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Home My WebLink About20022397.tiff RESOLUTION RE: APPROVE TASK ORDER RENEWAL LETTER #2 FOR HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS 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 Task Order Renewal Letter#2 for Health Care Program for Children with Special Needs 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 October 1, 2002, and ending September 30, 2003, with further terms and conditions being as stated in said task order renewal letter, and WHEREAS, after review, the Board deems it advisable to approve said task order renewal letter, 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 Task Order Renewal Letter#2 for Health Care Program for Children with Special Needs 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 task order renewal letter. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 4th day of September, A.D., 2002. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO � ATTEST: s �i tl . ,.> EXCUSED /�. fs , # ' �\ Gle Vaad, Cher Weld County Clerk to. a i David E. L g, Pro-Tei �a r? Deputy Clerk to the Board M. J..- eile/ / AP D AS T M: �L�' 7 / Tn H. Jer" ke1t County Attorne V V — Robert D. Masden CADate of signature: � Cpl' . WLCe O't+gj 20HL0029 • STATE OF COLORADO Bill Owens,Governor ---- Jane E.Norton,Executive Director 'epioA Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division \' Denver,Colorado 80246-1530 8100 Lowry Blvd. A*•tan'•�"`•'�i� Phone(303)692-2000 Denver,Colorado 80230-6928 TDD Line(303)691-7700 (303)692-3090 Colorado Department Located in Glendale,Colorado of Public Health http://www.cdphe.state.co.us and Environment August 1,2002 Task Order Renewal Letter Health Care Program for Children with Special Needs(HCP1 State Fiscal Year 2002-03, Task Order Renewal Letter Number 02 Task Order Renewal Letter Contract Routing Number 03 FAA 00419 (Master Contract Contract Routing Number 00 FAA 00008) (Task Order Contract Routing Number 01 FAA 00797) Pursuant to Part F5.of the Master Contract with contract routing number 00 FAA 00008 and paragraph E.17.of the Task Order with contract routing number 01 FAA 00797 and contract encumbrance number PO FAA HCP0100797,hereinafter referred to as the"Original Task Order",as amended by Task Order Renewal Letter 01,contract routing number 02 FAA 00497 and by Task Order Change Order Letter 01,contract routing number 02 FAA 01066,is attached hereto unless a Letter of Compliance has been submitted with this Task Order Renewal Letter,between the State of Colorado,Department of Public Health and Environment and Board of County Commissioners of Weld County, for the term from October 1,2002,through September 30,2003,the parties agree that the maximum amount payable by the State for the eligible services referenced in part B of the Original Task Order is increased by ONE HUNDRED THIRTY-THREE THOUSAND THREE HUNDRED TWENTY-EIGHT DOLLARS,($133,328.00) for a new total financial obligation of the State of FOUR HUNDRED THIRTY-SIX THOUSAND THREE HUNDRED FIVE DOLLARS,($436,305.00). The revised work plan,which is attached hereto as"Attachment 1",and the revised budget, which is attached hereto as"Attachment 2",are incorporated herein by this reference and made a part hereof. The first sentence in part C of the Original Task Order is hereby modified accordingly. All other terms and conditions of the Original Task Order are hereby reaffirmed. This amendment to the Original Task Order is intended to be effective as of October 1,2002. However,in no event shall this amendment be deemed valid until it shall have been approved by the State Controller or such assistant as he may designate. Please sign,date,and return all FIVE(51 originals of this Task Order Renewal Letter by September 10,2002,to the attention of: Peggy Becker,Colorado Department of Public Health and Environment,4300 Cherry Creek Drive South,Denver, Colorado 80246-1530,Mail Code: PSD-HCP-A4. One original of this Task Order Renewal Letter will be returned to you when fully approved. Board of County Commissioners of Weld County STATE OF COLORADO (a political subdiv' ion of that state of Colorado) Bill Owe Governor By: By: Name: David E. Lon For the Executiv irector Title: Chair Pro—Tem DEPARTMEN PUBLIC FEIN: 84-6000813 HEALTH AND IRONMENT Date: FOR THE STATE CONTROLLER: PROGRAM APPROVAL: Arthur L.Barnhart, State Controller By: By: Date: V30/0 Z WELD COUNTY DEPARTMENT OF PU C HEALT�gN9 ENV ON ME T Mark E. Wallace, MD, MPH•Director aa'a_.2397 Attachment 1 HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP) STATEMENT OF WORK 1. Under this Task Order Renewal Letter,a local public health agency, such as the Contractor, shall provide the core public health services of assessment,policy development,and assurance on behalf of children with special health care needs as described and defined in"Attachment lA","Core Public Health Services Delivered by MCH Agencies". Local public health agencies are required to assess the needs and develop the plan for services for the children with special health care needs(CSHCN)population at the same time that the needs of the perinatal population and the child and adolescent population are assessed and the MCH plans are developed. 2. Contractor shall engage in defined core public health activities designed to enhance the health status of children with special health care needs. The"Suggested Children with Special Health Care Need Activities", attached hereto as"Attachment 1B", which is incorporated herein by this reference and made a part hereof,may be used if appropriate as guidance. These activities may include direct or enabling services,population-based activities and infrastructure building activities as described in"Attachment IA", "Core Public Health Services Delivered by MCH Agencies". 3. The Contactor shall implement the Local Agency Maternal and Child Health(MCH)Plan for the CSHCN activities and services which will be carried out in federal fiscal year 2002-2003 (October 1, 2002 through September 30,2003), Weld County Health Department HCP Plan which is attached hereto as"Attachment 1C", incorporated herein by this reference, made a part hereof. The plan is designed to: contribute to the accomplishment of the State's MCH Priorities,National MCH Performance Measures,and Outcome Measures,as identified in"Attachment 1D". 4. Contractor shall perform in accordance with the HCP Performance Measures,attached hereto as "Attachment 1E", incorporated herein by this reference, made a part hereof. 5. Contractor shall ensure that all IRIS users attend IRIS Training and meet the"Standards for Usage of IRIS II",and any subsequent amendments thereof,attached hereto as"Attachment 1F", incorporated herein by this reference, made a part hereof. 6. Contractor shall implement the"IRIS II Security Policy and Procedures",and any subsequent amendments thereof,attached hereto as"Attachment 1G",incorporated herein by this reference,made a part hereof. 7. On or before May 1,2003,the Contractor shall submit an annual MCH plan for federal fiscal year 2003- 2004(October 1,2003 through September 30,2004). A sample format,which the Contractor may use,is attached as"Attachment 1H". The Contractor shall also submit to the State, for review and approval,a Budget Estimate Form for the plan using"Attachment II,Section II",attached hereto, incorporated herein by this reference,made a part hereof. Page 1 of 3 8. On or before December 1,2003,the Contractor shall submit to the State a"Final Expenditure Report" in the format attached hereto as"Attachment 1J", incorporated herein by this reference, made a part hereof, which has been signed by the Director or Authorized Representative. The final expenditure report shall contain actual expenditures and in-kind support for each expenditure category,with each employee's name and FTE for the personal services category, supported by the funding received from the State during the term of October 1, 2002 through September 30, 2003. Final Expenditure Report shall be sent to: Terry deLeon Colorado Department of Public Health and Environment Health Care Program for Children with Special Needs(HCP) 4300 Cherry Creek Drive South PSD—HCP—A4 Denver,Colorado 80246-1530 9. On or before December 1,2003,the Contractor shall submit to the State a signed "Task Order Duties and Obligations Certification Form",attached hereto as"Attachment K,incorporated herein by this reference, made a part hereof. The final payment for this renewal term is contingent upon the State's timely receipt of the signed submission of the Task Order Duties and Obligations Certification Form. 10. On or before December 15,2003,the Contractor shall submit,to the State Program Consultant, a Contract Performance Report using the"Contract Performance Tool"as a guide,which is attached hereto as "Attachment IL", incorporated herein by this reference,made a part hereof. 11. On or before January 15,2004, for October 1, 2002 through September 30,2003, the Contractor shall submit a"Year End Progress Report"to the State, following the format outlined in"Attachment 1M",or a similar format, attached hereto, incorporated herein by this reference,made a part hereof 12. The Contractor agrees that any charges for attendance and services at HCP medical specialty clinics sponsored by the Program must conform to the"Sliding Fee Schedule for HCP Clinics, "Attachment 1N" and any subsequent amendments thereto,attached hereto, incorporated herein by this reference,made a part hereof. 13. The Contractor will serve State recipients and recipient families who are determined to be eligible for Program services. Recipients served will be children residing or whose families have residence in Weld County. 14. The Weld HCP Regional Office shall work cooperatively with the public health nurses(PHNs)from Weld County. Page 2 of 3 • 15. The HCP Discipline Regional Coordinators funded through this contract shall serve State recipients who reside or whose families have residence in the counties as defined below: A. The Audiology Regional Coordinator shall serve Weld County. B. The OT/PT Regional Coordinator shall serve Weld County. C. The Speech Regional Coordinator shall serve Weld County. 