HomeMy WebLinkAbout20030652.tiff RESOLUTION
RE: APPROVE MEMORANDUM OF UNDERSTANDING FOR SATELLITE ELIGIBILITY
DETERMINATION 1 SITE AND AUTHORIZE CHAIR TO SIGN - CHILD HEALTH
ADVOCATES, OPERATED BY POLICY STUDIES, INC.
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 Memorandum of Understanding for
the Satellite Eligibility Determination 1 Site 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 Child Health Advocates, operated by Policy
Studies, Inc., commencing March 15, 2003, and ending June 30, 2003, with further terms and
conditions being as stated in said Memorandum of Understanding, and
WHEREAS, after review, the Board deems it advisable to approve said Memorandum of
Understanding, 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 Memorandum of Understanding for Satellite Eligibility
Determination 1 Site 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 Child Health Advocates, operated by Policy Studies, Inc., be, and
hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said Memorandum of Understanding.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 12th day of March, A.D., 2003.
BOARD OF COUNTY COMMISSIONERS
COUNTY C ORADO
ATTEST: "
^'"� David E. Long, Chair
Weld County Clerk tot B.: .
,1861 (\ -,Qw=y EXCUSED
'a� ¢�•. Robert D. Masden, Pro- em
BY:
Deputy Clerk to the B�`�(/ ; j EXCUSED DATE OF SIGNING (AYE1
M. J. Geile "
APPROV D AS TO FORM: )/0/1 V�
n William H. Jerke
of / !i ill ilif�-0---
County Attorney
g 3/- Glenn Vaa
Date of si nature:
2003-0652
�/ HL0030
2/27/03
MEMORANDUM OF UNDERSTANDING
Satellite Eligibility Determination 1 Site
This Memorandum of Understanding (MOU) dated
2003, by and between Child Health Advocates, operated by
�N(Policy Studies Inc. (PSI/CHA) and l� (Satellite Eligibility
Determination 1 Site) will become effective March 15, 2003.
WHEREAS, The Children's Basic Health Plan Act (Colorado Revised
Statutes, Sections 26-19-101, et.seq.) creates The Children's Basic Health Plan
(CBHP) marketed as The Child Health Plan Plus (CHP+) for the purpose of
providing outpatient and inpatient medical services to children under age nineteen
(19) and pregnant women in medically indigent families;
WHEREAS, PSI/CHA operates as a corporation governed by the laws of the
State of Colorado and has contracted with the Colorado Department of Health Care
Policy and Financing to administer and manage certain aspects of the CHP+,
including, but not limited to eligibility and enrollment functions, provider relations,
and outreach and marketing activities;
WHEREAS, authority exists in the law and funds have been budgeted,
appropriated and otherwise made available and a sufficient uncommitted balance `
remains available for encumbering and subsequent payment of fees to Satellite
Eligibility Determination (SED) Site under the terms and conditions of this MOU
through CBHP funding sources;
WHEREAS, authority exists for PSI/CHA to execute a MOU to perform its
responsibilities under the provisions of the statutory and contractual guidelines
referenced above;
WHEREAS, PSI/CHA and SED Site have obtained the required approvals,
clearances and coordination from and with appropriate agencies;
NOW THEREFORE, in consideration of the mutual promises contained herein,
the parties agree as follows:
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I. DEFINITIONS
For the purposes of this MOU, the following definitions shall apply:
CHP+ Application. That document entitled "Application for Colorado Health
Care," which may be amended from time to time, and shall reflect statutory
requirements with respect to financial and non-financial information for the
purpose of determining eligibility for the CHP+ program for the applicant.
Contact Person. That person or persons designated by the SED Site as the
individual(s) who shall be responsible for ensuring that every communication
from PSI/CHA regarding CHP+ is distributed in a timely fashion to all the
necessary and appropriate SED Site staff. The Contact Person(s) shall also
be available to answer questions and concerns regarding the application
process from applicants if other staff are not able to answer such questions.
