HomeMy WebLinkAbout20131733.tiffRESOLUTION
RE: APPROVE CONTRACT AMENDMENT #2 FOR HEALTHY COMMUNITIES OUTREACH
AND CASE MANAGEMENT (PREVIOUSLY EARLY AND PERIODIC SCREENING,
DIAGNOSIS, AND TREATMENT 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 Contract Amendment #2 for Healthy
Communities Outreach and Case Management (previously Early and Periodic Screening, Diagnosis,
and Treatment Program) between 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, and the Colorado Department of Public Health and Environment,
commencing July 1, 2013, and ending June 30, 2014, with further terms and conditions being as
stated in said amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, 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 Contract Amendment #2 for Healthy Communities Outreach and Case
Management (previously Early and Periodic Screening, Diagnosis, and Treatment Program)
between 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, and 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 amendment.
Cc. 4L
2013-1733
�If HL0040
CONTRACT AMENDMENT #2 FOR HEALTHY COMMUNITIES OUTREACH AND CASE
MANAGEMENT (PREVIOUSLY EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND
TREATMENT PROGRAM)
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 8th day of July, A.D., 2013, nunc pro tunc, July 1, 2013.
BOARD OF COUNTY COMMISSIONERS
WELD Y, COLORADO
ATTEST awe ,S)64......2.9::6.-4,
Weld County Clerk to the Board
BY:
Deputy Cle
APP:. ED AS
to the Bo
ttorney
Date of signature: JUL 16 2013
WilliartfF. Garcia, Chair
EXCUSED
Douglas Rademacher, Pro -Tern
Sean P. Conway
EXCUSED
Barbara Kirkmeyer
2013-1733
HL0040
TO:
FROM:
DATE:
SUBJECT:
Memorandum
William F. Garcia, Chair
Board of County Commissioners
Mark E. Wallace, MD, MPH, Director
Department of Public Health and Environment
June 13, 2013
Healthy Communities Outreach and Case Management
Contract Amendment No. 2
Enclosed for Board review and approval is a contract amendment between the Colorado Department of Health Care
Policy and Financing and the Board of County Commissioners of Weld County. This contract amendment allows
the Weld County Department of Public Health and Environment to continue providing Healthy Communities
services.
Funding for this contract will be used to provide health care case management, outreach and support services for
children ages birth to 21 who are on Medicaid. Emphasis is on educating families about age appropriate well child
services and helping them utilize these services available in the community.
The term of the contract is from July 1, 2013 through June 30, 2014. Funding for this renewal period will not exceed
$125,000.
Options and Impacts for the Board to consider:
I. Declining this grant would result in the loss of $125,000 in external support for health care access case
management and outreach services directed at Medicaid beneficiaries for the purpose of improving
health outcomes and reducing costs. The program could be discontinued with the loss of these outreach
and case management services for Medicaid beneficiaries. Should Weld County decline the renewal
option it is possible the Colorado Depahuent of Health Care Policy & Financing could award the
funding to another Weld County agency to provide these education, outreach and case management
services.
2. Approval of the grant would allow the Health Department to continue its historic outreach and support
services for children who are Medicaid eligible. In addition, with approval of this renewal agreement,
the Department would continue two other services currently a part of the Healthy Communities scope
of work: a.) Assisting in submitting Medicaid applications for the Needy Baby program, and b.)
Serving as a satellite Presumptive Eligibility site for pregnant mothers. These programs benefit not
only the Medicaid beneficiaries and area health care providers but also the Weld County Department
of Human Services.
I recommend your approval of this contract amendment.
Enclosure
2013-1733
Contract Routing Number 14-56679
CONTRACT AMENDMENT NO. 2
Original Contract Routing Number 2211-0150, CMS 24598
1. PARTIES
This Amendment to the above -referenced Original Contract (hereinafter called the "Contract") is
entered into by and between Board of County Commissioners of Weld County, 1555 North 17th
Avenue, Greeley, Colorado 80631, (hereinafter called "Contractor"), and the STATE OF
COLORADO, acting by and through the Department of Health Care Policy and Financing, 1570
Grant Street, Denver, Colorado 80203 (hereinafter called "Department" or "State.")
2. EFFECTIVE DATE AND ENFORCEABILITY
This Amendment shall not be effective or enforceable until it is approved and signed by the
Colorado State Controller or designee (hereinafter called the "Effective Date.") The Department
shall not be liable to pay or reimburse Contractor for any performance hereunder, including, but
not limited to, costs or expenses incurred, or be bound by any provision hereof prior to the
Effective Date.
3. FACTUAL RECITALS
The Parties entered into the Contract for Healthy Communities Outreach and Case Management.
The purpose of this Amendment is to amend Exhibit A, add Exhibit C, and extend the Contract
termination date.
4. CONSIDERATION
The Parties acknowledge that the mutual promises and covenants contained herein and other
good and valuable consideration are sufficient and adequate to support this Amendment.
5. LIMITS OF EFFECT
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
amendments thereto, if any, remain in full force and effect except as specifically modified
herein.
6. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. Section 4, Definitions, Subsection B, Exhibits and other Attachments, is hereby
deleted in its entirety and replaced with the following:
B. Exhibits and Other Attachments. The following documents are attached hereto and
incorporated by reference herein:
HIPAA Business Associate Addendum
Exhibit A, Statement of Work
Exhibit B, Sample Option Letter
Page 1 of 9
Exhibit C, Customer Relationship Management Procedures
B. Section 5, Term and Early Termination, Subsection A, Initial Term -Work
Commencement, is hereby deleted in its entirety and replaced with the following:
A. Initial Term -Work Commencement
The Parties' respective performances under this Contract shall commence on the later
of either the Effective Date or January 1, 2011. This Contract shall expire on June 30,
2014, unless sooner terminated or further extended as specified elsewhere herein.
C. Section 7, Payment to Contractor, Subsection A, Maximum Amount, is hereby
deleted in its entirety and replaced with the following:
A. Maximum Amount
The maximum amount payable under this Contract to contractor by the State for
Work performed in each State fiscal year is:
State Fiscal Year 2010-11
$60,000.00
State Fiscal Year 2010-11 Additional Work
$10,442.99
State Fiscal Year 2011-12
$120,000.00
State Fiscal Year 2012-13
$125,000.00
State Fiscal Year 2013-14
$125,000.00
Total for all State Fiscal Years
$440,442.99
D. Section 19, General Provisions, Subsection I, Order of Precedence, is hereby deleted
in its entirety and replaced with the following:
I. Order of Precedence
The provisions of this Contract shall govern the relationship of the State and
Contractor. In the event of conflicts or inconsistencies between this Contract and
its exhibits and attachments, including, but not limited to, those provided by
Contractor, such conflicts or inconsistencies shall be resolved by reference to the
documents in the following order of priority:
i. Colorado Special Provisions
i. HIPAA Business Associate Addendum
ii. The provisions of the main body of this Contract
iii. Exhibit A, Statement of Work
iv. Exhibit B, Sample Option Letter
Page 2 of 9
v. Exhibit C, Customer Relationship Management Procedures
E. Exhibit A, Statement of Work is hereby deleted in its entirety and replaced with
Exhibit Al, statement of Work, attached hereto and incorporated by reference into the
Contract. All references within the Contract to Exhibit A shall be deemed to reference
Al
F. Exhibit C, Customer Relationship Management Procedures, attached hereto and
incorporated herein by reference, is hereby added to the Contract.
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE
Except for the Special Provisions and the HIPPA Business Associates Addendum, in the event of
any conflict, inconsistency, variance, or contradiction between the provisions of this Amendment
and any of the provisions of the Contract, the provisions of this Amendment shall in all respects
supersede, govern, and control. The most recent version of the Special Provisions incorporated
into the Contract or any amendment shall always control other provisions in the Contract or any
amendments.
9. AVAILABLE FUNDS
Financial obligations of the state payable after the current fiscal year are contingent upon funds
for that purpose being appropriated, budgeted, or otherwise made available to the Department by
the federal government, state government and/or grantor.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 3 of 9
Contract Routing Number 14-56679
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Persons signing for Contractor hereby swear and affirm that they are authorized to act on
Contractor's behalf and acknowledge that the State is relying on their representations to that
effect.
CONTRACTOR:
Board of County Commissioners of
Weld County
By:
Signature of Authorized Officer
By:
Date: JUL 0 8 2013
Date:
William F. Garcia
STATE OF COLORADO:
John W. Hickenlooper, Governor
Susan E. Birch, MBA, BSN, RN
Executive Director
Department of Health Care Policy and
Financing
LEGAL REVIEW:
Printed Name of Authorized Officer John W. Suthers, Attorney General
By:
Chair, Board of Weld County Commissioners
Printed Title of Authorized Officer Date:
NIA
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not
valid until signed and dated below by the State Controller or delegate. Contractor is not
authorized to begin performance until such time. If Contractor begins performing prior thereto,
the State of Colorado is not obligated to pay Contractor for such performance or for any goods
and/or services provided hereunder.
ST E CONTROLLER:
PA, MBA, JD
By:
Depai
Date:
Page 4 of 9
c\20/3 - /7.3
Contract Routing Number 14-56679
EXHIBIT A
STATEMENT OF WORK
1.0 GENERAL REQUIREMENTS
1.1 The Contractor shall perform all work in accordance with all applicable Federal and State
statutes, regulations and rules, as now and hereafter amended, and the requirements
described within this Statement of Work and the purchase order.
1.2 The Contractor shall work closely and collaboratively with the Department, discuss
suggestions or issues as they occur and incorporate suggestions or guidance from the
Department while performing the work described within this Statement of Work and the
purchase order.