1:\HCPCommon\CONTRACTS\HCP\ROs\FY 03\Weld\Weld FY03 TORL Attachment I-Statement of Work.doc Page 3 of 3 Attachment 1A CORE PUBLIC HEALTH SERVICES DELIVERED BY MCH AGENCIES DIRECT HEALTH CARE SERVICES: (GAP FILLING) Examples: Basic Health Services, and Health Services for CSHCN ENABLING SERVICES: Examples: Transportation,Translation,Outreach, Respite Care,Health Education,Family Support Services,Purchase of Health Insurance, Case Management,Coordination with Medicaid, WIC,and Education POPULATION-BASED SERVICES: Examples: Newborn Screening,Lead Screening,Immunization, Sudden Infant Death Syndrome Counseling,Oral Health, Injury Prevention,Nutrition and Outreach/Public Education INFRASTRUCTURE BUILDING SERVICES: Examples: Needs Assessment,Evaluation,Planning,Policy Development, Coordination,Quality Assurance,Standards Development,Monitoring, Training,Applied Research,Systems of Care,and Information Systems MCHB/DSCH 10/20/97 Page 1 of 2 DEFINITIONS OF THE FOUR TYPES OF SERVICES BY WHICH THE CORE PUBLIC HEALTH SERVICES ARE PROVIDED BY MATERNAL AND CHILD HEALTH PROGRAMS AS DEFINED BY THE MATERNAL AND CHILD HEALTH BUREAU As of October 1,2001 1. Direct Health Care Services Direct health care services are defined as basic health services. Such services are generally delivered"one on one"between a health professional and a patient in an office,clinic or emergency room. Basic services include what most consider to be ordinary medical care, inpatient and outpatient medical services,allied health services, drugs, laboratory testing,x-ray services,dental care, and pharmaceutical products and services. State Title V programs support services such as prenatal care, child health, school health and family planning by directly operating programs or by funding local providers. Direct health care services also include health care services for children with special needs. 2. Enabling Services Enabling services are defined as services that allow or provide for access to and the derivation of benefits from the array of basic health care services. Enabling services include transportation,translation,outreach, respite care,health education, family support services,purchase of health insurance,case management,and coordination of care. These kinds of services are especially necessary for the low-income population which is disadvantaged, geographically or culturally isolated, and for those with special and complicated health needs. 3. Population-Based Services Population-based services are defined as services which are intended and available for the entire population, rather than for a selected group of individuals. Disease,prevention,health promotion and statewide outreach come under this heading. Oral health,injury prevention,nutrition and outreach and public education are topics which also belong in this category. Population-based services are generally available for women and children regardless of whether they receive care in the public or private sector or whether or not they have health insurance. 4 Infrastructure Building Services Infrastructure building services are defined as those services that are directed at improving and maintaining the health status of a population. Included among those services are development and maintenance of health systems, standards, and guidelines,training,data, and planning. Needs assessment,evaluation, policy development, quality assurance, information systems, and applied research are all contained within the infrastructure umbrella. 1\HCPCommmn\CONTRACTS\HCP\ROs\FY 03\Attachnsmts for FY03 TORL\FY03 TORL Attachment I A-Page 2-Pyramid Definitions.doc Page 2 of 2 Attachment 1B HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP) SUGGESTED CHILDREN WITH SPECIAL HEALTH CARE NEED ACTIVITIES TO FULFILL REQUIREMENTS FOR MCH LOCAL HEALTH CONTRACTS AND COUNTY PRELIMINARY AND STRATEGIC PLANS As of October 1, 2001 The following suggested strategies are offered as guidance to local public health agencies in defining how current or new services fit within the core public health functions. The Maternal and Child Health contract between local agencies and Colorado Department of Public Health and Environment(CDPHE)requires needs assessment of local communities. Local public health staff is currently doing many of the following activities. The CDPHE Health Care Program for Children with Special Needs(HCP)and Public Health Nursing consultant staff will provide technical assistance,as needed in assisting local public health agencies to define which of these—or other activities—are most appropriate for addressing the needs of children with chronic illnesses and disabilities. 1. Direct Services The policies establishing which diagnosis or conditions will be covered by the Colorado Health Care Program for Children with Special Needs(HCP)are set at the state level and the funding and payment for the direct personal specialty care services is administered at the state. Therefore, it is not necessary to establish a plan for direct care provision at the county level. 2. Enabling Services 2.1. Conduct an initial interview with a defined population(NICU, SSI, etc.)of new families to help them determine their need for information,referral and/or care coordination using a standard tool such as the "Family Status Profile"form. 2.2. Assist families who have insurance coverage, including private insurance,CHP+and Medicaid and those in managed care plans,to understand their benefits and their disenrollment and grievance procedures. 2.3. Refer families to agencies and services for which they are eligible and assist them with the registration or application process,(WIC,CHP+,Baby Care/Kids Care,Medicaid, SSI,etc.). Follow-up with the family to assure the family was able to make the suggested contacts. 2.4. Determine the status of primary care and immunizations and make appropriate referrals. Work in collaboration with the EPSDT outreach worker if the child is on Medicaid to assure that EPSDT benefits have been explained and an EPSDT screen has been completed and billed. 2.5. Initiate or participate in the development of a Care Plan or IFSP(Individual Family Service Plan) with the family when it has been determined that a family would benefit from care coordination. This includes a statement of the family's strengths and needs as identified by the family and strategies for enhancing the child's development. Include a statement of major outcomes to be achieved by the child and family. State the criteria,procedures and time lines. Document periodic statements of progress towards meeting family goals and the need for modifications or revisions. The process for the development of a care plan or IFSP should include all the disciplines involved with the child's care, i.e.,audiologist,CHIP therapist,social worker, family advocate, OT/PT, dietitian, speech therapist,etc. Page 1 of 4 2.6. Follow-up with family according to plans written on Care Plan or IFSP. Should HCP staff have no direct role in the IFSP or are not doing care coordination, assure that a contact with each family is made at least once a year to assure that the child and family are receiving necessary services and that the family is aware of community resources available to them. 2.7. Make home visits when appropriate. (Situations might include complex medical or surgical conditions or when resources or help can be provided relating to the home environment.) 2.8. Work in concert with the EPSDT outreach worker to review monthly listing of SSI recipients and Contact SSI families to assure that health care needs are being met. If there are needs which HCP can meet,assure that children are enrolled in the program. 2.9. Meet periodically with staff from local agencies such as social services,representatives from the Community Centered Board,mental health and special education services from local schools to collaborate around services to individual children and their families. 2.10. Work with the older children and their families to facilitate transition from pediatric services to adult health care services. (To begin at about age 12 years.) 2.11. Work with NICU Consortium contacts in hospitals to identify needs of newborns as the child prepares to leave the hospital to return to the community. Make contact with other community resources as needed. 2.12. Designs and maintains a clinic structure including identifying and scheduling clinic providers, facilities,and equipment. Sets clinic dates. Seeks referrals by contacting local doctors,Child Find, interagency councils, and Community Center Boards to inform them of the clinics. Distribute the local HCP clinic schedule to appropriate agencies and individuals. 2.13. Organizes,schedules and staffs each clinic using guidelines provided in the HCP Procedure Manual. Obtains a HCP Registration on each child scheduled for clinic and a consent for service signed by the parent or legal guardian. Provides the clinician with Medicaid and private insurance billing information and collects clinic fees from over-income families who do not have health insurance. 2.14. Completes a Clinic Encounter Form for each clinic patient.After each clinic submits Encounter Forms, a copy of the attendance list(schedule)and the dictation to the assigned Regional Office. 2.15. Assures that families have transportation to each clinic and that appropriate and competent interpretation services are available. 2.16. Depending on the complexity of the child's condition and the needs of the family, appropriate team members will attend and participate in the multi-county clinics. 2.17. Evaluates the clinic caseload,waiting list and summaries yearly to determine the number and type of specialty clinics needed. Reports findings to the Regional Office Team Leader. 2.18. Identify existing health care providers and support resources including translation,transportation and respite care. 3. Population-based Services 3.1. Promote public health services available to children, i.e.,HCP,WIC,Well Child,EPSDT, and Immunizations by using local media,posters and attendance at health fairs, etc. Page 2 of 4 3.2. Develop and maintain liaisons with the local community resources to maintain open communication,to promote the services of HCP and other services available to children with special needs,and to establish a network for working together to eliminate gaps or duplication of services and supports. 3.3. Assure that HCP staff is trained in Early Childhood Connections(Part C of IDEA)including the Colorado Interagency Coordinating Council Values Statements(see attached),IFSPs, Service Coordination,Procedural Safeguards and eligibility criteria. 3.4. Assure that HCP staff is trained in the eligibility criteria and referral procedures for Medicaid, SSI, Children's Medical Waiver 200,Children's Home Care Based Services Waiver(Katie Beckett- Model 200 Waiver),and EPSDT. Assure that EPSDT case managers are knowledgeable about HCP services. 