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Home My WebLink About30489 Plan and Budget Required Documents Checklist MODIFIED FY 2018/2019 County/City: Fresno Fiscal Year:____2018-19________ Document Page Number 1. Checklist 2. Agency Information Sheet 1 3. Certification Statements A. Certification Statement (CHDP) – Original and one photocopy 3 B. Certification Statement (CCS) – Original and one photocopy 4 4. Agency Description A. Brief Narrative 5 B. Organizational Charts for CCS, CHDP, HCPCFC, and PMM&O *Retain locally C. CCS Staffing Standards Profile Retain locally D. Incumbent Lists for CCS, CHDP, HCPCFC, and PMM&O 6 E. Civil Service Classification Statements – Include if newly established, proposed, or revised N/A F. Duty Statements – Include if newly established, proposed, or revised N/A 5. Implementation of Performance Measures – Performance Measures for FY 2016—2017 are due November 30, 2017. N/A 6. Data Forms Performance Measures 14 7. Memoranda of Understanding and Interagency Agreements List A. MOU/IAA List 45 B. New, Renewed, or Revised MOU or IAA N/A C. CHDP IAA with DSS biennially Retain locally D. Interdepartmental MOU for HCPCFC biennially N/A 8. Budgets A. CHDP Administrative Budget (No County/City Match) 1. Budget Summary 46 2. Budget Worksheet 47 County/City: Fresno Fiscal Year:____2018-19________ Document Page Number 3. Budget Justification Narrative 49 B. CHDP Administrative Budget (County/City Match) - Optional 1. Budget Worksheet N/A 2. Budget Justification Narrative N/A 3. Budget Justification Narrative N/A C. CHDP Foster Care Administrative Budget (County/City Match) - Optional 1. Budget Summary N/A 2. Budget Worksheet N/A 3. Budget Justification Narrative N/A D. HCPCFC & PMM&O Administrative Budgets 1. Budget Summary 51, 55 2. Budget Worksheet 52, 56 3. Budget Justification Narrative 53, 57 E. CCS Administrative Budget 1. Budget Summary 59 2. Budget Worksheet 62 3. Budget Justification Narrative 64 G.. Other Forms 1. County/City Capital Expenses Justification Form N/A 2. County/City Other Expenses Justification Form N/A 9. Management of Equipment Purchased with State Funds 1. Contractor Equipment Purchased with DHCS Funds Form (DHCS1203) N/A 2. Inventory/Disposition of DHCS Funded Equipment Form (DHCS1204) N/A 3. Property Survey Report Form (STD 152) N/A Agency Information Sheet County/City: Fresno/Fresno Fiscal Year: 2018-19 Official Agency Name: David Pomaville, Director Address: 1221 Fulton Street P.O. Box 11867 Fresno, CA 93775 Health Officer Sara Goldgraben, MD CMS Director (if applicable) Name: Address: Phone: Fax: E-Mail: CCS Administrator Name: Daniela Aghadjanian Division Manager Address: 1221 Fulton Street P.O. Box 11867 Fresno, CA 93775 Phone: 559-600-6595 Fax: 559-455-4789 E-Mail:daghadjanian@fresnocountyca.gov CHDP Director Name: Rose Mary Rahn Address: 1221 Fulton Street P.O. Box 11867 Fresno, CA 93775 Phone: 559-600-6363 Fax: 559-600-7726 E-Mail:rrahn@ fresnocountyca.gov CHDP Deputy Director Name: Julie Slaughter Address: 1221 Fulton Street P.O. Box 11867 Fresno, CA 93775 Phone: 559-600-6592 Fax: 559-600-7726 E-Mail:slaugj@ fresnocountyca.gov Clerk of the Board of Supervisors or City Council Name: Bernice Seidel Address: 2281 Tulare St, 3rd Floor Fresno, CA 93721 Phone: 559-600-3529 Fax: 559-600-1608 E-Mail:bseidel@ fresnocountyca.gov Page 1 of 64 Director of Social Services Agency Name: Delfino Neira Address: 200 W Pontiac Way, Bldg 3 Clovis, CA 93612 Phone: 559-600-2301 Fax: 559-600-2311 E-Mail:dneira@ fresnocountyca.gov Chief Probation Officer Name: Kirk Haynes 3333 E American Ave, STE B Fresno, CA 93725 Phone: 559-600-1298 Fax: 559-455-2412 E-Mail:khaynes@ fresnocountyca.gov Page 2 of 64 Children's Medical Services Plan and Fiscal Guidelines Certi.fication Statement -Child Health and Disapility Prevention (CHOP) Program County/City: Fres .. no Fiscal Year: 2018-19 ---------------- 1. certify that the CHDP Program Will comply with all appli!::able provisions of Health and Safety Code, Division 106, R~rt2, Chapter 3, Article 6(corrimencing with Section 124025), Welfare and lnstitwtion.s Code, Division 9, Part 3, Chapters 7 arid 8 (commencingwith Section 14Q00 and 14200), Welfare and lns.titutions Code Section 16970, and any applicable rules or regulations promulgated by DH CS pursuant tb that Article, those Chapters, and thatsection. I further certify that this CHOP Program will comply with the Children's Me.dical Servic~s Plan and Fiscal Guidelines Manual, ihcludir,rg but not liniitep to, S,ectioh 9 Federal Financial Participation. I further certify that this CHOP Program will comply with all federal laws and regulations governing and regulating recipients offunds granted to states for medical assistance pursuant ·to Title XIX qf the Social Security Act (42 U.S.C. Section 1396 et seq.). I further agree that this CHOP Prpgfam may be subject tq all s:anctions or other r~m.edies applicable if this CHOP Program violates any ofthe above laws, regulations and policies with which it has certified it will .comply. Date Signed . ~A&~ ~ 7 Si@nature of Director or f;{eilth Officer _µJ__CJh£_~ Date Signed Signature and Title Of Other--,-Optional··· Date Signed I certify that this plan has been approved by the local governing body. FOR ACCOUNTING USE ONLY: Fund/Subclass 0001/10000 ATTEST: BERNICE E. SEIDEL Clerk of the Board of Supervisors County 9f Fresno, State of California svd\:t>o.:~ ~ Deputy Organization#: 56201600, 56201611, 56201613, 56201618 Revenue Account# 3505, 3530, 5380, 5033, 5036, Page 3 of64 Certification Statement -California Children's Services (CCS) County/City: Fresno Fiscal Year: 2018-19 --------------- I certify that the CCS Program will comply with all applicable provisions of Health and Safety Code, Division 106, Part 2, Chapter 3, Article 5, (commencing with Section 123800) and Chapters 7 and 8 of the Welfare and Institutions Code (commencing with Sections 14000-14200), and any applicable rules or regulations promulgated by DHCS pursuant to this article and these Chapters. I further certify that this CCS Program will comply with the Children's Medical Services Plan and Fiscal Guidelines Manual, including but not limited to, Section 9 Federal Financial Participation. I further certify that this CCS Program will comply with all federal laws and regulations governing and regulating recipients of funds granted to states for medical assistance pursuant to Title XIX of the Social Security Act (42 U.S.C. Section 1396 et seq.) and recipients of funds allotted to states for the Maternal and Child Health Services Block Grant pursuant to Title V of the Social Security Act (42 U.S.C. Section 701 et seq.). I further agree that this CCS Program may be subject to all sanctions or other remedies applicable if this CCS Program violates any of the above laws, regulations and policies with which it has certified it will comply. 10/oq{lB Dat~Signed 1 ol ~ /,ff Date Signed Signature and Title of Other -Optional Date Signed I certify that this plan has been approved by the local governing body. FOR ACCOUNTING USE ONLY: Fund/Subclass: 0001/10000 \..)t)~ • le '2.C\~ I Date Signed ATTEST: BERNICE E. SEIDEL Clerk of the Board of Supervisors County of Fresno, State of California By di.\O.:, 45 DepWy Organization#: 56201600, 56201611, 56201613, 56201618 Revenue Account#: 3505, 3530, 4380, 5033, 5036 Paga 4 of ('j~. CMS PLAN Fiscal Year 2018-19 Agency Description Fresno County’s Child Health and Disability Prevention (CHDP) Program and California Children’s Services (CCS) are located in the Fresno County Department of Public Health. The CHDP Program includes the Health Care Program for Children in Foster Care (HCPCFC) and the Child RideSafe Program and is supervised by the CHDP Deputy Director, a Supervising Public Health Nurse. The CHDP Deputy Director is supervised by the Public Health Nursing Division Manager. The CMS Division Manager functions as the CCS Administrator. The CMS Division Manager reports directly to the Assistant Director of the Department of Public Health. As the CHDP Director, medical supervision for the CHDP Program is provided by Fresno County’s Health Officer. CCS medical supervision is provided by a CCS Medical Consultant, a board certified pediatrician. In the event that a board certified pediatrician is not available the CCS program defers to the State for medical consultation needs. A cooperative working relationship exists between CCS and CHDP. Since Fiscal Year 1990-91, an Intra-Agency Agreement between the CHDP and CCS has been in place. Medical and case management information is freely shared between the two programs to avoid duplication of case management activities and to provide for efficient client care. A written procedure developed and implemented in Fiscal Year 1994-95 assures all children who are in need of preventive health services are referred to the CHDP Program. The CHDP Gateway Program was implemented on July 1, 2003, making preventive health care available to children through their Primary Care Provider. The CHDP Deputy Director and CCS Administrator will continue to work closely to coordinate the activities of each program. Page 5 of 64 State of California - Health and Human Services Agency Department of Health Care Services - Children's Medical Services Incumbent List – California Children’s Services For FY 2017-18, complete the table below for all personnel listed in the CCS budgets. Use the same job titles for both the budget and the incumbent list. Total percent for an individual incumbent should not be over 100 percent. Specify whether job duty statements or civil service classification statements have been revised or changed. Only submit job duty statements and civil service classification statements that are new or have been revised. This includes (1) changes in job duties or activities, (2) changes in percentage of time spent for each activity, and (3) changes in percentage of time spent for enhanced and non-enhanced job duties or activities. Identify Nurse Liaison positions using: MCMC for Medi-Cal Managed Care; HF for Healthy Families; IHO for In-Home Operations, and; RC for Regional Center. County/City: Fresno/Fresno Fiscal Year: 2018-19 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Division Manager/Administrator Daniela Aghadjanian 90% No No Staff Analyst I Vacant 60% No No Administrative Assistant III Jennifer Miller 100% No No Rehabilitation Therapy Manager Harsharn Dhillon 20% No No Systems & Procedures Analyst III Peter Jew 10% No No Senior Accountant Jose Rodriguez 10% No No