1.3 The Contractor shall coordinate and prioritize all work to ensure that all deliverables and
deadlines are met.
1.4 The Contractor shall employ an internal quality control process to ensure that all
deliverables are complete, accurate, easy to understand, and of high quality. The
Contractor shall provide deliverables that, at a minimum, are responsive to the specific
requirements, organized into a logical order, contain no spelling or grammatical errors,
formatted uniformly, and contain accurate information and correct calculations. The
Contractor shall retain all work papers generated for reference through the duration of the
project and project acceptance. The Contractor shall participate in the review and
revision process, until the Department provides written acceptance of the deliverable.
1.5 The Contractor shall provide copies of any supporting documentation to the Department
upon request of the Department and without charge.
1.6 The Contractor shall respond to all telephone calls and e-mail inquiries from the
Department within one (1) business day.
1.7 The Contractor shall provide electronic deliverables using Microsoft 2007 software.
1.8 The Contractor shall understand Community Partners to include any individual or
organization who assists with any of the programs offered by the Healthy Communities
program.
2.0 PROJECT REQUIREMENTS
2.1 The Contractor shall notify the Depaitiuent of any new employee within thirty (30) days
of hire.
2.2 The Contractor shall provide outreach and case management on all of the following:
2.2.1 Client Outreach and Program Education
Page 5 of 9
2.2.1.1 The Contractor shall conduct a minimum of four (4) outreach activities per month
to actively generate awareness and provide education to women and children
currently enrolled in the Healthy Communities Program and those who are
eligible for the Healthy Community Program, but are not enrolled (EBNE). The
outreach activities shall, at a minimum, include information describing available
programs and eligibility requirements on all of the following:
2.2.1.1.1 Medical assistance programs other than Medicaid and Child Health Plan Plus
(CHP+).
2.2.1.1.2 Medicaid and CHP+ benefits, including, but not limited to public health,
mental health, and education programs.
2.2.1.1.3 Supplemental food programs for women, infants, and children.
2.2.1.1.4 Family Health Coordinators as a resource.
2.2.1.2 The Contractor shall assist clients in finding or accessing appropriate community
resources and ensure families have access to the abovementioned programs.
2.2.1.3 The Contractor shall work to increase the number of well child visits as counted
on the Centers for Medicare and Medicaid Services Early and Periodic Screening,
Diagnostic, and Treatment (CMS EPSDT) 416 report to 80% for all ages 0-20 and
eligible for Medicaid.
2.2.1.4 The Contractor shall work to increase all oral health visits by 10% over 5 years
for children enrolled in both Medicaid and CHP+.
2.2.1.4.1 The Contractor shall use the 2010 CMS EPSDT 416 report as the baseline for
the abovementioned increase.
2.2.2 Community Outreach and Program Education
2.2.2.1 The Contractor shall train and educate the client regarding the availability of
services offered by the Healthy Communities Program.
2.2.2.2 The Contractor shall assist Community Partners in understanding the Medicaid
and CHP+ medical assistance programs, program benefits, and program
administration.
2.2.2.3 The Contractor shall plan, manage, and coordinate collaborative efforts and/or
activities with Community Partners to ensure better service delivery and
education to the populations served.
2.2.2.4 The Contractor shall attend all relevant meetings, conferences, and other channels
of collaboration in conjunction with Community Partners at no additional cost to
the Department.
2.2.3 Provider Outreach and Program Education
2.2.3.1 The Contractor shall educate providers on all services provided by or available
through Healthy Communities Program.
2.2.3.2 The Contractor shall educate and assist providers with services covered by
Medicaid and CHP+.
Page 6 of 9
2.2.3.3 The Contractor shall educate the providers on all of the following:
2.2.3.3.1 The importance of well care.
2.2.3.3.2 Federal mandates that eighty percent (80%) of children between the ages of
four (4) and twenty (20) receive one (1) well child visit per year
2.2.3.3.3 Federal mandates that children between the ages of zero (0) and three (3)
receive at least 10 visits in that time period.
2.2.3.4 The Contractor shall refer providers to the appropriate local department of human
or social services, the Department, and/or community resource(s) as necessary
2.2.3.5 The Contractor shall assist providers with missed appointment follow-up as
requested.
2.2.4 Case Management and Program Navigation
2.2.4.1 The Contractor shall assist all EBNEs and clients enrolled in the Healthy
Communities Program with the overall program navigation of the Medicaid and
CHP+ programs.
2.2.4.2 The Contractor shall assist EBNEs with the application process, which includes
all of the following:
2.2.4.2.1 Assisting the EBNEs with a paper Medicaid application or the Colorado
Program Eligibility and Application Kit (PEAK).
2.2.4.2.2 Providing on site presumptive eligibility (PE) determinations for those who
may qualify.
2.2.4.2.3 Providing an appropriate referral, when necessary, to another application
assistance site, including, but not limited to a local department of human or
social services, a PE site, a Certified Application Assistant Site (CAAS), or a
Medicaid Assistance (MA) site.
2.2.4.3 The Contractor shall perform the following tasks for all individuals who qualify
for the Healthy Communities Program:
2.2.4.3.1 Follow-up with pregnant women, children, families, and EBNEs regarding the
status of their application as requested by the client.
2.2.4.3.2 Provide Healthy Communities Program clients with a list of appropriate
Medicaid and CHP+ providers and referrals when appropriate.
2.2.4.3.3 Provide appointment assistance as requested by Medicaid eligible clients.
2.2.4.3.4 Provide referrals for medical and non -medical programs to Healthy
Communities Program clients and their family members as requested by the
client or their family.
2.2.4.3.5 Provide missed appointment follow up as requested by physical, oral and
mental health providers.
2.2.4.3.6 Provide follow-up assistance to clients who have not received services within
six (6) months and/or annually for services defined in the Colorado
Periodicity Schedule or by the CHP+ oral health periodicity schedule.
Page 7 of 9
2.2.4.3.7 Assist in resolving any issues or concerns regarding enrollment into Medicaid
or CHP+ and/or eligibility issues, including, but not limited to, facilitating
contact with CHP+ contractors.
2.2.4.3.8 Assist clients with scheduling appointments and transportation needs through
the Medicaid Transportation Broker or local department of human or social
services.
2.2.4.3.9 Assist clients with billing issues and/or any additional questions and issues
regarding program benefits and/or navigation.
2.3 Customer Relationship Management System
2.3.1 The Contractor shall provide all employees access for the program to use the Healthy
Communities Customer Relationship Management System as required.
2.3.2 The Contractor shall assure that all local information needed to assist clients, such as
providers, community resources, etc are added to the Healthy Communities Customer
Relationship Management System as they relate to the Healthy Communities Program
in a timely manner to assure lists are available for use by clients and community
partners as needed.
2.3.3 The Contractor shall assure that staff are computer literate and able to use the Healthy
Communities Customer Relationship Management System to its full potential.
2.4 Reporting
2.4.1.1 The Contractor shall utilize the Healthy Communities Customer Relationship
Management System in accordance with the Department's established procedures
(Exhibit C) to provide reporting on program deliverables.
2.4.1.2 The Contractor shall submit a detailed Budget Report to the Department within 60
days of the issuance or renewal of a contract with the Department. At a minimum,
the Budget Report shall include all anticipated program related expenses for full
time employee(s) and operating expenses for the entire contractual period.
2.4.1.3 The Contractor shall assure the Healthy Communities Customer Relationship
Management System database is up to date by the 10th of the month following the
reporting month. The Department will pull reports for monthly contacts, referrals,
and outreach activities after the 10th and before the 15th of the month to meet the
monthly reporting requirements.
2.4.1.3.1 The Contractor shall submit all requests for extensions of this deadline to the
Department in writing no later than the 5th of the month.
2.4.1.4 The Contractor shall submit a Final Report to the Department utilizing reporting
and information from the Healthy Communities Customer Relationship
Management System database. The Final Report shall include, at a minimum, all
of the following:
2.4.1.4.1 An analysis of any successes and challenges faced by the Contractor, based on
their individual program and location, related to the Healthy Communities
program during the contracted period.
2.4.1.4.2 An analysis of the contract year's activities, outcomes, trends, and results.
Page 8 of 9
2.4.1.4.3 An analysis of their ability to meet CMS EPSDT requirements for well child,
oral health, and lead testing.
2.4.1.4.4 An analysis of their ability to meet the oral health periodicity schedule for
CHP+ eligible children.
2.4.1.5 The Contractor shall provide Ad Hoc Reports as requested by the Department.
2.4.1.5.1 When an Ad Hoc Report is requested, the Contractor shall coordinate with the
Department to confirm its understanding of the request and identify the best
method for response.
2.4.1.5.2 The Contractor shall provide all ad hoc reports within thirty (30) days of the
Department's request at no additional cost to the Department.
3.0 PAYMENT
3.1 The Contractor shall submit an invoice monthly based on the Contractor's actual
expenditures for the period specified. All invoices shall be submitted using the Contract
Reimbursement Statement Form attached to this Contract as Exhibit B. All invoices shall
reference the Contract by the Contract routing number that appears on the first page of
the Contract. Invoice shall be based upon the cost of the Work performed during the term
of this Contract, and, shall be supplemented or accompanied by supporting data and
subcontractor invoices, if any, covering the Work shown on the invoice. Indirect costs
shall not exceed five percent (5%) of the Contract Maximum Amount for the Contract
year. The total of the invoice submitted by the Contractor for all periods during a
Contract year shall not exceed the Contract maximum amount for that year.