There must be a Contact Person for each SED Site location.
Satellite Eligibility Determination Site Policy & Procedures Manual (SED
Manual). That policy and procedure manual prepared by PSI/CHA, which
may be amended from time to time, that shall govern the terms of application
submission and shall reflect statutory requirements, as well as the basic
policies and procedures, to be followed by the SED Site in carrying out the
terms and conditions of this MOU.
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Quality Assurance. The process whereby SED Site performance is reviewed
and monitored.
C-CHAMP System Look-up Capability. The process whereby SED Site may
access the C-CHAMP system in order to track CHP+ application status for the
purposes of customer service.
II. OBLIGATIONS OF SED SITE
A. SED Site shall abide by all applicable federal and state laws and
regulations in effect during the term of this MOU. SED Site shall
further abide by any reasonable subsequent amendments of CBHP
with advance written notice.
B. SED Site, in coordination with PSI/CHA, shall obtain training for all
SED Site personnel assisting families to complete CHP+ Applications.
When Medicaid staff are available, the training shall include Medicaid
training in addition to formal training provided by staff from PSI/CHA.
C. SED Site understands and agrees to abide by all provisions of the SED
manual prepared by PSI/CHA for the CHP+ program. PSI/CHA shall
inform SED Site, in writing, of any revisions, modifications or changes
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in policy, procedures or law to the SED manual. SED Site agrees to
update the SED manual at each location and abide by the most current
edition.
D. SED Site agrees to designate a Contact Person for all CHP+
communication, correspondence and eligibility processing inquiries at
each location where they accept applications. The Contact Person
shall respond to questions and concerns with respect to eligibility and
enrollment from PSI/CHA personnel within two (2) business days of the
initial inquiry. Fill out all below that apply. If more space is needed,
attach a separate sheet.
The Contact Person for SED Site location 1 shall be:
Contact name, phone, fax:
Location address:
Contact e-mail:
The Contact Person for SED Site location 2 shall be:
Contact name, phone, fax:
Location address:
Contact e-mail:
The Contact Person for SED Site location 3 shall be:
Contact name, phone, fax:
Location address:
Contact e-mail:
The Contact Person for SED Site location 4 shall be:
Contact name, phone, fax:
Location address:
Contact e-mail:
The Contact Person for SED Site location 5 shall be:
Contact name, phone, fax:
Location address:
Contact e-mail:
Please see attached sheet for more locations and contacts.
(Check if applicable.)
If/when Contact Person changes, SED Site shall notify PSI/CHA via e-
mail or fax of a new Contact Person and provide necessary contact
information within five (5) business days of the change.
E. SED Site shall, upon receipt of a paper CHP+ Application by personal
delivery or the U.S. Postal Service, date stamp and staple original
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envelope to the CHP+ Application, if available, to validate the date of
that CHP+ Application. Date validation for CHP+ Applications obtained
during a personal interview shall be the date that the CHP+ Application
is taken and should be stamped on the Application. Applications
submitted to the CHP+ office by the SED Site without a date stamp,
will not be reimbursed.
F. SED Site shall have five (5) business days from the date of receipt to
submit all applications, whether complete or incomplete, to PSI/CHA.
This date shall be measured from the date the application was
received at SED Site, to the date the envelope containing the
application(s) as sent to PSI/CHA is postmarked. For applications sent
via courier, the date of delivery to PSI/CHA shall serve as the
postmarked date. (Specific guidelines for application submission are
detailed in the SED manual).
G. In order to remain an active SED site and for the purposes of
Quality Assurance, SED Site shall meet a specified quality assurance
standard. If the standard is not met, the SED Site will have one
calendar month to meet the standard. If performance does not
improve during the month following the deficiency, the Site will no
longer be reimbursed. (Specific guidelines about the Quality
Assurance process are detailed in the SED manual).
H. SED Site shall provide information regarding CHP+ to its clients by
distributing current brochures and applications.
