HomeMy WebLinkAbout20032008.tiff RESOLUTION
RE: APPROVE TASK ORDER OPTION TO RENEW LETTER#3 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 a Task Order Option to Renew Letter#3
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, 2003, and ending September 30, 2004,
with further terms and conditions being as stated in said renewal letter, and
WHEREAS, after review, the Board deems it advisable to approve said 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 Option to Renew Letter#3 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 renewal letter.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 6th day of August, A.D., 2003.
B RD OF COUNTY COMMISSIONERS
���/��/�� COUNTY, COLOR O
ATTEST: iate"'f ��`7/leue4
vi E. Long, Chair
Weld County Clerk to the Board ('
Robert D. sden, Pro-Tem
B` .
_,,, to the Board
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M. J. Geile
Willis . Jerke
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Glenn Vaad
Date of signature: —4g ,o�
2003-2008
HL0030
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July 18,2003 TASK ORDER OPTION TO RENEW LETTER
Task Order Renewal Letter Number 03 Contract Routing Number 04 FAA 00118
State Fiscal Year 2003-04 Health Care Proaram for Children with Special Needs(HCP)
This Task Order Option to Renew Letter is issued pursuant to Part F.5.of the Master Contract identified by contract routing number
00 FAA 00008 and paragraph E.17.of the Task Order identified by contract routing number 01 FAA 00797 and contract
encumbrance number PO FAA HCP0100797. This Task Order Option to Renew Letter is between the COLORADO
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT and BOARD OF COUNTY
COMMISSIONERS OF WELD COUNTY. The Task Order has been amended by Task Order Option to Renew
Letter 01,contract routing number 02 FAA 00497 Task Order Change Order Letter 01 contract routing number 02
FAA 01066, and Task Order Option to Renew Letter 02 contract routing number 03 FAA 00419, if any. The Task
Order,as amended,if applicable,is referred to as the"Original Task Order". This Task Order Option to Renew Letter
is for the renewal term of October 1,2003 through September 30,2004. The maximum amount payable by the
State for the work to be performed by the Contractor during this renewal term is TWO HUNDRED THREE
THOUSAND SIX HUNDRED EIGHTY DOLLARS ($203,680.00)for an amended total financial obligation of the
State of SIX HUNDRED THIRTY-NINE THOUSAND NINE HUNDRED EIGHTY-FIVE DOLLARS,
($639,985.00). This is an increase of TWO HUNDRED THREE THOUSAND SIX HUNDRED EIGHTY
DOLLARS,($203,680.00)of the amount payable from the previous term. The Scope of Work for this renewal term
is incorporated herein by this reference,made a part hereof,and attached hereto as"Attachment 1",and the Budget
for this renewal term is incorporated herein by this reference,made a part hereof,and attached hereto as
"Attachment 2. 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 reaffirmed. This Task Order Option to Renew Letter is effective
upon approval by the State Controller,designee,or on October 1,2003,whichever is later.
Please sign,date,and return all FOUR(4)originals of this Task Order Option to Renew Letter by September 8,2003,
to the attention of: Peary 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 Option to
Renew Letter will be returned to you when fully approved.
BOARD OF COUNTY COMMISSIONERS STATE OF COLORADO
OF WELD COUNTY Bill Owens,Governor
(a pat' subdivision of the state of Colorado)
By: ..._ ; By:
Name: David E. Lon Char 08/06/2003 For the Ex= uti Director
4oard of W issioners DEPAR NT t F PUBLIC HEALTH
♦ • •p '1J0813 AND ENVIRi ' uENT
ATT 1, d'a RAM PROVAL:
tu. 4L
' 1861 ✓^
By:
®(WA, L CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
2 requires that the State Controller approve all state contracts. This contract is not valid until
the State Controller,or such assistant as he may delegate,has signed it. The contractor is not authorized to
begin performance until the contract is signed and dated below. If performance begins prior to the date
below,the State of Colorado may not be obligated to pay for the goods and/or services provided.
STATE CONTROLLER:
Arthur L.Barnhart
WELD COUNTY DEPARTMENT OF
3
PUBLIC^ ^HE^ALTH AN ENVVIIRONMEEN
By: -��..s '/ _ROQt
Date: - � ,8 -0 BY: v V�
Revised:08/30/02 Mark E. Wallace, MD, MPH-Director
c')s- d9DcF
Attachment 1
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP)
STATEMENT OF WORK
I. 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 A","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 B",which is incorporated herein by this reference and made a
part hereof, and the suggested activities that appear within the HERMAN document,which was provided to
the Contractor in March 2003,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 A", "Core Public Health Services Delivered by MCH Agencies".
3. The Contractor 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 2003-2004(October 1,2003 through
September 30,2004),Weld County Department of Public Health and Environment HCP Plan which is
attached hereto as"Attachment C", incorporated herein by this reference,made a part hereof. The plan is
designed to: contribute to the accomplishment of the National MCH CSHCN 6 Core Outcomes and
Performance Measures,as identified in"Attachment D",which is incorporated herein by this reference
and made a part hereof
4. Contractor shall perform in accordance with the HCP Performance Measures,attached hereto as
"Attachment E", incorporated herein by this reference,made a part hereof.
5. Contractor shall ensure that all IRIS users attend IRIS and security training and meet the"HCP Regional
Office Standards for Usage of IRIS II",and any subsequent amendments thereof,attached hereto as
"Attachment F",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 G", incorporated herein by this reference,made a part hereof
7. On or before May 3,2004 the Contractor shall submit to the State HCP Program Consultant,portions of the
HERMAN Document,which shall be provided to the Contractor by the State on or before October 1,2003,
as outlined in"HERMAN Document Instructions for HCP Regional Office MCH Plan for FY05",attached
hereto, incorporated herein by this reference,made a part hereof as"Attachment H".
8. On or before May 3,2004,the Contractor shall submit to the State, for review and approval, a Budget
Estimate Form for the plan using"Attachment I,Section II",attached hereto,incorporated herein by this
reference,made a part hereof.
Page 1 of 3
9. On or before December 1,2004,the Contractor shall submit to the State a"Final Expenditure Report"in
the format attached hereto as"Attachment J",incorporated herein by this reference,made a part hereof,
which has been signed by the agency's 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 1,2003 through September 30,2004. The final payment for this renewal
term is contingent upon the State's timely receipt of the signed Final Expenditure Report,which shall be
sent to:
Peggy Becker
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
10. On or before December 1,2004,the Contractor shall submit to the State a signed "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 Duties and Obligations Certification Form,which shall be sent to the attention of Peggy
Becker to the address provided in paragraph 9 above.
11. On or before January 17,2005,the Contractor shall submit,to the State Program Consultant Part I-A of the
HERMAN Document,which shall be provided to the Contractor by the State on or before October 1,2003.
12. On or before January 17, 2005, for October 1, 2003 through September 30,2004,the Contractor shall
submit a"Final MCH Report for FY04"to the State,as outlined in"Attachment L,attached hereto,
incorporated herein by this reference,made a part hereof
13. 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 MCP Clinics, "Attachment M
and any subsequent amendments thereto,attached hereto,incorporated herein by this reference,made a part
hereof
14. The Contractor shall serve the population of children and their families who fall within the MCH definition
of children with special health care needs(CSHCN)as defined in Attachment E, section A. Recipients
served will be children residing or whose families have residence in Weld County.
15. The Weld HCP Regional Office staff shall work cooperatively with the public health nurses(PHNs)from
Weld County.
16. The HCP Discipline Regional Coordinators funded through this contract shall serve the CSHCN who reside
or whose families have residence in the counties as defined below:
A. The Audiology Regional Coordinator shall serve Weld County.
B. The Nutrition Regional Coordinator shall serve Weld County.
Page 2 of 3
C. The OT/PT Regional Coordinator shall serve Weld County.
D. The Speech Regional Coordinator shall serve Weld County.
E. The Parent Consultant shall serve Weld County.
F. The Vision Regional Coordinator shall serve Weld County.
17. Contract shall submit reimbursement statements either through the Electronic Payment System or,upon the
Contractor's submission of an invoice,a sample of which is incorporated herein by this reference, made a
part hereof,and attached hereto as"Attachment N",requesting reimbursement for those services provided
in the previous month,which shall be sent to the attention of Peggy Becker,to the address provided in
paragraph 9 above.
Reimbursement under this renewal shall be made to the Contractor on a monthly or quarterly basis.
Accordingly,the Contractor shall be paid one twelfth(1/12)of the State's financial obligation under this
renewal each month for the first eleven(11)months or one fourth(1/4)for the first three(3)quarters.
The final payment for the twelfth(12th)month or fourth(4'h)quarter for this renewal period is contingent
upon the State's timely receipt from the Contractor of the"Final Expenditure Report" in the form attached
hereto as "Attachment J"and the signed submission of the"Duties and Obligations Certification Form",
attached hereto as "Attachment K".
The State shall reimburse the Contractor for actual indirect costs up to the Prevention and Intervention
Services for Children and Youth Division's maximum of twenty-five percent(25%)when the Contractor's
indirect rate is based on Direct Costs,twenty-seven percent(27%)when the Contractor's indirect rate is
based on Salary Only,or thirty percent(30%)when the Contractor's indirect rate is based on Salary and
Fringe where no other direct costs are charged.
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Page 3 of 3
Attachment A
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 Infomlation 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.
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Attachment B
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 1,2003
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
1.1 Seek out funding resources and work with specialty providers to establish alternative funding
sources for families.
1.2 Work with health providers so that they appropriately refer families to state and local resources
that can fund or discount specialty medical care services.
1.3 Offer access to SELECT specialty care through HCP Specialty Clinic program. However no direct
payment for services is available through HCP.
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,e.g.,WIC,CHP+,Baby Care/Kids Care,Medicaid, SSI,Part C,
Voc Rehab,Mental Health,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,IFSP(Individual Family Service Plan), or
IEP(Individual Educational Plan)with the family and medical home 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
Page 1 of 5
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, IFSP,or IEP should include all the disciplines involved with the child's care, i.e.,
medical home,audiologist,CHIP therapist,social worker,family advocate,OT/PT,dietitian,
speech therapist,etc.
2.6. Follow-up with family according to plans written on care plan,IFSP,or IEP. Should HCP staff
have no direct role in the IFSP or IEP, 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 application 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 support fees.
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 shall attend,when available,and participate in the HCP Specialty 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 and State
Nursing Consultant.
Page 2 of 5
2.18. Identify existing primary health care and specialty 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,EPSDT,and Immunization,
by using local media,posters and attendance at health fairs,etc.