4.0 DEPARTMENT RESPONSIBILITIES
4.1 The Department will:
4.1.1 Arrange for training on the Healthy Communities Customer Relationship
Management System database and access to the system for all of the Contractor's
current employees working with the Healthy Communities Program in a timely
manner.
4.1.2 Arrange for training on the Healthy Communities Customer Relationship
Management System database and access to the system for any new employee hired
by the Contractor working with the Healthy Communities Program within 60 days of
being notified of the new hire.
4.1.3 Submit payment to the Contractor upon the Department's review and acceptance of
deliverables and invoicing received from the Contractor.
Page 9 of 9
Contract Routing Number 14-56679
EXHIBIT C
CUSTOMER RELATIONSHIP MANAGEMENT PROCEDURES
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 1 of 1
Policy and Procedures Manual
Healthy Communities Program
Department of Health Care Policy and Financing
State of Colorado
Prepared by the Client Services Section
Nov 15, 2012
WHAT ARE POLICIES AND PROCEDURES 4
PROCEDURE WRITING BEST PRACTICES 4
HEALTHY COMMUNITIES PROGRAM POLICIES 6
CLIENT OUTREACH AND PROGRAM EDUCATION POLICY 9
COMMUNITY AND PROGRAM EDUCATION POLICY 11
PROVIDER OUTREACH AND PROGRAM EDUCATION POLICY 13
CASE MANAGEMENT AND PROGRAM POLICY 15
PRIVACY AND CONFIDENTIALITY POLICY 18
PROVIDE CLIENT OUTREACH AND PROGRAM EDUCATION SERVICES 21
TRAIN AND EDUCATE COMMUNITY ORGANIZATIONS AND PARTNERS ON THE
AVAILABILITY OF SERVICES PROVIDED BY HEALTHY COMMUNITIES 22
ASSIST COMMUNITY PARTNERS IN UNDERSTANDING THE MEDICAID AND CHP+
MEDICAL ASSISTANCE PROGRAMS, PROGRAM BENEFITS, AND GENERAL PROGRAM
ADMINISTRATION GUIDELINES
23
PLAN, MANAGE, AND COORDINATE COLLABORATIVE EFFORTS OR ACTIVITIES WITH
OTHER COMMUNITY PARTNERS TO ENSURE BETTER SERVICE DELIVERY AND
EDUCATION TO THE POPULATIONS SERVED 24
ATTEND MEETINGS, CONFERENCES, AND OTHER CHANNELS OF COLLABORATION IN
CONJUNCTION WITH COMMUNITY ORGANIZATIONS AND COMMUNITY PARTNERS 25
EDUCATE PROVIDERS ON THE SERVICES PROVIDED BY OR AVAILABLE THROUGH
HEALTHY COMMUNITIES 26
EDUCATE AND ASSIST PROVIDERS WITH SERVICES COVERED BY THE MEDICAID AND
CHP+ MEDICAL ASSISTANCE PROGRAMS 28
REFER PROVIDERS TO APPROPRIATE DEPARTMENT OR COMMUNITY RESOURCES
INCLUDING THOSE THAT WOULD LIKE TO BECOME MEDICAID OR CHP+ PROVIDERS 29
ASSIST CLIENTS WITH THE OVERALL PROGRAM NAVIGATION OF THE MEDICAID AND
CHP+ MEDICAL ASSISTANCE PROGRAMS ON A DAY TO DAY BASIS 31
CONTACT AND ASSIST ALL CLIENTS REFERRED TO THE HEALTHY COMMUNITIES
PROGRAM THROUGH FACE TO FACE, WRITTEN, ORAL, AND OTHER METHODS OF
COMMUNICATION INCLUDING THE USE OF SOCIAL MEDIA
33
ASSIST CLIENTS WITH THE APPLICATION PROCESS 34
PROVIDE FOLLOW UP TO PREGNANT WOMEN AND CHILDREN, FAMILIES, AND EBNE'S
ON THE STATUS OF THEIR APPLICATION AS REQUESTED AND/OR ASSIST THE CLIENT
2 Policy and Procedures Manual
IN RESOLVING ANY ISSUES OR CONCERNS REGARDING THEIR ENROLLMENT INTO A
MEDICAL ASSISTANCE PROGRAM AND/OR ELIGIBILITY ISSUES 36
ASSIST CLIENTS WITH THE REPORTING OF NEWBORNS 37
PROVIDE CLIENTS WITH A LIST AND REFERRAL TO AN APPROPRIATE MEDICAID OR
CHP+ PROVIDER 38
ASSIST CLIENTS WITH SCHEDULING OF APPOINTMENTS AND TRANSPORTATION
NEEDS 39
MANAGE COMPLAINTS OF PRIVACY BREACHES 40
CONTACT CLIENTS ATTENDING INMUNIZATION CLINICS 41
OUTREACH TO EPSDT CLIENTS AT EVENTS 42
OUTREACH TO CHILD CARE CENTERS / HOMES 43
OUTREACH TO COMMUNITY 44
PROVIDE CASE FOLLOW-UP 45
Policy and Procedures (Manual 3
WHAT ARE POLICIES AND PROCEDURES
Policies reflect the "rules" governing the implementation of the project processes.
Procedures, on the other hand, represent an implementation of policy and should evolve over
time as new tools emerge, new processes are designed, and the risks associated with an area
change in response to internal or external environmental changes. (In fact, there should be an
expectation that individuals will "challenge" outdated procedures and call them to the
attention of their owners.)
PROCEDURE WRITING BEST PRACTICES
The overall goal for any policy or procedure document is for the design to be simple, consistent,
and easy to use. In order to ensure a consistent format between documents, we'll be providing
Microsoft Word templates to help us get started.
GOOD POLICIES
• Policies are written in clear, concise, simple language.
• Policy statements address what is the rule rather than how to implement the rule.
• Policy statements are readily available to contractors and their authority is clear.
• As a body, they represent a consistent, logical framework for project action.
GOOD PROCEDURES
• Procedures are tied to policies. Making explicit this relationship along with how the
procedure helps the project achieve its goals or strategic plan helps ensure
understanding and compliance.
• Procedures are developed with the customer/user in mind. Well developed and thought
out procedures provide benefits to the procedure user.
• There is a sense of ownership among procedure users. For this reason, it helps to
involve users in the development of procedures.
• The procedures are understandable. Procedures should be written so that what needs
to be done can be easily followed by all users.
4 Policy and Procedures Manual
WRITING STYLE FOR POLICY AND PROCEDURE DOCUMENTS
• Concise, minimum of verbiage.
• If you use an acronym, spell it out the first time you use it.
• Include step-by-step instructions for completing (paper or electronic) forms (procedures
only).
• Not too technical —simple enough to be understood by a new employee.
• Fill in the holes - Ask yourself if your existing procedures cover all of the tasks users need to
complete. If you have a set of well written FAQs (and you should!), make sure there are
procedures for addressing the details of each FAQ.
• State the goal - Unless it is already obvious, begin by telling users the reason for
performing the procedure, and in what conditions it is applicable.
• Break it down - Lengthy procedures are harder to follow. Break these behemoths down
into smaller chunks and use hyperlinks to guide users from one granular task to the next.
Aim for in steps or less in each procedure.
• Don't assume - Read carefully through your procedures and ask, "Is there anything a user
would need to know that I've left out?" Don't assume that users know everything you know
about the process.
• Use warnings - For each step in your procedures, carefully consider whether there are any
potential risks or dangers that you haven't documented.
• Link related procedures - Whenever possible, especially in help, use cross- references to
point users to related procedures. Most users need to perform multiple related tasks in
order to complete their goals.
• Tell users what to expect - Consider whether the results of each step need to be
documented. Good candidates are those that result in changes in the state of the product
(e.g. an important prompt appears in the software). Your description of the result should
immediately follow the instructions for that step.
• Watch for branches - Often a step in a procedure can have multiple results. If your
procedure branches, consider making each branch a separate procedure. Use links or cross-
references to guide users through.
• Combine small steps - Usually it is best to write only one instruction per numbered step.
However, small steps can often be combined. For example, "Click the save button" and
"Close the application" can be combined into "Click the save button and close the
application." Combine multiple small steps only when the concepts are simple enough for
users to think of them as one.
• Give users an overview - Use a flowchart, list of links, or other visual cue to help users see
how procedures are related. This will provide users with an overview to guide them through
a complex series of tasks.
• Follow up with results - At the end of the procedure, clearly describe the results so that
users can assess whether they were successful in completing the task. The more
complicated the task, the more assurance users will need.
Policy and ?rocedures Manua! 5
HEALTHY COMMUNITIES PROGRAM POLICIES
DEFINITIONS
The Healthy Communities Outreach and Case Management Program focuses on providing
comprehensive outreach and case management services to all pregnant women and children,
and youth aged 20 and under for the Early Periodic Screening Diagnosis and Treatment
(EPSDT) Medicaid program, clients enrolled into the Child Health Plan Plus (CHP+) program
and the Eligible But Not Enrolled (EBNE) populations.
The authorities governing Healthy Communities Outreach and Case Management Program for
Medicaid are contained within the Social Security Act:
• Section 1go5(a)(4)(b)
• Section 19o5(r) - (OBRA 1989)
• Section 1902(a)(43)
• Section 1902(a)(10), following (g)
• Part 5 of the State Medicaid Manual
• Part 2 of the State Medicaid Manual
• 42 CFR 441.56 - 42 CFR 441.62, 42 CFR 457.50 through 42 CFR 457.110 and 42 CFR
457.340.
PURPOSE AND SCOPE
• The purpose of this policy is to establish and define the responsibilities of the Family
Health Coordinators that are related to performing outreach and case management
services for the Healthy Communities Outreach and Case management Program.
