HomeMy WebLinkAbout20013315.tiff RESOLUTION
RE: APPROVE MEMORANDUM OF UNDERSTANDING FOR CHILD HEALTH PLAN
PLUS AND AUTHORIZE CHAIR TO SIGN - CHILD HEALTH ADVOCATES
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 Child Health Plan Plus 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, commencing upon full execution
of said Memorandum of Understanding, and ending June 30, 2002, 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 the Child Health Plan Plus
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 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 5th day of December, A.D., 2001.
BOARD OF COUNTY COMMISSIONERS
WELD UNTY, COLORADO
ATTEST: ♦� E/. j Lay
M. J. Geile, air
Weld County Clerk to t i,€, r'
Glenn Vaaciaestem,
BY:
Deputy Clerk to the Boa
William erke
AP O D AS RM: ok.a Ncti/
prw
oun Atto ney D. Ma den
Date of signature: / �
2001-3315
HL0028
Atz:-. ;• 0Memorandum
TO: M.J. Geile, Chair
Board of County Co sinner /1
C FROM: Mark E. Wallace, MD, , Director
• Department of Public Health and
COLORADO Environment
DATE: December 3, 2001
SUBJECT: Memorandum of Understanding with Child
Health Advocates
Enclosed for the Board review and approval is a Memorandum of Understanding between the
Child Health Advocates and Weld County Department of Public Health and Environment.
According to the terms of this agreement, WCDPHE will continue to be a Satellite Eligibility
Determination Site for the Child Health Plan Plus (CHP+). This plan established by Colorado
Revised Statutes, Sections 26-19-101, 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, will determine eligibility for applicants, and will submit each application with all required
documentation to the Child Health Advocates.
This program will enhance existing services to other child health programs at the Health
Department such as the Health Care Program for Children with Special Needs, the EPSDT
Program, and Well Child Health Program.
In exchange for these services, WCDPHE will be paid $10.00 for each completed application
submitted and an additional$20.00 per application for eligibility determination for each correctly
determined application submitted. The term of this agreement is from the date of its signing
through June 30, 2002.
I recommend your approval of this agreement.
Enclosure
2001-3315
11/9/01
MEMORANDUM OF UNDERSTANDING
This Memorandum of Understanding (MOU) dated
2001, by and between the Child Health Advocates
(Advocates) and Weld County Board of (SED Site).
Commissioners
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) in medically indigent families;
WHEREAS, Advocates operates as a 501(c)(3) nonprofit 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 SED Site
under the terms and conditions of this MOU through CBHP funding sources;
WHEREAS, authority exists for Advocates to execute a MOU to perform its
responsibilities under the provisions of the statutory and contractual guidelines
referenced above;
WHEREAS, Advocates 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:
1
11/9/01
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.
Electronic Internet CHP+ Application. The electronic processes by which the
SED Site shall access the CHP+ C-CHAMP system and enter application
information to, determine eligibility, and submit Applications for CHP+
applicants.
CHP+ Satellite Eligibility Site Application Invoice Form. That document,
which may be amended from time to time, that shall be completed in full and
accompany each batch of CHP+ Applications.
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 Advocates 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 location that an SED Site has.
Eligibility Determination. That process which reviews and measures all
financial and demographic information provided by the applicant for the
purpose of determining if the applicant or members of the applicant's family
are within the financial parameters to be eligible for the CHP+ program.
Satellite Eligibility Determination Site Policy & Procedures Manual (SED
Manual). That policy and procedure manual prepared by Advocates, which
may be amended from time to time, that shall govern the terms of actual
eligibility determination 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.
Efficiency Criteria. Efficiency for SED Sites shall be calculated as the number
of correctly determined applications submitted divided by the total number of
applications submitted, multiplied by 100. An application shall be considered
correctly determined if:
1. a)The application is sent to the correct health care program; and
b)The application is complete and contains all necessary w A
documentation and information to be able to make an appropriate
CHP+ eligibility screen and determination; or
2
11/9/01
c)An incomplete application contains enough necessary documentation
and information to be able to make a reasonable CHP+ eligibility
estimate.
2. When a Site submits an incomplete application to CHP+ a copy of the
"Incomplete Application Request for Information" form must be
attached to the application. This will let the technicians at CHP+ know
that the SED Site was aware the application was incomplete upon
submission. These incomplete applications will not affect the Site's
efficiency rating. If a copy of the form is not attached to the
application, CHP+ will assume that the Site considered the application
complete and it will affect the site's reimbursement for that application.
(See attached Incomplete Application Request for Information form.)