For a minimum of one (1) year, SED Site shall maintain paper copies
of such records and provide, without additional charge, financial and
administrative information to PSI/CHA, as may be necessary, for the
purposes of compliance with any State, federal, administrative rule or
regulation pertaining to the CBHP, as well as for CHP+ program
management purposes. Upon reasonable notice, PSI/CHA shall have
access to examine the books, records and papers of SED Site relating
to the application assistance services provided to applicants.
J. SED Site shall submit all applications to:
Eligibility and Enrollment— SED Applications
Child Health Plan Plus
P.O. Box 469022
Glendale, CO 80246-9022
Send all non-application communications to:
Allison Hamm, SED Site Coordinator
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Child Health Plan Plus
P.O. Box 469022
Glendale, CO 80246-9022
L. SED Site shall be responsible for obtaining its own computer
equipment and access to the Internet that includes at a minimum
version 5.0 or higher of Microsoft Internet Explorer for accessing the
Look-up capability of the C-CHAMP system. Further, SED Site shall
be responsible for any technical hardware support.
M. SED Site shall be responsible for obtaining a written Confidentiality
Agreement provided by PSI/CHA for all SED Site personnel having
access to CHP+ applicant Internet files through Look-up capability.
SED Site shall hold in confidence any data or information pertaining to
the financial, demographic or other information obtained by SED site or
the PSI/CHA about the applicant. Moreover, SED Site shall be
prohibited from disclosing any information about any CHP+ applicant to
any third person, except in connection with quality assurance and peer
review, or unless a proper and lawful release has been obtained.
N. Upon execution of the Confidentiality Agreement by SED Site
personnel, PSI/CHA shall provide SED Site personnel with a user log-
on name and password for the purposes of accessing the Look-up
capability of the C-CHAMP system. SED Site personnel shall hold this
information in confidence at all times.
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III. OBLIGATIONS OF PSI/CHA
A. PSI/CHA shall coordinate training sessions for SED Site personnel for
the purposes of completing a CHP+ Application and for the application
screening process. PSI/CHA shall provide training on eligibility rules
and submitting applications to the CHP+ office. PSI/CHA shall provide
any additional training to SED Site as needed.
B. PSI/CHA shall provide SED Site with technical assistance.
C. PSI/CHA shall maintain a list of SED contact persons with whom all
communications regarding CHP+ shall be made. PSI/CHA shall
update this list upon notification from SED Site. PSI/CHA shall
respond to SED Site inquiries within two (2) business days.
D. PSI/CHA shall provide SED Site with the SED manual and all other
relevant materials required by SED Site to complete CHP+
Applications, including, but not limited to a current list of participating
medical providers. Further, PSI/CHA shall provide notice to SED Site
of any material changes to SED Manual.
E. PSI/CHA shall enroll eligible CHP+ applicants in the CHP+ program
effective when the CHP+ Application is complete.
F. PSI/CHA shall provide SED Site with all necessary forms required for
applicants to complete a CHP+ Application.
G. PSI/CHA may finalize incomplete CHP+ Applications submitted by
SED Site in the event SED Site fails to provide PSI/CHA with
information that would constitute a completed CHP+ Application.
H. PSI/CHA shall provide each enrolled CHP+ applicant with an
identification card.
PSI/CHA shall hold any data or information pertaining to the diagnosis,
treatment or health condition of any eligible CHP+ applicant in
confidence. Further, PSI/CHA shall not disclose or release
information to any third person except for the sole purpose of quality
assurance and peer review unless a lawful release has been obtained
from CHP+ applicant.
J. PSI/CHA shall perform quality assurance on a statistically significant
number of applications submitted by SED Sites.
IV. Reimbursement
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A. PSI/CHA shall pay SED Site ten dollars ($10.00) for the screening and
submission of an application to the CHP+ office within five (5) business
days.
B. All applications submitted to CHP+ by SED Sites must be date stamped
with the application receive date. Applications without a date stamp
will not be reimbursed.
