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3.8.2.2.2 The Primary Practitioner's Role in the PCS Benefit
A client accessing the PCS benefit must have a primary practitioner (a licensed physician, APRN, or PA) or a primary care provider who has a therapeutic relationship and ongoing clinical knowledge of the client. The primary practitioner or primary care provider must have established a diagnosis for the client and must provide continuing care and medical supervision of the client. When the DSHS case manager has determined the client has a need for the PCS benefit, the case manager contacts the client's primary practitioner or primary care provider to obtain a Practitioner Statement of Need. The Statement of Need certifies the client has a physical, cognitive, or behavioral limitation related to a disability or chronic health condition and is birth through 20 years of age. The Statement of Need must be signed and dated by the primary practitioner or primary care provider within 60 days of the initial start of care (SOC). The primary practitioner or primary care provider must mail or fax the completed Statement of Need to the appropriate DSHS Health Services Region. DSHS keeps the signed and dated Statement of Need in the client's case management record for the duration of the client's participation in the benefit.
When a behavioral health condition exists, the primary practitioner may be a behavioral health provider. The primary practitioner must maintain the Practitioner Statement of Need in the client's medical record. In addition, DSHS must maintain the Practitioner Statement of Need with the client's PCAF and other forms related to the client's case.
In the absence of primary practitioner medical record documentation and a Practitioner Statement of Need to support the client has a physical, cognitive or behavioral heal condition impacting the client's ability to perform an ADL and/or IADL PCS, payment maybe recouped.
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