External vs. Internal Referrals
|20.2.D||Referrals may only be billed to Part B if they are to an external agency. Internal referrals are not eligible activities under this service definition.||Documented in agency policies and case notes.|
Per standard 20.2D only external referrals may be billed for under Ryan White Part B.
Internal referrals may be tracked in CAREWare for data purposes but will have a $0 amount attached to them. Ineligible internal referrals include but are not limited to:
1. Clinics under the same organizational umbrella as the Part B service provider
2. Transportation companies, or cab companies paid for with Ryan White Part B funds
3. Dental providers paid for with Ryan White Part B funds.
4. Part B agency food banks
5. HOPWA or other housing programs embedded within a Part B agency
6. Substance use programs under the same organizational umbrellas as the Part B service provider
Frequency of Referrals
Case managers should make every attempt to ensure that a client is connected to the necessary resource after the referral is made. Follow up on referrals with a client may be billed as Non-Medical Case Management Non Face to Face activities under the encounter topic.
If a client does not complete the referral and become linked to services the Case Manager may refer them to the same resource, and bill for it, quarterly. However, it is the expectation of the STD/HIV Program that Case Managers work with their client to ensure that they are connected to the needed resources as quickly as possible. Additionally, Case Managers should not make unnecessary referrals to artificially inflate their referral billing.