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<br />Maternal and Child Health, 1994); Guidelines for Adolescent Preventive Services <br />(GAPS) (American Medical Association, 1995); Guidelines for Health Supervision III <br />(American Academy of Pediatrics, 1997); <br />· American Dental Association, Regulatory Compliance Manual, 1992; and, <br />· Changes in income guidelines as determined by RECEIVING AGENCY. <br /> <br />Within thirty (30) days of receipt of an amended standard(s) or guideline(s), PERFORMING <br />AGENCY shall inform RECEIVING AGENCY Program, in writing, if it will not continue <br />performance under this Attachment in compliance with the amended standard(s) or guideline(s). <br />RECEIVING AGENCY may terminate the Attachment immediately or within a reasonable <br />period of time as determined by RECEIVING AGENCY. <br /> <br />PERFORMANCE MEASURES <br />The following performance measures will be used to assess, in part, PERFORMING AGENCY'S <br />effectiveness in providing the services described in this contract Attachment, without waiving <br />the enforceability of any of the other terms of the contract. <br /> <br />PERFORMING AGENCY shall report on: <br /> <br />· Screening, referral and PHC eligibility services (PHC-200) <br />· Client intake - new and recertified clients (pHC-200) <br />· Number ofPHC eligible clients receiving medical services (PHC-200) <br />· Clients served by quarter (PHC-200) <br />· Cost and type of services provided (PHC-200) <br />· Client demographic data (PHC-300) (annual) <br /> <br />PERFORMING AGENCY shall report quality measures on the: <br /> <br />· Clinical Process = Outcome Measures report (PHC-301) <br />· Client Satisfaction Survey (PHC-302) (annual) <br /> <br />PERFORMING AGENCY shall use the required eligibility system as described in the PHC <br />Handbook or other system designated by RECEIVING AGENCY as the initial step. <br /> <br />CO-PAY <br /> <br />PERFORMING AGENCY may, except PERFORMING AGENCIES that are Local Health <br />Departments, assess a co-pay from clients provided services by RECEIVING AGENCY under <br />this Attachment if the co-pay is assessed according to the established fee schedule adjusted for <br />family size and income as published in the Primary Health Care (PHC) Handbook. A co-pay <br />assessment may not exceed 25% of the amount RECEIVING AGENCY pays PERFORMING <br />AGENCY for the provision of a given service. A client shall not be denied services due to <br />inability to pay. Local Health Departments shall comply with RECEIVING AGENCY fee <br />collection policies detailed in 25 TAC 9 1.91. <br /> <br />ATTACHMENT - Page 2 <br />