HomeMy WebLinkAbout991553.tiff RESOLUTION
RE: APPROVE CONTRACT RENEWAL LETTER #1 TO EPSDT PROGRAM
ADMINISTRATIVE OUTREACH AND CASE MANAGEMENT PROGRAM 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 to the
EPSDT Program Administrative Outreach and Case Management 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 July 1, 1999, and ending
June 30, 2000, 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 Contract Renewal Letter#1 to the EPSDT Program Administrative
Outreach and Case Management 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.
OP: fit_ 991553
HL0025
CONTRACT RENEWAL LETTER #1 TO EPSDT PROGRAM ADMINISTRATIVE OUTREACH
AND CASE MANAGEMENT PROGRAM
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 23rd day of June, A.D., 1999.
BOARD OF COUNTY COMMISSIONERS
D COUNTY, C LORADO
/Q
ATTEST: a Dale K. Hall, Chair
Weld County Clerk to the .ar•
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- / NZkg /� �c 'I''.1'G704arbar J. Kirkmeyer, ro-Tem (/
BY: - _.lt -. i►c�.
Deputy Clerk to the B • �l. / 1 -r
(Ls Georg6. xter
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PROV AS TO FORM: /27 41e,(,/
M. J.•Geile
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991553
HL0025
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COLORADO MEMORANDUM
TO: Dale K. Hall, Chairman, Board of County Commissioners
FROM: John S. Pickle, Director, Department of Public Health and
Environment
DATE: June 21, 1999
SUBJECT: Renewal Letter Number One to EPSDT Program Contract
Enclosed for Board review and approval is Renewal Letter Number One to the EPSDT contract.
This contract is between Weld County Department of Public Health and Environment
(WCDPHE) and the Colorado Department of Public Health and Environment.
The contract authorizes WCDPHE to provide case management, outreach and support services
for children ages 0 to 21 who are on Medicaid. Emphasis is on educating families about well
child services that are age appropriate and helping them to utilize these services that are available
in our community. This renewal letter will fund two additional case managers for the program.
For these services, WCDPHE will be reimbursed a sum not to exceed $79,903 for the time
period July 1, 1999 through June 30, 2000.
I recommend your approval of this renewal letter.
Enc.
991553
DEC-09 99 14:43 FROM:FCHSD'RDMIN 303-753-9249 TO:970 356 4383 PAGE:01
STATE OF COLORADO
818 Owens,Governor
Jane E.Norton,Executive Director
Dedicated to protecting and Improving the health and environment o(the people of Colorado
4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division `,► c:� i
Denver,Colorado 80246-1530 aloe Lowry Bbd. 4.4rSI
Phone(303)692.2000 Denver CO 00220-6920
Located in Glendale,Colorado (303)692.3090 Colorado Department
hopdfrevw.cdpheatate.co.us of Pmblic Health
and Environment
•
May 25, 1999
State Fiscal Year 1999-2000, Contract Renewal Letter Number L Contract Routing Number 00-00058
Pursuant to paragraph C-6 of the contract with contract routing number 99-00604 and contract encumbrance number YQ
FAA EPS9900604 hereinafter referred to as the"Original Contract" between the State of Colorado,Department of Public
Health and Environment and The Weld County Health Department for the renewal term fromJBLy J.1999 through '
Jane 30.2000 the parties agree that the maximum amount payable by the State for the eligible services referenced in
paragraph Qd of the Original Contract is increased by SEVENTY NINE TINIUSAND NINE HUNDRED AND THREE
A�NO/100 DOLLARS,($79,903.00)for a new total financial obligation of the State of ONE HUNDREp AND FEVF.
THOUSAND THREE HUNDRED TWENTY EIGHT AND NO/100 DOLLARS,($105.328.00). The revised project
guidelines,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 fa of the Original Contract
is hereby modified accordingly. All other terms and conditions of the Original Contract are hereby reaffirmed. This
amendment to the Original Contract is intended to be effective as of July 1.1999. However,jD no event shall this amendment
be deemed valid until it shall have been approved by the State Controller or wit assistant as he pay designate.
