Brief Office Visit:  A brief office visit is made to a primary care provider for acute illness care, evaluation or follow-up.  Payment is limited to $30 per visit.  (Federally Funded Section 330 Community Health Centers are paid $20 per office visit, as funds allow.)  Office procedures are reimbursed at Medicaid rate.  The Regional Case Manager or Program Director must authorize payment for medical care requiring more than three office visits per illness in one year in order to complete therapy. 

Laboratory/X-ray:  Services paid at Medicaid rate.  The Regional Case Manager or Program Director must authorize all services over $150.

Vision Care:  Eyeglasses and routine eye examinations are not paid by KSFHP.  However, KSFHP staff will work with local providers to identify other possible resources to meet these needs.  Visits associated with illness or injury of the eye or annual dilated eye exams for patients with diabetes are covered by KSFHP.

Pharmaceutical:  Prescription drugs (generic when available) are limited to $150 per year per client, and up to $300 for clients with diabetes.  Clients are asked to pay the first $5 of the prescription if income is sufficient and are responsible for any amount over the $50 value of the voucher.  KSFHP will not pay over the counter drugs without authorization from the Regional Case Manager or Program Director.  Refills will be paid for only on prescriptions originating from health care visits through KSFHP and on authorized diabetic supplies.

Prenatal Care:  All pregnant women must be screened for Medicaid eligibility.  All non-Medicaid eligible pregnant women are referred to low-cost prenatal care in their area.  Clients are responsible for prenatal office visits.  KSFHP pays associated labs and one ultrasound.  Further ultrasounds and fetal stress tests may be authorized as needed through the Regional Case Manager or Program Manager.  KSFHP may authorize limited prenatal care visits when no low cost prenatal services are available within the geographic area.

Dental:  Dental services are not restricted to emergency treatment of pain and infection.  Dental services include oral exams, child and adult prophylaxis, sealants, child and adult fluoride treatment, restorative services, oral surgery and rehabilitative services.  Payments for dental services are paid at fifty percent up to a total of $300 per year per farmworker client.  Clients are responsible for the other fifty percent not paid by KSFHP.  If the dental clinic has a sliding fee scale, clients should be placed on the scale initially and fees charged accordingly.

We appreciate your cooperation in providing quality services to our clients and ask your cooperation in prescribing treatments that enable KSFHP to control costs.