HomeMy WebLinkAbout20012272.tiff RESOLUTION
RE: APPROVE CONTRACT RENEWAL LETTER#1 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 Contract Renewal Letter#1 for the
Health Care Program for the Children with Special Needs Program between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,
on behalf of the Weld County Department of Public Health and Environment, and the Colorado
Department of Public Health and Environment, commencing October 1, 2001, and ending
September 30, 2002, with further terms and conditions being as stated in said contract renewal
letter, and
WHEREAS, after review, the Board deems it advisable to approve said contract 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 Contract Renewal Letter#1 for the Health Care Program for
the Children with Special Needs Program between the County of Weld, State of Colorado, by
and through the Board of County Commissioners of Weld County, on behalf of the Weld County
Department of Public Health and Environment, and the Colorado Department of Public Health
and Environment be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said contract renewal letter.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 13th day of August, A.D., 2001.
BOARD OF COUNTY COMMISSIONERS
WELD CO NTY, COLORADO
ATTEST: / AI�/:°� E /J% �.eS(i/
. J. Geile, Chair
Weld County Clerk to the •;;
•
I-nn Vaad, . m
Deputy Clerk to the Boar EXCUSED EXCUSED DATE OF SIGNING (AYE)
William Jerke
R ED AST `•k
David E. Long
ounty A ey EXCUSED DATE OF SIGNIN AYE
Robert D. Masden
Date of signature: i f7
2001-2272
HL0028
Memorandum •
' TO: M.J. Geile, Chair
OBoard of County Commissioners
• FROM: Mark E. Wallace, MD, MPH, Director
COLORADO Department of Public Health and
Environment `410:11-,
Q9 J S
DATE: August 9, 2001 J `� 1(�"
SUBJECT: Task Order Renewal Letter for Health Care
Program for Children with Special Needs
Program
Enclosed for Board review and approval is Renewal Letter Number One to the Task Order
between the Colorado Department of Public Health and Environment and Weld County
Department of Public Health and Environment for the Health Care Program for Children with
Special Needs Program.
This letter will authorize 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 $145,269 for the time period October 1, 2001 through
September 30, 2002.
I recommend your approval of this renewal letter.
Enclosure
2001-2272
STATE OF COLORADO
Bill Owens,Governor ..0.Coto
Jane E.Norton,Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division • .;,,,.�c
Denver,Colorado 80246-1530 8100 Lowry Blvd. �•1876.;
Phone(303)692-2000 Denver,Colorado 80230-6928
TDD Line(303)691-7700 (303)692-3090 Colorado Department
Located in Glendale,Colorado of Public Health
httpi/www.cdphe.state.co.us and Environment
July 12,2001 Task Order Renewal Letter •
Health Care Program for Children with Special Needs(HCP)
State Fiscal Year 2001 -02, Task Order Renewal Letter Number 01,
Task Order Renewal Letter Contract Routing Number 02-00497
(Master Contract Contract Routing Number 00-00008) (Task Order Contract Routing Number 01-00797)
This Task Order Renewal Letter is issued pursuant to paragraph E17 of the Task Order with contract routing number 01-00797
and contract encumbrance number PO FAA HCP0100797 hereinafter referred to as the"Original Task Order"(a copy of
which is attached hereto and by this reference incorporated herein and made a part hereof)between the State of Colorado,
Department of Public Health and Environment and Board of County Commissioners of Weld County for the term from
October 1,2001 through September 30,2002 the parties agree that the maximum amount payable by the State for the eligible
services referenced in paragraph B of the Original Task Order is increased by ONE HUNDRED FORTY-FIVE THOUSAND
TWO HUNDRED SIXTY-NINE DOLLARS ($145,269.00)for a new total financial obligation of the State of THREE
HUNDRED TWO THOUSAND FOUR HUNDRED SEVENTY-SEVEN DOLLARS ($302,477.00). The revised work
plan,which is attached hereto as"Attachment 1",and the revised budget,which is attached hereto as"Attachment 2",are
incorporated herein by this reference and made a part hereof. The first sentence in paragraph C of the Original Task Order is
hereby modified accordingly. All other terms and conditions of the Original Task Order are hereby reaffirmed. This
amendment to the Original Task Order is intended to be effective as of October 1,2001. However,in no event shall this
amendment be deemed valid until it shall have been approved by the State Controller or such assistant as he may designate.
Please sign, date,and return ally originals of this Task Order Renewal Letter by September 4,2001 to the attention of:Peggy
Becker,Colorado Department of Public Health and Environment,4300 Cherry Creek Drive South,Denver,Colorado
80246-1530,Mail Code: PSD-HCP-A4. One original of this Task Order Renewal Letter will be returned to you when fully
approved.
Board of County Commissioners of eld County STATE OF COLORADO
(a political subdivision of that st f Colorado) Bill Owens,Governor
By: We, By:
Name: . J. Gei e or tr Executive Dire
Title: Chair (08/13/2001) DEPARTMENT OF P :L
FEIN: 84-6000813 HEALTH AND ENV I.ON ENT
I
C_J c
APPROVALS:
FOR THE STATE CONTROLLER: PROGRAM:
Arthur L.� rt -�� la " v
By:
bl� By:
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH AND NVIRONMENT
BY: •
Mark E. Wallace, MD, MPH•Director
Attachment 1
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP)
STATEMENT OF WORK
1. Under this Contract,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 1A","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. 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 2001 -2002(October 1,2001 through
September 30,2002),as described in the Weld County MCH Plan which is attached hereto as
"Attachment 1B". The plan is designed to:contribute to the accomplishment of the State's priorities,
performance measures,and outcome measures,as identified in"Attachment 1C".
3. Contractor shall perform in accordance with the HCP Performance Measures,which is attached hereto as
"Attachment 1D".
4. On or before January 15,2002,for October 1,2000 through September 30,2001 and on or before January
15,2003 for October 1,2001 through September 30,2002,the Contractor shall submit a"Year End
Progress Report"to the State, following the format attached hereto as"Attachment 1E", or a similar
format.