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 knowledgeable in Early Childhood Connections(Part C of IDEA),IFSPs,
Service Coordination, Procedural Safeguards and eligibility criteria.
3.4. Assure that HCP staff is knowledgeable 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 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
could potentially benefit from HCP services 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.
Page 3 of 5
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.
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.
Page 4 of 5
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.
Revised June 17,2003
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Attachment C
Weld County Department of Public Health and Environment
HCP Plan
October 1, 2003 — September 30, 2004
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
HCP End-of-year Report and MCH-Plan
(HERMAN Document)
•
Objective 1: Families of CSHCN will partner in decision-making at all levels and will be satisfied with the
services they receive.
Objective 1.I. Surveillance of Need: Contract Performance, Local Statistics, and Current Regional Activities
Objective 1.
I-A. Contract Performance Measures (Due January 15,2004)
Contract Language Measurement Local Report
(4.7.) Assure family members Regional Office Team Leader will provide at Objective I:
participate as advisors in program and least one example of family participation in
policy-making activities on a regular program and policy activities.
basis
Note:The family members referred to in
measures(4.7.4,7.6)may be someone
other than the HCP Parent Consultant.
A variety of parents can be used for the
different activities mentioned.
(4.7.1.) Family members participate Team Leader will provide: Objective l:
on advisory committees and/or task I. Description of how Family Consultant team
forces and are offered training, member is mentored for role on team and
mentoring and reimbursement,when identify who has provided mentoring and
appropriate. training.
2. Documentation of reimbursements made to
family members for training opportunities.
(4.7.2.) Financial support(financial Team Leaders shall provide: Objective 1:grants,technical assistance,travel and • Documentation of the financial support
child care)is offered for parent activities provided to the Regional Family Consultant
or parent groups, in particular the to attend the Annual Family Consultant
Annual Family Consultant Team Team Meeting.
Meeting. • Documentation of travel and child care
support provided to parents or parent
groups.
Page 1 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
(4.7.3.) HCP Family Consultants Team Leader will provide: Objective I:
and/or other family members are • Documentation of how families,in
involved in in-service training of HCP particular the HCP Regional Family
staff, local health care providers and Consultant,are utilized for their expertise in
families. providing training in areas such as:
• Family centered care
• Medical Home
• Community resources
• Family-professional partnerships.
Family Consultant or in their absence Team
Leader will provide:
• Documentation of trainings conducted by
the consultant and/or other family members,
which list topic,attendance and evaluation.
(4.7.4.) Family members are hired Use same measurement as listed for Performance Objective I:
staff or consultants to the HCP regional measure 4.2. Team Leader will include relation
office for their expertise as a family to the CSHCN for the person who is filling the
member of a child with special health position of Regional Family Consultant.
care needs.
(4.7.5.) Family members of diverse Team Leaders will submit information on how Objective I:
cultures,which represent the diversity of family members self-identify their ethnic and
the community,are involved in all of the racial background.
above activities.
Team Leader will provide documentation of
financial support provided families from ethnic
and diverse backgrounds for training activities.
(4.7.6.) Family members are involved Team leaders will provide a description of how Objective 1:
in the Children with Special Health Care family members contributed to the CSHCN
Needs elements of the MCH Plan. elements of MCH Plan by methods such as:
I. Public hearings to assist in the development
of the MCH Plan
2. Focus groups for families
3. Family members invited to participate in the
development of the MCH Plan.
4. Family member surveyed to gather
information for needs assessments
Page 2 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 1.
I-B. Relevant Data/Statistics(Due May 1,2003)
Guidance Local Report
• Iris Report#62. Community encounters by staff(family Data is not available for IRIS Report#62.
consultant). For all IRIS reports,you may request assistance A limited survey was conducted for clients attending transitional neurology clinics as part of an HCP pilot
through the IRIS HOT LINE# 1-800-886-7689 x2383. project. Families that responded were very pleased with the services they received.
• Describe any local family surveys that may have been conducted Team Leader has no knowledge of any other family satisfaction surveys conducted in this county during FY
in your county. 2003.
Objective 1.
I-C. Other Regional Activities and Resources (Due Ma 1,2003)
Guidance/Recommendations to Include: Local Report
• Examples of family's participation in your HCP program that Eaton Support Group for families with CSHCN formed approximately two years ago. Sixty families actively
may not have been covered above. involved at present time.
• Family advocacy or support groups that are available for families
with CSHCN in your county.
Objective 1.
I-D. Progress on Activities Selected in MCH 2003 Plan (Activities for 2003 Plan that fit under this objective) (Due May 1, 2003)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome measures Write in progress toward outcome measures for MCH 2003 Plan—Due May I,2003
2003 Plan from MCH 2003 Plan
Not applicable.
Objective 1.
I-E. Final Report on MCH 2003 Plan-effective Oct 2002 through Sept 30,2003 (Due January 15,2004).
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome measures Write in final report of outcome measures for MCH 2003 Plan—Due January 15,2004
2003 Plan from MCI-I 2003 Plan
Page 3 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 1.
II. Self-Assessment and Prioritization (Due May 1, 2003)
Guidance Local Report
Briefly summarize what the information reported in your local The employment of Rhonda Stute as Family Consultant for the Weld Regional Team was a major step in
surveillance of need(Part I)means to your community regarding fulfilling this objective. She has become actively involved in team meetings and has provided parental
progress toward achieving this objective. Base your analysis on: input as the HCP program has recently undergone major changes. The initiation of a quarterly parent
• Degree to which Contract Performance Measures,related to this newsletter(I"edition mailed in February)and additional support groups for parents of CSHCN,
objective,were achieved. including one for those speaking Spanish only, is expected to increase parental involvement in the HCP
• Effectiveness of current levels of in-service training and outreach program.
Rhonda has attended one conference in the past 6 months. As a result,an in-service on cultural
activities by Family Regional Consultant.
• Adequacy of financial and mentoring support for Family Regional competency is planned for the Regional Team. Staff education is an expected function of the Family
Consultant to promote family involvement in the community. Consultant.
• resources or barriers related to promoting family involvement Financial support is lacking due to budget cuts at the state and local level. It was hoped the initial
New all levels.ou position of 4 hours/week would be increased to 8 hourshweek,but this has not been possible. Because
at Rhonda also works for Larimer County, it is anticipated that the two counties will share costs for
registration,travel, lodging and meals related to conferences. Rhonda has been able to find scholarship
funding to attend all trainings so far.
Rhonda is the most exciting new resource for this county. She has an abundance of knowledge,personal
experience as an advocate for CSHCN, is bilingual and has an innate ability to dig right in and tackle the
projects waiting to be done.
Insufficient funding and the resulting constraint on work time is a major barrier to the utilization of the
Family Consultant to her maximum potential. A minimum 0.5 FTE is required to adequately meet the
needs of Weld County's CSHCN and their families.
Objective 1.
III. Children with Special Health Care Needs/MCH 2004 Plan (effective Oct 1, 2003- Sept 30, 2004) (Due May 1, 2003)
Activity Evaluation—Outcome Measures
Current agency activities are fulfilling contract performance measures. In addition,self-assessment and prioritization suggest that other activities to achieve Objective I are
warranted. We will adopt the following suggested activities:
During FY 2004,the Weld County HCP Regional Office will 1. The HCP newsletter will be sent to all HCP families once each quarter during FY 2004. The
Xassist and support the HCP Parent Consultant in the creation of an newsletter will be issued in both English and Spanish.
active family support network in Weld County. 2. A monthly support group for Spanish-speaking families will be established by January I,2004.
3. Because the current support group in Eaton is at capacity,a 2nd monthly support group for English-
speaking families will be established by May 1,2004.
Page 4 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN,Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 2: All children with special health care needs will receive regular, ongoing comprehensive care
within a medical home.
Objective 2.I. Surveillance of Need: Contract Performance, Local Statistics, and Current Regional Activities
Objective 2.
I-A. Contract Performance Measures—None related to this goal
Objective 2.
I-B. Relevant Data/Statistics (Due May 1,2003)
Guidance on Statistics to Include: Local Report
• IRIS Report# ,number of children in the HCP program who Objective 2:
receive care coordination for any concern. IRIS reports on number of children with care coordination and/or primary care as a concern are not
• IRIS report#24. Number and percent of children on HCP available. (Technically,Care Coordination is a benefit type—not a part of the concern list. Children
caseload who have a consistent PCP(one measurement criteria enrolled for Full Service,Medicaid or Wraparound benefits will not be identified as receiving care
for a medical home). coordination in IRIS even though they often receive the highest level of care coordination services
• IRIS report#30. Number and percent of children on HCP provided by HCP.)
Site visit survey indicates 92.3%of charts audited had PCP information entered.
caseload who have primary care as a concern.
236 children(69.4%)of the HCP caseload between 10-1-02 and 4-22-03 have a consistent PCP. This is
• Evidence of the availability of primary care to children in your an increase from 58%in FY 2002.
county(ies),such as average waiting times to be seen for well- Wait time for appointments for well child/preventive care varies. A phone survey of clinics providing care
child/preventive care in private practices and FQHC community to low-income families indicated wait time to be from 1-2 weeks to 1-2 months. Clinic with 1-2 month
health clinics and whether your area is designated as a high need wait time is changing scheduling format to"same-day format", meaning clients will be seen on day they
area for primary care. call for appointment. This is due to high rate of failed appointments with current system. Private
• Site Visit Survey results regarding consistent entry of PCP pediatricians indicate wait time is 1 week or less,with 6 weeks indicated for only one particular
information. pediatrician.
Only the very southern most portion of Weld County, near Brighton,has been designated as a Health
Professional Shortage Area for Primary Medical Care according to information retrieved from the CDPHE
Rural and Primary Care Office.
Page 5 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May I, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number:(970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 2.
I-C. Other Regional Activities and Resources (Due May 1,2003)
Guidance on Information to Include: Local Report
• Community collaborations or initiatives related to the Medical Objective 2:
Home,such as collaboration with Part C regarding Physician HCP Regional Team Leader sits on Early Childhood Connections Advisory Board. Preliminary
Outreach discussions have been held around the need for Part C and HCP to collaborate on presentation of program
• Outreach activities geared toward key stakeholders,including information to local primary care providers. It is anticipated that the Medical Home Concept will be part
families and primary care providers,about the medical home of these presentations.
concept and providing primary care to CSHCN HCP Regional Team Leader has been a member of the Public Health Workgroup supporting the Colorado
• The agency or coalition that is taking the lead on medical home Medical Home Initiative. Weld County is awaiting outputs from Medical Home Initiative prior to
efforts in your county and the role of your agency. beginning a local community campaign to promote the concept of medical home. The HCP Regional
• How HCP care coordination services promote the medical home Office Team anticipates taking a lead role in the community campaign.