Page 6 of 64 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Program Technician I Vacant 100% No No Public Health Physician Dr. Rajeev Verma 50% No No Supervising Public Health Nurse Marla Bomgardner (MCMC, IHO, RC) 100% No No Head Nurse Sherilee Lawson 100% No No Staff Nurse III Quy Gip 100% No No Staff Nurse III Tim Yang 100% No No Public Health Nurse II Noel Almaguer 100% No No Public Health Nurse II Heather Woo 100% No No Staff Nurse III Belinda Mayugba 100% No No Physical Therapist III Joy Conde 100% No No Public Health Nurse (Extra Help) Stella Jauregui 40% No No Public Health Nurse (Extra Help) Amada Ozaeta 40% No No Page 7 of 64 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Staff Nurse I Megan Milburn 100% No No Staff Nurse II Kelly Stevens 100% No No Staff Nurse I Shavonne Smith 100% No No Staff Nurse III Joseph Burgess 100% No No Staff Nurse III Vivien Tagoe 100% No No Staff Nurse III Darawadee Martin 100% No No Staff Nurse III Jing Yang 100% No No Staff Nurse III Marjelyn Ramiro 100% No No Staff Nurse Maribeth Jensen 100% No No Public Health Nurse II Elizabeth Manfredi 100% No No Public Health Nurse I RJ Lee 100% No No Public Health Nurse I Sandy Sue Arce 100% No No Page 8 of 64 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Staff Nurse I Veronica Reyna 100% No No Staff Nurse I Khamsay Vanhelsdingen 100% No No Medical Social Worker I Martha Orejel 100% No No Medical Social Worker I Ariana Robles Solis 100% No No Senior Admitting Interviewer I Sonya Mendoza 100% No No Senior Admitting Interviewer I Bobbi Taylor 100% No No Admitting Interviewer II Vanessa Bong 100% No No Admitting Interviewer I Angel Rodriguez 100% No No Admitting Interviewer I Sarrina Staub 100% No No Admitting Interviewer II Rudy Constantino 100% No No Admitting Interviewer II Anita Tristan 100% No No Admitting Interviewer II Alicia Molina 100% No No Admitting Interviewer II Marcy Nava 100% No No Page 9 of 64 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Admitting Interviewer I Devony Prieto 100% No No Admitting Interviewer II Tiffany Acosta 100% No No Admitting Interviewer II Maria Escobedo 100% No No Admitting Interviewer II Bernard Thao 100% No No Admitting Interviewer II Luz Reyes 100% No No Admitting Interviewer I Rosa Lopez 100% No No Admitting Interviewer II Laurie Roberts 100% No No Admitting Interviewer I Xavier Gonzalez 100% No No Admitting Interviewer II Michael Vue 100% No No Admitting Interviewer I Pa Lee 100% No No Admitting Interviewer I Vacant 100% No No Supervising Office Assistant Alibra Carter 100% No No Office Assistant I Zulema Alderete 100% No No Office Assistant I Melinda Kelley 100% No No Office Assistant III Tamara Brown 100% No No Page 10 of 64 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Office Assistant III Mellissa Figueroa 100% No No Office Assistant III Teresa Valladolid 100% No No Office Assistant II Angela Klamm 100% No No Office Assistant I Natasha Jones 100% No No Office Assistant I Robert Romans 100% No No Office Assistant I Vacant 100% No No Office Assistant I Vacant 100% No No Account Clerk III Rodrigo De La Rosa 50% No No Page 11 of 64 State of California - Health and Human Services Agency Department of Health Care Services - Children's Medical Services Branch Incumbent List - Child Health and Disability Prevention Program For FY 2018-19 complete the table below for all personnel listed in the CHDP budgets. Use the same job titles for both the budget and the incumbent list. Total percent for an individual incumbent should not be over 100 percent. Specify whether job duty statements or civil service classification statements have been revised or changed. Only submit job duty statements and civil service classification statements that are new or have been revised. This includes (1) changes in job duties or activities, (2) changes in percentage of time spent for each activity, and (3) changes in percentage of time spent for enhanced and non-enhanced job duties or activities. County/City: Fresno/Fresno Fiscal Year: 2018-19 Job Title Incumbent Name FTE % on CHDP No County/ City Match Budget FTE % on CHDP County/City Match Budget FTE % in Other Programs (Specify) Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Supervising Public Health Nurse, Deputy Director Julie Slaughter 60% 0% 40% HCPCFC No No Public Health Nurse II Jeri Guerrero 100% 0% 0% No No Public Health Nurse II Ankara Lee 100% 0% 0% No No Health Education Assistant Brendon Matsumoto 100% 0% 0% No No Supervising Office Assistant II Lisa Renteria 100% 0% 0% No No Office Assistant I Vacant 90% 0% 10% Child RideSafe No No Office Assistant III Gracie Velasquez 100% 0% 0% No No Page 12 of 64 Page 13 of 64 ATTACHMENT 3 State of Ca liforn ia -Hea lth and Human Services Agency Department of Hea lth Services -Integrated Systems of Care Division HEAL TH CARE PROGRAM FOR CHILDREN IN FOSTER CARE INCUMBENT LIST FISCAL YEAR 2018-19 For FY 2018-19, complete the table below for all personnel listed in the Hea lth Ca re Program for Chi ld ren in Foster Care (HCPCFC ) Base , Psychotropic Med ication Mon itoring & Oversight (PMM&O), Case load Rel ief Augmentation (Caseload Relief), and appl icable Base County-City budgets. Use the same names and j ob titles for the in cumbent list, administrative budgets, and org anizatio nal cha rt . Tota l fu ll time equ ivalent (FT E) percent for an individual incumbent shou ld not be over 100 percent. The Wetfa re and Institutions Code requ ires that the services provided to foster ch ildren through the HCPCFC are performed by a Public Health Nurse (PHN). Some counties may experience d ifficu lty recru it ing and hiring a PHN into the ro le . A Reg istered Nu rse (RN ) w ithout a PHN certificate may on ly be used in the prog ram with documented j ustification , (to the extent feasible ) a commitment for the RN to obtain the PHN certificate , and a w aiver approved by the ISCD and COSS. Local prog rams that will need to hire an RN into the ro le must contact this office immed iately to request a w a iver form and instruction . Please note, contracted nurses (e.g ., hired through an agency) may not be used in the HCPCFC prog ram. Civil Service Classification Statements and Duty Statements are required for all in cumbents listed County/City : In cumbent FTE %on FTE %on FTE %on FTE %on FTE %on HCPCFC HCPCFC is PHN Base Ba se PMM &O Caseload Relief Other Programs In cumbent Name Job Ti tle Certified State/Federal Co unty-C ity/Fed eral State /Federal State/Federal (Spe cify Other IY/N) Budaet Budaet Budaet Budaet Proaram ) Revised Ju ly 2018 Page 1 of 2 County of Fresno Department of Public Health CCS Performance Measure 1 FY 2017-16 CCS Program staff conducts routine reviews of all active cases to ensure CCS clients have documented and up-to-date medical homes/primary care providers. Staff contacts clients and their parents/guardians and works collaboratively with Medi-Cal Managed Care plans, local hospitals and other local providers to determine current primary care providers. In addition, CCS Program staff conducts annual program eligibility reviews of all clients to identify primary care physicians and/or medical homes. Additionally, when families come to the CCS office they are asked to identify their primary care physician so their medical files can be updated. Based on the entire active caseload as of July 2018, the following findings are: • 88.8% of CCS clients in Fresno County have an identified primary care provider (PCP). This represents a decrease of 1.3% from the previous fiscal year. • Business Objects does not reliably reflect the number of clients with a PCP because many clients change PCPs and neglect to inform the CCS Administrative staff. Staff will continue with efforts to obtain PCP information for these clients. Page 14 of 64 CCS Performance Measure 1 – Medical Home Children enrolled in the CCS Program will have documented Medical homes/primary care providers. The goal is to have 100% compliance. Definition: Children in the CCS program will have a designated primary care physician and/or a physician who provides a medical home. Numerator: The total number of children with a completed field with identification of a primary care physician and/or a physician that provides a medical home. Denominator: The total number of children in the local CCS county program. Data Source: Sample of 100 charts or 10% of caseload if caseload under 1,000. Reporting Form: Number of children with a primary care physician/ Medical Home (Numerator) Number of children in the local CCS program (Denominator) Percentage of compliance 6,619 7,451 88.8% * Note: If county percentage of compliance is under 80%, counties need to submit with the annual report a plan for how they will work to improve this result. Page 15 of 64 County of Fresno Department of Public Health CCS Performance Measure 2 FY 2017-18 Client program eligibility was determined according to the guidelines established by the Children’s Medical Services Branch, California Children’s Medical Services Administrative Procedures Manual (July 2001 Revision). Fresno County CCS utilized a report created in MSBI to select a sample of 100 unduplicated new referrals. The findings are as follows: • A sample of 100 unduplicated new referrals was selected at random. Out of the 100 new referrals, 87% had their medical eligibility determined within the prescribed guidelines. This represents a 20.8% increase from the previous fiscal year. • A sample of 100 unduplicated new referrals was selected at random. Out of the 100 new referrals 99% had their financial and residential eligibility determined within the prescribed guidelines. This represents a 23.8% increase from the previous fiscal year. 93 cases were Full Scope Medi-Cal or TLICP clients and 7 were CCS only clients. • Manual procedures remain in place for the tickling of applications, Program Services Agreement (PSA), and program eligibility letters that are sent to the families. Page 16 of 64 CCS Performance Measure 2 – Determination of CCS Program Eligibility Children referred to CCS have their program eligibility determined within the prescribed guidelines per Title 22, California Code of Regulations, Section 42000, and according to CMS Branch policy. Counties will measure the following: Numerators: a. Medical eligibility within five working days of receipt of all medical documentation necessary to determine whether a CCS-eligible condition exists. b. Residential eligibility within 30 days of receipt of documentation needed to make the determination. c. Financial