3.5. Assure that training opportunities are provided to staff on cultural competency and family-centered care. 3.6. Establish or maintain interagency collaboration through periodic meetings with representatives of the local human services agencies,the Community Center Board, the mental health agency and special education services from the school district to understand their services, to learn about their eligibility criteria, and to provide them with information about HCP and other resources within the local community. 3.7. Participate in the community's early child identification process as an active member of the community team. This participation could include assigning staff time to directly participate in a community sponsored identification process or coordinating the agency's services such as Well Child,EPSDT,HCP and WIC,with other efforts so as to provide on-going systems of early identification for children 0-21 years. 4. Infrastructure-building Services 4.1. Know the numbers of children in the counties served by the agency and be able to estimate the number of children with special health care needs. Know the target population of children who are potentially eligible for HCP paid service benefits and the actual number of children currently registered with HCP. Analyze large discrepancies between target and actual caseloads. 4.2. Know and analyze the numbers of children enrolled on HCP for care coordination only. 4.3. Coordinate and/or participate in conducting a community needs assessment with public and private agencies, organizations,providers and parents which identifies problems or voids within the service delivery system for children with special health care needs,defines the problems and determines the services or changes necessary to meet the identified needs. Elements involved in this process include: 4.3.1. Involvement in tracking and data collection efforts of the community concerning the number of children with special health needs,the types of services needed, the types of services available, the accessibility of services,the quality of the services,whether the services are culturally competent and family centered, and a method to receive customer feedback about the services. 4.3.2. Awareness of and collaboration with other community agencies and projects regarding data that is being collected and use of the data to most effectively enhance the community service system for children with special needs. Page 3 of 4 4.3.3. Establishment of mechanisms to include strong family participation in the development of all assessments. 4.3.4. Coordination with other agencies and organizations to jointly survey the community including families,providers and human service agencies and development of a process to provide feedback to those who participated in the answering of the surveys. 4.4. Provide assessment reports to the community. 4.5. Coordinate and/or participate in the community planning process to develop policies goals and objectives based on the community needs assessment. 4.6. Develop local networks and partnerships with other community resource agencies to determine policies to support the development of comprehensive, community-based systems of care including identification, assessment,intervention and referral services for children with special health care needs. 4.7. Develop referral and follow-up care systems using available resources such as Colorado Responds To Children With Special Needs(CRCSN),NICU Consortium,Universal Newborn Hearing Screening Programs,and hospital discharge planners,to identify children who may need support, care coordination and/or referral to community resources. 4.8. Establish a mechanism for including input from parents regarding current services,planning, policy development,implementation and evaluation of HCP paid service benefits as well as community/health services for all children with special health care needs. The process should include a means to provide feedback to families about decisions made in these areas. 4.9. Develop and maintain a system of parent support that includes: 4.9.1. Parent to parent support and/or support groups; 4.9.2. Internal practices that support advocacy for family needs and problem solving; 4.9.3. Information and education; 4.9.4. Linkages with community agencies to assure the availability and adequacy of resources to support the needs of families. 4.10. Assure that there is community parent representation from families who have children with special needs in the community service system efforts. (For example,attending meetings,contacting representatives,providing input into quality and quantity of local services.) 4.11. Participate actively in a community interagency council(ICC)by meeting regularly for the purpose of planning and policy development. (These can be a formal or informal group of agencies, providers and parents who are interested in working together to discuss services for children with special needs,to identify barriers and gaps in the service delivery system,to develop collaborative plans for removing the barriers and gaps including writing community-based grants for improvement of local systems. \HCPConvnon\CONTRACIS\HCP\ROs\FY 03\Attachments for FY03 TORL\FY03 TORL Attachment I B-Suggested CSHCN Activitics.doc Page 4 of 4 Attachment 1C Weld County Health Department HCP Plan October 1, 2002 - September 30, 2003 Children with Special Health Care Needs Local Plan for FY 2003 Statement of Need Defming the population of children with special health care needs (CSHCN) in Weld County is difficult. According to the US 2000 census, there are 180,936 residents in our county. Of this population 32.5% or 58,709 residents are under the age of 202 With CSHCN comprising approximately 18%of the population, 10,563 children under the age of 20 would be expected to fit into this category. Statistics documenting the actual number of identified CSHCN are sketchy. Of the 10,433 children enrolled in Medicaid Fee for Service in 2000, 1,847 or 17.7% are identified as CSHCN. 3,977 children were enrolled in Medicaid HMO as of December 31, 2000 and 2,290 were enrolled in CHP+ as of February 2002. Statistics for the number of children identified as CSHCN in these two programs are not available. At any given time, Family Connects, our local Part C agency, actively serves between 150 and 170 children ages 0 to 3. The most current figures available from Colorado Responds to Children with Special Needs(CRSCN) indicate that 307 babies of the 2868 born in Weld County in 1999 were identified as having special health care needs, a rate of 10.7%. During 2001 the Health Care Program for Children with Special Needs (HCP) served 349 children. 17.2% were eligible for full service benefits, indicating they were not qualified to receive Medicaid or CHP+. These undocumented children represent a population that may not have been fully represented in the 2000 census. As of March 1, 2002, 26.9% of those enrolled in HCP had SSI. 53.8% were considered to have a medical home according to that program's definition of medical home which uses a consistent primary care physician and client satisfaction as its major criteria. The figures generated by the various health indicators are inconsistent and do not provide a clear picture of the number of children with special health care needs living in Weld County. The Weld County Department of Public Health and Environment is not planning a community needs assessment in the foreseeable future. Therefore, it is up to the HCP staff to begin to document the number of CSHCN living in our county. ' US Bureau of the Census;2000 Census of Population and Housing Census 200 Summary File;generated by Lori McCarty using Data Extraction System; littp://www.census.govica-binfferrett(22 April 2002). 2 Newacheck, P. "Epidemiologic Profile of Children with Special Health Care Needs,"Pediatrics,Volume 102,Number 1,July, 1998, pp.117-123_ Plan— Objectives, Activities, Monitoring, and Evaluating Health Care Program for Children with Special Needs Need: For the population of children with special health care needs (CSHCN). Weld County has a limited database. This database only describes children enrolled in public health funded insurance programs. Information about the migrant and undocumented population is absent. Objective: By September 30, 2003 HCP staff will determine additional data sources establish a baseline data set for CSHCN living in Weld County. Activities: 1. By November 1st 2002, HCP team will identify potential data resources in Weld County that serve CSHCN. 2. HCP team will develop a questionnaire for contacting the identified data sources by January 1st, 2003. 3. From February 29th, 2003, HCP team will implement the questionnaire by contacting the identified sources. 4. The HCP team will compile and interpret the data collected by March30th, 2003 so baseline data is accessible for the MCH report FY 2004. Type of Activity: Infrastructure Monitoring: 1. The number of identified contacts. 2. The number of surveys completed. 3. The deadlines set forth in the activities. Evaluation: Data sources are identified for future comparisons. B. Plan—Objective,Activities, Monitoring, and Evaluating Health Care Program for Children with Special Needs Need: Undocumented and underinsured families need care coordination to help them access appropriate health care for their child with special needs. Families with insurance applying for HCP will also receive care coordination as appropriate for referrals to medical and community providers to meet the gap of care coordination services in the insurance field. Program Objective: 100% of eligible children enrolled in the Weld County HCP program will receive care coordination during the FY 2003. Activities: 1. Eligibility will be determined within 45 days upon receipt of application or annual renewal during the FY 2003. 2.The acuity tool and care coordination child/family plan of care will be completed for each HCP child enrolled in FY 2003. 3. All ineligible children will be referred to other available community resources on a case by case basis for FY 2003. 4. The case load for each care coordinator will be assigned by HCP team leader for FY 2003. 