HomeMy WebLinkAbout20130347.tiffRESOLUTION
RE: APPROVE GRANT CONTINUATION APPLICATION FOR FISCAL YEARS 2013 AND
2014, INCLUDING 2012 PROGRESS REPORT, FOR NURSE HOME VISITOR PROGRAM
AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Grant Continuation Application for Fiscal
Years 2013 and 2014, for the Nurse Home Visitor Program, commencing July 1, 2013, and ending
June 30, 2014, including the 2012 Progress Report, for the period commencing July 1, 2012,
through December 31, 2012, from the County of Weld, State of Colorado, by and through the Board
of County Commissioners of Weld County, on behalf of the Weld County Department of Public
Health and Environment, to the Colorado Department of Public Health and Environment, with further
terms and conditions being as stated in said application, and
WHEREAS, after review, the Board deems it advisable to approve said application, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Grant Continuation Application for Fiscal Years 2013 and 2014, including
the 2012 Progress Report, for the Nurse Home Visitor Program from the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Weld County Department of Public Health and Environment, to the Colorado Department of Public
Health and Environment be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application
2013-0347
HL0040
GRANT CONTINUATION APPLICATION FOR FISCAL YEARS 2013 AND 2014, INCLUDING 2012
PROGRESS REPORT, FOR NURSE HOME VISITOR PROGRAM
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 4th day of February, A.D., 2013.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:
Weld County Clerk to the Board
APPR D AS,
Attorney
Date of signaturefEB 1 3 2013
William F. Garcia, Chair
ilc
Douglas Rademach r, Pro-Tem
Barbara Kirkmeyer
2013-0347
HL0040
Memorandum
TO: William F. Garcia, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health and
Environment
DATE: January 14, 2013
SUBJECT: FY2013-14 Nurse Home Visitor Program
(NHVP) Continuation Application
Enclosed for Board review and approval is the FY2013-14 NHVP Continuation Application between
the Colorado Department of Public Health (CDPHE) and Environment and Weld County Board of
Commissioners for the Weld County Department of Public Health and Environment's Nurse Home
Visitor program (WCDPHE/NHVP). This application completion will be seeking an agreement for the
continuation of funding from CDPHE.
CDPHE requires the enclosed documents from current grant recipients seeking continuation funding for
the Nurse Home Visitor Program (NHVP). WCDPHE is applying for funding in the amount of
$780,848. The contract is funded by the Colorado State Tobacco Settlement Funds and Medicaid
reimbursements. Funding is contingent upon an annual state appropriation, grantee program and fiscal
compliance, an acceptable grant application, and approval by the State Board of Health. The grant will
fund 8 FTE including 1 FTE OT, 6 FTE Public Health Nurse II and .75 FTE Public Health Nurse III,
Supervisor. At no cost to the client, specially trained registered nurses provide bi-monthly home visits
to low-income, first time mothers residing in Weld County. These home visits begin in pregnancy and
continue until the client's child reaches the age of two years. Clients are educated and encouraged to
develop positive maternal/child health practices, and understanding of infant/toddler developmental
needs, effective parenting and maternal economic self-sufficiency.
The term of this contract is for one year, for activities performed during the time period beginning July
1, 2013 and ending on June 30, 2014. I recommend your approval of this FY2013-14 NHVP Continuation
Application.
Enclosure
Attachment A
FY2013-14 Colorado Nurse Home Visitor Program
CONTINUATION APPLICATION (2012 Progress Report)
2013
January
CHECKLIST
Materials must be submitted in the order listed below.
Name of Agency: Weld County Department of Public Health & Environment
Attachment A: Continuation Application Checklist
Continuation Application (2012 Progress Report) Cover Sheet. This page must be typed and signed.