5. On or before December 1,2002,the contractor shall submit a final fiscal expenditure report,reporting
actual expenditures and in-kind contributions and signed by a certified official,following the format
attached hereto as"Attachment 1F"
6. On or before May 1,2002,the Contractor shall submit an annual MCH plan for federal fiscal year 2002-
2003(October 1,2002 through September 30,2003). A sample format,which the Contractor may use,is
attached as"Attachment 1G". The Contractor shall also submit to the State,for review and approval,a
Budget Estimate Form for the plan using"Attachment 1H,Section II".
7. Contractor shall engage in defined core public health activities designed to enhance the health status of
children with special health care needs. Using the"Suggested Children with Special Health Care Need
Activities",attached hereto as"Attachment 1I",which is incorporated herein by this reference and made a
part hereof,as guidance and an assessment of community needs,these activities may include direct or
enabling services,population-based activities and infrastructure building activities as described in
"Attachment lA","Core Public Health Services Delivered by MCH Agencies".
S. The Contractor will serve State recipients and recipient families who are determined to be eligible for
Program services. Recipients served will be children residing or whose families have residence in Weld
County.
Page 1 of 2
9. The Weld HCP Regional Office shall work cooperatively with the public health nurses(PHNs)from Weld
County.
10. The HCP Discipline Regional Coordinators funded through this contract shall serve State recipients who
reside or whose families have residence in the counties as defined below:
A. The Audiology Regional Coordinator shall serve Weld County.
B. The OT/PT Regional Coordinator shall serve Weld County.
C. The Speech Regional Coordinator shall serve Weld County.
1:\HCPConm on\CLERICAL\CONTRACT\WORD\ROs\FY 02\Weld ROWttachment 1-Statement of Workdoc
Page 2 of 2
Attachment IA
• CORE PUBLIC HEALTH SERVICES - -
DELIVERED BY MCH AGENCIES
DIRECT
HEALTH CARE
SERVICES:
(GAP FDI]NG)
•
Examptcs•.
Basic Hcdd.Services,
and Health Services(or CSHCN
ENABLING SERVICES:
Exempts
Mammalian. Omrc,cfi,
Respite Care,HulthEdacafmq Family
Sapped Semite;Ptttdusc orHcal&Inso aace,
Cast Management,Coordmidon with Medicaid.
WIC,.and.Eduction
POPULATION-BASED SERVICES:
Newborn Saeeaing Lad Screemage Immunkiewa,
Sudden Infant Death Syndrome CounreEng.Oral Health,
Injury Prcacdioa,NEWS' on
and Outreadt/Pable Education
INFRASTRUCTURE BUILDING SERVICES:
Example=
Needs Acsurmas,ErdaaGoa,Planning,Policy Development,
Coordination,Quality An-urinoc„Standards Development_Monitoring,
Training,Applied Attar.*Systems of Care,and Information Systems
MCKII/OSCH tenon,
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 1B
B. Plan- Objectives, Activities, Monitoring,and Evaluating
Health Care Program for Children with Special Needs
Need: Families need case management to help them access appropriate health care for their
child with special needs.
Program Objective: 75% of eligible children enrolled in the Weld County HCP program will
receive case management during the fiscal year.
Activities: 1. Eligibility determination complete upon receipt of application and
annual renewal during the contractual 2001 -2002 year.
2. Complete HCP/IRIS eligibility calculator within the State guidelines of
45 days. Cases pending Medicaid/CHP+may need extended time due to
processing time required by those systems.
3. Direct care services will be authorized according to HCP guidelines
and service availability.
4. Caseload assignments will be determined by the HCP Special Needs
Concern List Acuity Tool.
5. The Care Coordination Child/Family Plan of Care will be completed
for each HCP client enrolled in the 2001- 2002 year.
6. Ineligible children will be referred to other community resources.
Type of Activity: Direct Care, Enabling
Monitoring: 1. Track quarterly the number of families receiving case management
services.
2. Utilize IRIS Data to record enrollment completion and the number of
authorized direct services provided.
3. Review quarterly HCP caseload acuity levels per assigned care
coordinators.
4. The Care Coordination Child/Family Plan of Care will be present in
each active client's chart.
Evaluation: 1. IRIS data will indicate that 75% enrolled clients are assigned to case
management.
Page 1 of 1
Attachment IC
MATERNAL AND CHILD HEALTH(MCH)
PRIORITIES AND PERFORMANCE MEASURES
As of October 1,2001
Colorado MCH Priorities
1. Reduce teen pregnancy and unintended pregnancy in women of all ages.
2. Improve perinatal outcomes.
3. Reduce child and adolescent morbidity.
4. Increase health and safety in child care settings.
5. Improve efforts to reduce unintentional and intentional injury, addressing motor vehicle crashes, suicide,
child abuse and other violence.
6. Improve immunization rates for all children.
7. Increase access to health care(including behavioral health care).
8. Improve state and local infrastructure by increasing capacity to analyze data,carry out evaluations,develop
quality standards,and assure availability of services to all children,including children with special health
care needs.
9. Reduce substance abuse(alcohol,tobacco,and drugs).
10. Improve oral health and access to oral health care.
National MCH Performance Measures
1. The percent of State SSI beneficiaries less that 16 years old receiving rehabilitative services from the State
Children with Special Health Care Needs Program.
2. The degree to which the State Children with Special Health Care Needs Program provides or pays for specialty
and subspecialty services,including care coordination,not otherwise accessible or affordable to its clients(nine-
point scale).
3. The percent of Children with Special Health Care Needs in the State who have a"medical home".
4. Percent of newborns in the State with at least one screening for each of PKU,hypothyroidism,galactosemia,
hemoglobinopathies(e.g.the sickle cell diseases).
5. Percent of children through age 2 who have completed immunizations for Measles,Mumps, Rubella, Polio,
Diptheria,Tetanus,Pertussis,Haemophilus Influenza,Hepatitis B.