eligibility within 30 days of receipt of documentation make the determination. Denominator: Number of CCS unduplicated new referrals to the CCS program assigned a pending status in the last fiscal year. Data Source: 10% of the county CCS cases or 100 cases (which ever number is less). Page 17 of 64 Reporting Form: MEDICAL ELIGIBILTY Number of referrals determined medically eligible within 5 days (Numerator) Number of new unduplicated referrals (Denominator) Percentage of compliance Medical eligibility determined within 5 days of receipt of all necessary documentation 87 100 87% PROGRAM ELIGIBILITY Number of cases determined eligible within 30 days of receipt of documentation needed to make the determination (Numerator) Number of new unduplicated referrals (Denominator) Percentage of compliance Financial eligibility determined within 30 days FSMC /TLICP 93 CCS only 6 FSMC /TLICP 93 CCS only 7 99% Residential eligibility determined within 30 days 99 100 99% Page 18 of 64 County of Fresno Department of Public Health CCS Performance Measure 3 FY 2017-18 Part A: Annual team Report Fresno County CCS generated an MSBI report which identified 100 random clients (greater than 10%) out of the total list of clients with a diagnosis or condition that requires referral to a Cardiac, Renal, Pulmonary, Neurological or Endocrine Special Care Center, per NL 01-0108. Review of the random sample of 100 children who received a SCC authorization yielded the following: • 88% compliance for Annual Team Reports of SCC authorized clients. Out of 100 children with a SCC authorization, 88 had an Annual Team Report in their medical chart, 12 did not. Part B: Authorization of Child to SCC CCS generated an MSBI report which identified 100 children with a CCS diagnosis or condition that requires referral to Cardiac, Renal, Neuro- musculoskeletal, Endocrine, or Pulmonary Special Care Centers, per NL 01- 0108. • Of the 100 children who had a condition that required authorization to a SCC, 94 were in fact authorized for a SCC. • Fresno County is 94% compliant with appropriately authorizing SCC for children with eligible medical conditions. Page 19 of 64 CCS Performance Measure 3 (A & B) – Special Care Center This Performance Measure is evaluated in two parts. Part A: Annual Team Report Definition: This performance measure is based on the CCS requirement for an annual team report for each child enrolled in CCS whose condition requires Special Care Center services and has received an authorization to a Special Care Center. County CCS programs will evaluate this measure by the presence of an annual team conference report in the child’s medical file. Numerator: Number of children that received a Special Care Center authorization and were seen at least annually at the appropriate Special Care Center as evidenced by documentation and completion of the interdisciplinary team report. Denominator: Number of children enrolled in CCS whose condition as listed in categories defined in Numbered Letter 01-0108 requires CCS Special Care Center services and has received an authorization to a Special Care Center. Data source: 10% of the county CCS cases authorized to SCC or 100 cases (which ever number is less). Part B: Referral of a Child to SCC Definition: This measure is based on the CCS requirement that certain CCS eligible medical conditions require a referral to a CCS Special Care Center for ongoing coordination of services. Numerator: Number of children in CCS, with medical conditions in the categories as listed in Numbered Letter 01-0108 requiring a Special Care Center Authorization, who actually received an authorization for services. Denominator: Number of children enrolled in CCS, with medical conditions, requiring Special Care Center Authorizations. Data source: Counties shall identify and use four or five specific diagnosis categories (cardiac, pulmonary, etc) as listed in the Special Care Center Numbered Letter 01-0108 as it relates to the SCC(s) identified for your client population. The county shall identify one or more diagnostic codes and use the diagnosis codes indicated for the SCC categories selected for this PM. Page 20 of 64 Reporting Form - Part A: Category selected (cardiac, pulmonary, etc.) Number of children with annual team report in client’s medical records (Numerator) Number of children with SCC authorization (Denominator) Percentage of compliance Cardiac, Renal, Neuro- musculoskeletal, Pulmonary, Endocrine 88 100 88% Reporting Form - Part B: Category selected (cardiac, pulmonary etc.) Number of children with authorization to SCC (Numerator) Number of children with eligible medical conditions that require an authorization to a SCC (Denominator) Diagnostic Code Chosen Percentage of compliance Cardiac, Renal, Neuro- musculoskeletal, Pulmonary, Endocrine 94 100 E10, E11, E70, E71, Q05, N18 94% * Counties may select four (4) to five (5) specific medical conditions as outlined in the SCC NL to use as the basis for clients that should have a referral to a CCS SCC. Page 21 of 64 County of Fresno Department of Public Health CCS Performance Measure 4 FY 2017-18 Fresno County updated its Transition Planning protocols for the CCS Program in January, 2015 for clients who turn 14, 16, 18 and 20 years of age in the calendar year. Because of staffing constraints, we developed a relatively automated Transition Planning Process that generates age-focused Transition Planning packets of information for all clients with a medical condition that warrants Transition Planning. Fresno County understands the importance of Transition Planning on the overall health needs of our clients. Transition Planning packets include the following: • A Transition Planning letter addressed to the parents for 14 and 16 year olds and addressed to the clients who are 18 and 20 years old. The letter addresses the importance of client-based understanding of their medical needs, encourages discussion with the medical workers about transition planning, and underscores the importance of finding an adult care provider for when they become adults. • A Health care skills worksheet to be discussed with the Primary Care Physician. • Community resource contact list. • HIPAA forms (as appropriate) o Acknowledgment of Receipt of Privacy Rights under HIPAA o Authorization for Use and Disclosure (for 18 year olds who want to continue including their parents/guardians in their health care decisions). Together, these steps have helped Fresno County shore up Transition Planning outreach and engagement, helped reduce some of the paperwork of case managers, and most importantly contributes to the on-going medical needs of our CCS clients. Fresno County’s CCS Medical Therapy Program continuously provides transition planning for children at ages 3, 14, 16, 18 and 20. The FY 2017-18 Transition Planning Performance Measure includes the following findings: • Based on the results of an MSBI report, Fresno County randomly selected a sample of 1100 clients with an age of 14, 16, 18, or 20 who’s CCS eligible medical condition appropriately required Transition Planning. Page 22 of 64 • The random sample (890 Cases) of all non-MTP clients who turned 14, 16, 18 and 20 years old was created to see if they received Transition Planning after the implementation of the automated Transition Planning process. FY 2017-18 shows 98% of the selected sample received Transition Planning letters/information. • An MSBI report was created to review all clients in the Medical Therapy Program. Out of the 210 clients identified 179 (85%) had transition planning. MTU staff understands the importance of transition planning and will continue to take necessary steps to improve the transition planning protocols. Page 23 of 64 CCS Performance Measure 4 – Transition Planning Definition: Children, 14 years and older who are expected to have chronic health conditions that will extend past the twenty- first birthday will have documentation of a biannual review for long term transition planning to adulthood. Numerator: Number of CCS charts for clients 14, 16, 18, or 20 years containing the presence of a Transition Planning Checklist completed by CCS program staff within the past 12 months for children aged 14 years and over whom requires long term transition planning. Denominators: a. Number of CCS charts reviewed of clients 14, 16, 18, and 20 years in (10% of children aged 14 and over) whose medical record indicates a condition that requires a transition plan. b. Number of MTP charts reviewed of clients 14, 16, 18, and 20 years in (10% of children aged 14 and over) whose medical record indicates a condition that requires a transition plan. Data Source: Chart Audit, Completion of Transition Planning Checklist. * Due to caseload numbers in Los Angeles County, LA County should work with the Regional Office to select an appropriate number of clients to be included in their sample size. Page 24 of 64 Transition Planning Checklist Transition Documentation YES NO Comments 1. Client has an identified need for long-term transition planning. X CCS transition planning is performed for all clients 14, 16, 18, and 20 years old. 2. Transition planning noted in child’s medical record. X Transition planning for clients with appropriate DX is noted in client’s Annual Medical Reviews and other Case Notes. 3. Transition planning noted in SCC reports. X Most SCC’s document transition planning with client and are found in the Medical Social Workers’ notes. 4. Vocational Rehab noted in child’s reports. X Noted only in 14, 16, 18, and 20 year olds in the MTP. 5. Adult provider discussed or identified for children 17 years of age or older. X In all Transition Planning Case Notes, discussion of the need for an adult provider is included. 6. Transition planning noted in SELPA for those children that are in the MTP. X Schools begin noting transition needs at age 16. * Note: Not all of the items in the Checklist will be applicable for each chart review. Page 25 of 64 Reporting Form: Number of CCS charts reviewed 890 Number with transition planning 869 Percentage of compliance 98% Number of MTP charts reviewed 210 Number with transition planning 179 Percentage of compliance 85% Page 26 of 64 County of Fresno Department of Public Health CCS Performance Measure 5 FY 2017-18 This performance measure indicates the level of family participation in the CCS program. Narrative for each criterion follows: 1. CCS uses an existing CCS parent survey developed in February 2011 and updated in 2014. This survey is distributed widely in order to gauge parent/client satisfaction with CCS services. The survey was written at an elementary reading level in both English and Spanish. The survey provides CCS with information on how we can improve upon services, asking yes or no questions and providing opportunity to comment. Surveys are reviewed and CCS Administration employs every effort to improve upon areas of family participation. 