• All staff of the program shall perform these functions as defined in each of the
contractors Statement of Work.
RATIONALE
Family Health Coordinators are responsible for performing all outreach and case management
services to the defined populations.
GENERAL PRINCIPLES
• Family Health Coordinators shall perform all functions as outlined by the State of
Colorado, Department of Health Care Policy and Financing.
• Family Health Coordinators shall ensure the all appropriate and defined services and
provided to the outlined populations in accordance with state and federal regulations.
• Ensure all program deliverables are met within the established guidelines and the
Department provided Statement of Work.
POLICY STATEMENT
6 Policy and Procedures Manual
All Family Health Coordinators shall provide comprehensive outreach and case management
services to all pregnant women, as well as all children and youth aged 20 and underas all are
EPSDT (Medicaid). eligible,; along with those who are CHP+ eligible,; and those that are Eligible
But Not Enrolled (EBNE) populations.
POLICIES
1. Client Outreach and Program Education
2. Community Outreach and Program Education
3. Provider Outreach and Program Education
4. Case Management Services
S. Privacy and Confidentiality
Policy and Procedures Manual 7
PROGRAM POLICIES
8 Policy and Procedures Manual
CLIENT OUTREACH AND PROGRAM EDUCATION POLICY
Issue Date: mm/dd/yy Effective Date: mm/dd /yy
DEFINITIONS
Policy No. J. Page No. i of i
Family Health Coordinators shall perform "Client Outreach and Program Education" services
by actively generating awareness and provide education to all pregnant women, and children,
youth aged zo and under, as well as the EBNE populations on the availability of medical
assistance program through face to face, written, oral and other methods of communication.
Family Health Coordinators shall educate the outlined populations on the Medicaid and CHP+
program benefits including public health, mental health, education programs, and related
programs such as Health Care Program for Children with Special Health Care Needs (HCP),
Head Start, Title IXX social services programs, supplemental food programs for women, infants,
and children (WIC) to ensure the effectiveness of child health programs.
Family Health Coordinators shall assist clients in finding or accessing appropriate medical and
non medical community resources and ensure families have access to these programs.
Family Health Coordinators shall educate clients on the availability of Family Health
Coordinators as a resource to all outlined populations, community partners, providers, and all
other interested parties.
PURPOSE AND SCOPE
• The purpose of this policy is to establish and define the responsibilities of the Family
Health Coordinators as they related to Client Outreach Activities
• All staff of the program shall perform these functions as defined in each of the
contractors Statement of Work
• All services described shall be performed in accordance with all applicable state and
federal regulations and policies
RATIONALE
Clients eligible to receive services of this program shall be provided all appropriate resources
that will assist in the clients ability to be educated abouttheir program benefits and other
community resources to ensure positive outcomes for program members.
GENERAL PRINCIPLES
• Family Health Coordinators shall provide all outlined services in accordance with state
and federal regulations and policies.
• Perform Program client outreach and program education services on a daily basis to
best meet the needs of the clients served.
Policy and Procedures Manual', 9
PROVIDE CLIENT OUTREACH AND PROGRAM EDUCATION SERVICES TO
ALL ELIGIBLE CLIENT OF THE HEALTHY COMMUNITIES PROGRAM AND IN
A TIMELY MANNERPOLICY STATEMENT
Family Health Coordinators shall provide "Client Outreach and Program Education" services to
all eligible clients of the Healthy Communities Outreach and Case Management Program.
IMPLEMENTATION PROCEDURES
1. Provide client outreach and program education services through face to face, written,
oral or other methods of communication
10 Policy and Procedures Nlanuai
COMMUNITY AND PROGRAM EDUCATION POLICY
Issue Date: mm/dd/yy Effective Date: mm/dd /yy
DEFINITIONS
Policy No. i Page No. i of
Family Health Coordinators shall provide "Community Outreach and Program Education"
services by providing training and education on the availability of services offered bythe
Healthy Communities Program to community organizations and other program related
partners.
Family Health Coordinators shall assist community partners in understanding the Medicaid and
CHP+ medical assistance programs, program benefits, and general program administration
principles.
Family Health Coordinators shall plan, manage, and coordinate collaborative efforts or
activities with other community organizations and partners to ensure better service delivery
and education to the populations served.
Family Health Coordinators shall attend meetings, conferences, and other channels of
collaboration in conjunction with community organizations and community partners and
actively represent the program at those meetings.
PURPOSE AND SCOPE
• The purpose of this policy is to establish and define the responsibilities of the Family
Health Coordinators as they related to Community Outreach activities
• All staff of the program shall perform these functions as defined in each of the
contractors Statement of Work
• All services described shall be performed in accordance with all applicable state and
federal regulations and policies
RATIONALE
Clients eligible to receive services of this program shall be provided all appropriate resources
that will assist in the clients ability to be educated about their program benefits and other
community resources to ensure positive outcomes for program members.
GENERAL PRINCIPLES
• Family Health Coordinators shall provide all outlined services in accordance with state
and federal regulations and policies.
• Family Health Coordinators shall perform these activities to ensure community
partners, providers, and all other interested parties are informed aboutthe services
provided by Healthy Communities.
Policy and Procedures Manual 11
• Family Health Coordinators shall perform these activities to ensure all appropriate
resources and referrals and provided to the populations served.
POLICY STATEMENT
Family Health Coordinators shall provide "Community Outreach and Program Education"
services to community partners, providers, and all other interested parties on the services
provided by the Healthy Communities Outreach and Case Management Program.
IMPLEMENTATION PROCEDURES
1. Train and educate community organizations and partners on the availability of services
provided by Healthy Communities.
2. Assist community partners in understanding the Medicaid and CHP+ Medical
Assistance programs, program benefits, and general program administration
guidelines.
3. Plan, manage, and coordinate collaborative efforts or activities with other community
partners to ensure better service delivery and education to the populations served and
assure services are duplicated between partners.
4. Attend meetings, conferences, and other channels of collaboration in conjunction with
community organizations and community partners and actively represent the program.
12 Policy and Procedures Manual
PROVIDER OUTREACH AND PROGRAM EDUCATION POLICY
Issue Date: mm/dd/yy Effective Date: mm/dd /yy
DEFINITIONS
Policy No_ a. Page No. 3. of i
Family Health Coordinators shall provide education to providers on the services provided by or
available through Healthy Communities including but not limited to: Assisting with missed
appointment follow up; Provider office visits; Resolving or clarifying the client's program
eligibility: Reporting of the clients newborn; Scheduling or contacting the client for follow up
services or other visits; and other services needed by the client.
Family Health Coordinators shall educate and assist providers with services covered by the
Medicaid and CHP+ medical assistance programs.
Family Health Coordinators shall refer provider to the appropriate Department or other
community resources including those that would like to become Medicaid or CHP+ providers.
PURPOSE AND SCOPE
• The purpose of this policy is to establish and define the responsibilities of the Family
Health Coordinators as they related to Provider Outreach activities
• All staff of the program shall perform these functions as defined in each of the
contractors Statement of Work
• All services described shall be performed in accordance with all applicable state and
federal regulations and policies
RATIONALE
Family Health Coordinators shall ensure good relationships with external partners to ensure all
appropriate services can be offered to the populations served.
GENERAL PRINCIPLES
• Family Health Coordinators shall provide all outlined services in accordance with state
and federal regulations and policies.
• Family Health Coordinators shall perform these activities to ensure providers and all
other interested parties are informed about the services provided by Healthy
Communities.
• Family Health Coordinators shall perform these activities to ensure all appropriate
resources and referrals and provided to the populations served.
POLICY STATEMENT
Policy and Procedures Manual 13
Family Health Coordinators shall provide "Provider Outreach and Program Education" services
to providers and all other interested parties on the services provided by the Healthy
Communities Outreach and Case Management Program.
IMPLEMENTATION PROCEDURES
i. Educate providers on the services provided by or available through Healthy
Communities including but not limited to: Assisting with missed appointmentfollow
up; Provider office visits; Resolving or clarifying the clients program eligibility;
Reporting of clients newborn; Scheduling or contacting the client for follow up services
or other visits; and other services needed by the client.
2. Educate and assist providers with services covered by the Medicaid and CHP+ medical
assistance programs.
3. Refer providers to appropriate Department or community resources including those
that would like to become Medicaid or CHP+ providers.
14 ' Policy and Procedures Manual
CASE MANAGEMENT AND PROGRAM POLICY
Issue Date: mm/dd/yy Effective Date: mm/dd /yy
DEFINITIONS
Policy No.1 Page No. i of a
Family Health Coordinators shall assist clients with the overall program navigation of the
Medicaid and CHP+ medical assistance programs on a day to day basis including but not limited
to: Contacting and assisting all clients through face to face, written, oral, and other methods of
communication;
assist clients with the application process which can include assisting the client face to face with
a paper or PEAK application; Providing PE determinations on site to those that may qualify,
and/or an appropriate referral to another application assistance site such as aocal department
of social/human services, PEAK, CAAS, other PE, or MA Site to facilitate the client's enrollment
into Medicaid and CHP+;
Provide follow up to pregnant women and children, families, and EBNE's on the status of their
application as requested and/or assist the client in resolving any issues or concerns regarding
their enrollment into a medical assistance program and/or eligibility issues;
Assist clients with the reporting of newborns; includes processing Add -A -Baby request for cases
that are emergent or if services need to be expedited;
provide clients with a list and referral to an appropriate Medicaid or CHP+ provider;
Assist clients with scheduling of appointments and transportation needs through the Medicaid
Transportation Broker or appropriate local department of social/human services;
Provide follow up and assistance to clients who have not received services within six months of
initial eligibility and annually thereafter for services defined in the Colorado Periodicity
Schedule; and,
Assist clients with billing issues or other questions and issues regarding program benefits or
navigation.
