I further authorize payments to be made directly to: Pleasant Point Health Center Signature : Date_______________________
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Copyright © 2003
Passamaquoddy Tribe at Pleasant Point
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