Please sign,date,and return all three originals of this Contract Renewal Letter as soon as possible,to the attention of:Aunt
Lee Joseph,Colorado Department of Public Health and Environment,4300 Cherry Creek Drive South,Denver,
Colorado 80246,Mail Code:FCHSD-ADM-A4. One original of this Contract Renewal Letter will be returned to you
when fully approved.
Weld County Health Department STATE OF COLORADO
Weld County Boardof Commissioners Bill Owens,Governor
By: 1.):J62/?alitBy:
For the Executiv irector
Print Name: Dale K. Hall DEPARTMENT PUBLIC HEALTH
AND ENVIRONMENT
Title: Chair (06/23/99)
FEIN: 84-6000-813
APPROVALS: •
CONTROLLER: PROGRAM:
By: By: (... ,4/01,pstei<
Arthur L. arnheR
ATTACHMENT 1
EPSDT PROGRAM ADMINISTRATIVE
OUTREACH AND CASE MANAGEMENT
ACTIVITIES
FISCAL PERIOD
7/1/99 - 6/30/00
ATTACHMENT 2
APPLICANT: Weld County Health Department
PROJECT: EPSDT t
DETAILED BUDGET FOR THE PERIOD: July 1,1999 to June 30,2000
Annual Number Total Source of CDH Funds
DIRECT COST Salary Months %Time Amount Applicant Requested tPSUI Ketugee Other` Total
Rate Budget Required and Other from CDH CDH CDH
PERSONNEL SER 3.00
Office Tech.11 18,886 12 100% 18,886 18,886 18,885 18,885
Korgan,C. 18,638 12 100% 18,638 18,638 18,638 18,638
Office Tech.11 18,099 12 100% 18,099 18,099 18,099 18,099
Contractua9Fee for Service:
Supervising Personnel:
Welnmelster,C. 42,139 12 5% 2,107 2,107 0 0 0
Fringe Benefits 14,433 527 13,906 13,906 13,908
Total Personnel Services 72,163 2,634 69,528 69,528 0 0 69,628
OPERATING EXPENSES:
(Includes Building/Facility
Cost not part of Indirect)
Operating 2,160 2,160 2,160 2,160
Subtotal Operating 2,160 0 2,160 2,160 0 0 2,160
TRAVEL:
1,600 1,600 1,600 1,600
Subtotal Travel 1,600 0 1,600 1,600 1,600
EQUIPMENT:
771 771 771 771
Subtotal Equipment 771 0 771 771 771
Total Direct Costs(Personnel+Operating+Travel+Equip) 76,694 2,634 74,069 74,059 0 0 74,069
Administrative/Indirect Cost-10.77%TDC- 6,052 208 5,844 5,844 0 0 5,844
1 U I AL PKUJtL I LUST 82,746 2,842 79,903 79,9031 01 0 79,903 b
Source of Funding tor"Applicant and Omer"
2,842
Total Applicant an $2,842
**This contract will pay the actual approved rate for indirect costs finalized by the Colorado Department
"This contract will pay the actual approved rate for indirect costs finalized by the Colorado Department
of Health and subject to the maximum rates allowed by the Family and Community Health Services
Division,Colorado Department of Health. The finalized rate will be retroactive to the beginning of the contract.
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EXHIBIT B
7/1/99 -6/30/00
The following definitions and functions are intended to serve as guidelines for contracting agencies to
utilize in meeting their required EPSDT administrative outreach and case management functions.
I. DEFINITIONS
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1. At-risk client: The EPSDT-eligible client with identified actual and/or potential
health care needs, which may require outreach and case management efforts more
intensive than the non-at-risk EPSDT-eligible clients. The at-risk or priority
clients may include clients in families with no established linkage to health care
and/or assistance with provider selection, newborns and infants up to age two,
teenagers, particularly those newly enrolled in Medicaid, pregnant EPSDT-
eligible clients, refugee children in need of EPSDT administrative and case
management services, children and youth requiring preventive health and
corrective treatment services or assistance with referral services for children with
special health care needs, pregnant women eligible for enhanced prenatal services
and clients identified by EPSDT subsystem reports as being in need of follow up
and referral services.
2. Early Childhood Connections for Infants, Toddlers and Families: The statewide,
coordinated system of services made available through the Individual Disabilities
Education Act, Infant and Toddler Section, as governed by the Colorado
Department of Education. Services include an early intervention system of
supports and services that are directed at meeting the needs of infants and toddlers
with disabilities and their families.