Currently,the concept of medical home is not well understood in our community. No primary care
concept practices in the county fit the CO Medical Home Initiative's definition of a medical home. Through IRIS,
HCP care coordinators currently track families who have identified a primary care provider. Families
without an identified primary care provider are encouraged to find a physician or clinic to fulfill this need
and are given a list of potential providers from which to choose. All families registered in HCP are
assigned a care coordinator and receive some level of care coordination throughout the benefit year.
These care coordination services will serve as an example and/or resource to local providers as they begin
to embrace the concept of medical home.
Objective 2.
I-D. Progress on Activities Selected in MCH 2003 Plan (Activities in 2003 Plan that fit under this objective) (Due May 1,2003)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome measures Write in progress toward outcome measures for MCH 2003 Plan—Due May I,
2003 Plan from MCH 2003 Plan' 2003
100%of eligible children enrolled in the Care coordination will be documented by IRIS IRIS data not available. All children enrolled in HCP receive care coordination
Weld County Health Care Program for (Version)2 encounters related to specific (ranging from limited to extensive based on acuity level.)
Children with Special Needs will concerns on 100%of the children enrolled for
receive care coordination during FY HCP services in Weld County.
2003.
Page 6 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 2.
I-E. Final Report on MCH 2003 Plan- effective Oct 2002 through Sept 30,2003 (Due January 15,2004)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome measures Write in final report of outcome measures for MCH 2003 Plan—Due January 15,
2003 Plan from MCH 2003 Plan 2004
Objective 2.
II. Self-Assessment and Prioritization (Due May 1, 2003)
Guidance Local Report
Briefly summarize what the information reported in your local Weld County appears to have enough primary care providers, including pediatricians and family
surveillance of need(Pail I)means to your community regarding practitioners. to meet the needs of CSHCN. Nine county primary care providers currently accept clients
progress toward achieving this objective. Base your analysis on: covered by Medicaid,although only four of these providers will accept CO Access(Medicaid HMO).
• The availability of primary care in your region Wait times for well child/preventive services average about a week. One FQHC is about to change its
• The current level of activities to increase awareness of the scheduling practices in an effort to decrease the wait time as well as reduce the rate of failed appointments.
The Medical Home concept has not been widely publicized to date. No official efforts are under way at
medical home for children with special needs,among key
stakeholders including families and providers this time.
Children do not have access to care from a medical home in our county at this time as no practices fit the
• New resources or barriers to assuring the children have access to
criteria for this designation.
primary care within a medical home.
The North Colorado Health Alliance is being formed between Sunrise Community Health Center(the
FQHC which includes Monfort Children's Clinic),North Colorado Family Medicine,North Colorado
Medical Center and the Weld County Department of Public Health and Environment. This formal alliance
will link the five agencies that provide the majority of care for the low-income/indigent population in the
Greeley area. Clients' medical information will be accessible to all agencies typically asked to provide
care. This will contribute to more consistent medical care and perhaps to the development of a practice
that fits the definition of a medical home.
•
Page 7 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: lmccarty@co.weld.co.us
Objective 2.
III. Children with Special Health Care Needs/MCH 2004 Plan (effective Oct 1, 2003- Sept 30, 2004) (Due May 1, 2003)
Activity Evaluation—Outcome Measures
The HCP Regional Office Team will increase their own 1. By December 31,2003,HCP Team Leader will train Regional Team, including regional discipline
awareness of the medical home concept and prepare to coordinators,in the concept of the medical home.
Xdisseminate information related to Colorado's Medical Home 2. By June I,2004,HCP Regional team members will adapt CO Medical Home Initiative information
Initiative to local stakeholders. for this county and create a power point or formal presentation to educate key stakeholders in the
community.
3. By September 30,2004, HCP Regional Team will develop an evaluation tool to measure stakeholder
knowledge after participation in the formal presentation developed above.
•
Page 8 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 3: All families of children with special health care needs (CSHCN) will have adequate private
and/or public insurance to pay for the services they need
Objective 3.I. Surveillance of Need: Contract Performance, Local Statistics, and Current Regional Activities
Objective 3.
I-A. Contract Performance Measures (due January 15,2004)
Contract Language Measurement Local Report
(1.1.) Implement the program for Annual Site Visit Survey conducted by State Objective 3:
HCP Direct Service Benefits for eligible office
children according to the time lines,
policies and procedures described in the Monitoring of IRIS Data System by State Office
HCP Policy&Procedure and IRIS Help
File. Site Visit Tool should be used as an ongoing
guidance by regional office to monitor this
performance measure. •••
(2.1.) Assist in public awareness and Provide necessary information in sections below. Objective 3:
enrollment activities for programs such
as Medicaid,CHP+,and SSI.
Objective 3.
I-B. Relevant Data/Statistics(Due May 1,2003)
Guidance Local Report
• CHP+enrollment figures for your county. Obtain from state Objective 3:
CHP+report distributed to your regional office via the HCP CHP+enrollment for Weld County as of February 2003 was 98%with 3,019 out of an estimated 3,093
Statistical Analyst. eligible children enrolled in the program.
• Medicaid enrollment figures for your county. Obtain enrollment
estimates from Colorado Kids Count. As of April I2,2003,8784 clients are enrolled in Medicaid.
• IRIS report#26. Number of children in HCP caseload also 68 children enrolled in HCP are also enrolled in SSI. (20%of the caseload).
enrolled in SSI for your county.
• Number of families assisted by Regional Office in applying for
Medicaid,CHP+,and SSI. IRIS report# number and
percent of caseload with insurance concerns and IRIS report#
referral report indicating the number of clients referred to
Medicaid,CHP+and SSI.
Page 9 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 3.
I-C. Other Regional Activities and Resources (Due May 1,2003)
Guidance/Recommendations to Include: Local Report
• Your community's efforts related to assuring that CSHCN have Objective 3:
adequate health insurance,including the lead agency or coalition Over the past several years,WCDPHE has worked to establish SED sites throughout the county. One of
(Your agency may or may not be involved in these efforts), the most successful sites is located at WCDPHE and will remain there despite recent restructuring of the
• Role and level of involvement of your agency in the region's Medicaid/EPSDT program. A strong collaboration between EPSDT and the programs at the health
activities. department has developed. Families can easily be referred to Medicaid/CHP+and assistance with
applications is readily available. EPSDT is able to track applications through the COIN system and
notifies appropriate programs once eligibility is determined.
Objective 3.
I-D. Progress on Activities Selected in MCH 2003 Plan (Activities in 2003 Plan that fit under this objective) (Due May 1, 2003)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome measures Write in progress toward outcome measures for MCH 2003 Plan—Due May I.
2003 Plan from MCH 2003 Plan' 2003
Not applicable.
Objective 3.
I-E. Final Report on MCH 2003 Plan-effective Oct 2002 through Sept 30,2003. (Due January 15,2004)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome measures Write in final report of outcome measures for MCH 2003 Plan—Due January I5.
2003 Plan from MCH 2003 Plan 2004
Page 10 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May I, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 3.
II. Self-Assessment and Prioritization (Due May 1, 2003)
Guidance Local Report
Briefly summarize what the information reported in your local Objective 3:
surveillance of need(Part I)means to your community regarding 98%of the children expected to be eligible for CHP+in Weld County have been enrolled into the
progress toward achieving this objective. Base your analysis on: program. This is up from a 74%enrollment in February 2002. The Colorado state average enrollment is
• Degree to which Contract Performance Measures related to this 70%.
objective were achieved Trends in RO HCP caseload enrollment with SSI not identifiable as consistent entry of accurate data in
• Flow your county(ies)projected CHP+enrollment compared to IRIS began within last six months.
No new resources impacting the number of CSHCN with adequate insurance have been identified.actual enrollment numbers and to the state average.
• How your county(ies) Medicaid enrollment compare to the state The impact of current economic conditions can be seen as a barrier for adequate insurance coverage for
average. CSHCN. As unemployment increases,children are losing private insurance benefits. Medicaid has been
Trends in your RO HCP caseload enrollment with SSI coverage. inundated with new applications and with children who have fallen off of CHP+due to a decrease in
• family income deeming them ineligible(under the income requirements). Wait time for Medicaid
• Effectiveness of community efforts related to improving access to processing is currently between 6-8 months;CHP+processing is averaging about 3 weeks. State budget
insurance. reductions have forced some children to fall off of Medicaid and CHP+, i.e.children with legal immigrant
• New resources or barriers impacting the number of children with status no longer eligible for Medicaid coverage. In addition,the elimination of HCP direct service
special health care needs who have adequate insurance. benefits for children not eligible for public insurance programs will leave 76 children(24%of the current
caseload)without insurance coverage. The HCP team's collaboration with the local Realtors Association
has generated about$20,000 for medical expenses over the past year. This will not fill the gap in
insurance coverage CSHCN will be facing in the coming months.
Objective 3.
III. Children with Special Health Care Needs/ MCH 2004 Plan (effective Oct 1, 2003- Sept 30, 2004) (Due May 1, 2003)
Activity Evaluation—Outcome Measures
A Current agency activities are fulfilling contract performance Contract Performance Measures as reported in the HERMAN Document due January 15,2004
Xmeasures and are contributing to achieving Objective 3 in our
. community by 2010. Continue current activities as described.
Page 11 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May I, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 4: All children will be screened early and continuously for special health care needs
Objective 4.I. Surveillance of Need: Contract Performance, Local Statistics, and Current Regional Activities
Objective 3.
I-A. Contract Performance Measures (due January 15,2004)
Contract Language Measurement Local Report
(3.1.) Assure that Audiology Regional Audiology Regional Coordinators will Objective 4:
Coordinator works with birthing facilities in provide:
her region to implement or maintain an 1. Annual Report(reporting tool to be
Early Hearing Detection and Intervention provided by State Audiology Consultant)
program(Universal Newborn Hearing utilizing data from the Newborn
Screening)that will: Evaluation Screening and Tracking
(NEST)that indicate outcomes of
(3.1.1.) Screen 95%of all newborns newborn hearing screening for hospitals
before one month of age and preferably in their region,referral rate,and follow
prior to hospital discharge. up outcomes.
2. Summary of improvement plan(s)for
(3.1.2.) Have a Refer rate for further individual hospitals in their region that
evaluation of 4%or less of all newborns are not meeting the recommended
screened before discharge. guidelines for Universal Newborn
Hearing Screening.