Effectiveness Criteria. Effectiveness for SED Sites shall be calculated as
the number of applicants submitted divided by the Outreach Potential of
SED Site. Outreach Potential equals the number of uninsured children in
a county divided by the number of SED Sites in the county. Effectiveness
is a ratio calculated on a quarterly basis and is a cumulative measurement
from the start of the evaluation period. It is NOT an average of monthly
effectiveness ratings.
For example, SED Site X, in XX County submitted 30 applicants to CHP+
for quarter 1. The outreach potential for County XX is 900 (4,500
estimated eligible children in the County, divided by 5 SED Sites in that
County). To get the effectiveness rating for SED Site X, divide 30 by 900,
which equals .03.
For the next quarter, do the same calculation, this time adding the
previous quarter's applicants to the current quarter's applicants. Thirty
applicants first quarter, 60 this quarter, equals 90. Ninety divided by 900
-equals an effectiveness rating of .1 .
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 Advocates, shall obtain training for all
SED Site personnel assisting families to complete CHP+ Applications
as well as those SED Site personnel who process CHP+ Applications.
When Medicaid staff are available, the training shall include Medicaid °A
training in addition to formal SED training provided by staff from
Advocates.
3
11/9/01
C. SED Site understands and agrees to abide by all provisions of the SED
Manual prepared by Advocates for the CHP+ program. Advocates
shall inform SED Site, in writing, of any revisions, modifications or
changes in policy, procedures or law to the SED Manual. SED Site
agrees to update the SED Manual 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 and/or enter applications. The
Contact Person shall respond to questions and concerns with respect
to eligibility and enrollment from Advocates' 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: Leticia Mireles, (970) 304-6420 ext. 2238
Location address: 1555 North 17th Avenue, Greeley, CO (fax) (970) 304-6412
Contact e-mail: lmireles@co.weld.co.us
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.)
4
11/9/01
If/when Contact Person changes, SED Site shall notify Advocates via
e-mail or fax who the new Contact Person is 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
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 complete and should be stamped on the Application.
F. SED Site shall have ten (10) business days from the date of receipt to
submit all applications, whether complete or incomplete, to
Advocates. 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 Advocates is postmarked. For applications
sent via courier, the date of delivery to Advocates shall serve as the
postmarked date.
G. In order to remain an active SED site and for the purposes of
Quality Assurance, SED Site shall meet the following efficiency
benchmarks:
1. 70% efficiency rating by December 31, 2001, and submit all
complete applications electronically by January 31, 2002;
2. 80% efficiency rating by March 31, 2002;
3. 90% efficiency rating by June 30, 2002;
4. Shall maintain a 90% efficiency rating after June 30, 2002.
5. The above benchmarks are meant to serve as a mechanism for
Advocates and the Department of Health Care Policy and
Financing 'to monitor SED Site performance against a set of
benchmarks. They will clearly identify sites that are not meeting
performance standards, and thus allow Advocates and HCPF to
explore why sites are not meeting performance standards and
develop ways to improve site performance.
H. SED Site shall provide information regarding CHP+ to the public by
distributing brochures and applications and other materials consistent
with the SED Site outreach plan. SED Site shall develop an outreach
plan that includes outreach strategies to be used, target markets,
timelines and application goals. Outreach plan shall be developed and
approved by Advocates within 45 days of SED Site signing this MOU.
SED Site shall provide Advocates with quarterly outreach progress
reports in a prearranged format that Advocates has established. Upon
request by SED Site, Advocates shall provide SED Site with materials
to do outreach at no charge.
5
11/9/01
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 Advocates, 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, Advocates shall
have access to examine the books, records and papers of SED Site
relating to the eligibility determination services provided to applicants.
J. Any single original Application or batch of original Applications sent to
CHP+ shall be accompanied by a Satellite Eligibility Site Application
Invoice Form. The SED Site shall complete the CI-(P+ Satellite
Eligibility Site Application Invoice Form per the instructions contained
in the SED Manual. SED Site shall not receive reimbursement for any
CHP+ Application received without the Application Invoice Form.
K. SED Site shall submit all applications to:
Eligibility and Enrollment—SED Applications
Child Health Plan Plus
700 S. Ash St, #8105
Glendale, CO 80246-9022
Send all non-application communications to:
Allison Hamm, SED Site Coordinator
Child Health Plan Plus
700 S. Ash St., #8105
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. 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 Advocates for all SED Site personnel having
access to CHP+ applicant Internet files. SED Site shall hold in
confidence any data or information pertaining to the financial,
demographic or other information obtained by SED site or the
Advocates 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. (See
attached Confidentiality Agreement.)
6
11/9/01
N. Upon execution of the Confidentiality Agreement by SED Site
personnel, Advocates shall provide SED Site personnel with a user
log-on name and password for the purposes of accessing the eligibility
system. SED Site personnel shall hold this information in confidence
at all times.