2. On-going challenges exist in the areas of family participation. Currently, there are no advisory committees or task forces for family participation, nor is there a County policy to facilitate reimbursement for child care or transportation to such meetings, due to multiple years of budgetary cutbacks and staffing cuts that have only recently begun to rebound, albeit slowly. 3. Family members regularly participate in CCS Special Care Center meetings for care planning and transition planning. 4. Fresno County CCS has no family advocates under contract or as consultants to the program. Fresno County CCS Administration will explore opportunities for increasing family involvement, as dictated by Program considerations, including staffing and budgeting constraints. Page 27 of 64 CCS Performance Measure 5 – Family Participation The degree to which the CCS program demonstrates family participation. Definition: This measure is evaluated based on each of the following four (4) specific criteria that documents family participation in the CCS program. Counties need to indicate the score based on the level of implementation. Checklist documenting family participation in the CCS program. Yes No Comments 1. Family members are offered an opportunity to provide feedback regarding their satisfaction with the services received through the CCS program by participation in such areas as surveys, group discussions, or individual consultation. X Fresno County uses a parent survey and ensures maximum distribution to, and collection from, client’s families. 2. Family members participate on advisory committees or task forces and are offered training, mentoring and reimbursement when appropriate. X 3. Family members are participants of the CCS Special Care Center services provided to their child through family participation in SCC team meeting and/or transition planning. X 4. Family advocates, either as private individuals or as part of an agency advocating family centered care, which have experience with children with special health care needs, are contracted or consultants to the CCS program for their expertise. X Page 28 of 64 Reporting Form: Criteria Performing (25% for each criteria) Not Performing 1. Family members are offered an opportunity to provide feedback regarding their satisfaction with the services received through the CCS program by participation in such areas as surveys, group discussions, or individual consultation. 25% 2. Family members participate on advisory committees or task forces and are offered training, mentoring and reimbursement when appropriate. 25% 3. Family members are participants of the CCS Special Care Center services provided to their child through family participation in SCC team meeting and/or transition planning. 25% 4. Family advocates, either as private individuals or as part of an agency advocating family centered care, which have experience with children with special health care needs, are contracted or consultants to the CCS program for their expertise. 25% Total 50% 50% Page 29 of 64 CHDP Performance Measure 1 - Care Coordination FY 2016-17 The degree to which the local CHDP program provides effective care coordination to CHDP eligible children. Definition: CHDP health assessments may reveal condition(s) requiring follow-up care for diagnosis and treatment. Effective CHDP care coordination is measured by determining the percentage of health condition(s), coded 4 or 5, where follow-up care is initiated1 within 120 days of local program receipt of the PM 160. Numerator: Number of conditions, coded 4 or 5, where the follow-up care was initiated within 120 days of receipt of the PM 160. Denominator: Total number of conditions, coded 4 or 5, on a PM 160, excluding children lost to contact. Data Source: Local program tracking system. Reporting Form: Element Number of conditions coded 4 or 5 where follow - up care was initiated (Numerator) Total number of conditions coded 4 or 5, excluding children lost to contact (Denominator) Percent (%) of conditions where follow-up care was initiated within 120 days Conditions found on children eligible for fee-for-service Medi-Cal that required follow-up care 40 40 90% Conditions found on children eligible for State-funded CHDP services only (Aid code 8Y) that required follow-up care N/A N/A N/A *All 4 of the negatives were successfully linked to services after 120 days. *There are 10 children with conditions from FY 2017-2108 that are currently being followed up on, however their care is still pending. These 10 children were not included in the 40 noted above. 1 Centers for Medicare and Medicaid Services, Publication #45, the State Medicaid Manual, Chapter 5 EPSDT, Section 5310 A Page 30 of 64 http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021927.html Page 31 of 64 CHDP Performance Measure 2 - New Provider Orientation FY 2016-17 The percentage of new CHDP providers with evidence of quality improvement monitoring by the local CHDP program through a New Provider Orientation. Definition: The number of new CHDP providers (i.e., M.D., D.O., N.P., P.A.) added within the past fiscal year who were oriented by the local program staff. Numerator: The number of new CHDP providers who completed an orientation within the past fiscal year. Denominator: The number of new CHDP providers in the county or city (local program) added within the past fiscal year. Data Source: Local program tracking system. Reporting Form: Number of New Providers who Completed Orientation (Numerator) 63 Number of New Providers (Denominator) 63 Percent (%) of New Providers Oriented 100% Optional Local Program Data Tracking Form: Provider Provider Location Date of Orientation Number of Licensed Staff in Attendance Number of Non- Licensed Staff in Attendance 1. 2. 3. 4. Page 32 of 64 CHDP Performance Measure 3 - Provider Site Recertification The percentage of CHDP provider sites (excludes newly enrolled providers) who have completed recertification within the past fiscal year. Provider site visits may occur for other reasons. These can be documented for workload activities. The purpose of this performance measure is to ensure that all providers are recertified at least once every three (3) years. This performance measure is a benchmark to ensure that providers are recertified using the Facility and Medical Review Tools. These tools ensure that providers maintain CHDP standards for health assessments. Definition: An office visit which includes a medical record review and a facility review or Critical Element Review with a Managed Care Plan. Numerator: The number of CHDP provider sites who have completed the Recertification within the past fiscal year using the facility review tool and medical record review tool. Denominator: The number of active CHDP provider sites in the county/city due for recertification within the fiscal year. Data Source: Local program tracking system. Reporting Form: Number of Completed Site Recertifications (Numerator) 86 Number of Active CHDP Provider Sites Due for Recertification (Denominator) 86 Percent (%) with Completed Recertifications 100% Optional Workload Data Tracking Form: (Other reasons for a provider site visit by local program. This identifies workload.) Other reasons for provider site visits: Number of Visits 1. Provider change in location or practice 2. Problem resolution such as, but not limited to, billing issues, parental complaints, facility review and/or other issues.2 3. Medical record review. 4. Office visits for CHDP updates or in-service activities 5. Other Please Specify: 2 CHDP Provider Manual: Program, Eligibility, Billing and Policy. California Department of Health Care Services, Child Health & Disability Prevention (CHDP) Program. See website for current updates. Local Program Guidance Manual Chapter 10: Problem Resolution and/or Provider Disenrollment. California Department of Health Care Services, Child Health & Disability Prevention (CHDP) Program, May 2005. Both references available at: http://www.dhcs.ca.gov/formsandpubs/publications/Pages/CHDPPubs.aspx#dgmp. Page 33 of 64 CHDP Performance Measure 4 - Desktop Review: Dental, Lead Within the past fiscal year, identify the percentage of PM 160s with documentation indicating compliance with the CHDP Periodicity Schedule and Health Assessment Guidelines. Local programs may choose to evaluate the same provider sites over the 5-year Performance Measure cycle, or select different provider sites each year. Definition: A targeted desktop review for three high volume providers within the county/city by determining the percent of PM 160s that have documentation for: • Referral to a dentist at 1 year exam (12-14 months of age) • Lead testing or a referral for the test at 1 year exam (12-14 months of age) Numerator: The number of PM 160 elements recorded correctly per selected providers for the specific ages. Denominator: The total number of PM 160s reviewed per selected providers for the specific ages. Data Source: Local program tracking system. Reporting Form: Dental Referral Lead Test or a Referral Provider Number of PM 160s w/ Dental at 1 year exam (Numerator) Total PM 160s Reviewed (Denominator) Percent (%) Compliance Number of PM160s w/ Lead Test or Referral at 1 year exam (Numerator) Total PM 160s Reviewed (Denominator) Percent (%) Compliance 1. Adventist Health Selma (Rose Clinic) 26 49 53% 18 49 36.7% 2. Dr. Grace Lim 0 139 0% 46 139 33% 3. Dr. Prem Singh 81 81 100% 76 81 93.8% • Numbers may not reflect actual dental or lead referrals made as providers were not required to complete or submit PM 160s this fiscal year. Page 34 of 64 CHDP Performance Measure 5 – Desktop Review: BMI Within the past fiscal year, identify the percentage of PM 160s with documentation indicating compliance with the CHDP Periodicity Schedule and Health Assessment Guidelines. Local programs may choose to evaluate the same provider sites over the five-year Performance Measure cycle, or select different provider sites each year. Definition: A targeted desktop review for three (3) high volume providers within the county/city by determining the percent of PM 160s that have documentation for: • Body Mass Index (BMI) Percentile for ages two (2) years and over. • If BMI Percentile is abnormal, the description of weight status category3 and/or a related diagnosis are listed in the Comments Section. BMI percentile Weight status category < 5th %ile Underweight 85th - 94th %ile Overweight 95th - 98th %ile Obese ≥ 99th %ile Obesity (severe) Numerator: The number of PM 160s BMI-related elements correctly documented for ages two (2) years and over. Denominator: The total number of PM 160s reviewed per selected providers for ages two (2) years and over. Data Source: Local program tracking system. 