(3.1.3) Provide documentation of follow-
up on all infants who failed or missed Site Visit Survey results for documentation of
screening: including referral to appropriate IRIS Community Encounters for site visits with
medical,audiology and early intervention hospitals.
services.
Page 12 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 4.
I-B. Relevant Data/Statistics (Due May 1,2003)
Guidance Local Report
• Number of infants identified as CSHCN in your county by CRCSN. Objective 4:
Obtain through HCP Statistical Analyst or through Co-Hid website In 2002, 161 children with special health care needs were identified by CRCSN
at http://www.cdphestate.co.us/cohid.
• Number of infants whose families live in your county that are During the past year,the Part C/NICU Liaison Project has had 28 Weld County babies referred to the
discharged from NICU's. Obtain through Part C/NICU Liaison project from various Denver metro hospitals. This figure does not reflect the complete number of babies
Project. Contact information at living in Weld County that have been discharged from a Denver metro NICU.
www.cde.state.co.us/earlvchildhoodconnections. Click on"Contact
us". Data related to the number of children receiving appropriate well child checks is not available to EPSDT.
• Number of children receiving age appropriate well child checks via
EPSDT in your county. Obtain through your local EPSDT Program.
Page 13 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 4.
I-C. Other Regional Activities and Resources (Due May 1,2003)
Guidance/Recommendations to Include: Local Report
• Participation of your agency or others in CDPHE's early vision Objective 4:
screening protocol and results of any screening efforts conducted No agency in Weld County participates in the early vision-screening program at this time.
in your county,e.g.numbers screened,referral rate,follow up The newborn hearing-screening program at North Colorado Medical Center(NCMC)continues to be very
outcomes. successful. In 2001,99.4%of the 2108 babies born at the hospital were screened. The referral rate was
• Local Child Find activities related to developmental screening 2.25%with 4 infants identified with a confirmed hearing loss.
The transfer of Child Find services from the local Part C agency,Family Connects,to the 7 individual
and your agency's role.
school districts throughout the county was successful. All referrals for Child Find evaluation are routed
• Local EPSDT activities related to assuring access to well-child through the Child Find coordinator at the school district in which the child resides. Additionally,a referral
check ups for children with Medicaid and your agencies role. is made to Family Connects,the local Part C agency, for tracking to ensure that follow-up occurs within
• How infants identified by CRCSN in your county are being the federally mandated time frame. There is no problem with accessibility to Child Find at this time. The
monitored for special health care needs and developmental main role of the Regional HCP office is referral.
delays. (Your agency may or may not be directly involved) The CRCSN report is sent to Family Connects. Follow-up occurs in the form of a letter sent to all families
• Training efforts that may have occurred in your county related to on the list. If the family responds to the letter,the child is evaluated for Part C services. Because of
the importance of screening,appropriate screening tools,and best staffing and funding constraints,further follow up is not possible at this time. NICU referrals from the
practices for vision,hearing,developmental, behavioral,mental Part C/NICU Liaison Project and from NCMC go directly to Family Connects. The Department of Social
health,oral health,or metabolic screening. Services also refers any drug-positive newborns to Family Connects for screening.
No D& E clinic has been in existence during the past two years. Efforts are currently underway to resume
• Within the HCP Sponsored Specialty Clinic(s)held in your
this clinic. Little information about this effort has been made available to the HCP team leader during the
county,any regular screenings and follow up practices that take planning process. A training session for two local pediatricians has been scheduled for Tuesday. May 6th
place beyond the specialty medical assessments that are and the clinic coordinator has indicated a start-up date of late May or early June.
conducted.
Objective 4.
I-D. Progress on Activities Selected in MCH 2003 Plan (Activities in 2003 Plan that fit under this objective) (Due May 1,2003)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome Write in progress toward outcome measures for MCH 2003 Plan—Due May 1,
2003 Plan measures from MCH 2003 Plan' 2003
Not applicable.
Page 14 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 4. •
I-E. Final Report on MCH 2003 Plan-effective Oct 2002 through Sept 30,2003. (Due January 15,2004)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome Write in final report of outcome measures for MCH 2003 Plan—Due January
2003 Plan measures from MCH 2003 Plan 15,2004
Objective 4.
II. Self-Assessment and Prioritization (Due May 1,2003)
Guidance Local Report
Briefly summarize what the information reported in your local Objective 4:
surveillance of need(Part I)means to your community regarding The current system of follow-up for children identified by CRCSN is less than ideal. Part C has
progress toward achieving this objective. Base your analysis on: traditionally not referred children with complex medical needs to HCP. A Memorandum of
• Degree to which Contract Performance Measures related to this Understanding between Family Connects and the Weld Regional Office is in draft form. This
objective were achieved document will delineate clearer guidelines for cooperative efforts between the two agencies. It is
• The effectiveness of ongoing follow up and monitoring of anticipated that HCP care coordinators will begin to case manage the more medically complex
children identified by CRCSN and NICU referrals. infants and toddlers and will become more active consultants for the Part C Service Coordinators.
• The effectiveness of EPSDT to assure access to well child checks Infants referred by the area NICUs receive comprehensive follow-up from Part C, but referrals to
and to assure that they include a developmental component. HCP are not usually made. The creation of the MOU is a first step in beginning to rectify this.
• Accessibility of Child Find screenings for all families in your 1.5 FTE EPSDT Outreach Workers manage the current caseload of 8784 Medicaid clients. While
county. they are able to make all the required phone contacts with clients and their families, little time is left
• The effectiveness of other screening and follow-up services over for the provider outreach necessary to assure that EPSDT well child checks include
including those that might be conducted at HCP Specialty Clinics developmental components.
All Child Find screenings are easily accessible to families.
in your county.
Objective 4.
III. Children with Special Health Care Needs/MCH 2004 Plan (effective Oct 1, 2003- Sept 30, 2004) (Due May 1,2003)
Activity Evaluation—Outcome Measures
A. Current agency activities are fulfilling contract performance Contract Performance Measures as reported in the HERMAN Document due January 15,2004
X measures and are contributing to achieving Objective 4 in our
community by 2010. Continue current activities as described.
Page 15 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 5: Community based service systems for CSHCN and their families will be organized for easy use.
Objective 5.I. Surveillance of Need: Contract Performance, Local Statistics, and Current Regional Activities
Objective 5.
I-A. Contract Performance Measures (Due January 15,2004)
Contract Language Measurement Local Report
(2.2.) Use the HCP The Regional Office Team Leader will Objective 5:
multidisciplinary team(speech, describe how the needs of the child and
audiologist,OT, PT, nutrition,social family are met through multidisciplinary
work, parent,and nurse)to address the care coordination.
child's medical and mental health care
needs and family resources and Provide two examples of this team process.
supports for services and/or care Use examples that involved at least three
coordination. The development of a different disciplines on the
Care Coordination Plan should be part multidisciplinary team.
of the multidisciplinary process for
families enrolled for HCP direct service Site Visit Survey results for documentation of
benefits. written Care Plans for families enrolled for
HCP direct service benefits.
Page 16 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003 •
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
(2.3.) Collaborate with Part C to Note: Multicounty Regional Offices should Objective 5:
assist in the development of a system of describe all Early Childhood Connection
early intervention services for children agencies that serve their region.
birth through age two.
Regional Office Team Leader will:
(2.3.1.) Identify children enrolled 1. Describe interagency coalitions or
both in HCP and Part C. Work with the agreements in your county(ies)that
family and the Part C service include both HCP and Part C.
coordinator to identify and determine 2. Provide the number of children dually
the role of HCP in developing and enrolled in HCP and Part C.
implementing the IFSP. 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 HCP'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 1FSP 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.
Page 17 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003 •
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
(2.4.) Create and maintain a plan for The Regional Office Team Leader will Objective 5:
providing translation/transcription/ describe a plan for providing translation/
interpretation services through the transcription/interpretation services to
Regional Office. families in the Region.
Objective 5.
I-B. Relevant Data/Statistics (Due May 1,2003)
Guidance Local Report
• IRIS Report#_,number of children in the MCP program Objective 5:
who receive care coordination for any concern. Data not available.
• IRIS report#_. Numbers of families referred to other
community agencies,the agencies to which they were referred,
and the number of referrals completed.
• IRIS report# . Frequency of occurrence of the top five
concerns for which care coordination was provided among
HCP Caseload.
• IRIS report#62. Total number and type of community
encounters.
Objective 5.
I-C. Other Regional Activities and Resources (Due May 1,2003)
Guidance/Recommendations to Include: Local Report
• Community interagency coalitions that are working to build a Objective 5.
better system of service for CSHCN The Early Childhood Advisory Council consists of representatives from Family Connects(Part C),
• Evidence of successful collaborations or gaps in collaboration HCP,Centennial Developmental Services(the local CCB),Head Start,Child Find Coordinators
among agencies in your communities from Weld County School District#6 and BOCES and the Department of Social Services.
• Formal or informal agreements and collaborations between Entry into the Part C system is smooth no matter which agency makes the referral.
your agency and local Part C agencies and school districts in Communication after enrollment into Part C is less frequent. The MOU mentioned under Objective
your county. 4 will hopefully improve this.
Similarly communication between other agencies,such as Part B and the Community-Centered
Board is also lacking. There are no formal or informal agreements between HCP and these
agencies. An excellent rapport has been established between HCP and several school nurses in the
Greeley school district and communication about individual students served by both agencies is
open and thorough.
Page 18 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May I, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
•
Objective 5.
I-D. Progress on Activities Selected in MCH 2003 Plan (Activities in 2003 Plan that fit under this objective) (Due May 1,2003)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome Write in progress toward outcome measures for MCH 2003 Plan—Due May I,
2003 Plan measures from MCH 2003 Plan' 2003
Not applicable.
Objective 5.
I-E. Final Report on MCH 2003 Plan- effective Oct 2002 through Sept 30,2003.(Due January 15,2004)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome Write in final report of outcome measures for MCH 2003 Plan—Due January
2003 Plan measures from MCH 2003 Plan 15,2004
Objective 5.
II. Self-Assessment and Prioritization (Due May 1,2003)
Guidance Local Report
Briefly summarize what the information reported in your local Objective 5:
surveillance of need(Part I)means to your community regarding All children enrolled in HCP received care coordination at a level based on their acuity. Currently it
progress toward achieving this objective. Base your analysis on: is not possible to document the acuity level accurately with IRIS reports. Similarly, IRIS data on
• Degree to which Contract Performance Measures related to referrals is not complete for Weld County,as HCP care coordinators have not consistently or
this objective were achieved appropriately used this screen.