PURPOSE AND SCOPE
• The purpose of this policy is to establish and define the responsibilities of the Family
Health Coordinators as they related to case management activities
• All staff of the program shall perform these functions as defined in each of the
contractors Statement of Work
• All services described shall be performed in accordance with all applicable state and
federal regulations and policies
RATIONALE
Policy and Procedures Manual ' 15
All Family Health Coordinators shall provide comprehensive outreach and case management
services to all pregnant women, and children and youth aged zo and under who are EPSDT
(Medicaid) eligible, CHP+ eligible, and those that are Eligible But Not Enrolled (EBNE)
populations.
GENERAL PRINCIPLES
• Family Health Coordinators shall provide all outlined services in accordance with state
and federal regulations and policies.
• Family Health Coordinators shall perform these activities to ensure providers and all
other interested parties are informed about the services provided by Healthy
Communities.
• Family Health Coordinators shall perform these activities to ensure all appropriate
resources and referrals and provided to the populations served.
POLICY STATEMENT
Family Health Coordinators shall provide case management to all eligible pregnant women, and
children, youth aged 20 and under.
IMPLEMENTATION PROCEDURES
1. Assist clients with the overall program navigation of the Medicaid and CHP+ medical
assistance programs on a day to day basis;
2. Contact and assist all clients through face to face, written, oral, and other methods of
communication including the use of social media. Initial contact shall be within 6o days
of eligibility determination.
3. Assist clients with the application process; includes assisting the client face to face with
a paper or PEAK application; Providing PE determinations on site to those that may
qualify, and/or an appropriate referral to another application assistance site such as the
local department of social/human services, PEAK, CAAS, other PE, or MA Site to
facilitate the client's enrollment into Medicaid and CHP+.
4. Provide follow up to pregnant women and children, families, and EBNE's on the status
of their application as requested and/or assist the client in resolving any issues or
concerns regarding their enrollment into a medical assistance program and/or eligibility
issues.
5. Assist clients with the reporting of newborns which can include processing Add -A -Baby
request for cases that are emergent or if services need to be expedited.
6. Provide clients with a list and referral to an appropriate Medicaid or CHP+ provider;
7. Assist clients with scheduling of appointments and transportation needs through the
Medicaid Transportation Broker or appropriate local department of social/human
services.
8. Provide follow up and assistance to clients who have not received services within six
months from initial eligibility and annually thereafter for services defined in the
Colorado Periodicity Schedule.
g. Assist clients with billing issues or other questions and issues regarding program
benefits or navigation.
16 Policy and Procedures Manual
lo. Assist other family members in the home with referrals to low cost or free medical or
non -medical services within their community as needed.
Policy and Procedures Manual 17
PRIVACY AND CONFIDENTIALITY POLICY
Issue Date: mm/dd/yy Effective Date: mm/dd /yy
DEFINITIONS
Policy No. i Page No.3. of i
Privacy protects beneficiaries from unfair or unauthorized use of personal or sensitive
information. Personal information is any information that can lead to an individual being
identified or reasonably ascertained. Healthy Communities is obliged to meet the standards
required in The Health Insurance Portability and Accountability Act of 3.996 (HIPAA).
Confidentiality relates to how information that has been disclosed in the course of a
professional relationship is treated. The Healthy Communities staff have an obligation to take
all reasonable measures to ensure all information disclosed in confidence, is not disclosed
without beneficiary consent or otherwise unfairly or inappropriately.
PURPOSE AND SCOPE
• The purpose of this policy is to establish standards of privacy and confidentiality for all
aspects of the program's dealings with all beneficiaries (including family members) of
the service;
• The Privacy and Confidentiality Policy applies to all beneficiaries. The offices where
service is provided and any online presence of the program display brochures and/or
pamphlets in an appropriate range of languages and formats about beneficiaries rights
to privacy and confidentiality. The Privacy and Confidentiality Policy is to be provided
to beneficiaries on request;
• All staff of the program will be made aware of the Privacy and Confidentiality Policy,
and contribute to any review of the policy based on its applicability to practice.
RATIONALE
Healthy Communities is obliged to meet the standards required in the The Health Insurance
Portability and Accountability Act of 1996 (HIPAA).
GENERAL PRINCIPLES
• Beneficiaries are to be informed of the purpose for collecting any information;
• Information will be collected in a non -intrusive, non -coerced manner following the
expressed or implied consent, as appropriate;
• The only information about a benefit iary held by the service will be information
necessary to provide the service;
• Information about beneficiaries will be held securely;
• Details about beneficiaries are kept confidential, and only disclosed with the
beneficiary's consent for the purpose of ensuring that beneficiaries receive the service
they need;
18 Policy and Procedures Manual
• The beneficiary will be made aware of, and be required to consent to, any exchange of
information about the beneficiary made with another person, including family/
significant others, and with another service.
POLICY STATEMENT
The Healthy Communities Program has a responsibility to respect its beneficiary's right for
privacy and confidentiality by protecting them from unfair or unauthorised use of
personal/sensitive information and applying standards on how information is collected, used,
secured and disclosed.
IMPLEMENTATION PROCEDURES
a. Create New and Edit Beneficiary Records
2. Manage Enrollments
3. Log Interactions
4. Internal Communications
5. Reporting
6. System Security
7. Complaints of Privacy Breaches
Policy and Procedures Manual 19
PROGRAM PROCEDURES
20 Policy and Procedures Manual
PROVIDE CLIENT OUTREACH AND PROGRAM EDUCATION
SERVICES
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. z Page No. i of 1
OVERVIEW
By reaching out to all current and potential clients and providing program education, clients can
receive the optimal services from their Healthy Communities' Coordinator and therefore best
utilize the Medicaid/CHP+ Services and community services for the best health outcomes.
Provide client outreach and program education services through face to face, written, oral or
other methods of communication
POLICIES APPLICABLE
Client Outreach and Program Education Policy
PROCEDURE DETAILS
z_ Check CBMS for Medicaid/CHP+ Status by checking Med Span for each family member that is an HC Client.
Do not assume that all members are active because you find one member active.
2. If active, then you will check to see if this client is in the HC Data Base. If not, a new household will need to
be entered. This includes all active Medicaid / CHP+ members.
3. A contact will be made to the family by face to face, phone, letter,email or text as appropriate.
Warning: All communications by email with client data must be encrypted.
4. Educate families on EPSDT benefits for Medicaid eligible families, including well child and oral health care
as outlined by the Colorado Periodicity Schedule. Education shall include the need for lead testing at iz
and 24 months as well as between 36 and 72 months if not previously tested.
5. Educate families on benefits available for CHP+ eligible families, including well child and oral health care.
6. Educate on dangers of second-hand smoke and provide information on the Quit Line for those clients
wanting to quit smoking.
7. Provide information on the Nurse Support Line by explaining what it is, and giving the State Flyer. Provide
information and flyer for the pregnant women interested in Text4baby.
8. Assist families to find a provider for ail Medicaid /CHP+services by accessing the Provider list in the HC
data base.
g. Make necessary and appropriate referrals to Community Programs and Organizations.
zo. All contacts, referrals and follow up will be entered in the HC Data system.
Policy and Procedures Manual 21
TRAIN AND EDUCATE COMMUNITY ORGANIZATIONS AND
PARTNERS ON THE AVAILABILITY OF SERVICES PROVIDED BY
HEALTHY COMMUNITIES
Issue Date: mmlddlyy Effective Date: mm/dd /yy Procedure No. a Page No. z of i
OVERVIEW
Utilizing community organizations and partners is one of the best ways to reach out to many
families that could utilize HC Services. Community outreach must be done so that
organizations have a clear comprehension on the services provided by HC, understand the
value of the program, and therefore eager to refer their clients to HC. Community Outreach
must also be done to assure services are not duplicated within the programs used by a family or
pregnant woman.
POLICIES APPLICABLE
Community and Program education policy
PROCEDURE DETAILS
a. Contact community partner or organization to schedule a time to meet.
2. Meetings can be scheduled during monthly or quarterly team meetings to attempt to
meet with all staff. Sometimes early morning or lunch times are better times to try to
meet with many organizations/partners
3. Educate their teams about Healthy Communities, explaining the services you provide to
clients (ie educating families on their benefits, assisting families finding providers,
referring to appropriate resources) and the continued follow up.
4. Explain to the organization how you assist the Eligible But Not Enrolled. If you are a PE
Site, explain the benefits of receiving a PE and your role in the PE Process. If not a PE
Site, explain how you refer to the appropriate site to apply and how you follow-up with
the families to assure they have applied.
5. Stress the important role that the community partner or organization plays in referring
clients to you. Even if the partner is not sure it is an appropriate referral, they should
refer anyway and your office can either process PE or refer to appropriate site to apply.
6. Inform community partners and organizations that Healthy Communities is a neutral
program, and we do not favor any provider. HC offers the client options and allows the
client to make their own decision when selecting any provider.
7. All contacts, referrals and follow up will be entered in the HC Data system.
22 Policy and Procedures Manual
ASSIST COMMUNITY PARTNERS IN UNDERSTANDING THE
MEDICAID AND CHP+ MEDICAL ASSISTANCE PROGRAMS,
PROGRAM BENEFITS, AND GENERAL PROGRAM
ADMINISTRATION GUIDELINES
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. i Page No. 1. of i
OVERVIEW
Educating your community partners/organizations on the Medicaid/CHP+ benefits will allow
the agency/organization to better serve their families when they present to them having
medical/health problems or concerns. The organization/agency will know the best assistance
they can offer their family would be to refer them to HC for services and follow-up.