5. Community resource training will be offered to the HCP team members 4 - 6 times during the regularly scheduled monthly HCP team meetings for FY 2003. Type of Activity: Direct Care, Enabling, Infrastructure building Monitoring: 1. Pending eligibility calculator IRIS 2 report will be reviewed monthly by HCP team leader. 2. Each care coordinator will evaluate case load for completion of acuity tool and child/family plan of care on a monthly basis with the HCP team leader reviewing quarterly. 3. Ineligible children will be documented in IRIS 2 as community referrals. HCP team leader will request a state IRIS 2 report quarterly to review statistics related to children ineligible for direct services. 4. HCP team leader will monitor each care coordinators case load for acuity level and distribution of work load quarterly. 5. Minutes from HCP monthly team meetings will be kept on file documenting community resource training. Evaluation: Care coordination will be documented by IRIS 2 encounters related to specific concerns on 100% of the children enrolled for HCP services in Weld County. Attachment 1D MATERNAL AND CHILD HEALTH(MCH) PRIORITIES AND PERFORMANCE MEASURES As of October 1,2001 Colorado MCH Priorities 1. Reduce teen pregnancy and unintended pregnancy in women of all ages. 2. Improve perinatal outcomes. 3. Reduce child and adolescent morbidity. 4. Increase health and safety in child care settings. 5. Improve efforts to reduce unintentional and intentional injury, addressing motor vehicle crashes, suicide, child abuse and other violence. 6. Improve immunization rates for all children. 7. Increase access to health care(including behavioral health care). 8. Improve state and local infrastructure by increasing capacity to analyze data,carry out evaluations,develop quality standards,and assure availability of services to all children, including children with special health care needs. 9. Reduce substance abuse(alcohol,tobacco, and drugs). 10. Improve oral health and access to oral health care. National MCH Performance Measures I. The percent of State SSI beneficiaries less that 16 years old receiving rehabilitative services from the State Children with Special Health Care Needs Program. 2. The degree to which the State Children with Special Health Care Needs Program provides or pays for specialty and subspecialty services,including care coordination,not otherwise accessible or affordable to its clients(nine- point scale). 3. The percent of Children with Special Health Care Needs in the State who have a "medical home". 4. Percent of newborns in the State with at least one screening for each of PKU,hypothyroidism,galactosemia, hemoglobinopathies(e.g. the sickle cell diseases). 5. Percent of children through age 2 who have completed immunizations for Measles,Mumps, Rubella, Polio, Diptheria,Tetanus,Pertussis,Haemophilus Influenza,Hepatitis B. 6. The rate of birth(per 1,000) for teenagers aged 15 through 17 years. 7. Percent of third grade children who have received protective sealants on at least one permanent molar tooth. 8. The rate of deaths to children aged 1-14 caused by motorvehicle crashes per 100,000 children. Page 1 of 2 9. Percentage of mothers who breastfeed their infants at hospital discharge. 10. Percent of Children with Special Health Care Needs(CSHCN)in the State CSHCN program with a source of insurance for primary and specialty care. 11. Percent of all children in the state without health insurance. 12. The rate(per 100,000)of suicide deaths among youths aged 15— 19. 13. Percent of very low birth weight live births. 14. Percent of potentially Medicaid eligible children who have received a service paid by the Medicaid Program. 15. Percentage of newborns who have been screened for hearing impairment before hospital discharge. 16. The degree to which the State assures family participation in program and policy activities in the State CSHCN program. 17. Percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates. 18. Percent of infants born to pregnant women receiving prenatal care beginning in the fast trimester. Outcome Measures 1. The infant mortality rate per 1,000 live births. 2. The ratio of the black infant mortality rate to the white infant mortality rate. 3. The neonatal mortality rate per 1,000 live births. 4. The postneonatal mortality rate per 1,000 live births. 5. The perinatal mortality rate per 1,000 live births. D.\HCPCQmn,n\CONTRACTS\HCP\ROS\FY 03\Attachrncnts far FY03 TORL\FY03 TORL Attachment ID-MCH Priorities and Performance Measures.doc Page 2 of 2 Attachment 1E Revised July 30,2002 HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP) PERFORMANCE MEASURES FOR THE HCP REGIONAL OFFICE CONTRACTS FOR FY 2002 The Performance Measures below are minimum requirements for Regional Offices in accepting Maternal Child Health (MCH) and State funds through the Health Care Program for Children with Special Needs (HCP). The "Suggested Children with Special Health Care Need Activities", Attachment 1B of the Statement of Work, serve as guidance for communities defining optional indicators for local actions on behalf of children with special health care needs. A. The definition of children with special health care needs includes the following: 1. For the purpose of planning: Children with special health care needs are those who have or are at risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. (Developed by the Federal Bureau of Maternal Child Health in 1995.) 2. For the purpose of enrollment into HCP Full Service Benefits: Continued use of the much more limited definition covering chronic, physical medical conditions as defined in the HCP Manual. B. Performance Measures: 1. Direct Services 1.1. Implement the program of HCP Direct Service Benefits for eligible children according to the time lines, policies and procedures described in the HCP Policy& Procedure and the IRIS Help File. 1.2. The HCP Regional Office Discipline Coordinators will assist regional office staff in the activities as defined in the HCP Manual related to appropriate authorization of OT, PT, speech,nutrition,CHIP and DME benefits(including hearing aids). 1.3. Participate in the Site Visit Survey by providing access to charts and patient records. Include audit report results and any planned corrective measures in the HCP Contract Performance Report due to the state annually by December 15,2003. 1.4. Assure training for new employees/county staff in all of the following: * IRIS Data System * Acuity Assessment/Determination * Prior Authorization of Services * HCP Eligibility and Benefit types * Application and Renewal Process Page 1 of 3 2. Enabling Services 2.1. Assist in public awareness and enrollment activities for programs such as Medicaid, CHP+,and SSI. 2.2. Use the HCP multidisciplinary team(speech, audiologist, OT, PT, nutrition, social work, parent, and nurse)to address the child's medical and mental health care needs and family resources and supports for services and/or care coordination. The development of a Care Coordination Plan should be part of the multidisciplinary process for families enrolled for HCP direct service benefits. 2.3. Collaborate with Part C to assist in the development of a system of early intervention services for children birth through age two. 2.3.1. Identify children enrolled both in HCP and Part C. Work with the family and the Part C service coordinator to identify and determine the role of HCP in developing and implementing the IFSP. 2.4. Create and maintain a plan for providing translation/transcription/interpretation services through the Regional Office. 3. Population-Based Services 3.1. Assure that Audiology Regional Coordinator(s)work with birthing facilities in their region to implement or maintain an Early Hearing Detection and Intervention program (Universal Newborn Hearing Screening)that will: 3.1.1. Screen 95%of all newborns before one month of age and preferably prior to hospital discharge. 3.1.2. Have a Refer rate for further evaluation of 4%or less of all newborns screened before discharge. 3.1.3. Provide documentation of follow-up on all infants who failed or missed screening: including referral to appropriate medical, audiologic and early intervention services. 3.2. Regional office will use all members of the multidisciplinary team to promote population- based services. 4. Infrastructure and Capacity Building 4.1. Complete and submit the HCP Contract Performance Report by December 15,2003. 4.2. Each regional office team will consist of staff, either as FTE, contracted, or shared with another regional office, which includes the following core disciplines: nursing, nutrition, audiology, early intervention specialist for hearing loss, speech, occupational therapy or physical therapy, social work, parent or family advocate. To the extent possible, it is desirable to hire or contract with professionals who are also working, or have worked, in other care systems or community programs, (e.g., mental health, school district, community health center, community center board, Part C). In addition, specialists in community assessment,planning and evaluation, and epidemiology are highly encouraged Page 2 of 3 to be part of the team. The Multidisciplinary team will assist in ongoing needs assessment and facilitation of efforts to coordinate community health and support services for children with special health care needs(CSHCN). 4.3. Using the scope of work for each discipline, the Regional Office Team Leader and State Consultant will develop appropriate priorities for that discipline and the Regional Discipline Coordinator/Consultant for the contract year. 4.4. When Regional Discipline Coordinators/Consultants are shared with other HCP regional offices, the appropriate personnel (Regional Office Team Leaders, regional coordinators/consultants) will meet annually to discuss the roles and priorities for the position. The State Consultants would be invited to attend on request. 4.5. The Regional Office Team Leader will attend two meetings per year with the State HCP staff and participate in bi monthly Regional Office Conference calls. 4.5.1. Regional Discipline Coordinators/Consultants will either attend,or participate by conference call in,Regional Office Team meetings and at least two meetings of all the coordinators/consultants for that discipline,as convened by the State Discipline Consultants. 4.5.2. HCP technicians will attend quarterly HCP conference calls. 4.6. Ensure all IRIS users attend IRIS Training and meet the"Standards for Usage of IRIS II". Ensure all HCP Technicians, Regional Nursing Coordinators, and Team Leaders attend HCP IRIS and Eligibility training. 