C. PSI/CHA staff shall have the right at all times to review all CHP+
Applications for completeness and accuracy.
D. PSI/CHA shall remit reimbursement checks to SED Site once a month,
through PSI/CHA or its designee, in accordance with their regularly
scheduled payment dates.
Please include payment information:
Check Payable To:
Payment Address:
V. TERM AND TERMINATION
A. Term.
1. The initial term of this MOU shall begin on the date of signature and
shall continue until June 30, 2003 or until terminated by either
party. This MOU shall be terminated by either party by notifying the
• other in writing, not less than thirty (30) days prior to the renewal
date that it shall not renew the MOU.
2. The term of this MOU is renewable for an additional 12 months. At
least 30 days prior to the termination date, SED Site and PSI/CHA
shall review and sign an agreement to continue for another 12
months if both parties are in agreement to continue.
B. Termination.
1. Either party may terminate this MOU without cause by providing
the other party with thirty (30) days advance written notice.
Upon notice, SED Site shall not be paid for any new CHP+
Applications it submits to PSI/CHA; however, SED Site shall be
permitted to collect information and be reimbursed for current
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CHP+ Applications submitted to PSI/CHA within that thirty (30)
day period.
2. PSI/CHA may terminate this MOU immediately when any
professional organization having recognized jurisdiction or
judgment, finds any professional misconduct by SED Site or
employee of SED Site.
3. PSUCHA may terminate this MOU when SED Site becomes
insolvent or files for bankruptcy, or if the business of SED Site
shall come into the possession or control, even on a temporary
basis, of any trustee in bankruptcy, or if a receiver is appointed
on its behalf or if SED Site makes a general assignment for its
creditors.
4. PSI/CHA may terminate this MOU upon thirty (30) days prior
written notice in the event sufficient funds are not appropriated
by the Colorado General Assembly which prevents PSI/CHA
from reimbursing SED Site.
5. PSI/CHA may terminate this MOU upon thirty (30) days prior
written notice in the event SED Site is unable to comply with the
aforementioned requirements with respect to submitted CHP+
Applications.
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IN WITNESS WHEREOF, the parties hereto have executed this MOU on the day
first above written.
CHILD HEALTH ADVOCATES-
OPERATED BY POLICY STUDIES, INC. Satellite Eligibility Determination
(PSI/CHA) SITE (SED Site)
• •
By/4;,G 1cC��tLC / By
SED Site Authorized Person
Name: David E. Lon
Title: Chair (03/12/2003)
Federal Ta ID # If A.plic. i =• -6000-813
Attest: !i�... .l Ii�� � S.
By: ,�� Co• by �t �I
Deputy Clerk to ithe Bodcd : WI
WELD cnUNtY ttJAN1Mr 4
PUBLIC HEAL .•,IUD lR0NVM �,, �►
Mark E. Waiiare•jAD• MPH-Director
•
•
•
New Program Structure—Satellite Eligibility Determination (SED) Sites
March 2003
The new SED Site program looks to meet the needs of both SED Sites and PSI/CHA. The SED Site
program is SIMPLE and EASY! There is less paperwork for sites and faster results for families. SED
Sites will continue to have personal contact with families and will maintain vital public awareness of
the program throughout Colorado. Based on the 2002 evaluation year and the needs of sites and
PSI/CHA, the following new structure, outlining two levels of site involvement,was developed.
Satellite Eligibility Determination 1 Sites
SED 1 Sites will function as application and information sites. These sites will serve as a resource for
families applying for CHP+, assist in maintaining the program's enrollment base and preserve CHP+
community connections.
Site Functions:
• Assist families in the CHP+ application process
• Attend CHP+ Eligibility Trainings
• Submit all applications to the CHP+office within 5 business days
Site Support from PSUCHA:
• CHP+ program information and updates (monthly mailings)
• CHP+ Eligibility Trainings
• Technical assistance from the SED Site Coordinator
• C-CHAMP system 'look-up'capability to track application status
• $10 for family application assistance and Medicaid screen completion within time requirement
• Enrollment feedback regarding applications submitted to CHP+
Sites will NOT have to:
• Enter applications online
• Complete 'Request for Information' Forms
• Submit invoices with CHP+ applications
• • Submit outreach plans or reports
Site Quality Assurance:
• PSI/CHA staff will conduct monthly application audits to ensure adequate Medicaid screens
are being performed by each site.