3 CHDP Provider Information Notice No.: 07-13: Childhood Obesity Implementation Guide from the Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity- 2007. http://www.dhcs.ca.gov/services/chdp/Documents/Letters/chdppin0713.pdf Page 35 of 64 Page 36 of 64 Reporting Form for Performance Measure 5 – Desktop Review: BMI BMI Desktop Review Flow Diagram: Denominator 1 Select sample of PM 160s from each of three high volume CHDP providers. Numerator 1 Count number of PM 160s with BMI percentile documented correctly. Record on Reporting Form Calculate compliance and record on Reporting Form. Denominator 2 Of these PM 160s, select those PM 160s in the sample with BMI-for-age: < 5th %ile 85th- 94th %ile ≥ 95th %ile Numerator 2 Count number of PM 160s with abnormal weight status or associated diagnosis listed in comments section. Record on Reporting Form Calculate compliance and record on Reporting Form. Page 37 of 64 Reporting Form for Performance Measure 5 – Desktop Review: BMI Provider BMI percentile recorded on PM 160s for children ages 2 (two) and older If BMI percentile is < 5 %, 85 - 94 %, or ≥ 95 %, abnormal weight status category and/or related diagnosis listed in Comments Section Number of PM 160s with BMI %ile recorded (Numerator) Number of PM 160s reviewed (Denominator) Percent (%) Compliance Number of PM 160s with abnormal weight status category/ diagnosis in Comments (Numerator) Number of PM 160s with abnormal weight status reviewed for, diagnosis and follow-up (Denominator) Percent (%) Compliance Adventist 1.Health Selma Rose 776 779 99.6% 0 0 0% 2. Dr. Grace Lim 2413 2416 99.8% 12 1069 1.12% 3. Dr. Prem Singh 1087 1216 89.3% 66 511 12.9% • Numbers may not reflect actual BMI documentation or follow-up as providers were not required to complete or submit PM 160s this fiscal year. Page 38 of 64 Optional CHDP Performance Measure 6 - Desktop Review: Head Circumference Within the past fiscal year, identify the percentage of PM 160s with documentation indicating compliance with the CHDP Periodicity Schedule and Health Assessment Guidelines. Local programs may choose to evaluate the same provider sites over the 5-year Performance Measure cycle, or select different provider sites each year. Definition: A targeted desktop review for three high volume providers within the county/city by determining the percent of PM 160s that have documentation for: • Documentation of head circumference on children under 2 years of age. Numerator: The number of PM 160 elements recorded correctly per selected providers for the specific ages. Denominator: The total number of PM 160s reviewed per selected providers for the specific ages. Data Source: Local program tracking system. Reporting Form for Performance Measure 6 - Desktop Review: Head Circumference • Numbers may not reflect actual head circumference documentation as providers were not required to complete or submit PM 160s this fiscal year. Page 39 of 64 County of Fresno Department of Public Health CHDP HCPCFC Performance Measure 1 Care Coordination FY 2017-18 The Health Care Program for Children in Foster Care (HCPCFC) PHNs performed desktop reviews of all Foster Care referrals from CHDP Providers (including PM 160s and/or new HCPCFC referral forms) received for children in out of home care. Follow-up is implemented for any referrals received that indicate abnormal findings and require further diagnosis and/or treatment. The referrals are reviewed for quality assurance purposes. The goal of this program is to assure follow-up care is accomplished within 120 days of receiving referral. There were 22 referrals received from CHDP Providers this fiscal year. The 22 referrals were positive closures indicating a compliance rate of 100%. There were three additional referrals received that were not followed up on due to the children being adopted. The number of referrals received was significantly lower this fiscal year due to the termination of the PM 160 Form that providers were mandated to submit in prior years. This fiscal year, the providers were instructed to complete and submit the new HCPCFC Referral Form to the local CHDP office. It is apparent that CHDP Providers are not submitting the HCPCFC Referral Forms on all completed CHDP exams for children in the foster care system. We suspect this is because in prior years, the PM 160 Forms were tied to provider reimbursement and the current referral forms are not. At this time, the local CHDP Programs have no way to monitor or audit the submission of provider referrals. We expect this issue to be addressed at the State level in the coming Fiscal Year. Page 40 of 64 County of Fresno Department of Public Health CHDP HCPCFC Performance Measure 2 – Health and Dental Exams for Children in Out -of-Home Placement FY 2017-18 The data gathered for this Performance Measure was obtained from the Child Welfare System/Case Management System (CWS/CMS) Health and Education Passport (HEP) using the methodology explained here: http://cssr.berkeley.edu/cwscmsreports/methodologies/default.aspx?report=CDSS5B The percentage of children with timely medical exams was 63%. The number of children with timely dental exams was 76%. The data is only as accurate as the data entered into CWS/CMS HEP. Processes have put in place and continued assistance and education to DSS Staff are ongoing to increase data entry compliance. Some notes regarding completion rates according to data received include: 1. Only the physical and dental exams that are entered into the HEP are included in this data. 2. Due to the change in the referral process last fiscal year, the majority of health and dental exams completed must be requested from the health or dental care provider. The social worker/case manager is responsible for requesting, collecting and documenting needed data. 3. Information for a completed exam may not have been received from the medical or dental provider to be entered into the HEP. Page 41 of 64 California Children's Services Caseload Summary Form County: Fresno Fiscal Year: 2018-19 A B CCS Caseload 0 to 21 Years 1 2 3 4 5 6 7 8 9 10 11 16-17 Actual Caseload % of Grand Total 17-18 Actual Caseload % of Grand Total 18-19 Estimated Caseload based on first three quarters % of Grand Total MEDI-CAL Average of Total Open (Active) Medi-Cal Children 7305 83.6% 7167 84.6% 6273 83.6% Potential Case Medi-Cal 256 2.9% 251 3% 220 2.9% TOTAL MEDI-CAL (Row 1 + Row 2) 7561 86.6% 7418 87.6% 6493 86.5% NON MEDI-CAL OTLICP Average of Total Open (Active) OTLICP 750 8.6% 655 7.7% 617 8.2% Potential Cases OTLICP 26 0.3% 23 0.3% 22 0.3% Total OTLICP (Row 4 + Row 5) 776 8.9% 678 8% 639 8.5% Straight CCS Average of Total Open (Active) Straight CCS Children 383 4.4% 357 4.2% 359 4.8% Potential Cases Straight CCS Children 13 0.1% 12 .2% 12 0.2% Total Straight CCS (Row 7 + Row 8) 396 4.5% 369 4.4% 371 4.9% TOTAL NON MEDI-CAL (Row 6 + Row 9) 1172 13.4% 1047 12.4% 1010 13.5% GRAND TOTAL (Row 3 + Row 10) 8733 100% 8465 100% 7503 100% Page 42 of 64 CHDP Program Referral Data Complete this form using the Instructions found on page 4-8 through 4-10. County/City: FY 15-16 FY 16-17 FY 17-18 Basic Informing and CHDP Referrals 1.Total number of CalWORKs/Medi-Cal cases informed and determined eligible by Department of Social Services 224,952 49,943 Cumulative New Applications 232,338 32,301 Cumulative New Applications 249,901 32,795 Cumulative New Applications 2.Total number of cases and recipients in “1” requesting CHDP services Cases Recipients Cases Recipients Cases Recipients a.Number of CalWORKs cases/recipients 15,620 42,092 15,295 41,187 13,026 34,746 b.Number of Foster Care cases/recipients 4,945 4,945 3,459 3,459 3,312 3,312 c.Number of Medi-Cal only cases/recipients 6,623 17,966 2,542 4,468 1,808 2,913 3.Total number of EPSDT eligible recipients and unborn, referred by Department of Social Services’ workers who requested the following: a.Medical and/or dental services 2,312 2,656 1,749 b.Medical and/or dental services with scheduling and/or transportation 3,531 5,505 6,181 c.Information only (optional)9,914 13,112 11,953 Page 43 of 64 4.Number of persons who were contacted by telephone, home visit, face-to-face, office visit, or written response to outreach letter 2,987 3,405 2,396 Results of Assistance 5.Number of recipients actually provided scheduling and/or transportation assistance by program staff 26 37 16 6. Number of recipients in “5” who actually received medical and/or dental services 20 35 16 Page 44 of 64 MOU/IAA List 1. Intra-Departmental Agreement: CHDP and CCS 2. Inter-Departmental Agreement: Department of Public Health (DPH), Probation Department (PD), and Department of Social Services (DSS) for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Page 45 of 64 State of Ca liforn ia -Health and Human Se:rvi ces Age ncy De partment of Hea tth Care Se rvi ce s -Chitdren's Me dic al Se rvice s Bra nch CHOP Admi nistrative Budget Summary fo.r FY 20 18-19' No County/City Match County/City Name : -'F'-'r=e=sn=o _____ _ Column 1 Total Budget (2 + 3) CategoryJLine Item 1 I. Total P,e rson n el Expen ses $760,92 1 'II . Total OperaUng Expenses $82,837 'Ill. Total Capi tal Expen ses $0 IV. Total Ind i rect Expenses $20 1 ,644 · V. Total Oth er Expenses $0 Budget G r a n d Total $1 ,045 ,4 02 Colum n 1 Sour ce of Funds T otal Funds St ate Genera) Funds $0 Med i -Ca l Funds: $1,045,402 Stat e $404,147 F ederal (Tide XJX) $641 ,255 P repared By (Sig nature) 2 T otal CHOP Budget $0 $0 $0 $0 $0 $0 2 Total CHDP Budget ', I 3 Total Med i-Ca l Budget (4+ 5) $760,92 1 $82,837 $0 $20 1,644 $0 $1,045,402 3 Total Medi-Cal B u dget $1 ,045,402 llllamllfl .I I $404,147 $641 ,255 4 E nh anced State/Fed era I (25/75) $470,336 $3,879 4 E n hanced State/Federa l $1 18 ,554 $355 ,661 5 Nonen hanced State/Fede ra I (50./50) $290 ,585 $78 ,958 $0 $201 ,644 $0 $571 ,1 87 5 Non enhanced State/Fed eral , $285,593 I $285,594 ( 5 59) 600-33 30 axayavath@fresnoco untyca .gov Ph o ne Nu m ber Email Ad d ress (559) 