4.7. Assure family members participate as advisors in program and policy-making activities on a regular basis. Note: The family members referred to in measures 4.7. through 4.7.6.may be someone other than the HCP Family Consultant. A variety of parents can be used for the different activities mentioned. 4.7.1. Family members participate on advisory committees and/or task forces and are offered training,mentoring and reimbursement,when appropriate. 4.7.2. Financial support (grants, assistance, travel and child care) is offered for parent activities or parent groups, to include the Annual Family Consultant Team Meeting. 4.7.3. HCP Family Consultants and/or other family members are involved in in-service training of HCP staff, local health care providers and families. 4.7.4. Family members are hired staff or consultants to the HCP regional office based on their expertise as a family member of a child with special health care needs. 4.7.5. Family members from diverse cultures, who represent the diversity in the community,are involved in all of the above activities. 4.7.6. Family members are involved in CSHCN component of the MCH Plan. I HCPConm on\CONTRACTS\HCP\]OMFY 03\Weld\Wcld FY03 TORL ARadmrnt le-Performance Measurea.doc Page 3 of 3 Attachment IF Health Care Program for Children with Special Needs(HCP) Standards for Usage of IRIS II Registration and Annual Renewal 1. Policies and procedures and timelines are followed as described in the HCP Policy and Procedure Manual and IRIS Help File. 2. Complete Benefits Calculator within 45 days of receiving application 3. Enter Client Encounters using the concern list to document acuity level. IRIS II determines acuity level. Regional Offices will complete the Acuity Tool for any HMO with whom HCP has a contract for care coordination. (Refer to Care Coordination Booklet,March 2001,Fifth printing.) 4. HCP Caseload includes all persons entered as partial enrollments and full enrollments with current eligibility dates and if person encounters have been entered within previous twelve months of the reporting period. Acuity level is based on number of concerns with care coordination being provided. Community encounters provide documentation of system building activities. IRIS II data reported as of October 31,2002 will be used for the HCP funding formula effective October 1,2003. II. Services-All services and payers are entered on IRIS with approval letters and provider letters mailed for any services requiring financial reimbursement or tracking by HCP including the following examples: 1. All children receiving HCP direct services including children receiving nutrition,Home Intervention Program, speech,OT/PT,and social work services. 2. All children receiving care coordination services. 3. All children attending HCP clinics with follow-up diagnostic studies or referrals to other specialist or providers. Clinic visit screen will be completed for all children with clinic visits. All HCP clinics will be added to the IRIS II clinic schedule. 4. Home health services,lodging and meals. 5. Surgeries,hospitalizations, emergency services, orthodontia,pediatric/specialty consultation,durable medical equipment,hearing aids,and medications. III. Security procedures must be in place for all HCP staff that are IRIS users. Supervisors for each staff using IRIS II must sign security forms and User Profile forms. Personal passwords for each HCP staff must be changed every sixty days and kept completely confidential. The IRIS II Security Policy and Procedures must be followed. IV. HCP Regional Office staff are required to attend IRIS training: 1. Monthly HCP Eligibility and Orientation Class for new employees will include IRIS II training with additional eligibility training provided as needed by the state office staff. 2. Additional IRIS II training will be scheduled for Regional Office IRIS users as needed. 3. Regional Office staff will schedule and assist HCP state staff with IRIS training before implementation of IRIS II for the counties in the multi-county regional offices. 4. Training for IRIS II Reporting will be scheduled for Regional Office Team Leaders and Regional Coordinators. Revised July 30,2002 1:\HCPCommon\CONTRACTS\HCPVtOs\FY 03\Attachments far FY03 TORL\FY03 TORL Attachment IF-IRIS Standards.doc Attachment 1G Health Care Program for Children with Special Needs (HCP) IRIS II Security Policy and Procedures Security is very important to protect HCP information and IRIS data. The following security procedures are required for county agencies and HCP Regional Offices: 1. For the HCP IRIS database: a. All agency HCP staff will sign a security and confidentiality agreement before a personal ID and password are assigned for access to Citrix and the IRIS database. b. All agency HCP staff will have a personal ID and password assigned by the State HCP Office after completing IRIS training. c. Agency HCP staff will not allow new agency staff,another agency HCP staff person,staff from another program or any person to have access or use their Imago or IRIS ID and password. d. Agency HCP staff will complete IRIS training with the State HCP Office staff before using the IRIS database;IRIS training includes Security training. 2. County Agencies will have policies and procedures for security and confidentiality. All staff will be trained on the importance of security and confidentiality. 3. An agency supervisor will sign a security form for each agency HCP staff indicating the access that the staff person needs. Forms will be sent to the State HCP office to request a new ID and password for new staff or when duties change for current staff. A new ID and password will be issued based on the request of the supervisor and the discretion of the State HCP Office. Agency supervisors will not allow or request access for any staff who does not have the need to access HCP client specific data. 4. Agency HCP supervisors will contact the State HCP office and request that an ID and password be expired when a staff person leaves the HCP Program or no longer needs IRIS access. 5. Agency supervisors will notify the State HCP office when a security breach is suspected and request a specific ID/password be expired. A new ID and/or password will be issued based on the request of the supervisor and the discretion of the State HCP Office. 6. Agency supervisors will supervise and monitor access to the IRIS Database. Agency supervisors will not allow sharing of IDs or passwords. 7. Agency supervisors will monitor/implement HCP policies and procedures for release of information and consent for services including explanation to HCP families and clients. 8. When staff forgets a personal password,they will call the IRIS Hotline or the main State HCP phone number for help. The State HCP office will re-set the personal password to a default password. The staff person will immediately change the default password to a personal password. 9. Agency supervisors will require staff to change their personal password every 60 days or more frequent if it is suspected that the password has been compromised. Revised July 31, 2002 J:VICPCommon\CONTRACrSVICI'Ho, +Y 03\Attachments for FY03 TORLV+Y03 TORL Attachment IG-IRIS R Security Poacy.doc Page 1 of 1 Attachment 1H MATERNAL AND CHILD HEALTH(MCH) COUNTY MCH PLAN FOR OCTOBER 1,2003 THROUGH SEPTEMBER 30,2004 DUE DATE: MAY 1,2003 As of October 1,2002 The County MCH Plan asks the local public health agency to assess and prioritize the health status needs of the Perinatal Population,the Child and Adolescent Population and the Children with Special Health Care Needs Population(CSHCN)and to identify how the MCH funds will be used to address the priority needs. The Plan is to categorize the activities or services which will be used to address the needs by four types of services, i.e. direct care services, enabling services,population-based services or infrastructure-building activities as defined by the Maternal and Child Health Bureau in"Core Public Health Services Delivered by MCH Agencies". Quantitative and qualitative data gathered at the state and local levels should be used in assessing health status needs. The resources available in the community to meet the needs should also be assessed and considered in establishing the priorities to be addressed. Local public health agencies are encouraged to collaborate with public and private partners in the development of the Maternal and Child Health Plans. Colorado has identified ten MCH priorities to be addressed with MCH Block Grant funding. The services or activities provided under the MCH funding should be responsive to one or more of the priorities. There is no ranking of the ten priorities. They are as follows: 1. Reduce teen pregnancy and unintended pregnancy in women of all ages. 2. Improve perinatal outcomes. 3. Reduce child and adolescent morbidity. 4. Increase health and safety in child care settings. 5. Improve efforts to reduce unintentional and intentional injury,addressing motor vehicle crashes, suicide,child abuse and other violence. 6. Improve immunization rates for all children. 7. Increase access to health care(including behavioral health care). 8. Improve state and local infrastructure by increasing capacity to analyze data, carry out evaluations, develop quality standards,and assure availability of services to all children, including children with special health care needs. 9. Reduce substance abuse(alcohol,tobacco,and drugs). 10. Improve oral health and access to oral health care. Please present the Statement of Need and the Plan for children with special health care needs using the following format: I. CHILDREN WITH SPECIAL HEALTH CARE NEEDS POPULATION A. Statement of Need-What are the priority needs of the Children with Special Health Care Needs population in the County or District,based on an assessment of the health status needs and of the resources to address the needs? 