Continuation Application (2012 Progress Report), not including the proposed budget forms (Attachments C and C1) and other
attachments, is limited to no more than eight (8) single-spaced, 8% x 11 numbered pages. Use Calibri font, 11 point
I l Part A: 2012 Progress Report
pi Part B: Grantee Response to FY2012-13 NHVP Award Summary
gl Part C: Fiscal Management
❑ Attachment C: FY2013-14 Proposed Continuation Budget for the period of July 1, 2013 through June 30, 2014
❑ Attachment Cl: FY2013-14 Proposed Continuation Budget Narrative
Z1 Attachment D: Assurance of Intention to Meet Program Requirements
f�I] Attachment E: Assurance of Intention to be an Active Medicaid Provider
Attachment F: Assurance of Intention to Follow Caseload Guidelines
❑ Assembly and Submission:
• Page Specifications: FY13-14 Continuation Application (2012 Progress Report), not including the budget page (Attachment
CI) and other attachments, is limited to no more than eight single-spaced, 8'/= x 11 numbered pages. Use Calibri font, 11 pt.
• Binding: All materials must be binder clipped only. Rubber bands, staples and paperclips are not allowed.
• Signatures: Cover Sheet must be signed by both the agency authorized signer and the nurse supervisor.
• Hard Copies: One (1) complete set of all required materials, including all necessary attachments (cover sheet; Parts A, B, and
C; and Attachments A, C, Cl, D, E and F)
o Application Printing: Double -sided printing preferred, but not required. Whether the application is printed double or
single -sided, the format needs to be consistent
o Please refer to the checklist on page 17 for further instruction
• Electronic copy: One CD or flash drive with the entire application and all attachments:
o One electronic copy of Parts A, B, and C as an MS Word document
o One electronic copy of the budget and budget narrative as an MS Excel document
• Complete: All items listed in the Application Checklist (Attachment A) are included in each hard copy
• Due Date: Received by CDPHE on or before Friday, February 8, 2013 by 4:00 p.m.
• Mailed or delivered to:
Flora Kulwa Martinez, Home Visitation Operations CoordinatorColorado Department of Public Health and Environment
4300 Cherry Creek Drive South, PSD-A4
Denver, CO 80246-1530
Email Confirmation: Email Kelly Schmeer (kelly.schmeer@state.co.us), Home Visitation Programs Assistant, to notify the
Nurse Home Visitor Program of application submission
2013-0347
FY2013-14 Colorado Nurse Home Visitor Program
CONTINUATION APPLICATION (2012 Progress Report) January 2013
COVER SHEET
1. Name of Agency: Weld County Department of Public Health & Environment
Address/City/Zip: 1555 N. 17th Avenue Greeley, CO 80631
2. For the period of July 1, 2013 through June 30, 2014, please indicate:
Total funding request: $ 780,848 (TOTAL amount required whether covered by NI-It/P funds, Medicaid or other dollars)
County(ies) to be served: Weld
Total number of families to be served/caseload: 1
Total FTE to be funded: 7.75
Total number of nurse home visitors to be funded: 6
3. Name of person completing Progress Report: Barbara Francisco, RN
Position/Title: NFP Supervisor
Telephone: 970-304-6420 X2186 Email: bfrancisco@co.weld.co.us
4. Name of person completing budget forms: Tanya Geiser
Position/Title: Administrator Director
Telephone: 970-304-6410 x 2122 Email: tgeiser@co.weld.co.us
5. Name of Authorized
William F. Garcia, Chair
Signature of Authorized Signer
Position/Title: Chairman, Weld County Board of Commissioners
Telephone: 970-336-7204
Email: wgarcia@weldgov.com wRarcia@weldgov.com
6. Contact Information of Agency Contract Administrator for FY2013-14 contract:
Name: Mark Wallace,MD
Telephone: 970-304-6410 x2104 Email: mwallace@co.weld.co.us
Address for Contract Delivery: 1555 N. 17th Avenue Greeley CO 80631
2
FY2013-14 Colorado Nurse Home Visitor Program
CONTINUATION APPLICATION (2012 Progress Report)
January 2013
This document has been revised. Previous versions will not be accepted.
Part A. 2012 Progress Report
Complete this section using your Annual Plan initiated in July or August of 2012. The NFPNSO is in the process
of developing comprehensive tools and reports to assure the quality implementation of NFP. The Annual Plan
is one such tool. Quality evaluation focuses on outcome achievement, client interaction/process and program
implementation/structure. In this progress report you are requested to report on the 3 indicators (one
outcome, one client intervention/process, and one implementation/structural element) that you and your
team chose to focus intensive quality improvement efforts upon, as a basis for your Annual Plan. Use data
available in the Quarterly Reports or Efforts to OutcomesTM (ETO) Reports through September 2012.