3. Enrollment Facilitator: A non governmental agency i ontracted with Colorado
Medicaid to enroll or disenroll Medicaid clients in a managed care plan. The
Enrollment Facilitator will also maintain updated managed care provider
information including both prepaid health plan and PCPP providers.
4. EPSDT outreach and case management: The EPSDT administrative outreach and
case management services provided by the EPSDT Outreach and Case Manager
which are complementary to health care services provided by the Medicaid
provider. The services are aimed at the promotion of health,the prevention of
disease and improved access to health care services. The EPSDT administrative
service includes, but may not be limited to: (1) contacting EPSDT-eligible clients
to provide in-depth explanation of the EPSDT Program and its importance in the
medical benefits which are available. (2) offering assistance and information to
„the EPSDT-eligible client which will facilitate overcoming barriers which might
impede the client's access to the provision of the EPSDT services; (3) clarifying,
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if needed, the role of the primary care provider and, when appropriate, the
managed care/prepaid health plan, including Health Maintenance Organizations,
(4) the client's obligation to maintain the linkage between the child/youth and the
primary care physician; (5) maintaining periodic contact, as needed and feasible,
with the EPSDT client to encourage the utilization of EPSDT services needed or
promoted by referrals and assisting with referrals as needed; (6) contacting clients
not currently receiving assistance under the "Colorado Works Act" to inform
them of the possibility of continued eligibility for Medicaid; (7) initiating
collaborative activities with other child-related health and social services agencies
and resources within each county and referring EPSDT clients as needed to those
agencies and resources. (8) In selected counties, services provided by the EPSDT
outreach and case manager shall include assistance with the EPSDT and managed
care inform process, including referral to the Enrollment Facilitator, at the time of
application for Medicaid in local social service agencies and presumptive
eligibility sites.
5. EPSDT Outreach and Case Manager: The individual responsible for providing the
EPSDT Program administrative services of outreach and case management to
EPSDT-eligible children and their families.
6. EPSDT-enrolled client: Any individual under the age of 21 declared as eligible for
Medicaid by the appropriate county department of social services pursuant to
federal and state laws and regulations.
7. Medicaid Provider/vendor: Any entity or individual who has met the certification
requirement established by the State to participate in the Colorado Medicaid
Program, and who provides covered EPSDT medicalldental services, goods
and/or devices in accordance therewith.
8. Prenatal Plus Program: The health care program option that includes a package of
enhanced Medicaid prenatal services addressing nutritional and psychosocial
behaviors that could impact pregnancy outcome.
9. Prepaid Health Plan (PPHP): A commercial health care plan contracting with
Colorado Medicaid to provide comprehensive health care services, coordination,
and monitoring of patient utilization of services through the utilization of primary
care physicians. The primary care physicians agree to serve as gatekeepers for
comprehensive health services, including EPSDT services, as provided td
Medicaid clients.
10. Primary Care Physician(PCP): A Colorado Medicaid enrolled physician who has
ag-reed to serve as the"gatekeeper" for all medical care received by Medicaid
aliens, who have chosen him/her within the Primary Care Physician Program or
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Health Maintenance Organization. EPSDT medical screenings are conducted by
the selected primary care physician or a qualified provider upon referral from the
PCP, when applicable.
11. Primary Care Physician Program (PCPP): The health care program option in
which EPSDT-eligible clients select a physician who agrees to enroll or has
enrolled in the Primary Care Physician Program Under this program, the
physician accepts the responsibility of the clients' health care, guaranteeing a 24
hour access arrangement. Under this program the physician will also refer the
EPSDT-eligible client to other Medicaid providers, for medical care, and other
health care services as needed.
12. Provider Interface: The responsibility of the EPSDT Outreach and Case Manager
to work with local Medicaid providers. This process may include: (1) identifying
providers in a local county or adjacent client-accessible counties, who will deliver
medical screening, diagnostic and treatment services, dental, orthodontia, vision,
hearing, or other services to the EPSDT-eligible client; (2) explaining to the
providers the nature and intent of the EPSDT Program, including the PCP referral
requirement; (3) referring interested providers to the coordinator of the Primary
Care Physician Program at HCPF for assistance in acquiring more information
concerning the role of the primary care physician; (4) acting as a resource to
providers who have identified families in need of assistance with EPSDT
administrative case management services.