POLICIES APPLICABLE
Community and Program education policy
PROCEDURE DETAILS
i. Educate the community partner/organizations on the benefits provided to Medicaid and
CHP+ Eligible children and pregnant women.
2. Educate community partners that we refer to PCMP/Pediatricians, OB/Gyn, Dental, Vision,
Mental Health, and Specialty providers that are taking new and existing Medicaid and CHP+
families and individuals.
3. Inform community partners and/or organizations that HC is a State and Federally funded
program and must provide neutral navigation to services, and assistance is provided to
all Families, no matter their choice of provider or hospital.
4. Inform community partners and/or organizations that assists all Medicaid/CHP+
Providers no matter their affiliation.
g. Inform community partners and/or organizations that follow-up services are provided to
families and referrals made to community organizations for other assistance as needed
or requested.
6. Educate our community partners and/or organizations concerning Medicaid and CHP+
medical assistance programs, by introducing and informing about Presumptive
Eligibility, PEAK, MA sites, DHS and other avenues clients may access other Medical
assistance programs.
7. All contacts, referrals and follow up will be entered in the HC Data system.
Policy and Procedures Manual 23
PLAN, MANAGE, AND COORDINATE COLLABORATIVE
EFFORTS OR ACTIVITIES WITH OTHER COMMUNITY PARTNERS
TO ENSURE BETTER SERVICE DELIVERY AND EDUCATION TO
THE POPULATIONS SERVED
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. a Page No. a of a
OVERVIEW
Collaborating with community partners/organizations is an exceptional way to build strong
working relationships with the partners and organizations in your community. This is
imperative since many of these organizations/agencies work with the same families as Healthy
Communities. This also allows you to become aware and knowledgeable of the resources in
your community so that you can refer HC clients to agencies/programs and therefore provide
complete services. Collaboration also allows programs not to duplicate services within the
community or family structure.
POLICIES APPLICABLE
Community and Program education policy
PROCEDURE DETAILS
a. Attend Health fairs put on by your community and partner in planning as appropriate.
2. Participate with schools to host a table to provide HC information to families at open
houses, parent/teacher conferences, enrollment days
3. Contact any college/university in your area since some students may have children of
their own and may be eligible for Family Medicaid, or may now qualify for Medicaid
under the Adults without Dependent Children Program and are under the age of 22.
4. Coordinate with other HC Programs for annual festivities held in certain cities or towns.
5. Build strong working relationship with community partners.
a. Local library, schools (office staff, school counselor or nurse), fire departments,
senior citizen groups (many grandparents raising grandchildren), father's
groups, pregnancy centers, homeless shelters, food banks, head start
programs, early care and education providers, domestic violence shelters, to
name a few. These locations should know who you are and how you can assist
their clients through HC Services.
6. Actively participate with community partners in planning and attending events in your
community.
7. All contacts, referrals and follow up will be entered in the HC Data system.
24 ! Poiicy and Procedures Manual
ATTEND MEETINGS, CONFERENCES, AND OTHER CHANNELS
OF COLLABORATION IN CONJUNCTION WITH COMMUNITY
ORGANIZATIONS AND COMMUNITY PARTNERS
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. 1 Page No.1 of 1
OVERVIEW
Becoming involved in your community is an essential piece of the HC Program. These are
excellent opportunities for community outreach, building working relationships, decision
making in programs that that are utilized by HC Families, and educating the public on the
services provided by HC to families and providers.
POLICIES APPLICABLE
Community and Program education policy
PROCEDURE DETAILS
1. Participate as a member of Advisory Boards, representing HC, not a Department or Unit
2. Participate as a member of coalitions
3. Participate in early childhood councils
4. Participate in child welfare activities and meetings
5. Attend local city or county government meetings
6. Participate in your local school boards or PTA meetings
7. Participate in Health Fairs or other fairs in your community or surrounding communities
8. Network with other vendors at fairs; possibly set a time for an in-service
g. Network at local or state conferences
10. All contacts and follow up will be entered in the HC Data system.
Policy and Procedures Manual 25
EDUCATE PROVIDERS ON THE SERVICES PROVIDED BY OR
AVAILABLE THROUGH HEALTHY COMMUNITIES
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No.1 Page No. a of
OVERVIEW
The assistance HC offers to Providers can be a deciding factor as to whether that provider may
choose to accept new Medicaid/CHP+ patients, which is imperative with the shortage of
providers in many areas. Providers appreciate having a 'local' office to contact when having
issues/questions regarding patients and/or Medicaid/CHP+ benefits or billing. Advocating for
providers is mandated for HC FHCs.
POLICIES APPLICABLE
Provider Outreach and Program Education Policy
PROCEDURE DETAILS
1. Explain to Providers how you can assist to find 'real' time eligibility on patients by using
CBMS.
2. Train providers how to read the eligibility documentation from CMRS or another
eligibility system, including managed care and RCCO assignments as well as BHO
assignments and what those may mean to a practice.
3. If you are a presumptive eligibility site, explain what presumptive eligibility is, the
importance, and how Providers can use PE.
A. Provide samples of PE Cards to the providers so their office knows what to
expect when a patient presents coverage under PE.
4. Explain to the Provider the benefits that are covered under PE.
A. Make it clear in -patient is covered for children, while it is not for pregnant
women.
B. Dental is not covered under CHP+ until the client has received their Delta
Dental Card
C. PARs must be completed under PE as they would be required under Medicaid
Guidelines.
5. Offer assistance with problems that may arise from accepting a PE Card and billing
being rejected by State. The Family Health Coordinator will contact the state for any
denials for services provided under Presumptive Eligibility if a service was a benefit of
Medicaid/CHP+ and did not require a PAR.
6. Assist Providers with clients that have excessive missed appointments.
A. Contact the family to see what barriers may be preventing them from
attending their appointment.
26 Policy and Procedures Manual
B. Inform Providers that it will be stressed to families that a provider may chose to
not continue serving the patient for excessive missed appointments.
7. Inform providers that accept new Medicaid and or CHP+ patients that they will be on a
list given to clients who are looking for a provider. HC staff must work with the current
provider recruitment and retention staff as to best explain their options related to
accepting new or existing clients.
8. Inform Providers that if transportation is a barrier for their patients keeping their
appointments, providers should refer to Healthy Communities so we may make the
necessary referrals for the clients to receive transportation assistance.
9. Inform providers that Healthy Communities offices will coordinate with other Healthy
Communities teams to assist their patients that live in other counties.
10. Give providers contact information to their local Healthy Communities office.
ii. All contacts and follow up will be entered in the HC Data system.
Po'icy and Procedures Manual 27
EDUCATE AND ASSIST PROVIDERS WITH SERVICES COVERED
BY THE MEDICAID AND CHP+ MEDICAL ASSISTANCE
PROGRAMS
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No.1 Page No. s of i
OVERVIEW
Knowledge of Medicaid/CHP+ benefits and understanding treatment options will allow
providers to build relations with their patients and provide complete health care services.
Providers can also offer better health services to their patients by knowing about Presumptive
Eligibility (EBNE) and the referral process to HC
POLICIES APPLICABLE
Provider Outreach and Program Education Policy
PROCEDURE DETAILS
2. Provide the ACS Automated Voice Response System (AVRS) (1-800-237-0757 or i-800-
237-0044) regarding questions on Client Eligibility Verification, Claims Submission,
Claims Status, Claims Inquiry, and Provider Warrants Verification. Inform Providers that
there is no longer a limit of inquiries.
z. Provide information for the Provider services available in the HCPF website, including
providers interested in becoming a Colorado Medicaid Provider
3. Inform Providers they can visit the Benefits Collaborative section of the HCPF website
for ensuring that benefit coverage decisions are based on the best available clinical
evidence and that all benefit coverage policies promote the improved health and
functioning of Medicaid clients.
4. Refer Providers to the Provider tab in the HCPF for information regarding provider
services: Billing Manuals, Provider Bulletins, Colorado PAR Program, forms, frequently
asked questions, comprehending the reimbursement and supplemental payments.
5. Refer Providers to the Colorado Medical Assistance Program Web Portal. The user
guides and EDI Support for enrollment purposes is available also on the HCPF website.
6. All contacts and follow up will be entered in the HC Data system.
7. Referral process to other providers including the use of the Early Intervention Colorado
and Behavioral Health referral forms. Providers shall also be trained to understand the
different needs for managed care and accountable care related to referrals.
28 Policy and Procedures Manual
REFER PROVIDERS TO APPROPRIATE DEPARTMENT OR
COMMUNITY RESOURCES INCLUDING THOSE THAT WOULD
LIKE TO BECOME MEDICAID OR CHP+ PROVIDERS
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. 1 Page No. 1 of 1
OVERVIEW
Educating Providers on the community resources will allow the provider to not only care for
his/her patient's medical/health needs but also provide assistance to their patients with other
needs (social and/or or mental) which can attribute to better health outcomes.
POLICIES APPLICABLE
Provider Outreach and Program Education Policy
PROCEDURE DETAILS
i. Refer Provider to HCPF Website, Provider tab to include the Provider Services page for
the Colorado Medical Assistance Program.
2. Site includes the Medicaid Fee Schedule information
3. Provider then will go to enrollment tab which will provide FAQs, link for Provider not
yet enrolled, and link for providers already enrolled.
4. Information for the Provider Enrollment Application Workshop that providers are
strongly encouraged to attend.