• Trends in the number of children receiving care coordination Communication and collaboration with Part C is adequate but could be improved once a child is
services enrolled for Part C services. The pending interagency agreement is one effort being made towards
• Trends in the number of referrals to other agencies and improving collaboration.
number of referrals completed. Communication and collaboration with other agencies for children 3 years and older is less
• Trends in the number and nature of community encounters in satisfactory. No formal community coalition exists for agencies serving children eligible for Part B
your county and the effectiveness of community encounters services.
on improving communication and collaboration with other
agencies in your region.
• The effectiveness of communication and collaboration among
agencies that make up the service system for CSHCN in your
communities
•
Page 19 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May I, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 5.
III. Children with Special Health Care Needs/MCH 2004 Plan (effective Oct 1, 2003- Sept 30, 2004) (Due May 1,2003)
Activity Evaluation—Outcome Measures
C. Current agency activities are fulfilling contract performance measures. In addition,self-assessment and prioritization suggest that other activities to achieve
X Objective 5 are warranted. We will adopt the following suggested activities.
During FY 2004,the Weld County Regional HCP Office will 1. By July 1,2003,formalize draft Memorandum of Understanding between HCP and Part C.
improve collaboration between Part C(Family Connects)and 2. By end of FY 2004,HCP collaboration with Part C will improve as evidenced by:
HCP. • CRCSN report will be shared with HCP Regional Office on a monthly basis.
• At least one HCP Care Coordinator will become trained as a Part C service
coordinator.
• An HCP Care Coordinator will be the lead service coordinator for all infants and
toddlers with complex medical conditions eligible for Part C services.
• HCP Care Coordinators will be advised of IFSP meetings for all children dually
enrolled in HCP and Part C. HCP Care Coordinators will document their
participation in this process appropriately in IRIS.
3. HCP Care Coordinators will receive training on the IRIS referral screen by 10/01/2003. All
community referrals will be entered into IRIS on a consistent basis during FY 2004.
Page 20 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 6: All youth with special health care needs will receive services to transition to adult life
Objective 6.I. Surveillance of Need: Contract Performance, Local Statistics, and Current Regional Activities
Objective 6.
I-A. Contract Performance Measures—None related to this goal
Objective 6.
I-B. Relevant Data/Statistics (Due May 1,2003)
Guidance on Statistics to Include: Local Report
• Population in your county age 14-20 and estimate of CSHCN Objective 6:
in this age range. Obtain from Co-hid at Data from the CO Health Information Database indicates the population age 14-20 in Weld County
httn://www.cdnhe.state.co.us/cohid/ in 2001 was 24,274. Based on the estimate that CSHCN comprise approximately 18%of the
• IRIS report#_3_. HCP caseload age 14 years and older. population,4,369 children in this age group would be expected to have special health care needs.
• IRIS report# . Number and percent of caseload with
insurance concerns. For FY 2003 to date, 131 children out of the caseload of 342(38%)are between the ages of 14 and
• Site Visit Survey results on item for having transition plan in 21.
place
The site visit tool indicated no transition plans were in place for adolescent transition to adult
services in the 4 charts audited.
9 children were seen at a total of 11 provider visits during two transitional neurology clinics piloted
in Weld County during 2002.
Newacheck, P."Epidemiologic Profile of Children with Special Health Care Needs," Pediatrics, Volume 102,Number I,July, 1998,pp. 117-123.
Page 21 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May I, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 6.
I-C. Other Regional Activities and Resources (Due May 1,2003)
Guidance on Information to Include: Local Report
• HCP team's role and activities in the community related to Objective 6:
transition of adolescents to adult life. Trish McClain, RN,Neurology Clinic Coordinator,developed a transitional neurology clinic pilot
• The role and capacity of the School District(s),CCB's, project,approved by state to occur during 2002. The intent of the project was to help families
Vocational Rehab,and Family Advocacy services to assure transition adolescents to the care of an adult neurologist. Dr.Judith Vaughan,a board-certified
appropriate transition for adolescents in your county. neurologist,staffed one half-day neurology clinic with Dr.Reiley and then held a second half-day
• Any Healthy and Ready To Work(HRTW)activities/projects clinic on her own. Dr. Vaughan saw nine children during these two clinics. Families were able to
in your county. meet and establish a relationship with Dr. Vaughan in a familiar environment. The family
satisfaction survey completed by 3 families indicated a positive experience by all. These adolescent
clients are now comfortable seeing Dr.Vaughan in her private practice.
The exact role and capacity of other community agencies in assuring appropriate transition for
adolescents to adult services is not known at this time.
The Weld County Regional Office does not know of any Healthy and Ready to Work projects
occurring in this county.
Objective 6.
I-D. Progress on Activities Selected in MCH 2003 Plan (Activities in 2003 Plan that fit under this objective) (Due May 1,2003)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome Write in progress toward outcome measures for MCH 2003 Plan—Due May 1,
2003 Plan measures from MCH 2003 Plan' 2003
Not applicable.
Objective 6.
I-E. Final Report on MCH 2003 Plan- effective Oct 2002 through Sept 30,2003.(Due January 15,2004)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome Write in final report of outcome measures for MCH 2003 Plan—Due January
2003 Plan measures from MCH 2003 Plan 15,2004
Page 22 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 6.
II. Self-Assessment and Prioritization (Due May 1,2003)
Guidance Local Report
Briefly summarize what the information reported in your local The local HCP team recognizes the importance of the process of transition for adolescents
surveillance of need(Part I)means to your community regarding approaching adulthood. The neurology transition clinic was the major project of the team during
progress toward achieving this objective. Base your analysis on: 2002. Mende Warne,Model 200 waiver coordinator for Weld County,presented an in-service to the
• Trends in the population of your region and your HCP HCP care coordinators,office technicians and social worker,on the Medicaid waiver program, SS1
caseload for children age 14-20. and the reevaluation process at age 18.
• Your Regional Office's progress for having transition care The region's capacity to provide transition services is unknown.
plans in place for 14-20 year old clients in your HCP
caseload.
• Your assessment of your region's capacity to provide
transition services.
• New resources or barriers to assuring transition services for
adolescents with special health care needs in your region.
Objective 6.
III. Children with Special Health Care Needs/ MCH 2004 Plan (effective Oct 1, 2003- Sept 30, 2004) (Due May 1,2003)
Activity Evaluation—Outcome Measures
I. Identify and explore already existing training programs to 1. By May I,2004 contact school districts, Weld County Rehabilitation Services and other area
improve care coordination skills related to transition issues agencies that provide transitional services for youth to determine type of services provided,
Xfor family members,case managers,care coordinators, contact and eligibility information,etc.
service coordinators,HCP team members,and/or providers 2. By August I,2004 create an information sheet listing pertinent information for all county
in your region. transition resources for HCP Care Coordinators and any other interested stakeholders.
2. Improve consistency of including appropriate transitional I. Development and implementation of a"tickler"system that reminds care coordinators of the
Xgoals in care plans for children and youth receiving care need to address transition goals for youth receiving care coordination services through HCP.
coordination services through HCP. 2. Evidence of the presence of transitional goals in care plans of children age 14 and older 75%of
the time or greater,based on chart audit or site visit survey
Page 23 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 7: The regional model of operation for HCP will provide high quality, efficient services to families,
providers, and state and local partners
Objective 7.I. Surveillance of Need: Contract Performance, Local Statistics, and Current Regional Activities
Objective 7.
I-A. Contract Performance Measures (Due January 15,2004)
Contract Language Measurement Local Report
(4.1.) Complete and submit the The Regional Office Team Leader will submit Objective 7:
HCP Contract Performance Report by the Contract Performance Report to their State
January 15,2004. Program Consultant by January 15,2004.
(4.2.) Each regional office team The Regional Office Team Leader will Objective 7:
will consist of staff,either as FTE, provide:
contracted,or shared with another 1. Names of team members,their discipline,
regional office,which includes the dates of hire,number of hours per month
following core disciplines: nursing, if contract or percent of time if FTE,and
nutrition,audiology,early intervention other community agencies they work for,
specialist for hearing loss,speech, if applicable.
occupational therapy or physical 2. A list of any additional specialist(s)
therapy,social work,parent or family involved with the team on a periodic
advocate. To the extent possible, it is basis.
desirable to hire or contract with 3. A summary of community coordination
professionals who are also working,or activities for each discipline member of
have worked,in other care systems or team. •
community programs,(e.g.,mental 4. A description of the involvement of the
health,school district,community multidisciplinary team in the needs
health center,community center assessment planning process,the .
board,Part C). In addition,specialists writing of the Contract Performance
in community assessment,planning Report,and MCH Plan.
and evaluation,and epidemiology are
highly encouraged 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).
Page 24 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
(4.3.) Using the scope of work for The Regional Office Team Leader or Objective 7:
each discipline,the Regional Office Regional Discipline Coordinator/
Team Leader and State Consultant Consultant will report on the discipline
will develop appropriate priorities for team member's priorities and give
that discipline and the Regional examples of how those priorities were
Discipline Coordinator/Consultant for accomplished.
the contract year.
(4.4.) When Regional Discipline The Regional Office Team Leader will Objective 7:
Coordinators/Consultants are shared document the process used for developing
with other HCP regional offices,the priorities by providing meeting minutes or
appropriate personnel(Regional making them available by request.
Office Team Leaders,regional
coordinators/consultants)will meet *** An annual meeting to develop priorities
annually to discuss the roles and within the scope of work should be held
priorities for the position. The State prior to the contract renewal date of the
Consultants would be invited to attend Regional Discipline Coordinator/
on request. Consultant.
(4.5.) The Regional Office Team Meeting minutes and attendance as Objective 7:
Leader will attend two meetings per documented by State Office staff.
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.
Page 25 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May 1, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
(4.6.) Ensure all IRIS users attend State HCP Office will document attendance at Objective 7:
IRIS Training and meet the IRIS and Eligibility training sessions.
"Standards for Usage of IRIS II".
Ensure all HCP Technicians,Regional IRIS security forms will be complete and on
Nursing Coordinators,and Team file at State Office.
Leaders attend HCP IRIS and
Eligibility training.
Objective 7.
I-B. Relevant Data/Statistics—N/A
Objective 7.
I-C. Other Regional Activities and Resources (Due Ma 1,2003)
Guidance/Recommendations to Include: Local Report
Description of any changes or additional resources in your Objective 7:
Regional Office and parent agency The retirement of one newly trained HCP care coordinator and the promotion of a second care
coordinator to Child Health Team supervisor has left the Regional Office Staff without two 0.5 FTE.
Due to the current budget crisis, WCDPHE has frozen all new hiring at this time. In addition,HCP
staff members have been required to"fill in the gaps"in other programs, including family planning
and immunizations. Staff time has also been utilized to assist with the agency's Emergency
Response Plan(Mass Smallpox Immunization Plan).