13. Screening: An EPSDT medical service provided to EPSDT-eligible clients by a
Medicaid primary care physician, by a provider qualified to furnish medical
screening services upon referral from the primary care physician or managed care
system, or by other qualified providers in areas without available primary care
physicians.
The EPSDT medical service screening includes (a partial EPSDT screening is any
screen less than all of the 5 required components):
- Comprehensive health and developmental history with physical and mental
health components
- Comprehensive unclothed physical examination
- Appropriate immunizations according to age and health history
- Laboratory tests, including blood lead levels
- Health education, including anticipatory guidance
14. Subcontract: A written agreement between Health and local health agencies
and/or other local agencies which shall serve as a basis for EPSDT administrative
outreach and case management activities at the local level.
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15. Training and Technical Assistance: Work performed under the direction of Health
to assist Medicaid providers in developing and providing enhanced prenatal
services.
II. EPSDT ADMINISTRATIVE OUTREACH/CASE MANAGEMENT
The EPSDT Outreach and Case Manager offers and provides, when requested and/or necessary:
1. Provides outreach and/or case management activities for the EPSDT-eligible
client upon written or verbal request by the client or upon referral from Medicaid
providers or other agencies. The administrative activities may include, but not be
limited to, the following types of responsibilities:
1. Initiate face-to-face, telephone or mail contacts to explain the EPSDT
Program and the administrative case management role, assist in the
identification of health care needs, assist in requests for referrals for
preventive health services; assist in clarification and/or answering
questions, including, where applicable, questions/information regarding
managed care.
2. Provide mailings, as indicated, that include provider listings, descriptions
of basic EPSDT services, screening schedules, brochures and case
management information (hours of operation and business cards). Work
with the local social service agencies, outreach sites, and other agencies
where individual families apply for Medicaid to assure that such materials
are available.
3. Maintain and update a list of the names, addresses and telephone numbers
of Medicaid-enrolled providers and managed care organizations from
whom EPSDT medical, dental, hearing, and vision care may be obtained.
4. Facilitate provider interface by promoting the linkage of the EPSDT-
eligible client with the primary care physician or HMO and through
EPSDT advocacy efforts in the provider community, and through other
activities as defined in Section I of this exhibit.
5. Coordinate with nurse supervisor and initiate and/or participate in
interagency coordination with public health and other human resource
agencies as appropriate upon consultation with the nurse supervisor.
6. Upon consultation with the nurse supervisor make home visits to difficult-
- to-reach EPSDT-eligible clients or coordinate for this service with other
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community agencies that also provide home visitation services.
7. Facilitate, upon request of client or provider, referrals for Medicaid-
covered services.
8. As resources are available, and in consultation with the State office,
provide assistance with the inform process, including assistance with
provider selection, at selected local county social service departments.
2. In selected counties agreed upon by CDPHE and local agencies, EPSDT
administrative case management staff will provide assistance with the EPSDT
inform process in local social service agencies and presumptive eligibility sites.
3. The EPSDT Outreach and Administrative Case Manager will utilize data provided
by HCPF and local social service agencies which provide information for the
provision of EPSDT administrative outreach and case management activities and
will notify the State EPSDT office in writing of any errors, discrepancies,
inaccuracy or unavailability of information received from the State or local social
service agency which impede the provision of EPSDT administrative outreach
and case management activities.
4. The EPSDT Administrative Case Manager works under the supervision of a
registered nurse currently licensed in Colorado. The designated nurse supervisor
assures that the EPSDT Outreach and Case Manager's activities are performed as
identified in this Exhibit B.
III. EPSDT PROGRAM SUPPORT SERVICES
1. The EPSDT Outreach and Case Manager offers and provides,when requested
and/or necessary:
1. Assistance with scheduling appointments for EPSDT Program screening
services.
2. Assistance with scheduling appointments for follow-up diagnostic and
treatment services, including medical, dental, vision care and hearing
services.
3. Information to the EPSDT-eligible client concerning the availability of
transportation assistance which is offered through the local county
department of social services or the Colorado Foundation for Medical Care
(CFMC).
