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Home My WebLink AboutAgreement A-16-031 with Childrens Medical Services Plan..pdf Agreement No. 16-031 Children's(.0%dical Services Plan and FiscL.,43"uidelines COUNTY: Fresno FISCAL YEAR: 2015-16 Plan and Budget Required Documents Checklist MODIFIED FY 2015-16 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, and HCPCFC Retain locally C. CCS Staffing Standards Profile Retain locally D. Incumbent Lists for CCS, CHDP, and HCPCFC 6, 11, 13 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 14 ! 6. Data Forms A. CCS Caseload Summary 40 B. CHDP Program Referral Data 41 7. Memoranda of Understanding and Interagency Agreements List A. MOU/IAA List 43 , B. New, Renewed, or Revised MOU or IAA 44, 46 C. CHDP IAA with DSS biennially Retain locally , D. Interdepartmental MOU for HCPCFC biennially Retain locally 8. Budgets A. CHDP Administrative Budget (No County/City Match) 1. Budget Summary 62 2. Budget Worksheet 63 3. Budget Justification Narrative 65 Children's Medical Services Plan and Fiscal Guidelines COUNTY: Fresno FISCAL YEAR: 2015-16 Document Page Number B. CHDP Administrative Budget (County/City Match) - Optional 1. Budget Worksheet NIA 2. Budget Justification Narrative N/A 3. Budget Justification Narrative NIA 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 Administrative Budget 1. Budget Summary 61 2. Budget Worksheet 68 3. Budget Justification Narrative 70 E. CCS Administrative Budget 1, Budget Summary 72 77 83 2. Budget Worksheet 74 79 3. Budget Justification Narrative 85 G. Other forms 1. County/City Capital Expenses Justification Form NIA 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 NIA (DHCS1203) 2. Inventory/Disposition of DHCS Funded Equipment Form (D.HCS1204) N/A 3. Property Survey Report Form (STD 152) NIA Children's Medical Services Plan and Fiscal Guidelines COUNTY: Fresno FISCAL YEAR: 2015-16 Agency Information Sheet CountylCity: Fresno/Fresno Fiscal Year: 2015-16 Official Agency Name: David Pomaviile, Address: 1221 Fulton Mall Director P.O. Box 11867 Fresno, CA 93775 Health Officer Ken Bird, MD. CMS Director (if applicable) Name: Deborah Martinez Address: 1221 Fulton Mall P.O. Box 11867 Fresno, CA 93775 Phone: 559-600-6595 Fax: 559-455-4789 E-Mail: martidaa-co.fresno.ca.us CCS Administrator Name: Deborah Martinez Address: 1221 Fulton Mall P.O, Box 11867 Fresno, CA 93775 Phone: 559-600-6595 Fax: 559-455-4789 E-Mail: martidaaco.fresno.ca.us CHDP Director Name: Rose Mary Garrone Address: 1221 Fulton Mall P.O. Box 11867 Fresno, CA 93775 Phone: 559-600-6363 Fax: 559-600-7726 E-Mail: rgarrone@co.fresno.ca.us CHDP Deputy Director Name: Julie Slaughter Address: 1221 Fulton Mall P.O. Box 11867 Fresno, CA 93775 Phone: 559-600-6592 Fax; 559-600-7726 E-Mail: slaugj@co.fresno.ca,us Clerk of the Board of Supervisors or City Council Name: Bernice Seidel Address: 2281 Tulare St, 3 d Floor Fresno, CA 93721 Phone: 559-600-3529 Fax: 559=600-1608 B-Mail: bseidel@co.fresno.ca,us 1 Children's Medical Services Plan and Fiscal Guidelines COUNTY: Fresno FISCAL YEAR: 2015-16 Director of Social Services Agency Name: Delfino Neira Address: 2135 Fresno St, STE 100 Fresno, CA 93721 Phone: 559-600-2301 Fax: 559-600-2311 E-Mail: dneira@co,fresno.ca.us. Chief Probation Officer Name: Rick Chavez 3333 E American Ave, STE B Fresno, CA 93725 Phone: 559-600-129.8 Fax,. 