5. Standard Billing enrollment documents are also provided in this web site.
6. The Department's fiscal agent offers technical assistance to providers who
electronically submit Colorado Medical Assistance Program claims. This assistance
includes:
7. Enrolling providers in Electronic Claims Submission and Report Retrieval
8. Identifying and troubleshooting technical problems
9. Providing assistance with Submitter testing
2.o. Providing technical assistance to Billing Agents, Clearinghouses, and Software
11. Vendors
12. Verifying claim receipt
13. The Support Unit can provide practices with detailed information that will make a
transition to an electronic environment an easy one. Support is available Monday
through Friday, 8:oo AM to 5:0o PM at 1-80o-237-0757 or 1-800-237-0044, toll free
14. Contact State Recruiter and/or give contact information
15. Refer to the provider to the accountable care section of the HCPF website, including
but not limited to their local agency and/or ACC recruitment staff
16. Refer the provider to the managed care section of the website for information related
to referrals and plans
17. Refer the provider to the behavioral section of the website for information related to
plans, coverage and referrals including the Department referral form
Policy and Procedures Manuai 29
3.8. All contacts and follow up will be entered in the HC Data system.
30 Policy and Procedures Manual
ASSIST CLIENTS WITH THE OVERALL PROGRAM NAVIGATION
OF THE MEDICAID AND CHP+ MEDICAL ASSISTANCE
PROGRAMS ON A DAY TO DAY BASIS
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No.1
OVERVIEW
Page No. a of a
Educating, advocating, and continual follow up on the Medicaid/CHP+ Medical assistance
programs will empower your clients and encourage self-sufficiency. Clients can accept the
responsibility of their family's health care more readily with your enduring assistance and
support.
POLICIES APPLICABLE
Case Management and Program Policy
PROCEDURE DETAILS
11. Make sure families know: those under 21 years of age should have an EPSDT complete physical yearly, (or
more frequent for those under age z), developmental and autism screenings, dental checkups are every 6
months beginning at ages, lead testing is required at 12 and 24 months or between 36 and 73 months if not
previously tested, vision screenings and glasses are covered as needed and not limited to 1 pair/yr, hearing
screenings, and mental health screenings, depression screenings (including for teens) per the Colorado
Periodicity Schedule.Ask families if their children are current on their Immunizations, and provide an
immunization schedule. Provide information on Family Planning.
1. Educate on the dangers of second-hand smoke and provide information on the Quit Line for those clients
wanting to quit smoking.
2. Provide information on the Nurse Support Line by explaining what it is,.and giving the State Flyer. Provide
information and flyer for the pregnant women interested in Text4baby.
12. You will offer assistance in scheduling of appointments to both pregnant women and children with their
selected providers, unless the client prefers to schedule their own appointment(s).
13. If client prefers to utilize a provider list without assistance, follow up will be required with the family to
ensure a provider was selected and an appointment was scheduled. You will inform the family at time of
visit that you will follow up within zweeks.You must create a task to flag yourself in the data system for
follow up within 2 week time period .
14. Screening protocols should be followed to allow the HC staff to make necessary and appropriate referrals to
Community Programs and Organizations.
15. Assist family with the MedicaidlCHP+application and process PE.
a. If not a PE Site, then refer family to the PE Site in your county. It is strongly recommended you call the PE site
and schedule an appointment for your family so they know the time, date, and location where they need to
apply -
b. You will create a task to follow up after scheduled PE appt. to check PE status in CBMS. The follow up task
ensures that the family applied and received a PE .
c. If not in CBMS showing active PE, then a follow up contact is required to assist families in accessing services
needed.
16. All contacts, referrals and follow up will be entered in the HC Data system.
17. Provide the contact information for Health Colorado and explain why a client or family will need to contact
them, including upcoming letters for passive enrollment into managed care or accountable care
organizations
Policy and Procedures Manual ; 31.
a8. Provide the contact for the Ombudsman for Medicaid Managed Care and explain when they can assist a
client with specific issues or concerns.
ag. Provide education and assistance in using Colorado PEAK
.20. Give all contact information for their local HC Office
21. All contacts, referrals and follow up will be entered in the HC Data system.
32 Policy and Procedures Manual
CONTACT AND ASSIST ALL CLIENTS REFERRED TO THE
HEALTHY COMMUNITIES PROGRAM THROUGH FACE TO FACE,
WRITTEN, ORAL, AND OTHER METHODS OF COMMUNICATION
INCLUDING THE USE OF SOCIAL MEDIA
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No.1 Page No. a of i
OVERVIEW
Making a contact is not what is relevant, but the manner in which the contact is made is of
most importance. It allows you to build the relationships with your clients, which is crucial to
the success of the program. Whether a face to face, phone call, letter, text or email, if a client is
shown compassion, treated with respect, and knows that their FHC has done ALL that is
possible to assist him/her, clients will bond with their FHC and reach out to them for future
assistance.
POLICIES APPLICABLE
Case Management and Program Policy
PROCEDURE DETAILS
�. Face to Face could be scheduled or walk-in either at the clients home, a community
location or at the HC office.
a. Face to Face contacts are encouraged to create a relationship between
Family Health Coordinators and families.
2. Hospital visits/ER visits
3. Letter
a. State authorized correspondence only.
c,. Email
a. Warning: must be encrypted for HIPPA if contains Personal Health
Information
5. Telephone contacts
6. FAX
7. Text messages from HC date system
Policy and Procedures Manual 33
ASSIST CLIENTS WITH THE APPLICATION PROCESS
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No.1 Page No. i of
OVERVIEW
Applying for Medicaid/CHP+ can be a very confusing, time consuming, and very frustrating
process for many families, to the point where some would rather do without. The responsibility
of HC is to remove these barriers, provide a more friendly experience, and assure families apply
and receive the medical services they need and deserve.
Assisting clients with the application process includes assisting the client face to face with a
paper or PEAK application, providing PE determinations on site to those that may qualify,
and/or an appropriate referral to another application assistance site; local department of
social/human services, PEAK, CAAS, other PE, or MA Site to facilitate the client's enrollment
into Medicaid and CHP+
POLICIES APPLICABLE
Case Management and Program Policy
PROCEDURE DETAILS
1. Complete a financial screen by phone to see if client could be eligible for Medicaid
and/or CHP+. This avoids having a client come in if they will not be eligible for either
program and then referrals can be made to other programs for assistance.
2. If a PE Site, meet with the client as soon as they are able, so client is readily served. If
not a PE site, refer to appropriate location to apply (ie: PE Site, MA Site, DSS, or PEAK)
3. Follow up with client or site to assure client applied.
4. If a PE Site, Inform client of the documents required to complete an application.
Although not a requirement for PE, it can make the processing of the application more
expedient.
5. If a pregnant client, inform client proof of pregnancy is required. This must be signed
by a clinic, physician or nurse.
6. Meet with the client face to face.
7. Assist client with completing application, by answering questions and confirming all
sections that apply to the client have been completed.
8. Make sure application has been signed and dated.
a. Date stamp on application, date on affidavit (bottom of each child's page), and
the signature date must all be the same.
9. Enter data in CBMS and run PE, print PE Cards.
10. Explain the PE Card and all services provided under the PE Card
i1. Assure that each applicant has a PCP/Pediatrician, dental, vision provider. If pregnant,
assure the client has an OB Provider.
12. If a PE Site, follow up with your DSS or MA Site for status on application.
34 Policy and Procedures Manual
13. Assist clients to collect and submit necessary documents (income verification, birth
certificate, photo ID or other acceptable documents) if not provided at time of
application.
14. All contact and client interaction must be entered into HC data base.
Polity and Procedures Manual 35
PROVIDE FOLLOW UP TO PREGNANT WOMEN AND CHILDREN,
FAMILIES, AND EBNE'S ON THE STATUS OF THEIR
APPLICATION AS REQUESTED AND/OR ASSIST THE CLIENT IN
RESOLVING ANY ISSUES OR CONCERNS REGARDING THEIR
ENROLLMENT INTO A MEDICAL ASSISTANCE PROGRAM
AND/OR ELIGIBILITY ISSUES
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. i Page No. i. of i
OVERVIEW
Families will receive the medical benefits they need and deserve because providers will not
hesitate to serve them when the client's application has been processed and has been
approved.
POLICIES APPLICABLE
Case Management and Program Policy
PROCEDURE DETAILS
s. Assist clients to collect and submit necessary documents (income verification, birth
certificate, photo IdD if not provided at time of application
z. The FHC will advocate for clients, when they have questions or concerns about
eligibility and application status, by contacting the MA sites, County Department of
Human Services, CBMS system, HCPF, MAXIMUS, and/or assist the client navigate
PEAK.**
**Resolving the family's issues is not just giving a phone number to the client so the client can call.
Many families have already attempted these options, have gotten no response, and are now
reaching out to their FHC for further assistance. It is the responsibility of the FHC to acquire the
information for the family by making all necessary contacts.
36 ` Policy and Procedures Manual
ASSIST CLIENTS WITH THE REPORTING OF NEWBORNS
Issue Date: mmlddlyy Effective Date: mm/dd /yy Procedure No.1 Page No. i of i
OVERVIEW
When Add -a -babies are completed immediately after birth and processed by the client's
County DHS or MA Site, new babies born to Medicaid/CHP+ mothers can access health care
from their provider(s) from time of birth and through the baby's first year
Assisting clients with the reporting of newborns includes processing Add -A -Baby request for
cases that are emergent or if services need to be expedited
POLICIES APPLICABLE
Case Management and Program Policy
PROCEDURE DETAILS
1. All Healthy Communities will complete an Add -a -baby form for babies born to
Medicaid or CHP+ mothers
a. Make sure spelling is correct and verify date of birth and gender
2. Encourage mom to select a provider for her newborn baby, if she does not have one
already selected.
a. Provide appropriate provider list and offer assistance to schedule an
appointment.