1.Provide the 2012-13 NHVP
funded caseload for your agency
150
2.Note your agency's NFP
caseload on Jan. 15, 2013 and
include your source of
information (it may be from your
own records)
126 From NHVs Weekly Home Visit Itinerary
3.Indicate the number of clients
served for the last 3 quarters
(those that had a least one home
visit)
Please use data from the
Quarterly reports for the quarters
ending in June and September.
You may use data from your own
records for quarter ending in
December
June 30, 2012: 110
September 30, 2012: 110
December 31, 2012: 122
4.If your caseload size did not
meet NHVP contract requirements
during any of the reporting
periods above (Quarters ending
June 30, 2012, September 30,
2012 and December 31, 2012)
explain why and describe how and
when your team will achieve
funded caseload size.
A 1.0 FTE NHV retired, 6/29/2012, leaving a caseload of 18 clients to be
distributed among the other S NHVs. During May and June we did not
enroll new clients to leave time for the NHVs to do tandem visits with
the retiring NHV with clients they would take from the retiring NHV. The
open position was not filled until 12/17/2012 due to the county process
of reviewing the need to fill open positions by the County
Commissioners, and the time to advertise and interview.
Per ETO Client Discharge Assessment Data Report, during 2012 we
graduated 29 clients & discharged 68 clients for various reasons. The
majority of discharges, 20 we could not locate. 17 moved out of Weld
County, 10 returned to work or school, & 6 received what they needed
from the program, 2 each, refused a new nurse, had excessive missed
3
appointments, were pressured by family, or we were unable to provide
service. 1 experienced an infant death, 1 lost custody of her child, & 1
was dissatisfied with the program.
According to my records our caseload was 120 at the end of September.
The caseload deficit should be remedied by May or June,2013 as the
new NHV is trained and begins enrolling clients into her caseload.
Outcome Chosen by site on which to focus Intensive Quality Improvement
5. Outcome to focus on
Date
Participants
Infancy Attrition/Client Retention
in
Infancy
11/01/11
Supervisor
NHVs
Office Technician
6. Rationale: The NFP Objective is 20% or less
7. Current Status: The Weld County attrition rate during the Infancy phase of the NFP curriculum is
approximately 34%
8. Outcome to achieve: Decrease client attrition in the Infancy phase by 1% by 6/30/11
9. Strategy
Responsible person
How measured
1. Develop a list of reasons clients
drop out of program in Infancy
phase.
2. Assess clients' need for creative
visit schedule, i.e. phone visits,
fewer or more visits per month as
daily schedules change & every 3
months. Adjust schedule to meet
clients' needs. Offer fewer/more
visits and phone visits
3. Assess client interest, participa-
tion in curriculum every 3 months
&
PRN. Offer curriculum & supple-
mental material that supports
clients' interests & needs.
Supervisor
NHVs
NHVs
Supervisor
NHVs
Supervisor
1. Complete by 10/4/11
(Done)
2. Establish a baseline of
clients currently on flexible
schedules. Track number of
clients who choose a flexible
schedule between 10/1/11
and 6/30/12 (Done).
3. 10% of clients setting one or
more goals for the newborn
period of the infancy phase
will have met their goals
during the infancy phase.
(Yes)
4
4. Preview Infancy curriculum in
last
trimester of pregnancy,
emphasizing areas of interest to
4. Track how many clients
accept this offer and how
client. Assist client in setting a
NHVs
many of them graduate
long term goal for the newborn
by 6/30. (Done)
period of the infancy phase.
5. Offer to do a video album
through Infancy & Toddler phases
to be given to the client at
program graduation
5. Track the number of
albums that were given to
clients.
10. Ongoing Evaluation: I have been unable to get the report, Clients Who Left the Program Earl from the ETO
database and tech support has been unable to find the problem, so I am unable to calculate the Infancy
Attrition Rate for this report. In June, 2012 our Infancy Attrition Rate was 17%.
NHVs identified the reasons why clients dropped as; 1) felt family members could teach infant & child care, 2)
had enough experience with infants & toddlers prior to & during pregnancy, 3) no time for NFP due to school
&/or work, 4) family member would be responsible for majority of infant/child care.