6. The rate of birth(per 1,000)for teenagers aged 15 through 17 years.
7. Percent of third grade children who have received protective sealants on at least one permanent molar tooth.
8. The rate of deaths to children aged 1-14 caused by motorvehicle crashes per 100,000 children.
Page 1 of 2
9. Percentage of mothers who breastfeed their infants at hospital discharge.
10. Percent of Children with Special Health Care Needs(CSHCN)in the State CSHCN program with a source of
insurance for primary and specialty care.
11. Percent of all children in the state without health insurance.
12. The rate(per 100,000)of suicide deaths among youths aged 15— 19.
13. Percent of very low birth weight live births.
14. Percent of potentially Medicaid eligible children who have received a service paid by the Medicaid Program.
15. Percentage of newborns who have been screened for hearing impairment before hospital discharge.
16. The degree to which the State assures family participation in program and policy activities in the State CSHCN
program.
17. Percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates.
18. Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester.
Outcome Measures
1. The infant mortality rate per 1,000 live births.
2. The ratio of the black infant mortality rate to the white infant mortality rate.
3. The neonatal mortality rate per 1,000 live births.
4. The postneonatal mortality rate per 1,000 live births.
5. The perinatal mortality rate per 1,000 live births.
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Attachment 1D
Revised June 22,2001
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 IA of the Statement of
Work, serve as guidance for communities defusing optional indicators for local actions on behalf of children with
special health care needs.
A. The definition of children with special health care needs includes the following:
1. For the purpose of planning: Children with special health care needs are those
who have or are at risk for a chronic physical, developmental, behavioral or
emotional condition and who also require health and related services of a type
or amount beyond that required by children generally. (Developed by the
Federal Bureau of Maternal Child Health in 1995.)
2. For the purpose of enrollment into HCP Full Service Benefits: Continued
use of the much more limited definition covering chronic, physical medical
conditions as defined in the HCP Manual.
B. Performance Measures:
1. Direct Services
1.1 Implement the program for HCP Direct Service Benefits including clinic services for
eligible children according to the time lines, policies and procedures described in the
HCP Policy&Procedure,and IRIS Manuals.
1.2 Utilize the HCP Regional Office Discipline Coordinators to assist regional office staff in
activities as defined in the HCP Manual.
1.3 Participate with the annual state site visit survey tool and follow-up for quality assurance
for HCP Direct Services. Include site visit survey report results and the plan for
improvement in the HCP Contract Performance Report due to the State by October 31,
2002.
2. Enabling Services
2.1 Assist families who have children with special needs in applying for and receiving
resources from Medicaid,CHP+and SSI.
2.2 Define specific activities to build capacity in the community with other agencies to
collaborate with care coordination services specifically families, Part C, EPSDT, the
child's Medical Home,schools,day care,etc.
2.3 Assure appropriate multidisciplinary staffing of care coordination services,for developing
Care Coordination Plans and to begin to address not only the medical needs and
Page 1 of 3
resources,but also the mental health care needs and family support needs of the children
and families enrolled for HCP Direct Service Benefits.
3. Population-Based Services
3.1 Assure that the Audiology Regional Coordinators work with hospital staff to assure that at
least 95 percent of all newborns are screened with a less than four percent referral rate at
discharge by ensuring: I) the newborn hearing screening equipment and guidelines are
understood and in place in each birthing hospital in the service area,2)that recommended
procedures for children who fail the hearing screening are followed in each hospital, and
3) that local audiologists, pediatricians and hospital staff are educated on the importance
of early identification and intervention as well as the community resources available to
the professional and to families.
3.2 Use reports from the Colorado Infant Hearing Data Management System to follow up
with families,as appropriate.
3.3 Identify if all children have a Medical Home using the four screening questions on the
Health Questionnaire that is part of the HCP Application (Summer 2001). Refer all
children to a primary care physician if needed. Collaborate with the child's primary care
provider for medical care and care coordination.
4. Infrastructure and Capacity Building
4.1 Complete and submit the HCP Contract Performance Report by October 31,2002.
4.2 Each regional office team will consist of staff, either as FTE, contractor, or shared with
another regional office, which includes the following core disciplines: nursing, nutrition,
audiology, early intervention specialist for hearing loss, speech, occupational 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 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 become part of the
team. Multidisciplinary team members will assist in assessing needs and facilitating
efforts to coordinate community health and support services for children with special
health care needs.
4.3 The HCP Regional Office Team Leader and each State Discipline Consultant, will
determine and document,in writing,which priorities from the discipline's Scope of Work,
included in the HCP Policy & Procedure Manual, will be accomplished during each
contract period for the Social Work Service Provider, Parent Consultant, and each
Regional Discipline Coordinator(audiology,Co-Hear,nutrition,OT/PT,and speech).
4.4 When Discipline Regional Coordinators are shared with other HCP regional offices, the
appropriate Regional Office Team Leaders, state discipline consultants, and regional
coordinators will meet together at least annually to discuss issues, concerns, and
satisfaction with the contractor before renewing the contract.
4.5 HCP Regional Office Team Leaders will attend two meetings together with the State HCP
staff Discipline staff will attend specified Regional Office Team meetings or conference
calls and will attend at least two State meetings or conference calls per year of all the
coordinators for that discipline, as convened by the State Discipline Consultants. And
Page 2 of 3
will ensure that a minimum of one staff member attends the bi-monthly HCP conference
calls and quarterly HCP Technician conference calls.
4.6 Ensure all IRIS users attend IRIS Training and meet the"FY2002 Standards for Usage of
IRIS I and II, attached as "Attachment 11)1". Ensure a minimum of one staff member
attends the monthly IRIS Task Force conference calls.
4.7 To ensure the central role of families as advisors and participants in policy-making
activities and as documented in the HCP Contract Performance Tool Report.
4.7.1 Family members participate on advisory committees or task forces and are
offered training, mentoring and reimbursement. The family members referred to
in this measure do not all need to be an HCP Parent Consultant;different parents
may be used for the activities mentioned.
4.7.2 Financial support(financial grants, technical assistance, travel and child care) is
offered for parent activities or parent groups.
4.7.3 Family members are involved in training of HCP staff and providers.
4.7.4 Family members are hired staff or consultants to the HCP regional office for
their specific expertise.
