Role of Physicians with the BCMH Program

A child on a BCMH program must have their medical care managed by an MD or DO who is enrolled as a BCMH provider.  The physician may be a pediatrician, family practitioner or subspecialty physician.

Managing Physician

The managing physician:

·         Identifies children within his/her practice who have handicapping or potentially handicapping conditions

·         Informs families about the availability and services of the BCMH program and requirements for enrollment

·         Consults with families prior to requesting services from BCMH

·         Provides comprehensive, coordinated care through:

§  Collaboration with the family/client

§  Consultation and follow-up with primary care providers, subspecialty providers, public health agencies, schools, social service agencies, and community resources

§  Provision of care in specialized centers or by designated teams, as needed

§  Referral to BCMH providers in the child’s local community for additional services

§  Assistance for families with insurance/managed care plans, including pre-authorization of procedures, requests for out-of-network providers and appeal procedures when services are denied due to lack of medical information

·         Accepts referrals from public health nurses to evaluate children with potentially medically handicapping conditions

The managing physician is responsible for:

·         Completion in full and submission of a Medical Application Form (MAF) to enroll the child on the BCMH Diagnostic and/or Treatment Program; completion of an Interim Request Form to request additional services when needed; and submission of medical reports about the child’s condition annually and when special services are requested

Primary Care Physicians

The BCMH strongly supports the medical home concept of family-centered, community-based, coordinated care and advocates for the role of primary care in meeting the comprehensive needs of children with special health care needs.  The BCMH program is not designed to provide primary care services related to well child care, immunizations or acute care, but does acknowledge the importance of the primary care physician in providing care for the child’s handicapping condition and coordinating services for the child with other BCMH providers. 

Subspecialty Physicians

Other BCMH physicians provide consultation and follow-up as necessary for the child.  He/she communicates on a regular basis with the child’s managing physician to provide information on needs relating to care and services and notifies the managing physician of any care or services requiring approval or special authorization through the BCMH.

Updated 3/1/2009