During 2012 clients were offered alternative schedules. In October, 2012, 6 clients were on alternative
schedules. As of 1/4/13, 27 clients were utilizing alternative schedules. Utilized options were; 1) receiving
visits every 3 weeks, 2) once monthly or 3) more than twice monthly. Some clients received infrequent home
visits with phone visits between home visits.
Team members found supplemental material that supported NFP curriculum based on client needs. The team
discussed each piece & determined which to use with clients. Much of this material pertained to fetal
anomalies, and congenital defects. Other subjects added were applying for legal residency, Colorado laws
regarding paternity, and child support and visitation rights of fathers and grandparents.
Clients were encouraged to use the curriculum menus & ID their personal needs/goals so NHV could
individualize the curriculum. Some clients, mostly young teens, were uncomfortable having this responsibility.
Most appreciated this autonomy, although the NHVs did not feel this impacted longevity in the program.
HNVs helped clients identify at least one goal for the Infancy phase while they were pregnant and all felt this
helped increase interest in clients for continuing the program after L & D. 78% of clients setting goals for
Infancy completed those goals.
Only one NHV took photos and videos and held them as a graduation present to participating clients. She felt
strongly that this kept her clients more engaged until graduation. Other NHVs took photos and videos and
gave them to clients soon after they were taken. My assessment of this was that the nurse was excited to see
client reactions to the pictures or videos and did not want to wait. Some of these clients dropped out of the
program during the Infancy Phase. The NHVs did not have exact figures.
5
Intervention Chosen by site on which to focus Intensive Quality Improvement
11. Intervention to focus on
Date
Participants
Motivational Interviewing
11/01/11
Supervisor
NHVs
Office Technician
12. Rationale: Use of Motivational Interviewing techniques increases and
improves assessment and collection of information. Improved skills increase
focus on client needs, desires, and goals, strengthening the client-NHV
relationship and the satisfaction of both participants as they work together.
13. Current Status: Team supervisor is experienced in using and teaching communication skills. 5
NHVs have adequate skills* when using Motivational Interviewing techniques. One NI -IV is a novice
in using MI and has fair skills.
14. Ideal Status:
All team members will increase MI proficiency by one level, i.e. Adequate to Above Average and Fair
to Average.
Ratings based on rating skill levels used in Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency
15. Strategy
Responsible person
How measured
1. Team members will do a self
Supervisor
1 .Self rated proficiency will
rating 10/2011 & again 6/2012.
NHVs
increase one competency level.
Supervisor will provide rating
forms & compile results.
2. Once monthly the team will
Supervisor
2. 100% participation in 80% of
participate in discussions &
exercises using Building
NHVs
discussions. (Yes)
Motivational Interviewing Skills
workbook.
Supervisor
3. Supervisor will monitor team's
3. Team will use MI techniques
NHVs
use of MI techniques during client
when clients are presented in case
case conferences using
conferences
Motivational Interviewing
Assessment: Tools for Enhancing
Proficiency at 11/11/11 case
conference & at 6/26/12 case
conference,
4. Supervisor will observe & hear
4. NHVs will use MI techniques
Supervisor
NHVs
NHVs using MI techniques with
6
during supervisory home visits.
clients.
16. Ongoing Evaluation: Self ratings were completed on the above dates. Initial scores ranged from 3.7 to 5.9
on a scale of 1 (Never used) to 7 (Used almost always). We did not utilize the MI workbook as frequently as
expected due to the need to utilize team meetings for other program and agency updates, etc. We did use the
workbook as a format for discussing MI 5 times. NHVs used MI during case conferences and team meetings,
and began to recognize when others were using the techniques, i.e. during applicant interviews for our open
position. MI was used and discussed at supervisory visits. I felt there was a higher level of comfort with all
NHVs in using MI, and a more fluid flow in their discussions with their clients than I had observed the previous
year. Post assessment scores in 6/12 ranged from 4.3 to 5.9, with the increased degree of confidence ranging
from 0 to .9 per individual HNV. This skill will continue to be evaluated and discussed in the different forums.
I have definitely observed improvement in the skill levels among all the NHVs.