4.7.5 Family members of diverse cultures, which represent the diversity of the
community,are involved in all of the above activities.
5. For Multi-County Regional Offices
5.1 Orient and train new county staff assigned to HCP.
5.2 Meet at least once a year,individually or at regional meetings with each county,to review
their goals and objectives, and the Community Plans, and to provide consultation and
technical assistance around HCP policies for HCP full service benefits, care coordination,
CHP+,HCP clinics, newborn hearing screening,parent involvement, and development of
MCH Plans.
5.3 Convene at least one meeting annually of all regional office HCP team members including
county nurses and discipline coordinators.
5.4 Summarize the Community Plans from the county nursing agencies and submit a copy of
the summary to the State Program Consultant by January 15, 2002 and report the
Regional Office's responses, to the plans, in the Regional Office Contract Performance
Report by October 31,2002.
6. Negotiated Objectives in MCH Plan
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Attachment 1D1
Health Care Program For Children With Special Needs(HCP)
FY 2002 Standards for Usage of IRIS I and II
I. Registration and Annual Renewal
1. Policies and procedures and timelines are followed as described in the HCP Policy and Procedure and
IRIS Manuals.
2. Complete Eligibility Calculator within 45 days of receiving application
3. Use the concern list and enter acuity level on IRIS for all new HCP enrollees. (Use Care
Coordination Booklet,March 2001,Fifth printing.) The Acuity Tool will be completed by Regional
Offices for any HMO with whom HO'has a contract for care coordination.
Note: IRIS II will determine acuity level when encounters are completed using the concern drop down list.
Before IRIS II continue to use the concern list to determine acuity.
II. Services-All services,providers,and payers are entered on IRIS and approval letters mailed for any services
requiring financial reimbursement or tracking by HCP including the following examples:
1. All children receiving HCP direct services including children receiving nutrition,Home Intervention
Program,speech,OT/PT,and social work services.
2. All children receiving care coordination services paid by a third party such as CHP+,HMO or
Medicaid.
3. All children attending HCP clinics with follow-up diagnostic studies or referrals to other specialist or
providers. Clinic visit screen will be completed for all clinic visits when IRIS II is implemented.
4. Home health services,lodging and meals.
5. Surgeries,hospitalizations,emergency services,orthodontia,pediatric/specialty consultation,durable
medical equipment,hearing aids,and medications.
III. Weekly process for uploading and downloading is required. Security procedures must be in place for all HCP
staff who are IRIS users. Individual passwords for each HCP staff must be used and kept confidential.
Regional offices must not add additional IRIS users without receiving security clearance from the state office.
IV. HCP Regional Office staff are required to attend IRIS training before receiving security access.
1. IRIS I training is included in the monthly HCP Eligibility and Orientation Class with additional
training provided as needed by the state office staff.
2. IRIS II training will be scheduled for all Regional Office IRIS users before IRIS II is implemented.
3. Regional Office staff will assist HCP state staff with IRIS training before implementation of IRIS II
for the counties in the multi-county regional offices.
Revised June 20,2001
J.\HCPCommon\CLERICAL\CONTRACI\WORD\ROs\FY 020/dcW RO Attachment 101-IRIS Standards 701 doc
Attachment 1E
MATERNAL AND CHILD HEALTH(MCH)
OUTLINE FOR YEAR END PROGRESS REPORTS
for Federal Fiscal Year 2000-2001 (October 1,2000 through September 30,2001)
DUE JANUARY 15,2002
and
for Federal Fiscal Year 2001-2002(October 1,2001 through September 30,2002)
DUE JANUARY 15,2003
As of October 1,2001
Please put the agency name,contact person and telephone number at the beginning of the report or on a cover page.
I. MCH Plan Progress Report
A. Perinatal Population:
1. Restate the priority needs of the perinatal population for which the MCH funds were used.
2. For each priority need for which MCH funds were used:
a. Restate the objective(s)which addressed that priority need;
b. State if the objective was fully met,partially met,or not met;
c. Describe what was accomplished, including summarizing important activities.
B. Child and Adolescent Population:
1. Restate the priority needs of the child and adolescent population for which the MCH
funds were used.
2. For each priority need for which MCH funds were used:
a. Restate the objective(s),which addressed that priority need;
b. State if the objective was fully met,partially met,or not met;
c. Describe what was accomplished,including summarizing important activities.
C. Children with Special Health Care Needs(CSHCN)Population:
1. Restate the priority needs of the children with special health care needs population for
which the CSHCN funds were used,through the contract with the Health Care Program
for Children with Special Health Care Needs(HCP):
2. For each priority need for which the CSHCN funds were used:
a. Restate the objective(s)which addressed that priority need;
b. State if the objective was fully met,partially met, or not met;
c. Describe what was accomplished,including summarizing important activities.
Page 1 of 8
3. Please describe any mechanisms that are in place in your community for coordination of
health services which are new since the report in January of last year. This would include
coordination among providers of primary care,habilitative and rehabilitative service,or
other specialty medical treatment services,mental health services and home health care.
4. Please describe any mechanisms that are in place in your community for coordination and
service integration among programs serving children with special health care needs,
including early intervention and special education, social services and family support
services,which are new since the report in January of last year.
II. Describe any important changes in administrative or organizational aspects of the program which affected
service delivery during the twelve-month period.
III. Describe any emerging issues regarding the perinatal population,child and adolescent population and/or the
children with special health care needs population in your community.
IV. Fill out Tables I and II as applicable and submit along with your report.
V. Complete the Final Expenditure Report for Maternal and Child Health Programs for the MCH funded
services for the Perinatal Population and for the Child and Adolescent Population. (Attachment 1F).