• Sites submitting a significant number of Medicaid applications in relation to the number of total
applications they submit, will be provided with technical assistance and training. If incorrect
application submission continues, the site will no longer be reimbursed for applications
submitted.
Satellite Eligibility Determination 2 Sites
SED 2 Sites will serve as application and information sites, and will continue to enter applications and
make eligibility determinations online. Instead of reviewing every site application as done in the past,
PSI/CHA staff will rely on eligibility determinations made by the site to enroll families and then perform
a rigorous quality assurance (QA) process on only a sample of applications submitted from sites as is
done for PSI/CHA internal application processing staff. This creates time and cost savings in
processing these applications.
Criteria for Site Selection:
• Sites met acceptable efficiency standards during the 2002 evaluation year;
• Sites submitted a significant number of applications based on their geographic location; and
• Sites had a dedicated staff member to coordinate the SED Site process at their site and to
review applications.
Page 1 of 1
•
Site Functions:
• Assist families in the CHP+ application process
• Attend CHP+ Eligibility and Online Entry Trainings
• Online entry of all complete applications
• Submit complete applications to the CHP+ office within 10 business days
• Submit incomplete applications to the CHP+ office within 5 business days
Site Support from PSI/CHA:
• Provide CHP+ program information and updates (monthly mailings)
• Provide CHP+ Eligibility and Online Entry Trainings
• Technical assistance from the SED Site Coordinator
• C-CHAMP system online entry capability
• $10 for family application assistance and Medicaid screen completion within time requirement
• Additional $20 for applications entered online that include at least one CHP+ enrollment
Sites will NOT be required to:
• Complete 'Request for Information' Forms
• Submit invoices with CHP+ applications
• Submit outreach plans or reports
Site Quality Assurance:
• Sites will be required to maintain a 90 percent quality assurance standard, based on the
quality assurance measures used to evaluate applications processed by PSI/CHA staff. This
process will be detailed in full in the SED Site manual.
• Sites not meeting this standard will receive further training and technical assistance and will
have a one-month improvement period to meet the standard.
• Sites not able to meet the 90 percent quality assurance standard after the one-month
improvement period will become SED 1 Sites.
•
Page 2 of 2
. a t,
Memorandum
1 C TO: David E. Long, Chair Board of County Commissioners
•
COLORADO FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health and
Environment O4,doc��
DATE: March 10, 2003
SUBJECT: Memorandum of Understanding and
Addendum to MOU for CHP+ Satellite
Eligibility Determination Site
Enclosed for Board review and approval is a Memorandum of Understanding and an addendum
to the Memorandum of Understanding for Weld County Department of Public Health and
Environment to continue to be a SED (Satellite Eligibility Determination Site) for the Child
Health Plan Plus (CHP+). This plan provides for outpatient and inpatient medical services to
children under age nineteen in medically indigent families. As a Satellite Eligibility
Determination Site, WCDPHE will continue to assist clients in completing their applications for
this insurance plan and submit each application with required documentation to the Child Health
Advocates. For providing these services, WCDPHE will be paid $10.00 for each completed
application submitted within time requirements.
The addendum to this MOU states that WCDPHE qualifies as a Business Associate of PSI/CHA
(Policy Studies Inc./Child Health Advocates) and both parties agree to protect the privacy and
provide for the security of PHI (Protected Health Information) in compliance with the Health
Insurance Portability and Accountability Act of 1996 (HIPAA). The term of this memorandum
of understanding and the addendum to it is from March 15, 2003 through June 30, 2003.
I recommend your approval of these documents.
Enclosure
. .
2003-0652
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