Implementation Indicator Chosen by site on which to focus Intensive Quality Improvement
17. Implementation Indicator to
focus on
Date
Participants
Case Conference
10/1/2011
Supervisor, NHVs, Office
Technician
18. Rationale: NFP guidelines require twice monthly case conferences. Discussions of individual clients,
working on MI techniques, and having expert guests provide opportunities for team members to support each
other, fosters team building and individual growth reinforces strength —based focus and solution based
approaches
19. Current Status: Case conference and team meeting formats are unclear.
20. Ideal Status: Formats will be clearly defined with case conferences dedicated to presentation of clients for
the purpose of problem solving client issues with individual NHVs, professional growth, and program
implementation and evaluation.
21. Strategy
Responsible person
How measured
1. Review NFP definition of case
conference
2. Create a rotation schedule for
presentation of client issues, guest
presenters, and professional
Supervisor
NHVs
Office Technician
Supervisor
NHVs
1. Review completed by 11/11/11.
(Done)
2. Completed and posted by the
second week of each quarter.
Track number of Case Conferences
7
growth for each quarter until
Office Technician
from 10/11/11 to 6/30/12. (Done)
6/30/12.
Implement Case Conference
schedule
3. Review completed by 10/11/11
(Done)
3. Review Client Review Case
Conference form
and format with team.
Supervisor
4. NHVs will share how they feel re
NHVs
using the structure. (Discontinued)
4. Once a quarter during team
meetings & in supervision sessions
seek feedback regarding getting
effective support utilizing case
Supervisor
Conference structure.
NHVs
22. Ongoing Evaluation: Case conference definition and format was reviewed in a team meeting. A case
conference schedule was created. After initial review of the structure the team felt it was unnecessary to do a
review quarterly as they were able to verbalize the structure. The NHVs felt that case conferences were more
focused and productive. Presenters from the community included volunteers from a new Greeley program
called SEVA, a group of retired teachers who are working with new mothers to increase their personal literacy
and to reinforce the importance of introducing books to the mothers' children. These volunteers are
partnering with the NHVs, doing a tandem visit to be introduced to clients who are interested in participating
in the SEVA program. Other outside speakers came from Child Protective Services, the Northern Colorado
Medical Center Speech Therapy program and WIC. During year 2012 the team had 46 meetings. We had 32
(69%) team meetings and 14 (31%) case conferences. Three consecutive meetings were utilized to do team
interviews of potential NHV candidates. Two consecutive meetings were used to construct our Leadership
Characteristics centerpiece for the State Meeting. Meetings were cancelled due to the team being at the NFP
State meeting, for a mandatory county training that was announced the week before, and four meetings were
cancelled due to most of the team being out of the office. During some team meetings, NHVs talked
informally about concerns with clients and received input from their teammates.
8
Part B. Grantee Response to FY12-13 NHVP Award Summary
Continue focus on reduction in client attrition. Set reasonable goal+ of 1% change.
Please see Item to Focus On: Infancy Attrition/Client Retention in Item 5 in 2013 Progress Report.
Work with IIK nurse consultant to strengthen your case conference process.
During discussions with Barbara Hughes we agreed that the strategies outlined in #17, Implementation Indicator to
Focus On, were adequate measures to improve our case conference process. Per #22, Ongoing Evaluation, we
increased the number of case conferences last year and were able to be more focused, increasing productivity.
Continue to evaluate CAB membership. Set more specific goals for engagement and use.
All members were asked to respond to a request for continued participation in the Weld CAB. 5 Individuals resigned
and 4 others requested to continue receiving meeting minutes without attending meetings. Our CAB had previously
been combined with the Health Babies program CAB. In 2010 the CABS separated at the request of the Healthy Babies
Campaign coordinator. The CABs were combined again in September, 2012. The combined meeting draws 8
additional members to our CAB. Most members participated in both CABs. Expectations of the CAB will be reviewed
at the 3/2013 meeting.
Incomplete explanation for caseload size on June 30, 2011. In future, provide more in-depth information for
caseload fluctuation.
Please see Item #4 in 2013 Progress Report in 2013 Progress Report
9
Part C. Fiscal Management
Complete items 1-2 below.