Please submit five(5)copies of your report to:
Carolyn Dodge,CPS,PSD-ADM A4
Division of Prevention and Intervention Services for Children and Youth
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver,CO 80246-1530
no later than 5:00 P.M.on Tuesday,January 15,2002
for the period October 1,2000 through September 30,2001
and
no later than 5:00 P.M.on Wednesday,January 15,2003
for the period October 1,2001 through September 30,2002
I:UICPConmon\CLERICAL\CONfRAC11WORD\ROe\FY 02\Wcld ROUllman R IE-Outline for Year End Progress Repon.doc(09/25/00)SM/pw
Page 2 of 8
Program
Prepared by
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TABLE I (7 AR)
NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED) UNDER TITLE V
By Class of Individuals and Health Coverage, FY 00-01*
(1) (2) (3) (4) (5) (6)
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 Insurance4 Coverages Unknown
Pregnant women, postpartum and deliveries6
Infants under age one (not elsewhere)8
Children age 1-22 (not elsewhere)to
Children with special health care needs
Other individuals (not elsewhere)9
Total MCH Population"
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 1,2000 through September 30,2001
Page 3 of 8
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. These 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, 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 Progress Report due January 15, 2002, to Carolyn Dodge, CPS, 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).
°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.
6Total number of pregnant(or postpartum)women who received any services provided or paid for in whole or in part by Title V.
7Total 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.
8Total number of infants less than one who received any services provided or paid for in whole or in part by Title V.
9Total 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.
10Total 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).
"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, 7/26/00
c:\123r3\mchapp02\6mo&fpr.doc
i:\sue\mchapp02\6mo&fpr.doc
Page 4 of 8
Table II applies only to programs providing service to pregnant women and/or infants under the age of 1.
Program
Prepared by
Telephone
TABLE II (8 AR)
NUMBER OF DELIVERIES AND INFANTS SERVED BY TITLE V
UNDUPLICATED COUNT BY RACE AND ETHNICITY, FY 00-01*
(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'
i I I
Total Infants served by program=
* October 1, 2000 through September 30, 2001.
'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 Progress Report due January 15, 2002, to Carolyn Dodge, CPS, PSD-ADM-A4, Colorado Department of
Public Health and Environment, 4300 Cherry Creek Drive South, Denver, CO 80222-1530.
Table II
Page 5 of 8
Program
Prepared by
Telephone
TABLE I (7 AR)
NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED) UNDER TITLE V
By Class of Individuals and Health Coverage, FY 01-02*
(1) (2) (3) (4) (5) (6)
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 Population"
_ 1
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 1,2001 through September 30,2002
Page 6 of 8
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. These 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, 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 Progress Report due January 15, 2003, to Carolyn Dodge, CPS, 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):
1Total 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).
4Number 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.
6Total number of pregnant(or postpartum)women who received any services provided or paid for in whole or in part by Title V.
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.
8Total number of infants less than one who received any services provided or paid for in whole or in part by Title V.
9Total 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.
10Total 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, 7/26/00
c:\123r3\mchapp02\6mo&fpr.doc
i:\sue\mchapp02\6mo&fpr.doc
Page 7 of 8
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, FY 01-02*
(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 program2
* October 1, 2001 through September 30, 2002.
'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 Progress Report due January 15, 2003, to Carolyn Dodge, CPS, PSD-ADM-A4, Colorado Department of
Public Health and Environment,4300 Cherry Creek Drive South, Denver, CO 80222-1530.
Table II
Page 8 of 8
Attachment IF
APPLICANT:
PROJECT: Health Care Program for Children with Special Needs (HCP)
ACTUAL EXPENDITURES:
FOR THE PERIOD: OCTOBER 1,2001 through SEPTEMBER 30,2002
Annual Full Total Source of Funds
Salary Time Amount *Applicant Requested
Rate Equivalent Required and Other from CDPHE
PERSONNEL EXPENSES:
Fringe Benefit Rate and Expenses
Total Personnel Expenses
CONTRACTED SERVICES:
Sub-total Contracted Services
OPERATING EXPENSES:
(include only costs not part of indirect)
Sub-total Operating Expenses
TRAVEL:
Sub-total Travel Expenses
EQUIPMENT:
Sub-total Equipment Costs
Administrative/Indirect Rate and Costs
TOTAL PROJECT COSTS
*Source of Funding for "Applicant and Other"
State Percapita Funds lil $
Local/County Funds (2) $
Medicaid Funds $
Patient Fees $
Other $
Total Applicant and Other $
iii May these State Percapita funds be used to match
Colorado's Maternal and Child Health Block Grant? YES NO
(2) May these Local/County funds be used to match
Colorado's Maternal and Child Health Block Grant? YES NO
Signature of Director or Authorized Representative Date
I:ViCPConmon\Cleric Conva"\WOMFommtgnditwe Report Fmmxlt
Attachment 1G
MATERNAL AND CHILD HEALTH(MCH)
COUNTY MCH PLAN
As of October 1,2001
The County MCH Plan asks the local public health agency to assess and prioritize the health status needs of the
Perinatal Population,the Child and Adolescent Population and the Children with Special Health Care Needs
Population(CSHCN)and to identify how the MCH funds will be used to address the priority needs. The Plan is to
categorize the activities or services which will be used to address the needs by four types of services,i.e. direct care
services,enabling services,population-based services or infrastructure-building activities as defined by the Maternal
and Child Health Bureau in"Core Public Health Services Delivered by MCH Agencies".
Quantitative and qualitative data gathered at the state and local levels should be used in assessing health status needs.
The resources available in the community to meet the needs should also be assessed and considered in establishing
the priorities to be addressed. Local public health agencies are encouraged to collaborate with public and private
partners in the development of the Maternal and Child Health Plans.
Colorado has identified ten MCH priorities to be addressed with MCH Block Grant funding. The services or
activities provided under the MCH funding should be responsive to one or more of the priorities. There is no
ranking of the ten priorities. They are as follows:
1. Reduce teen pregnancy and unintended pregnancy in women of all ages.
2. Improve perinatal outcomes.
3. Reduce child and adolescent morbidity.
4. Increase health and safety in child care settings.
5. Improve efforts to reduce unintentional and intentional injury,addressing motor vehicle crashes,
suicide,child abuse and other violence.
6. Improve immunization rates for all children.
7. Increase access to health care(including behavioral health care).
8. Improve state and local infrastructure by increasing capacity to analyze data,carry out evaluations,
develop quality standards,and assure availability of services to all children,including children
with special health care needs.