Objective 7.
I-D. Progress on Activities Selected in MCH 2003 Plan (Activities in 2003 Plan that fit under this objective) (Due May 1,2003)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome Write in progress toward outcome measures for MCH 2003 Plan—Due May I,
2003 Plan measures from MCH 2003 Plan' 2003
Not applicable.
Objective 7.
I-E. Final Report on MCH 2003 Plan-effective Oct 2002 through Sept 30,2003. (Due January 15,2004)
Activity Evaluation—Outcome Measures Local Report
Copy in selected activity from MCH Copy in selected evaluation-outcome Write in final report of outcome measures for MCH 2003 Plan—Due January
2003 Plan measures from MCH 2003 Plan 15,2004
Page 26 of 27
Agency Name: Weld County Department of Public Health and Environment
Date of Report: May I, 2003
Contact Person for Report: Lori McCarty, RN, Team Leader Weld County HCP Regional Office
Contact Person's Phone Number: (970)-304-6420 ext. 2309
Contact Person's Email: Imccarty@co.weld.co.us
Objective 7:
II. Self-Assessment and Prioritization (Due May 1,2003)
Guidance Local Report
Briefly summarize what the information reported in your local Objective 7:
surveillance of need(Part I)means to your community regarding Despite the challenges in budget and decrease in staff,this regional office has done an excellent job
progress toward achieving this objective. Base your analysis on: of fulfilling the performance measures outlined in the HCP contract. It is difficult to predict how the
• Degree to which each contract performance measure was caseload will change following the cessation of paid service benefits on July 1,2003. Children who
fulfilled. are enrolled in HCP for orthodontia or hearing services may not choose to continue their
• New barriers,developments, resources that you encountered participation in the program. However,children without any other source of funding will require a
this last year in your Regional Office and parent agency. more intensive level of care coordination as the staff attempts to locate alternative ways to allow
these CSHCN to receive the care they require. The role of resource and referral will require an
increased number of community encounters. It is unclear whether the current staffing level will be
able to support this workload adequately.
Objective 7:
III. Children with Special Health Care Needs/MCH 2004 Plan (effective Oct 1,2003-Sept 30,2004) (Due May 1,2003)
Activity Evaluation—Outcome Measures
A. Current agency activities are fulfilling contract performance Contract Performance Measures as reported in the HERMAN Document due January 15,2004
Xmeasures and are contributing to achieving Objective 7 in our
community by 2010. Continue current activities as described.
Respectfully submitted by Lori McCarty, RN, BSN. Team Leader for Weld County Regional Office.
LB/pb
19HCPCommon\CLERICAL\HCP Plan Templates\Finals\HCP-MCH Plan Template-ROs.doc(Revised 3-25-03)
•
Page 27 of 27
Attachment D
MATERNAL AND CHILD HEALTH(MCH)
CHILDREN WITH SPECIAL HEALTH CARE NEEDS(CSHCN)
6 CORE OUTCOMES AND PERFORMANCE MEASURES
As of October I,2003
Outcome#1: Families of children with special health care needs(CSHCN)will partner in decision making at
all levels,and will be satisfied with the services they receive.
1. Percent of families of CSHCN reporting satisfaction with the quality of:regular source of primary care,
getting referrals and appointments for needed services,coordination between primary and specialty care
overall services.
2. Percent of parents of CSHCN who report satisfaction with their level of involvement/input in setting concerns
and priorities to make decisions about their child's care plan.
3. Percent of parents of CSHCN who report knowing the steps to take when they are not satisfied with the
services their child/family receives.
4. Number of parents of CSHCN who are supported financially for their involvement in state and local
activities.
5. Number of parents of CSHCN who report that they are effective partners in policymaking at the state and
local levels.
Outcome#2: All children with special health care needs will receive coordinated ongoing comprehensive care
within a medical home.
1. Percent of CSHCN with a regular source of primary medical care through a primary care provider.
2. Percent of CSHCN whose regular source of care communicates in a way that is clear and understandable to
the family.
3. Percent of parents whose regular source of primary medical care identifies,discusses,and addresses the
comprehensive needs of their child and family.
4. Percent of CSHCN whose regular source of primary medical care ensures age-appropriate well-child checks,
including: vision,hearing,developmental,behavioral/mental health,oral health,newborn screening,
immunizations.
5. Percent of parents of CSHCN who receive referrals and assistance from their regular source of primary
medical care in accessing needed/desired services.
Outcome#3: All families of children with special health care needs will have adequate private and/or public
insurance to pay for the services they need.
1. Percent of CSHCN with insurance that covers costs of needed services,including:mental health,dental care,
age-appropriate well-child checks,durable medical equipment,ancillary services,non-durable medical
supplies,care coordination,prescriptions,specialty care,related therapies(e.g.,PT,OT, speech/language,
audiology),in-home nursing.
Page I of 3
2. Amount of out-of-pocket costs paid by families of CSHCN,including costs of: mental health,dental care,
age-appropriate well-child checks,durable medical equipment, ancillary services,non-durable medical
supplies,respite care,transportation,care coordination,prescriptions, specialty care,related therapies(e.g.,
PT,OT,speech/language,audiology), in-home nursing,home modifications, car/van modifications.
3. Percent of CSHCN who can choose the providers of their choice.
4. Percent of CSHCN whose insurance provides:timely approval for needed care, overall parental satisfaction,
clear information,about coverage resources,and complaint procedures to providers and parents.
Outcome#4: All children will be screened early and continuously for special health care needs.
1. Percent of infants whose mothers began prenatal screening in the fust trimester of pregnancy,for smoking,
alcohol,drugs,tests for birth defects,HW,physical abuse.
2. Percent of infants and families being tracked for special health care needs and developmental delays.
3. Percent of children receiving age-appropriate well-child checks including: vision,hearing, developmental,
behavioral,mental health, oral health,metabolic, and EPSDT(if implemented in state).
4. Percent of children receiving needed follow-up due to failed screening or risk factors:vision,hearing,
developmental,behavioral,mental health,oral health, and metabolic.
Outcome#5: Services for children with special health care needs and their families will be organized in ways
that families can use them easily.
1. Percent of parents of CSHCN who have a single coordinated service plan that involves all providers and a
lead service coordinator who communicates with the family.
2. Percent of parents of CSHCN who report that they are able to access comprehensive services for their child
and family.
3. Percent of parents of CSHCN who have specialty care available in their region of the state.
4. The degree to which the state service system has an enrollment/eligibility process that links families of
CSHCN(and their medical home)with a wide variety of public and private services and resources.
5. Number of private/public partnerships to provide community-based,comprehensive medical services for
CSHCN,e.g.,data sharing,contracts,MOAs.
Outcome#6:All youth with special health care needs(SHCN)will receive the services necessary to make
appropriate transitions to adult health care,work and independence.
1. Percent of youth with SHCN who by age 14 have a transition plan that addresses employment,transportation,
housing,independent living,physical and mental health and necessary accommodations; and percent of youth
with SHCN by age 16 have a transition plan that includes appropriate agencies as part of the transition
planning team.
2. Percent of youth with SHCN whose regular source of primary medical care facilitates the transition from
pediatric to adult providers.
3. Percent of adult health care providers who are prepared to serve youth with SHCN.
Page 2 of 3
4. Percent of youth who report satisfaction with the information and training they received to make informed
decisions about their health care and other services.
5. Percent of youth with SHCN who receive necessary services/supports by age 21:Health insurance, Post-
secondary education,Employment,Transportation,Housing,Personal care attendant,SSI, SSA-related work
incentives,e.g.PASS, 1619 a&b.
1.\HCPCommon\CONTRACTS\PY 04\ROs\Single County ROsUttacbnenl D-MCH CSHCN 6 Core OCs&PMs.comdoc
Page 3 of 3
Attachment E
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 B 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:
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.)
B. Performance Measures:
1. Direct Services
1.1. Implement the HCP Specialty clinic program and other program services of HCP
according to the time lines, policies and procedures described in the HCP Policy &
Procedure and the IRIS Help File.
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 receiving
individual intensive level care coordination services.
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 known to both HCP and Part C; work with the family, medical
home, 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 regional office plan for providing translation/transcription/
interpretation services,as needed, for families receiving HCP services.
Page 1 of 3
2.5. 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 HERMAN
Document,Section I-A,due to the state by January 15,2004.
2.6. Assure training for new employees/county staff in all of the following:
* IRIS Data System and Security
* Acuity Assessment/Determination
* Application and Renewal Process
* HCP Specialty Clinic Program Policies and Procedures
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 Part I-A of the HERMAN Document on or before January 15,2004.
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
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 for the contract year.
Page 2 of 3
4.4. When Regional Discipline Coordinators are shared with other HCP regional offices, the
appropriate personnel (Regional Office Team Leaders, regional coordinators) 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 shall either attend,or participate by
conference call in,Regional Office Team meetings and at least two meetings of
all the coordinators 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 new HCP Technicians and Regional Officer Team Leaders attend state HCP
IRIS,program and security 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 Coordinator. 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 Coordinator Team
Meeting.
4.7.3. HCP Family Coordinators 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 Local MCH Plan.
Revised June 23,2003
1\HCPConm on\CONTRACTS\FY O4\ROs\Single County ROMttachrrcnt E-Performance Measures doe
Page 3 of 3
•
Attachment F
Health Care Program for Children with Special Needs(HCP)
HCP Regional Office Standards for Usage of IRIS II
I. Data Entry
1. Policies,procedures,and timelines shall be followed as described in the HCP Policy and Procedure
Manual,IRIS Help File,agency contract and training materials.
II. Documentation of Activities
1. Community Encounters will be entered to provide documentation of systems building and population
based activities.
2. Referrals with outcomes and concerns will be entered to document all referrals.
3. Client Encounters will be entered to document client contact and to determine acuity level by
indicating concerns needing care coordination.
4. All HCP clinics will be entered with outcome documented on the Clinic Schedule.
III. Data entry for Children with Special Health Care Needs(CSHCN)Caseload on IRIS
1. CSHCN Caseload on IRIS includes all CSHCN with whom agency staff have had client encounters
and/or provided referrals within previous twelve months of the reporting period.
2. Each person receiving any level of care coordination services will have a Client Encounter entered
showing acuity level. Acuity level is determined by number of concerns with care coordination
provided by agency. Concerns and acuity will be updated as needed at least yearly.
3. Client Referrals will be entered for all children receiving resource and referral services.
4. Data for all children receiving screening and consultation from a HCP Regional Coordinator is
entered on service screen and with client encounters.