6 00-6592 jsla ughter@ tresnocountyca.gov Phone Nu mber Emai l Ad dress Page 46of 64 State of California – Health and Human Services Agency Department of Health Care Services – Children's Medical Services Branch CHDP Administrative Budget Worksheet for FY 2018-19 No County/City Match State and State/Federal County/City Name:FRESNO 1A 1B 1 2A 2 3A 3 4A 4 5A 5 % or FTE Annual Salary Total Budget (1A x 1B or 2 + 3) CHDP % or FTE Total CHDP Budget Total Medi-Cal % Total Medi-Cal Budget (4 + 5) % or FTE Enhanced State/Federal (25/75) % or FTE Nonenhanced State/Federal (50/50) 60%$104,529 $62,717 0.00%$0 100.00%$62,717 51%$31,986 49%$30,731 100%$99,309 $99,309 0.00%$0 100.00%$99,309 86%$85,406 14%$13,903 100%$99,309 $99,309 0.00%$0 100.00%$99,309 86%$85,406 14%$13,903 100%$37,829 $37,829 0.00%$0 100.00%$37,829 78%$29,507 22%$8,322 100%$52,543 $52,543 0.00%$0 100.00%$52,543 44%$23,119 56%$29,424 90%$24,574 $22,117 0.00%$0 100.00%$22,117 0%$0 100%$22,117 100%$39,407 $39,407 0.00%$0 100.00%$39,407 0%$0 100%$39,407 $413,231 $0 $413,231 $255,424 $157,807 $413,231 0.00%$0 100.00%$413,231 61.81%$255,424 38.19%$157,807 Staff Benefits (Specify %)84.14%$347,690 $0 $347,690 $214,912 $132,778 $760,921 $0 $760,921 $470,336 $290,585 $4,075 $0 $4,075 $2,519 $1,556 $2,200 $0 $2,200 $1,360 $840 $4,105 $0 $4,105 $4,105 $57,562 $0 $57,562 $57,562 5. Equipment Maintenance $1,000 $0 $1,000 $1,000 $6,500 $0 $6,500 $6,500 $4,345 $0 $4,345 $4,345 $1,050 $0 $1,050 $1,050 $1,000 $0 $1,000 $1,000 $1,000 $0 $1,000 $1,000 $82,837 $0 $82,837 $3,879 $78,958 4. Health Education Assistant (B. Matsumoto) 5. Supervising OA (L. Renteria) Column Category/Line Item I. Personnel Expenses 1. Supervising PHN (J. Slaughter) 2. Public Health Nurse II (J. Guerrero) 3. Public Health Nurse II (A. Lee) 6. Office Assistant I (Vacant) 6. Office Expense 7. Postage Total Salaries and Wages Less Salary Savings 7. Office Assistant III (G. Vasquez) 8. Professional and Specialized Services 10. Food 4. Facilities & Household Expenses Net Salaries and Wages I. Total Personnel Expenses II. Operating Expenses 1. Travel 3. Communication 2. Training 9. Printing II. Total Operating Expenses Page 47 of 64 State of Cafrfomia -Health and 1-!u man Seivices Agency County/City Name: FRESNO Column Category/line Item Il l. Capita I Expenses Il l. Total Capita l Expenses IV . End i [ect Expenses 1. Inte rnal Spec· % 26.500% 2. External Speci %) 0 .0-00% IV. T otal Indirect Expenses V. Ottler Expenses , V. Tota l Oltler Expenses Budget Grand Total 1A % or FTE Depart ment of Health Ca.re Ser,ices -Childre n's Medical Sef'Vices Bra nch C HOP Administrative Budget Worksheet for FY 2018-19 No County/City Match State and Stat e/Federal 1B 1 2A 2 CHOP TotatCHDP % orFTE Budget Total Budget Annual Sa.lary (1A x 1 8 or 2+3) so $201 ,644 $0 $201,6 so 3A T ota l Me-d i-Cal % 3, T ota l Medi-Cal Budget (4 +5) S201 ,S44 so S201 .644 so $1 ,045.402 (559} 600-3330 4A % or FTE Phone NumbeI 559 600-6592 Ph one Numbei 4 SA 5 Enhanced Nonenhanoed State/Federal % o r FTE State/Federal (2517 5) (50/50) so $.201,644 so $201 ,64 4 $0 3571.187 axayavath@fresnccou n1vca.goy Email Ad.d ress slau ohle fresn.oco un vca. av Email Ack lfess. Page 48 of 64 I.PERSONNEL EXPENSES $413,231 $347,690 $760,921 II. $4,075 $2,200 $4,105 $57,562 $1,000 $6,500 $4,345 FRESNO COUNTY CHILD HEALTH AND DISABILITY PREVENTION (CHDP) PROGRAM BUDGET FY 2018-19 BUDGET JUSTIFICATION Total Salaries:Salary and Benefits for 7 positions, total of 6.50 FTE. Benefits rate calculated with estimated average of total benefits for the positions. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benefits Administration. Total Benefits: TOTAL PERSONNEL EXPENSES: OPERATING EXPENSES 1. Travel Private mileage reimbursement at $0.545/mile and costs for usage of County cars associated with provider visits and travel to State-sponsored meetings and conferences. 2. Training Cost of tuition & registration fees for program staff to attend State-sponsored training and other trainings to enhance knowledge and skills. 3. Communication Office telephones utilized by program staff. Costs provided by Internal Services. 4. Facilities & Household Expenses Facilities, utilities and security costs. Includes janitorial services and cleaning supplies made available to program, e.g. paper towels, light bulbs. Costs provided by Internal Services, based on square footage of office space occupied by program staff. 5. Equipment Maintenance Copy machine fees/maintenance costs and audiometer calibration. 6. Office Expense General office supplies including paper supplies, computer supplies, pens, ink cartridges, publications, legal notices, pamphlets and brochures for providers, clients, schools and community agencies, etc. Health education materials for provider trainings and health fairs. Includes items such as eye charts, audiometric screening tools. 7. Postage Postage costs for mailing information notices to providers and letters to clients. Page 49 of 64 FRESNO COUNTY CHILD HEALTH AND DISABILITY PREVENTION (CHDP) PROGRAM BUDGET FY 2018-19 BUDGET JUSTIFICATION $1,050 $1,000 10. Food $1,000 TOTAL OPERATING EXPENSES:$82,837 III. N/A $0 $0 IV. a. Internal @ 26.50%$201,644 b. External @ 0.000%$0 $201,644 V. N/A $0 $0 BUDGET GRAND TOTAL:$1,045,402 8. Professional and Specialized Services Interpretation/translation costs for client visits and translating health education material to threshold languages. Also includes confidential document shredding, CPR training and hearing & vision testing class needed for SPMP staff. 9. Printing Charges related to office printing, chart forms, & informational handouts. Food for provider trainings. OTHER EXPENSES TOTAL OTHER EXPENSES: CAPITAL EXPENSES TOTAL CAPITAL EXPENSES: INDIRECT EXPENSES Fresno County Department of Public Health's indirect rate is 26.5% of personnel costs approved for use by Fresno County’s Auditor Controller/Treasurer-Tax Collector.TOTAL INDIRECT EXPENSES: Page 50 of 64 State of Cal iforn ia-Health and Human Se rvices Agency Department of Hea lth Care Services -Children 's Med ica l Services Bra nch Health Care Program for Children i n Foster Care -Caseload Relief Budget Summary Fiscal Yea r 2018-19 Coi umn Category/Line Item t Total Personnel ,Expenses H. Total Operating Expenses m. Total Capital. Expenses IV. Tota I Indirect Expenses V. Total Other Expenses, Expenditures Grand T otal. Column Source of Funds State Funds Federal Funds (Title XlX) T otal Sou rce of Funds Prepa red By {Signature} filiDP Di re ctor ,,[)eputy Di recto r (S ignature) County/City Name: FRESNO 1 Total Budget (2 + 3) $259,05 1 $5,700 2 Enhanced Stat e/Federal (25/75) $233,145 $5 ,130 3 Nonenhanced State/Federal, (50/50) $25,905 $570 , . . • . . ·1 ~ ·---. j . • • -·-·. ·_ • --'-·-. _._.: 1 2 3 En h anced No nenh a need S tate.lF eder al Tota[ Funds State/Federal (5,0/50) (25/75) $107,13 1 $59 ,569 $47 ,562 $226,268 $178,706 $47 ,562 $333,399 $238,275 $95 ,1 24 ___ ,_ .. 0,+/_3_,_fr_r_I-_____ ....;;(5_5_9;;....) 6_0_D-_3_33_o _______ axayava th@fresnocountyca .gov Date 'Prepared Phone Nu mber Emai l Address ____ /_0__,_/5_9__,/;......._..,.[..__ ____ (5_5_9)_6_o_o-_6_59_2 _______ jslaughte r@f resnocountyca .gov ' Date Phone Numbe r Email Address Page 51 of 64 Stale o f Gal ifo mra -Heal lh and Human Services Age nc ~ Deprutme ot of Heaitti Gare Serv ices -Chilclren's Medical Se rv ices Health Care Program for Child ren in Fos ter Care -Caseload Re l ief Budget Summary Budget Worksheet Fiscal Year 2018 -19 County/City Name: FRESNO olumn 1A 18 1 2A 2. 3A 3 T otat Budget %0,r Enhanced % or Nonenhanced Category/Une Item %or FTE Annual Salary (1Ax 1Bor FTE State/Federal FTE State/F edera& 2 + 3} (25175) (50/50) V. Total Other Ex enses (559) 600-3330 axayavalh @fresnocount vca.ge Phone Number Email Address Phone Number Page 52 of 64 I.PERSONNEL EXPENSES $155,276 $103,775 $259,051 II. 1. Training $4,000 2. Travel $1,000 3. Office Expenses $500 4. Professional Services $200 TOTAL OPERATING EXPENSES:$5,700 III. TOTAL PERSONNEL EXPENSES: OPERATING EXPENSES Salary and Benefits for 2 FTE PHN II. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benefits Administration. Private auto mileage reimbursement at $0.545/mile for program staff travel to complete program activities and attend State-sponsored meetings, including regional meetings, sub- committee meetings, and training specific to job duties. General office supplies including paper supplies, computer supplies, pens, ink cartridges and publications to perform program activities. Registration costs for PHNs to attend State recommended training and workshops to maintain professional competence and gain program specific skills. Also includes ancillary costs related to attending training and State-convened meetings. Interpretation/translation services, CPR training. FRESNO COUNTY HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE CASELOAD RELIEF FY 2018-19 BUDGET JUSTIFICATION Total Salaries: Total Benefits: CAPITAL EXPENSES Page 53 of 64 N/A $0 $0 IV. $68,648 $68,648 V. N/A $0 $0 BUDGET GRAND TOTAL:$333,399 TOTAL OTHER EXPENSES: TOTAL CAPITAL EXPENSES: a. Internal @ 26.5%: TOTAL INDIRECT EXPENSES: INDIRECT EXPENSES OTHER EXPENSES Fresno County Department of Public Health's indirect rate is 26.5% of personnel costs approved for use by Fresno County’s Auditor Controller/Treasurer-Tax Collector. Page 54 of 64 Sta te of Califo rnia -Hea lth an d Human Services Agency Depa rtm ent of Health Care Se rvi ces -C hildre n's Medical Services Bran ch HCPCFC Psychotropic M edications M oni tori ng & Oversight Adm i n istrative Budget S ummary Fiscal Year 2018-19 Col um n Category/Line Item I. T otal Person nel Expenses IL T o t al Oper ating Expenses Ill. T otal Capital Expenses IV. Total i ndir ect Expenses V. Total Other Expen ses Exp enditu res Grand Total I Col um n Sou rce of Fu n ds State F u n ds Federal Fu nds (Title X IX ) Total Source of Fu n ds Prepa re d By (Signat u re) Q,.du&~ /CH OP rnrectororputyDfrecto r (Signatu re ) i County/C i ty Name: FRESNO 1 T otal Budget (2 +3} 1 T otal Fu n d s $53,70 4 $113 ,499 $167 ,203 I 2 En h anced State/Federal (25/75) 2 En ha n ced State/Feder a l (25/75) $29 ,898 $89 ,693 $1 19 ,591 I 3 No n enhan ced St ate/Federal (50/50) 3 Nonenh anced State/Fe d e r al. (50/50) $23 ,8 0 6 $23,8 06 $47 ,6 12. i O / 3.../; Jc (55 9) 600-33 30 axayavath@fresnoco u ntyca.go v -..a....-,.1 ---"'b"-r·~a ..... te ........ P-re_p_a_r-ed ____ ....;._..:....,__P_h_on_e_N_u_m_b_e_r___ Email A ddress __ l_a~0_t:?._._0 ..... 