1. Health and related service needs-What information about the health and related service needs of the children with special health care needs in your county or district were used to select the priority needs? Page 1 of 3 2. Resources to address the health and related service needs-What are the resources of the public health agency and of other agencies in the community which address the health and related service needs of children with special health care needs in your community? a. Direct Care Service Needs-What are the resources in the community which provide direct health care services for the children who have conditions or illnesses which are diagnostically eligible for direct care payment by the Health Care Program for Children with Special Health Care Needs? Are there gaps or unmet needs in such direct care services? Are there issues of availability and accessibility? b. Enabling Services-What are the resources in the community which provide enabling services, i.e.transportation,interpretation and translation,outreach, health education,family support services,case management and service coordination with other related services? Are there gaps or unmet needs? c. Population-Based Service Needs-What are the resources which provide population-based services for children with special health care needs in the community, i.e.newborn hearing screening or vision screening services? d. Infrastructure-Building Services or Activity Needs-What infrastructure-building services,resources or activities are needed to promote the development of community-based systems of services for children with special health care needs and their families? Present information regarding the need for activities such as planning activities,needs assessments,program evaluation,policy development, program coordination,quality assurance activities, standards development, monitoring,training,research,developing systems of care and related services, or development of information systems. 3. Unmet or continuing needs-Considering the health and related service needs and the resources which address the needs that were identified above,what are the continuing or unmet needs for direct care,enabling,population-based and/or infrastructure building services? B. Children with Special Health Care Needs Plan 1. Priority Needs for use of CSHCN funds-Considering the unmet or continuing needs identified in the Statement of Need(Section A),what are the priority needs of the children with special health care needs population for which CSHCN finding under the contract with the Health Care Program for Children with Special Needs(HCP)will be used? Explain your rationale for selecting these needs to be the ones addressed with the CSHCN funds. 2. Operational Plan-Objectives,Activities,Monitoring and Evaluating Need Restate each of the needs that will be addressed with CSHCN funding Objective State the objective or objectives(one to four objectives suggested)that will address this need. All objectives should be reasonable,specific, time-framed and measurable. Page 2 of 3 Activities Describe the specific activities that will be carried out to achieve each objective. Include"Best Practice"or"Evidence-Based"interventions or activities whenever possible. Categorize the activities according to the level or type of service being carried out(i.e.,direct health care, enabling,population-based, or infrastructure-building). Monitoring Describe your methods of monitoring to assure quantity of service (numbers of clients and services)and quality of service(measured through use of protocols,chart audits,policy procedure manuals,etc.). Infrastructure-building activities or services may be monitored by tracking the completion of planned activities or whether benchmarks have been realized or protocols or policy procedures put in place. Evaluation Describe your methods of evaluation the effectiveness of your activities in addressing the identified need. Please submit your plan,via e-mail,for the period October 1,2003 through September 30,2004,no later than 5:00 P.M.on Thursday,May 1,2003 to: Carolyn Dodge—E-mail Address: carolvn.dodae( state.co.us 1.\HCPConm on\CONTRACaSIHCP ROs\FY 03\Attachments for FY03 TORL\FY03 TORL Attachment I H-County MCH Plan Instructions.doc Page 3 of 3 Attachment 11 MATERNAL AND CHILD HEALTH HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP) • BUDGET ESTIMATE FORM DUE DATE: May 1,2003 CONTRACTOR: FOR THE PERIOD OF: October 1,2003 through September 30,2004 MATERNAL AND CHILD HEALTH REPORTING FOR THE CORE PUBLIC HEALTH SERVICES INCLUDING CHILD HEALTH,PERINATAL HEALTH AND CHILDREN WITH SPECIAL NEEDS PROGRAMS Section I Based on your county plan,please estimate the following based on your MCH funding formula contract amounts: AMOUNT AND PERCENTAGE ALLOCATED TO: DOLLARS PERCENTAGE CHILD HEALTH PERINATAL HEALTH TOTAL 100% CHILD HEALTH PERCENTAGE ALLOCATED TO: DIRECT SERVICES ENABLING SERVICES POPULATION-BASED SERVICES INFRASTRUCTURE BUILDING SERVICES TOTAL 100% PERINATAL HEALTH PERCENTAGE ALLOCATED TO: DIRECT SERVICES ENABLING SERVICES POPULATION-BASED SERVICES INFRASTRUCTURE BUILDING SERVICES TOTAL 100% Section II DOLLARS AMOUNT OF FUNDS ALLOCATED TO: CHILDREN WITH SPECIAL NEEDS CHILDREN WITH SPECIAL NEEDS PERCENTAGE ALLOCATED TO: DIRECT SERVICES ENABLING SERVICES POPULATION-BASED SERVICES INFRASTRUCTURE BUILDING SERVICES TOTAL 100% NOTE: Administrative costs can be allocated to each of the above categories as appropriate. 1\HCPCommon\Cantracls HER ROstWY 03Attachments for FY03 TORL\FY03 TORL Attachment II-Budget Estimate Form.xls • • Attachment 1J HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP) FINAL EXPENDITURE REPORT DUE DATE: December 1,2003 CONTRACTOR: FOR THE PERIOD OF: October 1,2002 through September 30,2003 Annual Full Total SOURCE OF FUNDS Salary Time Amount Received Rate Equivalent Required OTHER` from COPHE PERSONAL SERVICES. ContractuavFee for Service — — — — Supervising Personnel — Fringe Benefits' Rate= TOTAL PERSONAL SERVICES $ $ $ OPERATING EXPENSES(which are not pal of indirect). TOTAL OPERATING EXPENSES $ $ $ TRAVEL EXPENSES(In-state/Out-state) TOTAL TRAVEL EXPENSES $ $ $ Contractual TOTAL CONTRACTUAL EXPENSES $ $ $ Total Direct Costs(Personal ServIces+Operating+Travel+Contractual) $ $ $ ADMINISTRATIVE/INDIRECT COST TOTAL ADMINISTRATIVE/INDIRECT COSTS $ $ $ TOTAL PROJECT COST $ $ $ *Source of funding for"Other"(Match or In-kind)I.e.Maternal and Child Health Programs Local/County Funding $ Medicaid(will not be used to match) $ Patient Fees $ Other(List): $ $ TOTAL$ May the NON FEDERAL funds be used as match? YES NO Signature of Authorized Representative Date J WCPCammoniContrac4WCPVY0a1FY 01Wtachmenta for FY03 TORL1FY01 TORL Attachment 1,1.Fine Expenditure Report Form da • Attachment 1K COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP) TASK ORDER DUTIES AND OBLIGATIONS CERTIFICATION FORM DUE DATE: December 1, 2003 TO: Terry de Leon Colorado Department of Public Health and Environment Health Care Program for Children with Special Needs(HCP) 4300 Cherry Creek Drive South PSD-HCP-A4 Denver, Colorado 80246-1530 Telephone: (303)692-2370;FAX#:(303)782-5576 FROM: • TYPE OF PROGRAM: FEDERAL ID NUMBER: This is to certify that the "Duties and Obligations of the Contractor" have been performed per Task Order Contract Routing Number for the period of October 1,2002 through September 30,2003. SIGNATURES: Contractor or Authorized Designee Date HCP Regional Office Team Leader Date I hereby certify that all task order requirements have been met and final payment of$ for task order services for the period of October 1,2002 through September 30, 2003 is authorized. SIGNATURES: HCP Program Consultant Date HCP Program Director or Authorized Designee Date I:WCPCOSLNONK]NTRACISWCTROSEY OINTTACw4ENTS FOR FYOI TOM-TYCO TORT ATTACHMENT IK-TO DUTIES&OBLIGATIONS CERTIFICATION DOC Attachment 1L Health Care Program for Children with Special Needs(HCP) Contract Performance Tool Effective October 1,2002-September 30,2003 Purpose: To evaluate the outcome of the HCP Contract Performance Measures(Attachment 1E)and to provide guidance for the contents of the annual HCP Contract Performance Report,which is due December 15,2003. 1. Direct Services Measurement Content (How will we know it is accomplished?) (Contract Language) Blue Items: to be included in the Annual HCP Contract Performance Report ***=Recommendation Only 1.1. Implement the program of HCP Direct Service Benefits Annual Site Visit Survey conducted by State office. for eligible children according to the time lines,policies and procedures described in the HCP Policy&Procedure and the Monitoring of IRIS Data System by State Office. IRIS Help File. *** Site Visit Tool should be used as an ongoing guidance by regional office to monitor this performance measure. 1.2. The HCP Regional Office Discipline Coordinators will The Regional Office Team Leader will describe in their assist regional office staff in the activities as defined in the HCP annual report the process that involves Regional Manual related to appropriate authorization of OT,PT,speech, Coordinators in authorization and delivery of HCP paid nutrition,CHIP and DME benefits(including hearing aids). services. Annual Site Visit Survey conducted by State Office. Monitoring of IRIS Data System by State Office. 1.3. Participate in the Site Visit Survey by providing access The Regional Office Team Leader will provide summary of to charts and patient records. Include audit report results and any the results of the Site Visit Survey and any planned planned corrective measures in the HCP Contract Performance corrective measures. Report due to the state annually by December 15,2003. 1.4. Assure training for new employees/county staff in all of Team Leaders will have documentation of training records the following: available on request. * IRIS Data System * Acuity Assessment/Determination Annual Site Visit Survey conducted by State Office. * Prior Authorization of Services * HCP Eligibility and Benefit types Monitoring of IRIS Data System by State Office. * Application and Renewal Process Page 1 of 6 2.Enabling Services Measurement Content (How will we know it is accomplished?) (Contract Language) Blue Items: to be included in the Annual HCP Contract Performance Report ***=Recommendation Only 2.1. Assist in public awareness and enrollment activities for The Regional Office Team Leader(TL)will provide: programs such as Medicaid,CHP+,and SSI. 1. Data that indicate numbers of children eligible for CHP+in their region and the actual number enrolled. 