1. Related to FY2011-12 (July 1, 2011 through June 30, 2012):
A
B
C (=B/A)
CDPHE NHVP funding
( do not include Medicaid or
Other Sources)
FY2011-12
Final Budget
(after mid -year budget
revision) ($)
FY2011-12
Final Expenditures billed
to CDPHE ($)
FY2011-12
% of budget expended *
$658,658.00
$652,653.42
99%
*If the percentage of your budget expended is less than 97.0%, please provide a detailed explanation of
why your organization under -spent the budget.
A
B
C (=B/A)
Medicaid
Total Medicaid
Reimbursements for
Claims with dates of
payments between
7/1/2011 - 6/30/2012
($)
Final Medicaid
Expenditures for the
period 7/1/2011 -
6/30/2012 ($)
% of reimbursements
received**
Medicaid
48,072.00
$47,953.35
($50,308.16- if include
claims paid after 6/30/12)
99.7%
Notes:
This figure should
match reports from the
Department of Health
Care Policy and
Financing. Flora
Martinez emailed this
figure on 10/10/12.
This figure should be in
your accounting system
AND should match the
total cumulative shown on
the cost reimbursement
statements for the period
7/1/2011- 6/30/2012
**If the percentage of your reimbursements received is less than 97.0%, please provide a detailed
explanation of why your organization under -spent the budget.
10
2. Related to FY2012-13 Mid -year (July 1, 2012 through December 31, 2012):
A
B
C (=B/A)
CDPHE NHVP Funding
Budget for FY 2012-13
($)
Expenditures 7/1/2012 —
12/31/12
% budget expended***
CDPHE NHVP Funding
(do not include Medicaid or
Other Sources)
$638,889.00
$296,960.80
46%
Medicaid
Medicaid Estimate for
FY2012-13 ($)
Total Medicaid
Reimbursements for
Claims with dates of
payments between
7/1/2011- 6/30/2012 ($)
% of reimbursements
received***
Medicaid
$77797.00
$14995.55
19%
***50% of the contract period has elapsed. If % of budget expended or % of reimbursements is less than
40% of your NHVP Funding or Medicaid Estimate, please explain.
***We were short one NHV provider from 6/30/2012 to 12/17/12, so fewer clients were seen. The
Medicaid Estimate was set by CDPHE after Medicaid rates were lowered. The highest annual Medicaid
revenue we have received from Medicaid since we switched to the new reimbursement rates is $ 50,000.00.
n
Attachment D
FY2013-14 Colorado Nurse Home Visitor Program (NHVP)
ASSURANCE of INTENTION to MEET PROGRAM REQUIREMENTS
NHVP applicants seeking funding must assure that they intend to meet the Program Requirements, as
described in Sections 1.6, 1.7 and 1.8 of the Rules Concerning the Nurse Home Visitor Program (Attachment
H), by initialing each of the outlined areas below and by signing this assurance page.
X Annual Plan
X Training Requirements
X Visit Protocols
X Program Management Information Systems
X Reporting and Evaluation System
X Staffing Requirements including to hire nurses as stated in Definitions (11) and (13) of the
Rules
Concerning the Colorado Nurse Home Visitor Program and to obtain and retain
documentation demonstrating all nurses have a current license.
X Eligibility of Clients including securing and maintaining proof of income for each
mother
participating in the program.
Name of Agency: Weld County Department of Public Health & Environment
Name of Authorized Signer: William F. Gar
Signature of Authorized Signer: X
Date:
FEB 0 4 2013
13
Attachment E
FY2013-14 Colorado Nurse Home Visitor Program (NHVP)
ASSURANCE of INTENTION to be an ACTIVE MEDICAID PROVIDER
The Center for Medicaid and Medicare Services (CMS) has approved Medicaid reimbursement for Targeted Case Management (TCM)
services provided by NHVP sites. Targeted Case Management services are defined by CMS as "services which will assist individuals eligible
under the Colorado State Plan in gaining access to needed medical, social, educational, and other services." Nurse home visitors provide
targeted case management through 1) assessment of the needs for health, mental health, social service, educational, housing, child care
and related services to women and children; 2) development of care plans to obtain the needed services; 3) referral to resources to obtain
the needed services, including medical providers who provide care to a first-time pregnant woman and her first child; and, 4) routine
monitoring and follow-up visits with the women where progress in obtaining the needed services is monitored, problem -solving assistance
is provided and the care plans are revised to reflect the woman's and child's current needs."