9. Reduce substance abuse(alcohol,tobacco,and drugs).
10. Improve oral health and access to oral health care.
Please present the Statement of Need and the Plan for children with special health care needs using the following
format:
I. CHILDREN WITH SPECIAL HEALTH CARE NEEDS POPULATION
A. Statement of Need-What are the priority needs of the Children with Special Health Care Needs
population in the County or District,based on an assessment of the health status needs and of the
resources to address the needs?
1. Health and related service needs-What information about the health and related service
needs of the children with special health care needs in your county or district were used to
select the priority needs?
2. Resources to address the health and related service needs-What are the resources of the
public health agency and of other agencies in the community which address the health and
related service needs of children with special health care needs in your community?
Page 1 of 3
a. Direct Care Service Needs-What are the resources in the community which
provide direct health care services for the children who have conditions or
illnesses which are diagnostically eligible for direct care payment by the Health
Care Program for Children with Special Health Care Needs? Are there gaps or
unmet needs in such direct care services? Are there issues of availability and
accessibility?
b. Enabling Services-What are the resources in the community which provide
enabling services,i.e.transportation,interpretation and translation,outreach,
health education,family support services,case management and service
coordination with other related services? Are there gaps or unmet needs?
c. Population-Based Service Needs-What are the resources which provide
population-based services for children with special health care needs in the
community,i.e.newborn hearing screening or vision screening services?
d. Infrastructure-Building Services or Activity Needs-What infrastructure-building
services,resources or activities are needed to promote the development of
community-based systems of services for children with special health care needs
and their families? Present information regarding the need for activities such as
planning activities,needs assessments,program evaluation,policy development,
program coordination,quality assurance activities,standards development,
monitoring,training,research,developing systems of care and related services,
or development of information systems.
3. Unmet or continuing needs-Considering the health and related service needs and the
resources which address the needs that were identified above,what are the continuing or
unmet needs for direct care,enabling,population-based and/or infrastructure building
services?
B. Children with Special Health Care Needs Plan
Priority Needs for use of CSHCN funds-Considering the unmet or continuing needs
identified in the Statement of Need(Section A),what are the priority needs of the children
with special health care needs population for which CSHCN funding under the contract
with the Health Care Program for Children with Special Needs(HCP)will be used?
Explain your rationale for selecting these needs to be the ones addressed with the CSHCN
funds.
2. Operational Plan-Objectives,Activities,Monitoring and Evaluating
Need Restate each of the needs that will be addressed with CSHCN funding
Objective State the objective or objectives(one to four objectives suggested)that
will address this need. All objectives should be reasonable,specific,
time-framed and measurable.
Activities Describe the specific activities that will be carried out to achieve each
objective. Include"Best Practice"or"Evidence-Based"interventions
or activities whenever possible. Categorize the activities according to
the level or type of service being carried out(i.e., direct health care,
enabling,population-based,or infrastructure-building).
Page 2 of 3
Monitoring Describe your methods of monitoring to assure quantity of service
(numbers of clients and services)and quality of service(measured
through use of protocols,chart audits,policy procedure manuals,etc.).
Infrastructure-building activities or services may be monitored by
tracking the completion of planned activities or whether benchmarks
have been realized or protocols or policy procedures put in place.
Evaluation Describe your methods of evaluation the effectiveness of your activities
in addressing the identified need.
I:UICPConnnn\CLERICAL\CONrRAC11WORD ROs\FY 02\Weld ROUttachrctn 1O-County MCH Plan.doc(09/28/00)SM/pw
Page 3 of 3
Attachment 1H
BUDGET ESTIMATE FORM FOR THE PERIOD:
CONTRACTOR:
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 amount
DOLLARS PERCENTAGE
AMOUNT AND PERCENTAGE ALLOCATED TO: - -
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-
h:4nchreprtNursing_wb2
Page 1 of 1
Attachment 1I
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP)
SUGGESTED CHILDREN WITH SPECIAL HEALTH CARE NEED ACTIVITIES
TO FULFILL REQUIREMENTS FOR MCH LOCAL HEALTH CONTRACTS
AND COUNTY PRELIMINARY AND STRATEGIC PLANS
As of October 1,2001
The following suggested strategies are offered as guidance to local public health agencies in defining how current or
new services fit within the core public health functions. The Maternal and Child Health contract between local
agencies and Colorado Department of Public Health and Environment(CDPHE)requires needs assessment of local
communities. Local public health staff is currently doing many of the following activities. The CDPHE Health Care
Program for Children with Special Needs(HCP)and Public Health Nursing consultant staff will provide technical
assistance as needed in assisting local public health agencies to define which of these—or other activities—are most
appropriate for addressing the needs of children with chronic illnesses and disabilities.
1. Direct Services
The policies establishing which diagnosis or conditions will be covered by the Colorado Health Care
program for Children with Special Needs(HCP)are set at the state level and the funding and payment for
the direct personal specialty care services is administered at the state. Therefore,it is not necessary to
establish a plan for direct care provision at the county level.
2. Enabling Services
2.1. Conduct an initial interview with a defined population(NICU,SSI,etc.)of new families to help
them determine their need for information,referral and/or care coordination using a standard tool
such as the "Family Status Profile"form,attached hereto as Attachment 1I1
2.2. Assist families who have insurance coverage,including private insurance,CHP+and Medicaid and
those in managed care plans,to understand their benefits and their disenrollment and grievance
procedures.
2.3. Refer families to agencies and services for which they are eligible and assist them with the
registration or application process,(WIC,CHP+,Baby Care/Kids Care,Medicaid, SSI,etc.).
Follow-up with the family to assure the family was able to make the suggested contacts.
2.4. Determine the status of primary care and immunizations and make appropriate referrals. Work in
collaboration with the EPSDT outreach worker if the child is on Medicaid to assure that EPSDT
benefits have been explained and an EPSDT screen has been completed and billed.