2. Data that indicate numbers of children dually enrolled in SSI and HCP. 3. Description of regional goal and plan for increasing enrollment of children with special health care needs (CSHCN)in Medicaid,CHP+,and SSI. 4. Number of families assisted by the Regional Office in the process of applying for Medicaid,CHP+,and SSI. 2.2. Use the HCP multidisciplinary team(speech, The Regional Office Team Leader(TL)will describe how the audiologist,OT,PT,nutrition,social work,parent,and nurse)to needs of the child and family are met through address the child's medical and mental health care needs and multidisciplinary care coordination. family resources and supports for services and/or care coordination. The development of a Care Coordination Plan Provide two examples of this team process. Use examples should be part of the multidisciplinary process for families that involved at least three different disciplines on the enrolled for HCP direct service benefits. multidisciplinary team. Site Visit Survey results for documentation of written Care Plans for families enrolled for HCP direct service benefits. 2.3. Collaborate with Part C to assist in the development of Note: Multicounty Regional Offices should describe all Early a system of early intervention services for children birth through Childhood Connection agencies that serve their region. age two. Regional Office Team Leader will: 2.3.1. Identify children enrolled both in HCP and Part C. 1. Describe interagency coalitions or agreements in your Work with the family and the Part C service coordinator to county(ies)that include both HCP and Part C. identify and determine the role of HCP in developing and 2. Provide the number of children dually enrolled in HCP implementing the IFSP. and Part C. 3. Describe how service coordination occurs for children who are dually enrolled in HCP and Part C,including the HCP team involvement in developing the IFSP. 4. Provide data of the number of children served by Part C in your county(ies)and discuss whether the number served indicates adequate identification of CSHCN in the 0-3 year old population. 5. Describe RCP's role in public awareness and outreach to identify children eligible for HCP and/or Part C(Child Find). Site Visit Survey results for documentation in chart of IFSP information for those children dually enrolled in HCP and Part C. Site Visit Survey results for documentation of IRIS Community Encounters for meetings with Part C. 2.4. Create and maintain a plan for providing The Regional Office Team Leader(TL)will describe a plan translation/transcription/interpretation services through the for providing translation/transcription/interpretation Regional Office. services to families in the Region. Page 2 of 6 3. Population-Based Services Measurement Content (How will we know it is accomplished?) (Contract Language) Blue Items: to be included in the Annual HCP Contract Performance Report ***=Recommendation Only 3.1. Assure that Audiology Regional Coordinator(s)work Audiology Regional Coordinators will provide: with birthing facilities in their region to implement or maintain 1. Annual Report(reporting tool to be provided by State an Early Hearing Detection and Intervention program(Universal Audiology Consultant) utilizing data from the Newborn Newborn Hearing Screening)that will: Evaluation Screening and Tracking(NEST)that indicate outcomes of newborn hearing screening for hospitals in 3.1.1. Screen 95%of all newborns before one month of age their region,referral rate,and follow up outcomes. and preferably prior to hospital discharge. 2. Summary of improvement plan(s)for individual hospitals in their region that are not meeting the 3.1.2. Have a Refer rate for further evaluation of 4%or less of recommended guidelines for Universal Newborn Hearing all newborns screened before discharge. Screening. 3.1.3. Provide documentation of follow-up on all infants who Site Visit Survey results for documentation of IRIS Community failed or missed screening:including referral to appropriate Encounters for site visits with hospitals. medical,audiologic and early intervention services. Monitoring of NEST data by State Office 3.2. Regional office will use all members of the The Regional Office Team Leader(TL)will describe other multidisciplinary team to promote population-based services. population based interventions that team members participate in and include any process or outcome information(data)supporting these activities(e.g. promoting medical home,vision screening,provider and public health education related to CSHCN or HCP program,and outreach efforts). Page 3 of 6 4.Infrastructures and Capacity Building Measurement Content (How will we know it is accomplished?) Blue Items: to be included in the Annual HCP Contract (Contract Language) Performance Report ***=Recommendation Only 4.1. Complete and submit the HCP Contract Performance The Regional Office Team Leader will submit the Contract Report by December 15,2003. Performance Report to their State Program Consultant by December 15,2003. 4.2. Each regional office team will consist of staff,either as The Regional Office Team Leader will provide: FTE,contracted,or shared with another regional office,which 1. Names of team members,their discipline,dates of hire, includes the following core disciplines:nursing,nutrition, number of hours per month if contract or percent of time audiology,early intervention specialist for hearing loss,speech, if FTE,and other community agencies they work for,if occupational therapy or physical therapy,social work,parent or applicable. family advocate. To the extent possible,it is desirable to hire or 2. A list of any additional specialist(s)involved with the contract with professionals who are also working,or have team on a periodic basis. worked,in other care systems or community programs,(e.g., 3. A summary of community coordination activities for mental health,school district,community health center, each discipline member of team. community center board,Part C). In addition,specialists in 4. A description of the involvement of the multidisciplinary community assessment,planning and evaluation,and team in the needs assessment planning process,the epidemiology are highly encouraged to be part of the team. The writing of the Contract Performance Report,and MCH Multidisciplinary team will assist in ongoing needs assessment Plan. and facilitation of efforts to coordinate community health and support services for children with special health care needs (CSHCN). 4.3. Using the scope of work for each discipline,the The Regional Office Team Leader or Regional Discipline Regional Office Team Leader and State Consultant will develop Coordinator/Consultant will report on the discipline team appropriate priorities for that discipline and the Regional member's priorities and give examples of how those priorities Discipline Coordinator/Consultant for the contract year. were accomplished. 4.4. When Regional Discipline Coordinators/Consultants The Regional Office Team Leader will document the process are shared with other HCP regional offices,the appropriate used for developing priorities by providing meeting minutes or personnel(Regional Office Team Leaders,regional making them available by request. coordinators/consultants)will meet annually to discuss the roles and priorities for the position. The State Consultants would be *** An annual meeting to develop priorities within the scope invited to attend on request. of work should be held prior to the contract renewal date of the Regional Discipline Coordinator/Consultant. 4.5. The Regional Office Team Leader will attend two Meeting minutes and attendance as documented by State Office meetings per year with the State HCP staff and participate in bi staff. monthly Regional Office Conference calls. 4.5.1. Regional Discipline Coordinators/Consultants will either attend,or participate by conference call in,Regional Office Team meetings and at least two meetings of all the coordinators/ consultants for that discipline,as convened by the State Discipline Consultants. 4.5.2. HCP technicians will attend quarterly HCP conference calls. 4.6. Ensure all IRIS users attend IRIS Training and meet the State HCP Office will document attendance at IRIS and "Standards for Usage of IRIS II". Ensure all HCP Technicians, Eligibility training sessions. Regional Nursing Coordinators,and Team Leaders attend HCP IRIS and Eligibility training. IRIS security forms will be complete and on file at State Office. Page 4 of 6 Measurement Content (How will we know it is accomplished?) Blue Items: to be included in the Annual HCP Contract (Contract Language) Performance Report ***=Recommendation Only 4.7. Assure family members participate as advisors in Regional Office Team Leader will provide at least one program and policy-making activities on a regular basis. example of family participation in program and policy activities. Note: The family members referred to in measures 4.7.through 4.7.6.may be someone other than the HCP Family Consultant. A variety of parents can be used for the different activities mentioned. 4.7.1. Family members participate on advisory committees Regional Office Team Leader will provide: and/or task forces and are offered training,mentoring and 1. Description of how the Family Consultant team member reimbursement,when appropriate. is mentored for their role on the team and identifies who has provided mentoring and training. 2. Documentation of reimbursements made to family members for training opportunities. 4.7.2. Financial support(grants,assistance,travel and child The Regional Office Team Leader will provide: care)is offered for parent activities or parent groups,to include 1. Documentation of the financial support provided to the the Annual Family Consultant Team Meeting. Regional Family Consultant to attend the Annual Family Consultant Team Meeting. 2. Documentation of travel and child care support provided to parents or parent groups. 4.7.3. HCP Family Consultants and/or other family members The Regional Office Team Leader will provide: are involved in in-service training of HCP staff,local health care 1. Documentation of how families,in particular the HCP providers and families. Regional Family Consultant,are utilized for their expertise in providing training in areas such as: a) Family centered care b) Medical Home c) Community resources d) Family-professional partnerships. 2. The Family Consultant,or the TL,will provide documentation of trainings conducted by the Family Consultant and/or other family members,which list topic,attendance and evaluation. 4.7.4. Family members are hired staff or consultants to the Use same measurement as listed for Performance measure HCP regional office based on their expertise as a family member 4.2.and include the Family Consultant's relation to the of a child with special health care needs. CSHCN. 