The Colorado Department of Public Health and Environment and the Colorado Department of Health Care Policy and Financing have created
a Medicaid Management Information System that allows for electronic billing of TCM services under the NHVP. All NHVP sites are required
to be active Medicaid providers, if not already, and must bill Medicaid for TCM services as allowed. A portion of the annual funding for each
NHVP site is derived from Medicaid reimbursements.
NHVP applicants seeking funding must assure that they intend to meet the Medicaid requirements by initialing each of the outlined areas
below and by signing this assurance page. The entity will:
X Be an active Medicaid Provider on or before July 1, 2013 through June 30, 2014.
X Enroll all NHVP nurses in Medicaid as providers.
X Have a Medicaid consulting physician.
X Submit TCM claims as established by Medicaid billing rules and requirements,
including timely filing of claims.
X Ensure that all Medicaid -eligible participants are identified and receive assistance with
enrollment and referrals to other programs, including the Early and Periodic Screening, Diagnosis and
Treatment (EPSDT).
Name of Agency: Weld County Department of Public Health & Environment
Name of Authorized Signer: William F. Garcia ..—
Signature of Authorized Signer: X
Date: FEB 0 4 2013
14
Attachment F
FY2013-14 Colorado Nurse Home Visitor Program (NHVP)
ASSURANCE of INTENTION to Follow CASELOAD GUIDELINES
The 2006 NHVP audit conducted by the Office of the State Auditor included a recommendation to the CDPHE to work with the State Board
of Health and the NHVP management partners to address program costs through caseload standards and attrition rates. More specifically,
the Department should:
(a) Determine why local sites are not achieving and maintaining caseload standards and develop strategies to help increase
participation.
(b) Establish guidelines for reducing caseloads and funding when sites do not meet caseload standards.
(c) Provide attrition analyses to the local sites and develop specific strategies to reduce the level of addressable attrition at each local
site.
It is understood that sites will not always reach 100% of their funded caseload due to factors such as (1) nurse turnover, (2) new nurses
learning the NFP model, (3) caseload build-up over 7-9 months, and (4) sites developing adequate referral networks. Instead, a statewide
baseline of an 85% active caseload of the total number of participants funded to be served within a given fiscal year has been set. Active
clients are defined in the NFP Efforts to Outcomes (ET0'") software as those that have not been discharged from the NFP program and have
had a completed nurse visit within 90 days. The CDPHE and the NHVP management partners will review site -specific active caseload trends
covering a three-year period (current year and two years prior) to assess for legitimate caseload size variances and to arrive at site -specific
funding recommendations based on a reasonable expected active caseload size. Please acknowledge review of this material by signing
below.
Sites are expected to track their active caseload numbers using ETO reports and will be expected to report any caseload variations. Sites
will be alerted to any issues they need to address to ensure they are meeting active caseload expectations.
The NHVP mid -year budget adjustment process will be enhanced to consider year-to-date expenditures based on active caseload size. If a
site has cost savings as a result of a lower active caseload, those dollars may be redistributed to another grantee site.
For sites indicating an active caseload deficiency (consistently below baseline over the three-year trend period), a Performance
Improvement Plan will be required, including specific strategies and time lines for meeting active caseload expectations.
If a site does not meet the Performance Improvement Plan active caseload size expectation, a recommendation may be made to the State
Board of Health to reduce the active caseload number and funding in the site's contract to be commensurate with the site's consistent
performance.
The CDPHE contract will include active caseload size expectations as well as this plan as a means to formalize these requirements and to
hold all parties accountable for maximum caseload and funding efficiency.
The CDPHE and NHVP management team will develop a detailed caseload maintenance process and time line to guide and assist the sites in
effectively managing caseload size, including implementation of proven strategies to retain clients or to recruit new participants to the
program.
Name of Agency: Weld County Department of Public Health & Environment
Name of Authorized Signer: WilliamGar yia
Signature of Authorized Signer: X
Date:
FEB 0 4 2013
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