2.5. Initiate or participate in the development of a Care Plan or IFSP(Individual Family Service Plan)
with the family when it has been determined that a family would benefit from care coordination.
This includes a statement of the family's strengths and needs as identified by the family and
strategies for enhancing the child's development. Include a statement of major outcomes to be
achieved by the child and family. State the criteria,procedures and time lines. Document periodic
statements of progress towards meeting family goals and the need for modifications or revisions.
The process for the development of a care plan or IFSP should include all the disciplines involved
with the child's care,i.e.,audiologist,CHIP therapist,social worker,family advocate,OT/PT,
dietitian,speech therapist,etc.
Page 1 of 4
2.6. Follow-up with family according to plans written on Care Plan or IFSP. Should HCP staff have no
direct role in the IFSP or are not doing care coordination,assure that a contact with each family is
made at least once a year to assure that the child and family are receiving necessary services and
that the family is aware of community resources available to them.
2.7. Make home visits when appropriate. (Situations might include complex medical or surgical
conditions or when resources or help can be provided relating to the home environment.)
2.8. Work in concert with the EPSDT outreach worker to review monthly listing of SSI recipients and
Contact SSI families to assure that health care needs are being met. If there are needs which HCP
can meet,assure that children are enrolled in the program.
2.9. Meet periodically with staff from local agencies such as social services,representatives from the
Community Centered Board,mental health and special education services from local schools to
collaborate around services to individual children and their families.
2.10. Work with the older children and their families to facilitate transition from pediatric services to
adult health care services. (To begin at about age 12 years.)
2.11. Work with NICU Consortium contacts in hospitals to identify needs of newborns as the child
prepares to leave the hospital to return to the community. Make contact with other community
resources as needed.
2.12. Designs and maintains a clinic structure including identifying and scheduling clinic providers,
facilities,and equipment. Sets clinic dates. Seeks referrals by contacting local doctors,Child
Find,interagency councils,and Community Center Boards to inform them of the clinics.
Distribute the local HCP clinic schedule to appropriate agencies and individuals.
2.13. Organizes,schedules and staffs each clinic using guidelines provided in the HCP Procedure
Manual. Obtains a HCP Registration on each child scheduled for clinic and a consent for service
signed by the parent or legal guardian. Provides the clinician with Medicaid and private insurance
billing information and collects clinic fees from over-income families who do not have health
insurance.
2.14. Completes a Clinic Encounter Form for each clinic patient.After each clinic submits Encounter
Forms,a copy of the attendance list(schedule)and the dictation to the assigned Regional Office.
2.15. Assures that families have transportation to each clinic and that appropriate and competent
interpretation services are available.
2.16. Depending on the complexity of the child's condition and the needs of the family,appropriate team
members will attend and participate in the multi-county clinics.
2.17. Evaluates the clinic caseload,waiting list and summaries yearly to determine the number and type
of specialty clinics needed. Reports findings to the Regional Office Team Leader.
2.18. Identify existing health care providers and support resources including translation,transportation
and respite care.
3. Population-based Services
3.1. Promote public health services available to children,i.e.,HCP,WIC,Well Child,EPSDT,and
Immunizations by using local media,posters and attendance at health fairs,etc.
Page 2 of 4
3.2. Develop and maintain liaisons with the local community resources to maintain open
communication,to promote the services of HCP and other services available to children with
special needs,and to establish a network for working together to eliminate gaps or duplication of
services and supports.
3.3. Assure that HCP staff is trained in Early Childhood Connections(Part C of IDEA)including the
Colorado Interagency Coordinating Council Values Statements(see attached),IFSPs,Service
Coordination,Procedural Safeguards and eligibility criteria.
3.4. Assure that HCP staff is trained in the eligibility criteria and referral procedures for Medicaid,SSI,
Children's Medical Waiver 200,Children's Home Care Based Services Waiver(Katie Beckett-
Model 200 Waiver),and EPSDT. Assure that EPSDT case managers are knowledgeable about
HCP services.
3.5. Assure that training opportunities are provided to staff on cultural competency and family-centered
care.
3.6. Establish or maintain interagency collaboration through periodic meetings with representatives of
the local human services agencies,the Community Center Board,the mental health agency and
special education services from the school district to understand their services,to learn about their
eligibility criteria,and to provide them with information about HCP and other resources within the
local community.
3.7. Participate in the community's early child identification process as an active member of the
community team. This participation could include assigning staff time to directly participate in a
community sponsored identification process or coordinating the agency's services such as Well
Child,EPSDT,HCP and WIC,with other efforts so as to provide on-going systems of early
identification for children 0-21 years.
4. Infrastructure-building Services
4.1. Know the numbers of children in the counties served by the agency and be able to estimate the
number of children with special health care needs. Know the target population of children who are
potentially eligible for HCP paid service benefits and the actual number of children currently
registered with HCP. Analyze large discrepancies between target and actual caseloads.
4.2. Know and analyze the numbers of children enrolled on HCP for care coordination only.
4.3. Coordinate and/or participate in conducting a community needs assessment with public and private
agencies,organizations,providers and parents which identifies problems or voids within the
service delivery system for children with special health care needs,defines the problems and
determines the services or changes necessary to meet the identified needs. Elements involved in
this process include:
4.3.1. Involvement in tracking and data collection efforts of the community concerning the
number of children with special health needs,the types of services needed,the types of
services available,the accessibility of services,the quality of the services,whether the
services are culturally competent and family centered,and a method to receive customer
feedback about the services.
4.3.2. Awareness of and collaboration with other community agencies and projects regarding
data that is being collected and use of the data to most effectively enhance the community
service system for children with special needs.
Page 3 of 4
4.3.3. Establishment of mechanisms to include strong family participation in the development of
all assessments.
4.3.4. Coordination with other agencies and organizations to jointly survey the community
including families,providers and human service agencies and development of a process to
provide feedback to those who participated in the answering of the surveys.
4.4. Provide assessment reports to the community.
4.5. Coordinate and/or participate in the community planning process to develop policies goals and
objectives based on the community needs assessment.