4.7.5. Family members from diverse cultures,who represent The Regional Office Team Leader will describe how the the diversity in the community,are involved in all of the above Regional Family Consultant and family members self- activities. identify their ethnic and racial background. The Regional Office Team Leader or Regional Family Consultant will provide documentation of participation in HCP activities by families from diverse ethnic and cultural backgrounds. Page 5 of 6 • Measurement (How will we know it is accomplished?) Content Blue Items: to be included in the Annual HCP Contract (Contract Language) Performance Report ***=Recommendation Only 4.7.6. Family members are involved in CSHCN component of The Regional Office Team Leader will provide a description the MCH Plan. of how family members contributed to the CSHCN component of MCH Plan by methods such as: 1. Public hearings to assist in the development of the MCH Plan. 2. Focus groups for families 3. Family members were invited to participate in the development of the MCH Plan. 4. Family members were surveyed to gather information for needs assessments. MCH plan and report Submit your Contract Performance Report(due by Monday,December 15,2003)to: Lynn Bindel Program Consultant Health Care Program for Children with Special Needs(HCP) 4300 Cherry Creek Drive South PSD-HCP A4 Denver,CO 80246-1530 1:\HCPCormmn\CONTRACTS\HCP\ROs\FY 03\Weld\Weld FY03 TORL Attachment IL-Contract Performance Tool.doc(LB/pb) Page 6 of 6 Attachment 1M MATERNAL AND CHILD HEALTH(MCH) OUTLINE FOR YEAR END PROGRESS REPORTS FOR THE PERIOD OF:October 1,2002 through September 30,2003 DUE DATE:January 15,2004 As of October 1,2002 Please put the agency name,contact person and telephone number at the beginning of the report or on a cover page. MCH Plan Progress Report A. Perinatal Population: 1. Restate the priority needs of the perinatal population for which the MCH funds were used. 2. For each priority need for which MCH funds were used: a. Restate the objective(s)which addressed that priority need; b. State if the objective was fully met,partially met,or not met; c. Describe what was accomplished, including summarizing important activities. B. Child and Adolescent Population: 1. Restate the priority needs of the child and adolescent population for which the MCH funds were used. 2. For each priority need for which MCH funds were used: a. Restate the objective(s),which addressed that priority need; b. State if the objective was fully met,partially met,or not met; c. Describe what was accomplished,including summarizing important activities. C. Children with Special Health Care Needs(CSHCN)Population: 1. Restate the priority needs of the children with special health care needs population for which the CSHCN funds were used,through the contract with the Health Care Program for Children with Special Health Care Needs(HCP): 2. For each priority need for which the CSHCN funds were used: a. Restate the objective(s)which addressed that priority need; b. State if the objective was fully met,partially met,or not met; c. Describe what was accomplished, including summarizing important activities. Page 1 of5 3. Please describe any mechanisms that are in place in your community for coordination of health services which are new since the report in January of last year. This would include coordination among providers of primary care,habilitative and rehabilitative service, or other specialty medical treatment services,mental health services and home health care. 4. Please describe any mechanisms that are in place in your community for coordination and service integration among programs serving children with special health care needs, including early intervention and special education,social services and family support services, which are new since the report in January of last year. II. Describe any important changes in administrative or organizational aspects of the program which affected service delivery during the twelve-month period. III. Describe any emerging issues regarding the perinatal population,child and adolescent population and/or the children with special health care needs population in your community. IV. Fill out Tables I and II as applicable and submit along with your report. V. Please submit your Year End Progress Report,via e-mail,for the period of October 1, 2002 through September 30,2003,no later than 5:00 P.M. on Thursday,January 15,2004 to: Carolyn Dodge—E-mail Address: carolvn.dodeeAstate.co.us J:\HCPConmmn\CONTRACTSVICP\ROs\FY 03\Attaclm nts for FY03 TORL\FY03 TORT.Attachment IM- Year End Progress Report Outlinc.doc Page 2 of 5 i ( H» ii In ® $ Cli ( Z ° ( & m § / ) t � \ k y � \/ \ \) E— � � ( / % z °' e _ § 6 / / g / + ) / '§ F L Z H / eco t am y4 •.-- §§ 00 ) } 7 � \ R � §/ ) boy f � / * m U 4 > en W Q - . . . 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F� Q o c m co aoi y 4, 5 O V `o ° b s a o P ± L E Co a I* ON C cu y R U O .4 CC tl W a o b a 0 LI e �" a 10 o � a N O O Aco m c7W Q' F a .0 E 'N 3 '^ a0+ O •V W 9 E z a) O O y U N 4�, R R O y N M v s O O 0. 0 ti 40 O a 0 rc r u U O > a 4.2, 5L ,. o l- o ..-. a) 3A O a N a 3 .d U E " a .. a) 7 p, o `.. O Q .. w tlo °' '" 'O •0 w VI L d o c IC a°, i' 4 p 0b .0 � a ill •° a, 4 U o ° ad u >. o ``a a g 4 O O y O A' +' a) c81 2 V y [d 5 IZ 5 * E" F" F tC M ti P. ►ii A 0 F a F • Attachment 1N COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP) SLIDING FEE SCHEDULE FOR HCP CLINICS Effective October 1,2002 The Health Care Program for Children with Special Needs(HCP)is committed to the HCP Sponsored Specialty Clinics. We want to ensure that throughout Colorado families have access to the HCP clinics. HCP has designed a Clinic Support Fee Schedule to offset the infrastructure cost of the clinics. The sliding fee schedule affects families that have an HCP financial rating above 133%Federal Poverty Guidelines(FPG). The clinic physician will bill Medicaid and private insurance for all children who have Medicaid or private insurance benefits. This policy does not address the statewide Developmental Evaluation Clinic System. HCP is billed by each Developmental Evaluation Clinic on a fee for service basis for children with HCP benefits. A. Audiology/Otology,Orthopedic,Pediatric Cardiology,Pediatric Neurology,Rehabilitation, and Spinal Defects Clinics 1. Clients with an HCP financial rating of 133%FPG or less will not be charged a clinic support fee, however will continue to receive: a. diagnostic evaluations(to include one follow up visit to interpret the results)at no cost to the family, b. continuing clinic visits at no cost to the family for children who are diagnostically eligible,and c. labs and X-rays at no cost to the family. 2. Clients on Medicaid will not be charged a clinic support fee. 3. Clients with a rating of 134%FPG and above: a. will be charged a clinic support fee for both diagnostic evaluations and continuing clinic visits. The family will be assessed a: (1) $10 fee per visit for a rating of 134 to 185%FPG (2) $30 fee per visit for a rating of 186 to 211%FPG (3) $50 fee per visit for a rating of 212 to 399%FPG (4) $100 fee per visit for a rating of 400%FPG or greater b. and will pay all labs and x-rays ordered out of clinic. Page 1 of 2 4. All clinic patients must be registered with HCP and complete a financial statement included in the HCP application. Families who choose not to complete the financial statement will be charged the maximum fee on the schedule per visit. 5. The clinic sites and ROs shall negotiate the percent each of them shall receive of the Clinic Support Fees collected from the families. The fees collected are to support HCP clinic activities such as: clinic supplies,clinic equipment,clinic furniture or parent/professional stipends. Records on the distribution of collected Clinic Support Fees shall be maintained according to HCP policy. B. Pediatric Clinics Children attending an HCP Pediatric Clinic without an HCP eligible diagnosis: 1. If the child's PCP requests continuing consultation from the pediatrician,the child may be seen in the HCP Pediatric Clinic and pay fee for service according to the established sliding fee. 2. Families with a financial rating of 133%FPG or below will be required to pay at the 134 to 185% FPG level. (HCP is providing access for these families,but not paying for services to children who are not diagnostically eligible.) 3. Family pays all labs and x-rays ordered out of clinic. 1:\HCPCOMMON\CONTRACTS\HCP\ROS\FY 03\WELD\WELD FY03 TORL ATTACHMENT IN-CLINIC SLIDING FEE SCHEDULE.DOC(08/01/02)LB/pw Page 2 of 2 Attachment 2 APPLICANT: Weld County Department of Public Health and Environment PROJECT: Health Care Program for Children with Special Needs (HCP) FOR THE PERIOD: OCTOBER 1, 2002 through SEPTEMBER 30, 2003 Funded by CDPHE HCP Weld County Regional Office: (1/12 payable monthly for October through August, September's payment contingent upon Annual Expenditure Report) 127,078 Sub-total HCP Weld County Regional Office: {1} 127,078 HCP Regional Coordinators: (line item billing) Audiology 2,000 Travel for Colo. Academy of Audiology meeting 250 Occupational or Physical Therapy 2,500 Speech 1,500 Sub-total Regional Coordinators 6,250 Total HCP Weld County Regional Office 133,328 Note: Regional Coordinators' honorarium rate is $24.00 per hour. {1} Year 3 of 3 of the HCP funding formula implementation, 100% of change. Memorandum 0-At TO: Glenn Vaad, Chair Board of County Commissioners I C FROM: Mark E. Wallace, MD, MPH, Director Department of Public Health and � 0)4 Environment and COLORADO V IJ DATE: August 26, 2002 SUBJECT: Task Order Renewal Letter #2 for the Health Care Program for Children with Special Needs Enclosed for Board review and approval is Renewal Letter Number Two to the Task Order between the between the Colorado Department of Public Health and Environment (CDPITE) and Weld County Department of Public Health and Environment (WCDPHE) for the Health Care Program for Children with Special Needs. This letter authorizes WCDPHE to provide case finding, community outreach, care coordination, clinic management, program management. parent arid family involvement, and interagency collaboration to children and their families who are determined to be eligible for services. Eligible children are those who have or are at risk for a chronic physical, developmental, behavioral, or emotional condition. For providing these services, WCDPHE will be paid an amount not to exceed S133,328 for the time period October 1, 2002 through September 30, 2003. I recommend your approval of this renewal letter. Enclosure 2002-2397 Hello