3. Inform mom that her newborn should be seen by baby's provider according to the
Colorado Periodicity Schedule.
4. Inform mom of the process and give an approximate time when she may receive a
Medicaid Card.
5. Inform mom of the benefits her newborn is eligible for under Medicaid or CHP+
6. Give mom your contact information so that she can contact your for a vision provider
list at 6 months, and a dental provider list before lyr.
7. Inform mom of the periodicity schedule for well child visits
8. Provide an immunization schedule
9. Give other educational materials
10. Send Add -a -baby form to be processed by MA Site or DHS
11. Follow up with Site to see when baby is added and contact mom to give her State ID
and ensure she is able to access services.
12. If it has been more than 2 weeks and baby has not been added, it is the responsibility of
the FHC to follow up with the necessary agencies so that baby is added. Some providers
may not be willing to provide services until baby has a State ID.
Policy and Procedures Manual 37
PROVIDE CLIENTS WITH A LIST AND REFERRAL TO AN
APPROPRIATE MEDICAID OR CHP+ PROVIDER
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No.1 Page No. 3. of s
OVERVIEW
Clients may have a Medicaid/CHP+ card, but may still not access health care for all benefits
offered by their health plan if they do not have the appropriate providers. FHC's will provide
lists of the providers currently accepting new patients. Clients can overcome many of their
barriers with the assistance of their FHC so they can receive the preventive health care services
and receive health care when ill.
POLICIES APPLICABLE
Case Management and Program Policy
PROCEDURE DETAILS
i. Compile and keep a list of all Providers that are taking new Medicaid and CHP+ families
that is accessible to clients and community agencies and providers.
a_ Enter all providers into the HC data base, including hours, ages, working hours,
affiliations, ADA accessible, etc.
2. Notify the provider that you will be emailing them every 6 months to assure all of the
information in the data base is up to date.
3. Every 6 months send out an email compiled from the HC data base to update provider
information.
4. Assure all clients have the appropriate providers, have scheduled the necessary
appointments for preventive health, and assist with barriers preventing them from
receiving these services.
38 Policy and Procedures Manual
ASSIST CLIENTS WITH SCHEDULING OF APPOINTMENTS AND
TRANSPORTATION NEEDS
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No.1 Page No. i of a
OVERVIEW
Some clients are more likely to receive health care, in a timely manner, if an appointment is
made for him/her, so by assisting in scheduling an appointment, you are assured that the client
has been scheduled to be seen by the provider of their choice. Clients state a barrier to
receiving health care is the inability to get to the provider. By assisting clients with
transportation issues, the client will receive the health care needed.
Assist clients with scheduling of appointments and transportation needs through the Medicaid
Transportation Broker or appropriate local department of social/human services
POLICIES APPLICABLE
Case Management and Program Policy
PROCEDURE DETAILS
1. You will offer assistance in scheduling of appointments to both pregnant women and children with their
selected providers, unless the client prefers to schedule their own appointment(s).
2. If client prefers to utilize a provider list without assistance, follow up will be required with the family to
ensure a provider was selected and an appointment was scheduled. You will inform the family at time of
visit that you will follow up within zweeks.You must create a task to flag yourself in the data system for
follow up within 2 week time period.
3. Have working knowledge of your Transportation broker or DHS contact person in your
area, so that a referral can be given to a client needing transportation for Medical
appointments.
Policy and Procedures Manual 39
MANAGE COMPLAINTS OF PRIVACY BREACHES
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. 2 Page No. i of 1
OVERVIEW
Keeping protected health information safe is of primary concern. FHC staff will share only the
minimal information that is needed to assure services or benefits are accessed. Information will
not be shared with other programs or units within FHC offices unless approved by the State.
Data sharing for data sake is not allowed. Data requests can be made directly with the
Department for other programs or units needed information related to Medicaid clients.
POLICIES APPLICABLE
Privacy and Confidentiality Policy
PROCEDURE DETAILS
1. All FHC staff need to assure data is kept in a manner that meets federal privacy
standards.
2. ALL FHC staff need to meet their own employers policies related to HIPAA.
3. All FHC staff must only share minimal information with others that is needed to assure
the service or benefit can be accessed.
4. All FHC staff will understand a business associate of the program and share information
accordingly
5. All staff have the ability to access data from their local WIC programs and should assure
this option is exercised when tracking clients
40 Policy and Procedures Manual
CONTACT CLIENTS ATTENDING INMUNIZATION CLINICS
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No.3. Page No. 1 of 1
OVERVIEW
Contacting clients while attending Immunization clinics, assures clients are current with their
immunizations. You can assist clients find a provider for other preventive health care benefits,
and to receive medical attention when ill. This also offers an opportunity to provide education
on other health issues and refer to other community services.
POLICIES APPLICABLE
Privacy policy related to immunization clinics and appropriate outreach to clients
PROCEDURE DETAILS
1. Contact local Health Department to participate in immunization clinics
a. Bring provider lists and applications to assist those clients without a medical
home or those that are uninsured EBNE's to apply for Medicaid or CHP+.
2. If applicable and necessary, contact your Immunization Coalition for local opportunities
and to provide information on your availability and services to the shared clients in the
area
Policy and Procedures Manual ! 41
OUTREACH TO EPSDT CLIENTS AT EVENTS
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. z
OVERVIEW
Page No. a of i
Outreach to clients at events is an avenue FHCs can use to provide information about the
services provided by HC. Information can be given to large number of current and/or potential
clients (EBNE).
Events include Healthy Children Clinic, HCP Ortho and Neuro Clinics, Child Find, Head Start
registration, Boo at the Zoo in October for Lead Testing, WIC clinics, health fairs, school
functions, or any other local event where there will be families and children.
POLICIES APPLICABLE
Network with all programs that provide services to clients who are HC clients
PROCEDURE DETAILS
i. Provide educational material, Healthy Community brochures
2. Provider lists
3. Community Resources
4. Applications
5. Answer questions and concerns concerning barriers or requests to receive services
6. Provide contact information
7. Enter Outreach / Event in HC data base
42 Policy and Procedures Manual
OUTREACH TO CHILD CARE CENTERS / HOMES
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. i Page No. i of
OVERVIEW
Families with very young children (birth to pre-school ages) can be informed ofthe services
provided by HC.
POLICIES APPLICABLE
Outreach to early care and education providers (day care) as well as regular meetings with Head
Start, Early HeadStart and other early care and education programs in your service areas.
PROCEDURE DETAILS
1. Network with school districts for Colorado Preschool Program enrollments
2. Work with your local Early Childhood Council
3. Call local daycare and childcare facilities to schedule an in-service
4. Meet with local HeadStart and Early HeadStart offices at least twice a year.
Policy and Procedures Manual 43
OUTREACH TO COMMUNITY
Issue Date: mm/dd/yy Effective Date: mm/dd /yy Procedure No. z Page No. i of
OVERVIEW
More families can be informed about HC services through several avenues, one being
collaborative efforts with other county HCs. Current or potential clients can be contacted at
regional events, fairs, and festivities. Community outreach does not mean providers only, but
can also include any location or event where current/potential clients can be found, information
about HC can be provided, and therefore your yearly quota can be met.
Establish a yearly quota that takes into account the size of the county.
POLICIES APPLICABLE
Establish quota for outreach in the community to a realistic number, but not one that is less
than 2 contacts per month.
Partner with other HC offices when your service areas overlap (ie RCCO or HCP regions)
PROCEDURE DETAILS
1. Health Fair participation
2. In service to Providers
3. In service to community organizations and partners such as food banks or other non-
profit organizations in your service area.
4. Schools
a. School based clinic
b. Child Find
c. Enrollment
d. Back to school nights
e. Open houses
5. Health Department
6. Fire stations
7. DHS
8. Police Departments
9. Community coalitions and advisory boards
44 Policy and Procedures Manual
PROVIDE CASE FOLLOW-UP
Issue Date: mm/dd/yy Effective Date: mm/dd Jyy Procedure No.1 Page No. i of
OVERVIEW
A state requirement for all Healthy Communities is care coordination. That includes not only
the initial contact you have with a client, but the continued assistance to the client. The follow-
up will assure you your clients are receiving all medical services required to be healthy
(physically and emotionally)and that your clients receive the care they need when they become
ill.
Prioritize dental and depression screening follow-up, come up with other priorities for follow-up
POLICIES APPLICABLE
HC offices are required to assure that at least 8o% of the children in their service areas are
accessing well child visits one time per year
HC offices are required to assure at least 80% of their children in their service areas are
accessing a oral health service one time per year. As of 2O13, a 5% increase in required over
2010 EPSDT 426 rates.
HC offices are required to assure that applicable lead testing is being completed in the
community and to make provides aware this is required in Colorado.
HC offices are required to assure that applicable and needed behavioral health assessments are
being referred to local BHO providers to complete.
PROCEDURE DETAILS
1. Assure that local goals and objectives include those for EPSDT
2. Choose priority areas, but understand that all areas will need to be reached in order to
meet state and federal goals
3. Priorities can include:
a. Children with special needs
b. Children with severe medical conditions
c. Pregnant teens
d. High risk pregnancies
e. Dental screenings
f. Depression screenings for teens
g. Immunizations
h. EPSDT well child visits ---
Policy and Procedures Manual 45
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