Information for Providers
The Los Angeles County CHAIN – Medical Subspecialty Services Referral Program (CHAIN Program) serves uninsured and under-insured, indigent residents of Los Angeles County who have an HIV diagnosis and no other source of health care coverage. The program provides care to approximately 1,000 eligible patients in Los Angeles County and covers certain outpatient specialty consultations and outpatient surgeries and procedures for patients with HIV/AIDS-related health conditions. Almost 500 Ryan White Part A specialists provide outpatient specialty consultations, surgeries and procedures through the CHAIN Program. Inpatient acute care is not covered by the program.
The CHAIN Program accepts eligible patient referrals from Los Angeles County-funded medical outpatient clinics (MOPs), which are comprised of Los Angeles County Division of HIV and STD Program (DHSP) and Los Angeles County Department of Public Health (LAC-DPH) MOPs. Patients who receive specialty care through the CHAIN Program are referred back to their MOP of origin for ongoing primary care by their CHAIN Program specialists.
AIDS Healthcare Foundation (AHF) is contracted with DHSP to provide CHAIN Program administration consisting of utilization management; medical oversight; provider recruitment; contracting and credentialing; and claims processing. More detailed program information can be found in the CHAIN – Medical Subspecialty Services Referral Program Provider Information Publication.
Covered Services
The CHAIN Program covers the following medically indicated and appropriate services and procedures through contracted Ryan White Part A specialists throughout Los Angeles County (see the CHAIN – Medical Subspecialty Services Referral Program Provider Directory for contracted specialists). The services listed in the following table are covered through the CHAIN Program if an eligible patient’s condition is related to HIV/AIDS. Patients who have conditions not related to HIV/AIDS should be referred to appropriate Los Angeles County MOPs.
|
Service Category |
Criteria |
| Anesthesia | Requires authorization. Anesthesia covered with CHAIN-covered outpatient procedure. |
| Laboratory Testing | Requires authorization. Covered labs related to specialty work-up that was not performed by the PCP. Must use contracted labs. |
| Outpatient Surgery | Requires authorization. Coverage for HIV-related conditions. |
| Pathology | Requires an authorized outpatient procedure. |
| Podiatry | Requires authorization. Coverage for HIV-related conditions. |
| Specialist Consult/Services | Requires authorization. Specialties covered:
|
The CHAIN Program also covers limited diagnostic imaging to include but not limited to:
- Ultrasound
- Echocardiography
- CT Scan
- MRI
- DEXA Bone Scan
Excluded Services
The CHAIN Program does not cover the following services and procedures:
- Acupuncture
- Chemotherapy
- Chiropractic Services
- Dental Care
- Emergency Care
- Holistic Health Care
- Home Health Care
- Hospice
- Inpatient Services
- Medical Supplies
- Mental/Behavioral Health Services
- Obstetrics
- Oncology (Some exemptions apply, refer to Referral Overlay Criteria for more details)
- Pediatrics
- Prescription Drugs
- Primary and Routine Health Care
- Rehabilitation Services
- Sleep Medicine
- Substance Abuse or Addition Treatment
- Transportation
- Vision Care
Prior Authorization Process
To refer a CHAIN-eligible patient to network specialists, MOP primary care providers (PCPs) must complete a CHAIN – Medical Subspecialty Services Referral and Authorization Request form and submit it to AHF’s Utilization Management (UM) department along with a screen captures from CaseWatch® to demonstrate patient eligibility and supporting physician progress notes and/or ancillary data.
The CHAIN – Medical Subspecialty Services Referral and Authorization Request form includes instructions where and how to submit it. Routine authorization requests are rendered within five (5) days; urgent requests in 72 hours. Questions regarding the authorization request process should be directed to the CHAIN – Medical Subspecialty Services Referral Program at (866) 644-5025, Monday through Friday, 8:30 a.m. to 5:30 p.m.
For More Information
For more information about program benefits and coverage, please call the CHAIN – Medical Subspecialty Services Referral Program at (866) 644-5025, Monday through Friday, 8:30 a.m. to 5:30 p.m.