5. Each clinic visit is entered on clinic visit screen for all children attending HCP clinics.
IV. Security procedures must be in place for all HCP IRIS users. Staff and supervisors will sign security forms
and User Profile forms yearly. Personal passwords for each HCP staff will be changed every sixty days and
kept confidential. The IRIS II Security Policy and Procedures will be followed.
V. IRIS training
1. HCP IRIS Training for new employees will include IRIS II and security. New HCP Regional Office
Team Leaders and HCP Regional technicians are required to attend State HCP New Employee
Training.
2. HCP Regional Offices will negotiate additional IRIS II training as needed with the state HCP office.
3. Regional Office staff will assist HCP state staff with IRIS training for local IRIS users. IRIS training
materials and instructor manual will be available for Regional Office staff during FY 2004.
Revised June 17,2003
1:'HCPConmon\CONTItACTS\FY 04\ROs\Singlc County ROs\Attachmcnt F-IRIS Standards 04 1413.doc
Attachment G
Health Care Program for Children with Special Needs (HCP)
IRIS II Security Policy, Procedures and Guidelines
Security policy and procedures protect personal health information and IRIS data. The following IRIS
security procedures are required for County Nursing Services,Health Departments and HCP Regional
Offices:
1. IRIS Users
a. IRIS users will sign a security and User Profile form before a personal ID and password are assigned for
access to Citrix and the IRIS database. Users will sign a new security form yearly.
b. IRIS users will have a personal ID and password assigned by the State HCP Office after completing IRIS
training.
c. IRIS users will not allow new agency staff,another agency staff person,staff from another program or
any person to have access or use their Citrix/IRIS ID and password.
d. IRIS users will complete IRIS and security training with the HCP Regional Office or State HCP Office
staff before using the IRIS database.
2. An agency supervisor will sign the security form for each HCP/IRIS user 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 that does not have the need to access HCP client specific data on IRIS.
3. Local Health Department,HCP Regional Office and Nursing Service agencies will have policies and
procedures for IRIS security and confidentiality. All staff will be trained on the importance of security and
confidentiality.
4. Agency supervisors will contact the State HCP office and request that an ID and password be expired when an
IRIS user leaves the HCP Program or no longer needs IRIS access.
5. Agency supervisors will notify the State HCP office to request a specific person's ID/password be disabled
when a security breach is suspected. 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 clinic services including HIPAA disclosures as defined with local agency HIPAA policy. (The
Health Insurance Portability and Accountability Act of 1996(HIPAA) 164.528 regarding accounting for
disclosures.)
Page 1 of 2
8. Access to Newborn Evaluation,Screening,and Tracking(NEST)data will be for predefined agencies and
staff. The agency will identify staff members that have a need to know the public health information from the
NEST database.
9. The agency will take appropriate action for all data referrals and requests for follow-up on IRIS from the
centralized CDPHE NEST database. The IRIS security policies will be followed for all NEST data.
10. When an IRIS user forgets a personal password,they will call the IRIS Help Line or the State HCP office for
assistance. The IRIS Help Line staff will re-set the personal password to a default password. The IRIS user
will immediately change the default password to a secure personal password as defined in training material.
11. Agency supervisors will require IRIS users to change their personal password every 60 days or more frequent
if it is suspected that the password has been compromised.
Revised July 11,2003
1:\HCPCommon\CONTRACTS\FY 04\ROs\Single County ROs\Attachment G-IRIS II Security Policy 04.doc
Page 2 of 2
Attachment H
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP)
HERMAN DOCUMENT INSTRUCTIONS FOR HCP REGIONAL OFFICE MCH PLAN
FOR PERIOD OF:OCTOBER 1,2004 THROUGH SEPTEMBER 30,2005
DUE DATE: MAY 3,2004
As of October 1,2003
Please present the Statement of Need and the Plan for children with special health care needs by following the
instructions provided below for completing the appropriate parts of the HERMAN Document:
A. Provide a cover page at the beginning of the report that contains the following information:
1. Title the Report:"HERMAN Report for FY 05"
2. agency name
3. contact person,and
4. contact's telephone number
B. Complete Part I-B &I-C-Surveillance of Need. This fulfills the needs statement for the MCH 2005 Plan.
C. Follow the guidance in HERMAN for specific data sets and IRIS reports to utilize. If IRIS reports are not
available,then state"data not available"in your report.
D. Complete Part II—Self-Assessment and Prioritization. Review the information provided in Part I-B&I-C
and your 2002 HCP Annual Contract Performance Report, submitted October 1,2002. DO NOT resubmit
information from the HCP Annual Report. This section should be a brief summary paragraph or two.
Your summary should address the areas in the guidance provided under this section
E. Complete Part III-MCH Plan Activities and Evaluation Outcome Measures. When choosing activities under
Part III:
1. Choose at least one activity from A,B,or C.
2. If you choose"A",check box and you are done with Part III.
3. If you choose"B",write in modified activity,dates and evaluation.
4. If you choose"C",you may choose from one of the suggested strategies or activities and use the
evaluation measures provided OR
5. If you choose"C",you may choose to write your own optional activity, and provide description of
activity,dates and evaluation plan.
6. Delete the remaining suggested activities for the objective so this section only notes the activities that
you will be performing
F. Many agencies perform activities that go above and beyond the minimum requirements of the Local MCH
plan. In order to acknowledge these achievements,please incorporate these activities into your Local MCH
plan and/or evaluation.
G. Name your document using the following formula:Agency Name-HERMAN-May 2004.doc. Example:
Jefferson-HERMAN-May 2004.doc. Save your newly named HERMAN document to your hard drive or a
floppy disk.
H. Submit your plan,via e-mail,for the period of October 1,2004 through September 30,2005,no later
than 5:00 P.M.May 3,2004 to:
Jan Reimer—E-mail Address:jan.reimer®state.co.us
And
Your State HCP Program Consultant(See list of e-mail addresses on the next page.)
Page 1 of 2
•
HCP PROGRAM CONSULTANTS,
REGIONAL OFFICE ASSIGNMENTS
Effective: June 24, 2003
HCP PROGRAM E-MAIL ADDRESSES
REGIONAL OFFICES CONSULTANT &PHONE NUMBERS
Boulder HCP Regional Office Lynn Bindel 303-692-2399
Denver HCP Regional Office Judy Grange 303-692-2464
El Paso HCP Regional Office Linda Fudge 303-692-2397
Jefferson HCP Regional Office Judy Grange 303-692-2464
-Broomfield Health Dept.
Larimer HCP Regional Office Shirley Babler 303-692-2455
Northeast HCP Regional Office Lynn Bindel 303-692-2392
Northwest HCP Regional Office Karen Umemoto 303-692-2362
Pueblo HCP Regional Office Paula Hudson 303-692-2413
South Central HCP Regional Office Shirley Babler 303-692-2455
-Las Animas-Huerfano Health Dept.
Southeast HCP Regional Office Paula Hudson 303-692-2413
• Southwest HCP Regional Office Judy Grange 303-692-2464
Tri-County HCP Regional Office Karen Umemoto 303-692-2362
Weld HCP Regional Office Lynn Bindel 303-692-2392
Western Slope HCP Regional Office Paula Hudson 303-692-2413
-Delta Health Dept.
Revised June 24, 2003
1:V1CPCo m on\CONTRACTSPY 04\ROs\Single County ROs'Attachment H-HERMAN Instruclions.doc
Page 2 of 2
Attachment I
MATERNAL AND CHILD HEALTH
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP)
BUDGET ESTIMATE FORM
DUE DATE: May 1, 2004
CONTRACTOR:
FOR THE PERIOD OF: October 1,2004 through September 30,2005
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\HCPConunon\Contoms\FY 04 ROs\Single County ROs\AttacLment I.Budget Estimate Form xls
Attachment J
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP)
FINAL EXPENDITURE REPORT
DUE DATE: December 1,2004
CONTRACTOR:
FOR THE PERIOD OF: October 1,2003 through September 30,2004
Annual Full Total SOURCE OF FUNDS
Salary Time Amount Received
Rate Equivalent Required OTHER' from CDPHE
PERSONAL SERVICES:
Contractual/Fee for Service
Supervising Personnel
Fringe Benefits: Rate=
TOTAL PERSONAL SERVICES._$ $ $
OPERATING EXPENSES(which are not part 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) $ 1$ $
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): S --
$
TOTAL$
May the NON FEDERAL funds be used as match? YES NO
Signature of Authorized Representative Date
Attachment K
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP)
DUTIES AND OBLIGATIONS CERTIFICATION FORM
DUE DATE: December 1,2004
TO: Peggy Becker
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 Contract Routing
Number for the period of October 1, 2003 through September 30, 2004.
SIGNATURES:
Contractor or Authorized Designee Date
HCP Regional Office Team Leader Date
This section is to be completed at the HCP State Office
I hereby certify that all requirements have been met and final payment of$ for the services
during the period of October 1,2003 through September 30, 2004 is authorized.
SIGNATURES:
HCP Program Consultant Date
HCP Program Director or Authorized Designee Date
I WQLOI.AgMC0NTRACTS FY 04 ROSBBSGIE COUNTY ROSATIACIPIPIT K-DIMES&OBLIGATIONS 6RTIFlGIION.DOC
Attachment L
MATERNAL AND CHILD HEALTH(MCH)
INSTRUCTIONS FOR SUBMITTING THE FINAL MCH REPORT FOR FY04
FOR THE PERIOD OF:October 1,2003 through September 30,2004
DUE DATE:January 17,2005
As of October 1,2003
Provide a cover page at the beginning of the report that contains the following information:
1. Title the Report:"FINAL MCH Report for FY04"
2. agency name
3. contact person,and
4. contact's telephone number
II. Final MCH Report for:
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:
I. 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: Follow the instructions provided
below for completing the appropriate parts of the HERMAN Document:
I. Complete Part I-E. You can cut and paste any appropriate information that you submitted
under Part I-D for the progress report in May 2003. This fulfills the MCH 2004 Plan Final
Report.
2. Leave intact the information in the rest of the document that represents your current MCH
plan.
Page 1 of 6
3. Name your document using the following formula:Agency Name-HERMAN-January
2005.doc.Example: Jefferson-HERMAN-January 2005.doc. Save your newly named
HERMAN document to your hard drive or a floppy disk.
III. Describe any important changes in administrative or organizational aspects of the program that affected
service delivery during the twelve-month period.
IV. 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.
V. Fill out Table I(7 AR)and Table II(8 AR),pages 3 and 5 of this attachment,as applicable and submit
along with your report.