1_(_· ------_(5_5_9)_6_0_0-_6_59_2 _______ isla ughter@fr esnoco un tyca .gov • Da t e Phone Nu mber Ema i[ Ad d ress Page 55of 64 I Sla te of California -Health and Human Services Agency Department of Health Care Services -Children's Medical Services HCPCFC Psychotropic Medications Monitoring & Oversi ght Administrative Budget Worksheet Fi scal Year 2018-19 County/City Name: FRESNO Col umn tA 18 1 2A 2 3A 3 Total Budget %or Enhan ced % or Nonenhanced Category/Line Item % orFTE Annual Salary (1A x 1B or FTE State/Federal FTE State/Federal 2 + 3) (25/75) (50/50) enses. 26.500% 0 .00 0% V. Total Other Ex enses (5 59 ) 600-3330 axayavath @fresn ocou nty ca .ge P hone Number Email Address 559 600-6592 Dat e Phone Number Page 56 of 64 I.PERSONNEL EXPENSES $77,638 $51,887 $129,525 II. 1. Training $1,000 2. Travel $1,753 3. Office Expenses $600 TOTAL OPERATING EXPENSES:$3,353 III. N/A $0 $0 IV. $34,324 $34,324 CAPITAL EXPENSES TOTAL CAPITAL EXPENSES: a. Internal @ 26.5%: TOTAL INDIRECT EXPENSES: INDIRECT EXPENSES Fresno County Department of Public Health's indirect rate is 26.5% of personnel costs approved for use by Fresno County’s Auditor Controller/Treasurer-Tax Collector. FRESNO COUNTY HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE Psychotropic Medications Monitoring & Oversight FY 2018-19 BUDGET JUSTIFICATION Total Salaries: Total Benefits: TOTAL PERSONNEL EXPENSES: OPERATING EXPENSES Salary and Benefits for 1 FTE PHN II. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benefits Administration. Registration costs for PHN to complete online & in-person trainings/workshops regarding PMM&O. Reference books, guides & subscriptions for current information on PMM&O related topics. Travel expenses (transportation, lodging, meals, etc.) related to in- person trainings. Page 57 of 64 V. N/A $0 $0 BUDGET GRAND TOTAL:$167,203 TOTAL OTHER EXPENSES: OTHER EXPENSES Page 58 of 64 State of California – Health and Human Services Agency CCS CASELOAD Actual Caseload Percent of Total CCS Caseload STRAIGHT CCS - Total Cases of Open (Active) Straight CCS Children 359 4.95% CCS Administrative Baseline Budget Worksheet OTLICP - Total Cases of Open (Active) OTLICP Children 617 8.51% MEDI-CAL - Total Cases of Open (Active) Medi-Cal (non-OTLICP) Children 6273 86.54% TOTAL CCS CASELOAD 7249 100% 1 2 3 4A 4 5A 5 6A 6 7A 7 8A 8 % FTE Annual Salary Total Budget (1 x 2 or 4 + 5 +6 ) Caseload % Straight CCS County/State (50/50) Caseload % Optional Targeted Low Income Children's Program (OTLICP) Co/State/Fed (6/6/88) Caseload %Medi-Cal State/Federal Enhanced % FTE Enhanced Medi-Cal State/Federal (25/75) Non- Enhanced % FTE Non-Enhanced Medi-Cal State/Federal (50/50) 90.00%129,532 116,579 4.95%5,773 8.51%9,923 86.54%100,883 100.00%100,883 60.00%51,350 30,810 4.95%1,526 8.51%2,622 86.54%26,662 100.00%26,662 100.00%48,282 48,282 4.95%2,391 8.51%4,110 86.54%41,781 100.00%41,781 20.00%110,994 22,199 4.95%1,099 8.51%1,889 86.54%19,210 100.00%19,210 10.00%78,676 7,868 4.95%390 8.51%670 86.54%6,809 100.00%6,809 10.00%56,732 5,673 4.95%281 8.51%483 86.54%4,909 100.00%4,909 100.00%35,522 35,522 4.95%1,759 8.51%3,023 86.54%30,739 100.00%30,739 511,088 266,933 13,219 22,720 230,993 230,993 50.00%156,000 78,000 4.95%3,863 8.51%6,639 86.54%67,498 64.00%43,199 36.00%24,299 100.00%94,952 94,952 4.95%4,702 8.51%8,082 86.54%82,168 71.00%58,339 29.00%23,829 100.00%117,754 117,754 4.95%5,832 8.51%10,023 86.54%101,900 44.00%44,836 56.00%57,064 100.00%78,884 78,884 4.95%3,907 8.51%6,714 86.54%68,263 72.00%49,149 28.00%19,114 100.00%71,942 71,942 4.95%3,563 8.51%6,123 86.54%62,256 94.00%58,521 6.00%3,735 100.00%87,568 87,568 4.95%4,337 8.51%7,453 86.54%75,778 83.00%62,896 17.00%12,882 100.00%82,342 82,342 4.95%4,078 8.51%7,009 86.54%71,256 82.00%58,430 18.00%12,826 100.00%89,232 89,232 4.95%4,419 8.51%7,595 86.54%77,218 87.00%67,180 13.00%10,038 100.00%100,906 100,906 4.95%4,997 8.51%8,589 86.54%87,320 71.00%61,997 29.00%25,323 40.00%69,472 27,789 4.95%1,376 8.51%2,365 86.54%24,048 72.00%17,315 28.00%6,733 40.00%69,472 27,789 4.95%1,376 8.51%2,365 86.54%24,048 72.00%17,315 28.00%6,733 100.00%58,240 58,240 4.95%2,884 8.51%4,957 86.54%50,399 72.00%36,287 28.00%14,112 100.00%64,038 64,038 4.95%3,171 8.51%5,451 86.54%55,416 76.00%42,116 24.00%13,300 100.00%58,240 58,240 4.95%2,884 8.51%4,957 86.54%50,399 45.00%22,680 55.00%27,719 100.00%89,232 89,232 4.95%4,419 8.51%7,595 86.54%77,218 72.00%55,597 28.00%21,621 100.00%89,232 89,232 4.95%4,419 8.51%7,595 86.54%77,218 65.00%50,192 35.00%27,026 100.00%89,232 89,232 4.95%4,419 8.51%7,595 86.54%77,218 81.00%62,547 19.00%14,671 100.00%89,232 89,232 4.95%4,419 8.51%7,595 86.54%77,218 79.00%61,002 21.00%16,216 100.00%89,232 89,232 4.95%4,419 8.51%7,595 86.54%77,218 100.00%77,218 0.00%0 100.00%89,232 89,232 4.95%4,419 8.51%7,595 86.54%77,218 83.00%64,091 17.00%13,127 100.00%96,044 96,044 4.95%4,756 8.51%8,175 86.54%83,113 74.00%61,504 26.00%21,609 100.00%69,472 69,472 4.95%3,441 8.51%5,913 86.54%60,118 72.00%43,285 28.00%16,833 100.00%69,472 69,472 4.95%3,441 8.51%5,913 86.54%60,118 72.00%43,285 28.00%16,833 100.00%58,240 58,240 4.95%2,884 8.51%4,957 86.54%50,399 72.00%36,287 28.00%14,112 1. Daniela Aghadjanian, Administrator 2. VACANT, Staff Analyst I 3. Jennifer Miller, Administrative Assistant III 4. Harsharn Dhillon, Rehabilatative Therapy Manager Subtotal Medical Case Management 1. Dr. Rajeev Verma, Medical Consultant (EXTRA HELP) 2.Marla Bomgardner, Supervising Public Health Nurse 8. Belinda Mayugba, Staff Nurse III Column Category/Line Item I. Personnel Expense Program Administration 9. Joy Conde, Physical Therapist III 5. Tim Yang, Staff Nurse III 6. Noel Almaguer, Public Health Nurse II 7. Heather Woo, Public Health Nurse II 7. VACANT, Program Technician I 24. Veronica Reyna, Staff Nurse I 11. Amada Ozaeta, Public Health Nurse (EXTRA HELP) 10. Stella Jauregui, Public Health Nurse (EXTRA HELP) 12. Megan Milburn, Staff Nurse I 5. Peter Jew, Systems & Procedures Analyst III 18. Jing Yang, Staff Nurse III 6. Jose Rodriguez, Senior Accountant 3. Sherilee Lawson, Head Nurse 4. Quy Gip, Staff Nurse III Straight CCS Optional Targeted Low Income Children's Program (OTLICP)Medi-Cal (Non-OTLICP) Department of Health Care Services – Integrated Systems of Care Division 2018-19 County: Fiscal Year: Fresno 19. Marjelyn Ramiro, Staff Nurse III 20. Maribeth Jensen, Staff Nurse III 21. Elizabeth Manfredi, Public Health Nurse II 22. RJ Lee, Public Health Nurse I 23. Sandy Sue Arce, Public Health Nurse I 13. Kelly Stevens, Staff Nurse II 14. Shavonne Smith, Staff Nurse I 15. Joseph Burgess, Staff Nurse III 16. Vivien Tagoe, Staff Nurse III 17. Darawadee Martin, Staff Nurse III Page 59 of 64 State of California – Health and Human Services Agency CCS CASELOAD Actual Caseload Percent of Total CCS Caseload STRAIGHT CCS - Total Cases of Open (Active) Straight CCS Children 359 4.95% CCS Administrative Baseline Budget Worksheet OTLICP - Total Cases of Open (Active) OTLICP Children 617 8.51% MEDI-CAL - Total Cases of Open (Active) Medi-Cal (non-OTLICP) Children 6273 86.54% TOTAL CCS CASELOAD 7249 100% 1 2 3 4A 4 5A 5 6A 6 7A 7 8A 8 % FTE Annual Salary Total Budget (1 x 2 or 4 + 5 +6 ) Caseload % Straight CCS County/State (50/50) Caseload % Optional Targeted Low Income Children's Program (OTLICP) Co/State/Fed (6/6/88) Caseload %Medi-Cal State/Federal Enhanced % FTE Enhanced Medi-Cal State/Federal (25/75) Non- Enhanced % FTE Non-Enhanced Medi-Cal State/Federal (50/50) Column Category/Line Item Straight CCS Optional Targeted Low Income Children's Program (OTLICP)Medi-Cal (Non-OTLICP) Department of Health Care Services – Integrated Systems of Care Division 2018-19 County: Fiscal Year: Fresno 100.00%58,240 58,240 4.95%2,884 8.51%4,957 86.54%50,399 72.00%36,287 28.00%14,112 2,085,902 1,924,536 95,309 163,807 1,665,422 1,231,555 433,867 100.00%48,646 48,646 4.95%2,409 8.51%4,141 86.54%42,096 51.00%21,469 49.00%20,627 100.00%58,474 58,474 4.95%2,896 8.51%4,977 86.54%50,601 18.00%9,108 82.00%41,493 107,120 107,120 5,305 9,118 92,697 30,577 62,120 100.00%47,944 47,944 4.95%2,374 8.51%4,081 86.54%41,489 100.00%41,489 100.00%39,858 39,858 4.95%1,974 8.51%3,393 86.54%34,492 100.00%34,492 100.00%32,630 32,630 4.95%1,616 8.51%2,777 86.54%28,237 100.00%28,237 100.00%27,690 27,690 4.95%1,371 8.51%2,357 86.54%23,962 100.00%23,962 100.00%27,690 27,690 4.95%1,371 8.51%2,357 86.54%23,962 100.00%23,962 100.00%39,234 39,234 4.95%1,943 8.51%3,339 86.54%33,952 100.00%33,952 7. Anita Tristan, Admitting Interviewer II 100.00%33,644 33,644 4.95%1,666 8.51%2,864 86.54%29,114 100.00%29,114 8. Alicia Molina, Admitting Interviewer II 100.00%41,730 41,730 4.95%2,067 8.51%3,552 86.54%36,112 100.00%36,112 9. Marcy Nava, Admitting Interviewer II 100.00%33,644 33,644 4.95%1,666 8.51%2,864 86.54%29,114 100.00%29,114 100.00%27,690 27,690 4.95%1,371 8.51%2,357 86.54%23,962 100.00%23,962 100.00%36,894 36,894 4.95%1,827 8.51%3,140 86.54%31,927 100.00%31,927 100.00%35,776 35,776 4.95%1,772 8.51%3,045 86.54%30,959 100.00%30,959 100.00%33,644 33,644 4.95%1,666 8.51%2,864 86.54%29,114 100.00%29,114 100.00%41,730 41,730 4.95%2,067 8.51%3,552 86.54%36,112 100.00%36,112 100.00%28,548 28,548 4.95%1,414 8.51%2,430 86.54%24,704 100.00%24,704 100.00%35,776 35,776 4.95%1,772 8.51%3,045 86.54%30,959 100.00%30,959 100.00%30,342 30,342 4.95%1,503 8.51%2,583 86.54%26,257 100.00%26,257 100.00%33,644 33,644 4.95%1,666 8.51%2,864 86.54%29,114 100.00%29,114 100.00%27,690 27,690 4.95%1,371 8.51%2,357 86.54%23,962 100.00%23,962 100.00%31,278 31,278 4.95%1,549 8.51%2,662 86.54%27,067 100.00%27,067 687,076 687,076 34,026 58,483 594,571 594,571 100.00%44,876 44,876 4.95%2,222 8.51%3,820 86.54%38,834 0.00%100.00%38,834 100.00%25,220 25,220 4.95%1,249 8.51%2,147 86.54%21,824 0.00%100.00%21,824 100.00%25,220 25,220 4.95%1,249 8.51%2,147 86.54%21,824 0.00%100.00%21,824 100.00%39,234 39,234 4.95%1,943 8.51%3,339 86.54%33,952 0.00%100.00%33,952 100.00%39,234 39,234 4.95%1,943 8.51%3,339 86.54%33,952 0.00%100.00%33,952 100.00%39,234 39,234 4.95%1,943 8.51%3,339 86.54%33,952 0.00%100.00%33,952 19. Pa Lee, Admitting Interviewer I 10. Devany Prieto, Admitting Interviewer I 11. Tiffany Acosta, Admitting Interviewer II 12. Maria Escobedo, Admitting Interviewer II 13. Bernard Thao, Admitting Interviewer II 14. Luz Reyes, Admitting Interviewer II 15. Rosa Lopez, Admitting Interviewer I 16. Laurie Roberts, Admitting Interviewer II 1. Martha Orejel, Medical Social Worker I 17. Xavier Gonzalez, Admitting Interviewer I 18. Michael Vue, Admitting Interviewer II 2. Zulema Alderete, Office Assistant I 3. Melinda Kelley, Office