4.6. Develop local networks and partnerships with other community resource agencies to determine
policies to support the development of comprehensive,community-based systems of care including
identification,assessment,intervention and referral services for children with special health care
needs.
4.7. Develop referral and follow-up care systems using available resources such as Colorado Responds
To Children With Special Needs(CRCSN),NICU Consortium,Universal Newborn Hearing
Screening Programs,and hospital discharge planners,to identify children who may need support,
care coordination and/or referral to community resources.
4.8. Establish a mechanism for including input from parents regarding current services,planning,
policy development,implementation and evaluation of HCP paid service benefits as well as
community/health services for all children with special health care needs. The process should
include a means to provide feedback to families about decisions made in these areas.
4.9. Develop and maintain a system of parent support that includes:
4.9.1. Parent to parent support and/or support groups;
4.9.2. Internal practices that support advocacy for family needs and problem solving;
4.9.3. Information and education;
4.9.4. Linkages with community agencies to assure the availability and adequacy of resources to
support the needs of families.
4.10. Assure that there is community parent representation from families who have children with special
needs in the community service system efforts. (For example,attending meetings,contacting
representatives,providing input into quality and quantity of local services.)
4.11. Participate actively in a community interagency council(ICC)by meeting regularly for the purpose
of planning and policy development. (These can be a formal or informal group of agencies,
providers and parents who are interested in working together to discuss services for children with
special needs,to identify barriers and gaps in the service delivery system,to develop collaborative
plans for removing the barriers and gaps including writing community-based grants for
improvement of local systems.
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Attachment 1I1
ooWV.So COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP)
FAMILY ASSESSMENT TOOL
CURRENT FAMILY STATUS PROFILE
Date Completed: / /
Child's Name Date of Birth: / /
Child's Address:
County:
Mother's Name:
Father's Name:
Legal Guardian's Name:
Guardian's Employer:
Home#: Work#: Message#:
Completed by
Signature Relationship
Reviewed by R.N.
Signature
SUBJECTIVE DATA
1. How can we help you?
2. What are your concerns about your child's health issues?
3. Is your child visiting a doctor or clinic on a regular basis? ❑YES ❑NO
If YES: Who is your child's regular doctor or care provider?
How often does your child see his/her regular doctor or care provider?
What medications and/or treatments has your child's doctor recommended?
Are you able to get the medications and/or treatment your child needs? ❑YES ❑NO
Have you had any difficulties getting your child's medicines? ❑YES ❑NO
Have you had any problems getting the treatments that your doctor has
recommended? ❑YES ❑NO
Are your child's shots (immunizations)up-to-date? ❑YES ❑NO
Do you have a copy of your child's shot records and could we have a copy? ❑YES ❑NO
Page 1 of 4
4. What other people or organizations are involved in your child's care?
5. Is there anyone involved who is helping you to pull these people and services together?
❑YES ❑NO
If YES,What is his or her name?
and
What is his or her relationship to you?
6. How do your child's needs affect you and your family?
7. What are your plans and hopes for your child?
Long-term:
Short-term:
8. What are your child's plans and hopes for him or herself? (if applicable)
Long-term:
Short-term:
9. What is being done to support your child and your family to be successful with those plans?
10. What do you see as strengths in your family?
11. We know that many times families have needs that are not necessarily medical, but make it difficult to care for
their family. Do you or your family have any other issues that we can help you with, i.e., housing, food,
clothing?
12 Are you able to get away from the house to do things for yourself if you need to? ❑YES ❑NO
13. Are you able to go to the doctor if you need to? ❑YES ❑NO
14. Are you and your family covered by Medicaid or health insurance? ❑YES ❑NO
15. Is there anything else we could assist you with?
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OBJECTIVE DATA OBSERVED (if on-site interview conducted) use additional paper if needed
ASSESSMENT FORM
This form should only be used as a guide for assessment. Further studies are needed in order to quantify
assessment guide and assess for validity and reliability.
ASSESSMENT(place check mark in appropriate column of each question)
Column A Column B Column C
YES TO SOME NO
DEGREE
Family understands medical condition?
Family following medical treatment plan including
follow-up appointments?
Community resources accessed?
Care coordination in place?
Goals set?
Goals being pursued?
Support systems in place?
Family strengths identified?
Child's needs are being met?
Family's needs are being met?
NOTES:
1. If all answers fall in Column A—may only need to follow-up in one year or as needed.
2. If most answers fall in Column A, some answers in Column B or C -may need additional follow-up and/or referrals.
3. If all answers fall in Columns B and/or C--will need further assessment and determination of why, and I.F.S.P.
ASSESSMENT FINDINGS:
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FOLLOW-UP PLAN
(place check mark by appropriate items)
Information given only(specify)
1.
2.
3.
4.
DATE TIME
Conference scheduled for I.F.S.P. development. / /
Home Visit scheduled / /
Clinic Appointment made / /
Referral made to(document date referral made)
Child Find / /
School District / /
Community Center Board / /
Social Services / /
W.I.C. / /
Parent Support team / /
Support Group / /
EPSDT / /
Medicaid / /
Public Health Nurse / /
Other(specify) / /
/ /
/ /
Family does not want interventions, Follow-up / /
Follow-up with family in one year or P.R.N. per HCP Standards.
Other(specify)
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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, 2001 through SEPTEMBER 30, 2002
Funded
by
CDPHE
HCP Weld County Regional Office:
(1/12 payable monthly for October through August,
September's payment contingent upon Annual Expenditure Report) 139,519
Sub-total HCP Weld County Regional Office: {t} 139,519
HCP Regional Coordinators: (line item billing)
Audiology{2} 2,000
Travel for Colo. Academy of Audiology meeting 250
Occupational or Physical Therapy {2} 2,500
Speech {2) 1,000
Sub-total Regional Coordinators (2) 5,750
Total HCP Weld County Regional Office 145,269
{1} Year 2 of 3 of the HCP funding formula implementation, 60%of change.
{2} Regional Coordinator rate increase to $24.00 per hour.
Regional Coordinators' total budget appears to be sufficient for rate increase,based on
Contract Year 2000-01 actual budget utilization.
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