7
11/9/01
III. OBLIGATIONS OF ADVOCATES
A. Advocates shall coordinate training sessions for SED Site personnel
for the purposes of completing a CHP+ Application and for the
Application screening and eligibility determination process. Advocates
shall provide training on eligibility rules, processing applications,
submitting applications, accessing the CHP+ Website and downloading
completed applications electronically. Further, Advocates shall provide
training with respect to invoicing for correctly determined CHP+
Applications submitted to Advocates. Advocates shall provide any
additional training to SED Site as needed.
B. Advocates shall provide SED Site with outreach training and technical
assistance, including development and monitoring of an outreach plan,
outreach materials, and giveaways. Advocates shall provide these
materials at no cost to SED Site up to a reasonable, predetermined
amount.
C. Advocates shall maintain a list of SED contact persons with whom all
communications regarding CHP+ shall be made. Advocates shall
update this list upon notification from SED Site. Advocates shall
respond to SED Site inquiries within two (2) business days.
D. Advocates 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, Advocates shall provide notice to SED
Site of any material changes to SED Manual.
E. Advocates shall enroll eligible CHP+ applicants in the CHP+ program
effective when the CHP+ Application"is complete.
F. Advocates shall provide SED Site with all necessary forms required for
applicants to complete a CHP+ Application.
G. Advocates may finalize incomplete CHP+ Applications submitted by
SED Site in the event SED Site fails to provide Advocates with
information that would constitute a completed CHP+Application.
H. Advocates shall provide each enrolled CHP+ applicant with an
identification card.
I. Advocates shall hold any data or information pertaining to the
diagnosis, treatment or health condition of any eligible CHP+ applicant
in confidence. Further, Advocates shall not disclose or release
information to any third person except for the sole purpose of quality
8
11/9/01
assurance and peer review unless a lawful release has been obtained
from CHP+ applicant.
IV. Reimbursement
A. Advocates shall pay SED Site ten dollars ($10.00) per application for
outreach for any paper or electronic CHP+ application submitted to
Advocates by SED Site, effective upon the signing of this document.
Paper and electronic applications shall be submitted to Advocates
within the specified time frames noted above. SED Site shall not be
reimbursed anything for applications where all applicants are obviously
eligible only for Medicaid.
B. Advocates shall pay SED Site an additional twenty dollars ($20.00) per
application for eligibility determination for each correctly determined
paper or electronic CHP+ Application submitted to Advocates by SED
Site that also is submitted in a timely fashion:
1. All complete applications shall contain all necessary documentation
and information to be able to make an appropriate Medicaid or
CHP+ eligibility screen and determination. (Guidelines shall be
given in training sessions and SED Manual).
2. All incomplete applications shall contain enough necessary
documentation and information to be able to make a reasonable
Medicaid or CHP+ eligibility estimate. Applications that appear to
be Medicaid eligible shall be sent to the county Medicaid office for
further processing. Applications that appear to be CHP+ eligible
shall be sent to Advocates for further processing. Applications sent
to CHP+ shall include a copy of the Incomplete Application Request
• for Information form sent to the applicant or they will not be
reimbursed. (Specific guidelines shall be given in training sessions
and SED Manual).
3. All applications shall be submitted to CHP+ within ten (10) business
days to be considered for reimbursement. (Complete paper
applications shall no longer be reimbursed after January 31, 2002).
4. SED Site shall not be reimbursed anything for applications where
all applicants are obviously eligible only for Medicaid.
C. Advocates' staff shall have the right at all times to review all CHP+
Applications, whether paper or electronic, for completeness and
accuracy.
D. Advocates shall remit reimbursement checks to SED Site once a
month, through Advocates or its designee, in accordance with their
regularly scheduled payment dates.
9
11/9/01
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, 2002 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 Advocates
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 CHA; however, SED Site shall be
permitted to collect information and be reimbursed for current
CHP+ Applications submitted to Advocates within that thirty (30)
day period.
2. Advocates 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. _ Advocates 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. Advocates 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 Advocates
from reimbursing SED Site.
5. Advocates 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.
10
11/9/01
IN WITNESS WHEREOF, the parties hereto have executed this MOU on the day
first above written.
CHILD HEALTH ADVOCATES SATELLITE ELIGIBILITY
(Advocates) DETERMINATION SITE (SED Site)
By By
Bonnie Sherman, Executive Director S D Site Authorized Person
Name: M. J. Geile
Title: Chair (12/05/2001)
Federal Tax ID # If Applicable: 84-6000-813
WELD COUNTY DEPARTMENT OF
PUBL HEALTH AND ENVIRONMENT
BY:
Mark E. Wallac , , PH•three o
•
11
Hello