Assistant I 4. Tamara Brown, Office Assistant III 5. Melissa Figueroa, Office Assistant III 1. Sonya Menoza, Senior Admitting Interviewer I 2. Bobbi Taylor, Senior Admitting Interviewer I Subtotal Ancillary Support 2. Ariana Robles Solis, Medical Social Worker I 25. Khamsay Vanhelsdingen, Staff Nurse I Subtotal Other Health Care Professionals Clerical and Claims Support 1. Alibra Carter, Supervising Office Assistant 6. Teresa Valladolid, Office Assistant III 20. VACANT, Admitting Interviewer I Subtotal 3. Vanessa Bong, Admitting Interviewer II 4. Angel Rodriguez, Admitting Interviewer I 5. Sarrina Staub, Admitting Interviewer I 6. Rudy Constantino, Admitting Interviewer II Page 60 of 64 State of California – Health and Human Services Agency CCS CASELOAD Actual Caseload Percent of Total CCS Caseload STRAIGHT CCS - Total Cases of Open (Active) Straight CCS Children 359 4.95% CCS Administrative Baseline Budget Worksheet OTLICP - Total Cases of Open (Active) OTLICP Children 617 8.51% MEDI-CAL - Total Cases of Open (Active) Medi-Cal (non-OTLICP) Children 6273 86.54% TOTAL CCS CASELOAD 7249 100% 1 2 3 4A 4 5A 5 6A 6 7A 7 8A 8 % FTE Annual Salary Total Budget (1 x 2 or 4 + 5 +6 ) Caseload % Straight CCS County/State (50/50) Caseload % Optional Targeted Low Income Children's Program (OTLICP) Co/State/Fed (6/6/88) Caseload %Medi-Cal State/Federal Enhanced % FTE Enhanced Medi-Cal State/Federal (25/75) Non- Enhanced % FTE Non-Enhanced Medi-Cal State/Federal (50/50) Column Category/Line Item Straight CCS Optional Targeted Low Income Children's Program (OTLICP)Medi-Cal (Non-OTLICP) Department of Health Care Services – Integrated Systems of Care Division 2018-19 County: Fiscal Year: Fresno 100.00%27,508 27,508 4.95%1,362 8.51%2,341 86.54%23,804 0.00%100.00%23,804 100.00%24,466 24,466 4.95%1,212 8.51%2,082 86.54%21,172 0.00%100.00%21,172 100.00%24,466 24,466 4.95%1,212 8.51%2,082 86.54%21,172 0.00%100.00%21,172 100.00%27,638 27,638 4.95%1,369 8.51%2,352 86.54%23,917 0.00%100.00%23,917 100.00%27,638 27,638 4.95%1,369 8.51%2,352 86.54%23,917 0.00%100.00%23,917 50.00%37,232 18,616 4.95%922 8.51%1,585 86.54%16,110 0.00%100.00%16,110 381,966 363,350 17,995 30,925 314,430 314,430 3,349,015 4.95%165,857 8.51%285,052 86.54%2,898,113 43.55%1,262,132 56.45%1,635,981 Staff Benefits (Specify %)79.53%2,663,472 4.95%131,906 8.51%226,702 86.54%2,304,864 1,003,771 1,301,093 6,012,487 4.95%297,763 8.51%511,754 86.54%5,202,977 2,265,903 2,937,074 3,500 4.95%173 8.51%298 86.54%3,029 43.55%1,319 56.45%1,710 11,000 4.95%545 8.51%936 86.54%9,519 43.55%4,146 56.45%5,373 45,000 4.95%2,229 8.51%3,830 86.54%38,941 100.00%38,941 30,000 4.95%1,486 8.51%2,553 86.54%25,961 100.00%25,961 9,000 4.95%446 8.51%766 86.54%7,788 100.00%7,788 10,000 4.95%495 8.51%851 86.54%8,654 100.00%8,654 31,000 4.95%1,535 8.51%2,639 86.54%26,826 100.00%26,826 122,000 4.95%6,042 8.51%10,384 86.54%105,574 100.00%105,574 27,000 4.95%1,337 8.51%2,298 86.54%23,365 100.00%23,365 6,800 4.95%337 8.51%579 86.54%5,884 100.00%5,884 39,600 4.95%1,961 8.51%3,371 86.54%34,268 100.00%34,268 21,000 4.95%1,040 8.51%1,787 86.54%18,173 100.00%18,173 355,900 17,626 30,292 307,982 5,465 302,517 4.95%0 8.51%0 86.54%0 0 0 0 0 0 0 1. Internal 9.07%545,333 4.95%27,007 8.51%46,416 86.54%471,910 100.00%471,910 2. External 0.00%0 4.95%0 8.51%0 86.54%0 100.00%0 545,333 27,007 46,416 471,910 471,910 42,600 4.95%2,110 8.51%3,626 86.54%36,864 100.00%36,864 42,600 2,110 3,626 36,864 36,864 6,956,320 344,506 592,088 6,019,733 2,271,368 3,748,365 8. Natasha Jones, Office Assistant I 13. Rodrigo De La Rosa, Account Clerk III V. Total Other Expense Budget Grand Total III. Total Capital Expense IV. Indirect Expense IV. Total Indirect Expense V. Other Expense 1. Maintenance & Transportation 10. Special Department Expenses 11. Data Processing 12. Translation Services II. Total Operating Expense III. Capital Expense 1. 2. Training 8. Facility Services (Rent, Utilities) 9. Communication 3. Office Expenses 4. Postage 5. Small Tools 6. Householde Expenses 7. Maintenance-Equipment, Bldg. & Security II. Operating Expense 9. Robert Romans, Office Assistant I 10. VACANT, Office Assistant I 1. Travel 11. VACANT, Office Assistant I Subtotal Total Salaries and Wages I. Total Personnel Expense 7. Angela Klamm, Office Assistant II Page 61 of 64 Sta:c e cf Cab:mA -He alh a id J-bnan S er-u:::es.Ag;.!n:,r l'ffi:IHIL OII' Ac:1ual T°"'I CC. CCS CASEIL0.00 c:aseico.d c»eJNd S TRAIGtlT CCS - TCU! Giisl!s -::C: Cpffl (.Adl.'tl t Suaigll CCSOJJa,m :!59 -1 .sc...,-. CCS Adm i nistrative B asel i ne B udget Wo rk s h eet 0 11.ICP -617 11-5?% T-C""50: 0,,,,, (Ad:l.,e )OTJ.£?Ch""'1 F iscal Year. 20 1 8-1 9 rt EDJ-cAL -Tcti:11 ~~ Coen (.Ato.<e l Wtc M:a-1 6Z1J """"" ~U::F)CHd'."' C OUlllly: Fres.rao TOTAL CC S CASfLOAD 7'Z49 I 100':& SJ.,aig'~CCS I Optk,J:gl f il rge~d LO¥!' lrn::MM --j tk>n-OTUX:~) I Ch t.d"ren's. Pr-o.gt iUJ'J JOTl.lCP'.J c ....... 1 > 3 ... .. ! ~ ... 5 61>, 6 7A 7 8A & Op1JDNJ Tar,;et.ett ;Enh.w"~l'd Ncn-&naneed """"" TOUll~t Sts.;g,.tOCS C ilHN<HI Low-b::o l'l:e --~Id,., lltedl -C a1 Nm-Wea-C al c-.,;r,it..n,"""" %FTE Sa lary (1 .i:2 or C-..s d :i.e lll 'i Co""'JlSta.h> " CN1 d rtm'$ c..clo;a d -S. S tlle.'f~a f1E S tato,'f edtl:al Etaoc...i·!G. st,ln.'Federai -4 + :5 <16 ~ 49JJ~f P,,=am (O'TUCl'f FIE Co.~t:tt:i.'88) 1>517~) ls.:>m) ~I I -, ~3ndar1 Hl'berer 8.00J2ll1 8 55~21 P, is.. ~11 Pr~Bl-'9-f(Prr.Jea: UmmeJ Ca k!<Prepare-:i Ph::ne t~imt« c----.. ./ /} ~:, , "-Al' I ~ ~ .ot 01 l 1.otR" c ~ II O...E!f'a A;ihacj i!Un 55~595 .rri-. .I .1:v ) / CCS.Mni".ma>:< (P<i'r.o<lN .m<) c-s.inr.1 Fha"!e t4 1.mber .--., y Page <62 of 64 CCS CASELOAD Acwo! Caselood CCS CaseOo<td' STRAIGHT CCS Totlll Cases or Cpen (A.c:dY,e) Slnigtr. cc-s Chi Olea 359 4S5% CCS Administrative Baseline Budget Summary OTLJCP--I Tolnl! Caus cr-Cpeo (Adh,e.) OlUCP Chld:m 617 S.5-1% 2018-19 Fiscal Year: MEDICAL-6273 86.54%. Tol.r.tlCases cfCpen (/tn,1�"e.) Mad.Cll1 (111:n..OTLrcp} Chl�:tffl Fresn.o County: TO TAL CCS CA.S£LOAD 7249 100% Cal, 1 a: c� 2+.1-+4 Slr.lightCCS OTI.ICP Medi·C·�J <no.n-OTUCPI· 1ca1umn .cs Coi.lmns· 5 • 6� Column 1 2 3 • �6 Op,tio,Yl,orlJ(<e<I luM Sin;g,,tOC:S b:on,o,ChiJ.dren.'1o E':nlvn«ldl Medi-Cit Nc:z:n.cnh.meed Mndi- c·myor,,t.in.e,'btm TotalBl.ldgd: County.!Sta.Q! Progr:.un, (OT·�t it,edi-Cal StltuJFltdrrnl St:ltcl�edernl (2�75) Cal Sr.:a.to.fFcderal JM>�I· County,ts::ta-'.e."Fedl 150,ro1 (616.�31 L 'Tot:al Pt:nonne!ll&PfflSC 6,iU2,4!i7 297.J� S11,75c. �io2.s-n 2.2'S5 ·,9Dl 2.,9S7JJ,7'. IL Total Operat'.hg IE,;J>mW! J.:55,:9CO 17,625 30,292 J07,S<R �.+65 302:,5-17 Ml'.Tobl�e_,.e �Cl D 0 D W. iobllndlreci. Expense !.45.?l3 27.007 •6,416 471,910 471,9L0 V. Tobi Other Ex pN'tS't 42.&,:(I 2.110 s.e;!6 J6,ll4 35µ4 Budgl'! Grand TCAI 6,9'!6,l:il> 3"4 ,500 :.92,.o:.!8 6,1>19,733 2.27t,3S� l,746,= C'ol1zCo12•-5':roight ccs OTLICP lll�al tnon-OTUCpt (C 'ol.lrrn 4 -"E ·Coti.ann• 5, • 'io) Column 1 2 3 • 6 6 OpliDlnJII T•yotcd Low S..Y.1ightCCS lneanti Childrffls Enhanced Medi-Cal .Non-Em2D:cd' lilet£. SCQJ'Ce cC kmd5 TotJI B,;,dgc1 CountyfSUde Prog,..., (OlLICP) Mcdi-C'.)j Sbb!l'Fede.ra.L St.Jt.eJ'FCdC!ral l2�'i':S� CIG S.�"'Feda.-.1 (l5DJrot C°""'Yl'Strtc lf«I i!<Jf50) �1'6JU) S<ralght ccs. .S..,t, 172,253 172�3 I CO"Unty 172,253 172�3 OTUCP I State •7JJ67 47,357 c-,,y 4'7.;!67 47,357 �edenol (T�le XXI) 497 $4 �W.35< �- St,m 2,,442,025 2..#�25 ;,;J,842 1P4.l•Bl N<ler.ll(T 'le.XIX., 3�Ti.7Ci1 �.S77,7DB 1,703.� 1.87-4,182 "2--') 1--' ---BmndonHcberer bheberer@fresnoorun1yca.gov Pr�SC31� /J Pr,tf:'ilred ·2.y (P�4 t�ime> &nal.Ac:dress -��,..IJ.�, --daahadjar.iar>@fresnoooomyca.gov �� ,_DnnWa Aghalfjw111S;,n .... ,.i-/ CCS ""tinb'113lDI (P:i'll:ed Warne) EmalMd:ns �� Page63 of64 3,349,015$ 6,012,487$ 3,500.00$ 11,000.00$ 45,000.00$ 30,000.00$ 9,000.00$ 10,000.00$ 31,000.00$ 122,000.00$ 27,000.00$ 6,800.00$ 39,600.00$ 21,000.00$ 355,900.00$ -$ 545,333.00$ -$ 545,333.00$ 42,600.00$ 42,600.00$ 6,956,320.00$ V. Other Expenses Maintenance & Transportation Same amount as previous FY. Reimbursments and payments to families for travel, lodging and meals incurred while obtaining CCS authorized services allowing for special circumstances and other contingencies. Total Other Expenses: Budget Grand Total: IV. Indirect Expenses Internal @ 9.07% Represents a 36% decrease from previous fiscal year. Fresno's actual indirect rate is 26.5% but the amount was lowered to meet the allocation. External @ 0%Same amount as previous FY. Total Indirect Expenses: Translation Services Same amount as previous FY. Total Operating Expenses: III. Capital Expenses Total Capital Expenses:Same amount as previous FY. Communication Represents a 2.7% increase from previous FY based on expenditures. Special Dept. Expenses Represents a 1.5% increase from previous FY based on expenditures. Data Processing There was no amount budgeted in the previous FY. Household Expenses Represents a 9.7% increase from previous FY based on expenditures. Maint-Equip, Bldg, & Security Represents a 0.9% increase from previous FY based on expenditures. Facility Services(rent, utilities)Represents an 8.7% increase from previous FY based on expenditures. Office Expenses 5.2% increase from previous fiscal year based on expenditures. Postage Based on expenditures from previous FY. No change from previous FY. Small Tools Represents a 5.5% increase from previous FY based on expenditures. II. Operating Expenses Travel Based on expenditures: Milage, Meals, Lodging, Freight, Praking, Garge Fees, etc. (9% increase from previous FY) Training Includes registration and/or tuition fees for CCS trainings, seminars, conferences, etc. This is a 9.6% increase from the previous FY based on expenditures. Staff Nurse Represents a 14.0 FTE. This is an increase of 1.0 FTE from previous FY to better match Staffing Standards. Medical Social Worker Represents 2.0 FTE. Meets Staffing Standards. Admitting Interviewer Represents 18.0 FTE with one vacancy (an increase of 2.0 FTE from previous FY). Total Personnel Expenses: Staffing Changes Public Health Physician Represents a .5 FTE from an Extra Help position. This is a .1 FTE increase from the previous FY. Public Health Nurse Represents a 5.8 FTE. This is a 3.2 FTE decrease from the previous FY. I. Personnel Expenses Total Salaries: Total Benefits:2,663,472$ Staff benefits represent an estimated 79.53% of salaries; this is a decrease of .37% from the previous fiscal year. This estimate was reached by using an average of the actual benefits paid for the previous fiscal year with an added 3% to adjust for projected pay raises and promotions. Page 64 of 64