VI. Please submit your Final MCH/HERMAN Report for FY04,via e-mail,for the period of October 1,2003
through September 30,2004,no later than 5:00 P.M. on January 17,2005 to:
Jan Reimer—E-mail Address: ianreimeastate.co.us
And
Your State HCP Program Consultant(See list of e-mail addresses on the next page.)
Page 2 of 6
HCP PROGRAM CONSULTANTS,
REGIONAL OFFICE ASSIGNMENTS
Effective:June 24,2003
HCP PROGRAM E-MAIL ADDRESSES
REGIONAL OFFICES CONSULTANT &PHONE NUMBERS
Boulder HCP Regional Office Lynn Bindel 303-692-2399
Denver HCP Regional Office Judy Grange 303-692-2464
El Paso HCP Regional Office Linda Fudge 303-692-2397
Jefferson HCP Regional Office Judy Grange 303-692-2464
-Broomfield Health Dept.
Larimer HCP Regional Office Shirley Babler 303-692-2455
Northeast HCP Regional Office Lynn Bindel 303-692-2392
Northwest HCP Regional Office Karen Umemoto 303-692-2362
Pueblo HCP Regional Office Paula Hudson 303-692-2413
South Central HCP Regional Office Shirley Babler 303-692-2455
-Las Animas-Huerfano Health Dept.
Southeast HCP Regional Office Paula Hudson 303-692-2413
Southwest HCP Regional Office Judy Grange 303-692-2464
Tri-County HCP Regional Office Karen Umemoto 303-692-2362
Weld HCP Regional Office Lynn Bindel 303-692-2392
Western Slope HCP Regional Office Paula Hudson 303-692-2413
-Delta Health Dept.
Revised June 24,2003
1:\HCPCommon\CONTRACrS\WY 04 ROs\Singk County ROs Attachment I.-Instructions for Final MCH-HERMAN Report for FY04-Pages 1-3.doc
Page 3 of 6
Program
Prepared by
Telephone
TABLE I (7 AR)
NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED) UNDER TITLE V
By Class of Individuals and Health Coverage, FFY 02-03*
(1) (2) (3) (4) (5) (6)
I
Number
Number With Number Number
Unduplicated Count by With Title XXI With Other With No Number
Class of Individual Served Total Number' Medicaid2 (CHIP)3 Insurance° Coverages Unknown
Pregnant women, postpartum and deliveries6
Infants under age one (not elsewhere)8
Children age 1-22 (not elsewhere)10
Children with special health care needs'
Other individuals (not elsewhere)9
Total MCH Populationu i — ir
-
Please take the Total Number shown in Column 1 for Children age 1-22 and estimate the number in each of the following age groups:
Age 1-4: Age 5-9: Age 10-14: Age 15-19: Age 20-22:
*October 1, 2003 through September 30, 2004
Page 4 of 6
Estimates (round numbers) are acceptable and are preferable to no data. Please estimate to the best of your ability. Be sure that Col. (2) + Col. (3) -
Col. (4) + Col. (5) + Col. (6) = Col. (1). If a person can be counted in more than one class in a year, select one class only in which to report them. If
you cannot provide information on health coverage, show Col. (1) figures in Col. 6 (number unknown) as well. This data will be used at the state
level to compile Colorado's Annual Form 7 AR in the MCH federally required Annual Report. If you need help call Sue Ricketts, Prevention
Services Division, Colorado Department of Public Health and Environment, (303) 692-2316.
Include this table with the Final MCH Report that is due January 17, 2005, to Jan Reimer, PSD-ADM-A4, Colorado Department of Public
Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80246-1530.
Footnotes for Table I (7 AR):
Total number of individuals who received a direct service (in person or by phone) from the Title V program regardless of the primary source of
coverage.
2Number of individuals in Column 1 whose primary source of coverage was Title XIX.
3Number of individuals in Column 1 whose primary source of coverage was Title XXI (Child Health Insurance Program).
4 Number of individuals in Column 1 whose primary source of coverage was private insurance, including HMOs, PPOs, etc.
5Number of individuals in Column 1 for whom there was no payment. It will be assumed that the costs of care for these patients was wholly
supported by Title V.
6 Total number of pregnant (or postpartum) women who received any services provided or paid for in whole or in part by Title V.
7 Total number of individuals under the age of 22 who received any services under the State plan for children with special health care needs provided
or paid for in whole or in part by Title V.
8 Total number of infants less than one who received any services provided or paid for in whole or in part by Title V.
9 Total number of individuals (other than pregnant or postpartum women, infants, children age 1 through 21 or children with special health care
needs) who received services provided or paid for in whole or in part by Title V.
10 Total number of individuals ages 1 through 21 who received any services provided or paid for in whole or in part by Title V (excluding children
with special health care needs or pregnant women through 21).
11 Total is the sum of the numbers shown for each of the classes of individuals (each class is mutually exclusive of every other class).
Table I, 6/17/03
1:\HCPCommon\CONTRACTS\FY 04\ROs\Single County ROs\Attachment L-Table 7&8-Pages 4-6.doc
Page 5 of 6
Table II applies only to programs providing service to pregnant women and/or infants under the age of I.
Program
Prepared by
Telephone
TABLE II (8 AR)
NUMBER OF DELIVERIES AND INFANTS SERVED BY TITLE V
UNDUPLICATED COUNT BY RACE AND ETHNICITY, FFY 03-04*
(1) (2) (3) (4) (5) (6) (7) (8)
Asian or
Total All American Pacific Other& Total Total
Races White Black Indian Islander Unknown Hispanic Non-Hispanic
Total Pregnant Women served by
program
Total Infants served by program
* October 1, 2003 through September 30, 2004.
Total number of pregnant/postpartum/delivery care women paid for in whole or in part by Title V. While the table title says deliveries, the number
should include women who received prenatal care regardless of how their delivery was covered.
'Total infants under the age of 1 who received any services provided or paid for in whole or in part by Title V.
The numbers in Column 1 should be the same as the numbers in Column 1 in Table I(7AR)! Estimates are acceptable and are preferable to no
data. Please estimate to the best of your ability.
Be sure that Col. (2)+Col. (3)+Col. (4)+Col. (5)+Col. (6)=Col. (1). Columns(7)and(8)must also equal Col. (1). These data will be used at the
state level to compile Colorado's Annual Form 8 AR in the MCH federally required Annual Report. If you need help call Sue Ricketts, Division of
Prevention and Intervention Services for Children and Youth, Colorado Department of Public Health and Environment, (303) 692-2316.
Include this table with the Final MCH Report that is due January 17, 2005, to Jan Reimer, PSD-ADM-A4, Colorado Department of
Public Health and Environment,4300 Cherry Creek Drive South, Denver, CO 80222-1530.
Table II
•
Page of 6
Attachment M
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, 2003
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 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.
A. Audiology/Otology, Orthopedic,Pediatric Cardiology,Pediatric Neurology,Rehabilitation,and Spinal
Defects Clinics
1. Clients on Medicaid will not be charged a clinic support fee.
2. Clients not on Medicaid:
a. will be charged a clinic support fee for all clinic visits. The family will be assessed a:
(I) $5 fee per visit for a rating of 133%FPG or less
(2) $10 fee per visit for a rating of 134 to 185%FPG
(3) $30 fee per visit for a rating of 186 to 211%FPG
(4) $50 fee per visit for a rating of 212 to 399%FPG
(5) $75 fee per visit for a rating of 400 to 450%FPG
(6) $100 fee per visit for a rating of 451%FPG or greater
b. and will pay all labs and x-rays ordered out of clinic.
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 fmancial 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.
Page 1 of 2
B. Pediatric Clinics
Children attending an HCP Pediatric Clinic:
1. Upon referral from the child's PCP requesting a diagnostic evaluation and/or continuing
consultation from the pediatrician,the child may be seen in the HCP Pediatric Clinic.
2. Families not on Medicaid will be charged a clinic support fee. (HCP is providing access for these
families,but not paying for services to children.)
3. Family pays all labs and x-rays ordered out of clinic.
Revised June 19,2003
1\HCPCOMMON\CONTRACrs\FY 04\ROS\SINGLE COUNTY ROS\ATTACHMENT M-CLINIC SLIDING FEE SCHEDULE.rYIC
Page 2 of 2
INVOICE NUMBER
ATTACHMENT N
REIMBURSEMENT STATEMENT
TO: Peggy Becker FROM: •
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
FAX: ( 303 ) 782-5576 DATE OF EXPENDITURE:
TYPE OF FROM: Final
PROGRAM: Bill?
FEDERAL II) TO: O Yes
NUMBER: ❑ No
Reimbursement
Description of Expenditure Local Agency Match Amount Requested Total
GRAND TOTAL
This is to certify that the above expenses were incurred per Contract# and we are requesting reimbursement for same.
SIGNATURE (CONTRACTOR): DATE:
I hereby certify that all contract requirements have been met and the amounts are correct. Payment is authorized.
AUTHORIZED DESIGNEE (STATE): DATE:
Contractor Notified of Reimbursement Amount Change?
0 Yes 0 Na Initial:
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 1,2003 through SEPTEMBER 30, 2004
Funded
by
CDPHE
HCP Weld County Regional Office:
(1/12 payable monthly October through August,
September's payment contingent upon receipt of Final Expenditure Report
and Duties and Obligations Certification Form) 167,901
One-time funding (10/01/03 -06/30/04) 13,729
Sub-total HCP Regional Office: 181,630
HCP Regional Coordinators: (line item billing)
Regional Coordinator Training and Travel 2,500
Parent Consultant 10,000
Audiology 2,000
Travel for Colo. Academy of Audiology meeting 250
Occupational or Physical Therapy 2,500
Nutrition 2,300
Vision 1,000
Speech 1,500
Sub-total Regional Coordinators 22,050
Total HCP Weld County Regional Office 203,680
Note: Regional Coordinators' honorarium rate is $24.00 per hour.
Attachment 2-Budget Pages-Fy04 Single Cty.XLS/Weld Page 1 of 1 7/14/2003
Memorandum
I CTO: David E. Long, Chair Board of County Commissioners
•
COLORADO FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health and � � �
Environment '1A�O.iJjt p„� _Q�_ ,"]
/71-,DATE: July 31, 2003
SUBJECT: Task Order Renewal Letter#3 for the Health
Care Program for Children with Special
Needs
Enclosed for Board review and approval is Renewal Letter Number#3 to the Task Order
between the between the Colorado Department of Public Health and Environment (CDPHE) 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 and 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 $203,680 for the time period October 1, 2003 through September 30, 2004.
I recommend your approval of this renewal letter.
Enclosure
2003-2008
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