MCQG1005 (previously Guideline/Procedure Number: Lead Department: Health Services MPQG1005 & QG1001050) Guideline ☒External Guideline/Procedure Title: Adult Preventive Health Guidelines Internal Guideline ☐ Next Review Date: 06/13/2019 04/25/1994 Original Date: Last Review Date: 06/13/2018 Applies to: Medi-Cal ☒ Employees IQI P & T QUAC Reviewing ☒ ☐ ☒ Entities: OPerations Executive Compliance Department ☐ ☐ ☐ ☐ BOARD COMPLIANCE FINANCE PAC ☐ ☐ ☐ Approving ☒ Entities: CEO COO Credentialing DEPT. DIRECTOR/OFFICER ☐ ☐ ☐ ☐ Approval Signature: Approval Date: 06/13/2018 Robert Moore, MD, MPH, MBA RELATED POLICIES: MCQP1021 - Initial Health Assessment and Behavioral Risk Assessment IMPACTED DEPTS: N/A DEFINITIONS: guidelines address periodic health and behavioral risk screening and preventive services for asymptomatic adults. Individuals identified as being at high risk for a given condition may require screening at intervals that are more frequent or the performance of additional screening tests specific to the condition. High-risk individuals are defined as those individuals whose risk behaviors, family history, socioeconomic status, or life style is associated with a higher tendency towards a specific disease. and screening interventions for various conditions as adapted from the U.S. “Required” “recommended” Preventive Services Task Force (USPSTF) guidelines are listed in Attachment A Required interventions are considered to be an integral component of primary care, and consequently, the compliance of each primary care provider (PCP) in performing these services is audited by Partnership HealthPlan of California (PHC) (during the Medical Record Review, at least every 3 years). Recommended interventions are considered to constitute good clinical care, but not required by PHC and are not considered as audit criteria. ATTACHMENTS: PURPOSE: To specify and define PHC guidelines for adult health screening and preventive services provided by primary care physicians to adults age 18 and over, as recommended by: The United States Preventive Services Task Force (USPSTF) and Other nationally recognized standards of practice from: American Academy of Family Physicians (AAFP) American College of Obstetricians and Gynecologists (ACOG) American College of Physicians (ACP)
Guideline/Procedure Number: MCQG1005 (previously MPQG1005 & QG1001050) Lead Department: Health Services Guideline/Procedure Title: Adult Preventive Health Guidelines ☒External Guideline ☐ Internal Guideline Original Date: 04/25/1994 Next Review Date: 06/13/2019 Last Review Date: 06/13/2018 Applies to: ☒ Medi-Cal Employees Reviewing Entities: ☒ IQI ☐ P & T ☒ QUAC ☐ OPerations ☐ Executive ☐ Compliance ☐ Department Approving Entities: ☐ BOARD ☐ COMPLIANCE ☐ FINANCE ☒ PAC ☐ CEO ☐ COO ☐ Credentialing ☐ DEPT. DIRECTOR/OFFICER Approval Signature: Robert Moore, MD, MPH, MBA Approval Date: 06/13/2018 RELATED POLICIES: MCQP1021 - Initial Health Assessment and Behavioral Risk Assessment IMPACTED DEPTS: N/A DEFINITIONS: guidelines address periodic health and behavioral risk screening and preventive services for asymptomatic adults. Individuals identified as being at high risk for a given condition may require screening at intervals that are more frequent or the performance of additional screening tests specific to the condition. High-risk individuals are defined as those individuals whose risk behaviors, family history, socioeconomic status, or life style is associated with a higher tendency towards a specific disease. “Required” and “recommended” screening interventions for various conditions as adapted from the U.S. Preventive Services Task Force (USPSTF) guidelines are listed in Attachment A Required interventions are considered to be an integral component of primary care, and consequently, the compliance of each primary care provider (PCP) in performing these services is audited by Partnership HealthPlan of California (PHC) (during the Medical Record Review, at least every 3 years). Recommended interventions are considered to constitute good clinical care, but not required by PHC and are not considered as audit criteria. ATTACHMENTS: PURPOSE: To specify and define PHC guidelines for adult health screening and preventive services provided by primary care physicians to adults age 18 and over, as recommended by: The United States Preventive Services Task Force (USPSTF) and Other nationally recognized standards of practice from: American Academy of Family Physicians (AAFP) American College of Obstetricians and Gynecologists (ACOG) American College of Physicians (ACP)