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4. Referral assistance to the local county department of social services for the
EPSDT-eligible client requiring transportation assistance.
5. Assistance with provider selection in selected areas as appropriate and
when resources permit.
2. The EPSDT Outreach and Case Manager provides the additional support services
of:
1. Maintaining the lists of the names, addresses and telephone numbers of
agencies or human resource groups who have expressed a willingness to
furnish uncovered services at little or no expense to the EPSDT-eligible
• client and/or family.
2. Referring clients in all categories of the WIC target population to the local
WIC Program available within each county.
3. Initiating and promoting of collaborative activities with Head Start, Early
Childhood Connections, Family Healthline, Family Resource Centers,
Bright Beginnings, the Colorado Child Health Plan Plus (CCHP+), school
districts and other child health related social agencies which are available
within each local county to promote the availability and utilization of the
services.
3. The EPSDT Case Manager works with the regional and local coordinators of the
Health Care Program for Children with Special Needs (HCP) whereby families
and EPSDT-enrolled clients will be informed of the availability of HCP services
and referred for these services as appropriate.
4. The EPSDT Case Manager facilitates the referral of EPSDT-eligible clients
needing uncovered treatment, health services or social services,and clients who
lose Medicaid eligibility to community and rural health centers, CCHP+,
Colorado Indigent Care Program,Title V agencies, or other community agencies
that provide assistance, either at no cost or on a sliding fee scale, to low income
populations.
IV. EPSDT PROGRAM DOCUMENTATION REQUIREMENTS
1. The EPSDT Case Manager maintains documentation that identifies EPSDT
administrative outreach/case management activities on behalf of the EPSDT-
eligible client.
2. fhe-EPSDT Case Manager assures that documentation of the outreach and case
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management activities occurs and that the documentation includes the following:
1. Written materials utilized by the EPSDT Outreach and Case Manager to
facilitate the administrative services provided for the EPSDT-eligible
clients (brochures, reminder cards, etc.).
2. Written or computerized documentation of all administrative EPSDT
outreach and case management activities which occurred.
C. The EPSDT Case Manager shall assure that these materials and/or client
documentation are available to HCPF or Federal reviewers upon written request
and shall submit to the State monthly a computerized summary of EPSDT
activities.
4. The EPSDT Outreach and Case Manager maintains up-to-date program manuals,
records, and/or procedures that:
1. Describe the methods used to assure that outreach and administrative case
management services are provided appropriately and in a timely manner.
2. Describe the function of written and/or computerized documentation
available at the local agency and/or health offices.
3. Assure that information is available to local agencies and/or health offices
that can be accessed for determination of compliance with State plan
requirements.
4. Describe how all activities performed by the EPSDT Outreach and Case
Manager are monitored by the local RN supervisor, or by a nurse
consultant at CDPHE.
V. PLANNING, EVALUATION, MONITORING
1. Site reviews by Colorado Department of Health EPSDT staff will be arranged on
a mutually agreed upon basis with local EPSDT staff. Site reviews will include:
1. Names of agency sites reviewed with listing of the assigned EPSDT
Outreach and Case Manager(s) and the designated RN supervisor.
2. Review of EPSDT outreach and case management activities, including
written materials, designed to assure that EPSDT clients receive requested
assistance in a timely manner.
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3. Review of EPSDT Procedure Manual for accuracy and content of required
materials.
4. Review of collaborative activities with medical providers including
managed care organizations, WIC, HCP, Child Find, Family Healthline.
Family Resource Centers, Bright Beginnings, Early Childhood
Connections, and other child health related social agencies.
5. Review of compliance status with standards developed for mandated
activities. This includes review of computerized documentation for
completeness and accuracy.
6. Review of agency written protocols/guidelines for outreach and case
management, including at-risk client definitions. Review of measures to
be taken to bring activities into compliance with federal requirements.,
7. Review of agency written protocols for nurse supervision.
8. Discussion of EPSDT Case Manager needs, concerns and requests.
9. ' Input from the nurse supervisor on EPSDT issues, needs, etc.
10. Training activities provided to EPSDT Outreach and Case Managers
and/or RN supervisor as needed.
EXH 5/98
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