559=455-2412 E-Mall: rrchavez@co.fresno.ca.us 2 Children's radical Services Plan and Fisc , Suidelines COUNTY: Fresno FISCAL YEAR: 2015-16 Certification Statement - Child Health and Disability Prevention (CHDP) Program County/City: Fresno/Fresno Fiscal Year: 2015-16 I certify that the CHDP Program will comply with all applicable provisions of Health and Safety Code, Division 106, Part 2, Chapter 3, Article 6 (commencing with Section 124025), Welfare and Institutions Code, Division 9, Part 3, Chapters 7 and 8 (commencing with Section 14000 and 14200), Welfare and Institutions Code Section 16970, and any applicable rules or regulations promulgated by DHCS pursuant to that Article, those Chapters, and that section. I i further certify that this CHDP 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 CHDP 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.). I further agree that this CHDP Program may be subject to all sanctions or other remedies applicable if this CHDP Program violates any of the above laws, regulations and policies with which it has certified it will comply. - `[ - Signature o CH P Director Date Signed Signature of Director or H alth Officer Dare Sj ned { Signature and Title of Other-Optional Date Signed I certify that this plan has been approved by the local governing body. l -d17- 1 LP Signature of Local Governing Body Chairperson Date ATTEST: BERNICE E.SEIDEL,Clerk Board of Supervisors By -SUS&,% IJ 1 SXIc-C� Deputy 3 Children1 s(O"'Idical Services Plan and Fisc�uidelines i COUNTY: Fresno FISCAL YEAR: 2015-16 Certification Statement -California Children's Services (CCS) County/City: Fresno/Fresno Fiscal Year: 2015-16 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. Cg—nature—of CCS Administr ate Signed i J iL Signature of Dir ctor or Heap/officer Date ign Signature and Title of Other— Optional Date Signed I certify that this plan has been approved by the local governing body. 1 • Lo Signature of Local Governing Body Chairperson Date Signed ATTEST: BERNICE E.SEIDEL,Clerk Board of Supervisors By �l�lS OEM L�l J1f, Deput 4 Children's Medical Services Plan and Fiscal Guidelines COUNTY: Fresno FISCAL YEAR: 2015-16 CNIS PLAN Fiscal Year 2015-16 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. 5 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 State of Califomia.- Health and Human Services Agency Department of Health Care Services-.Children's Medical Services Incumbent List— California Children's Services For FY 2015-16, 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: 2015-16 Have Job Has Civil FTE % on Duties Service Job Title Incumbent Name CGS Admin Classification Budget (Yes or No) Changed? (Yes or No) Division Manager/Administrator Deborah Martinez 100% No No Administrative Assistant Jennifer Miller 100% No No Staff Analyst Brandon Heberer 100% No No Rehabilitation Therapy Manager Harsham Dhillon 20% No No Systems & Procedures Analyst Peter Jew 10% No No �i Accountant Michael Chu 10% No No 6 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR.: 2015-16 Have Job Has Civil FTE % on Duties Service Job Title, Incumbent Name CCS Admin Changed? Classification Budget Changed? (Yes or No) (Yes or No) Public Health Physician Vacant 100% No No Public Health Physician Vacant 100% No No f Supervising Public Health Nurse Nancy Sullivan (MCMC, IHO, RC) 100% No No i Head Nurse Sherilee Lawson 100% No No 'Public Health Nurse Ania Abueg 100% No No Public Health Nurse Elizabeth Manfredi 100% No No I Public Health Nurse Heather Woo 100% No No Public Health Nurse Noel Almaguer 100% No No Public Health Nurse Rene Martz 100% No No Public Health Nurse Theresa Hartsock 100% No No Public Health Nurse Hilary Davis 100% No No Public Health Nurse (Extra Help) Amada Ozaeta 100% No No Public Health Nurse (Extra Help) Stella Jauregui 100% No No Public Health Nurse (Extra Help) Hope Garcia 100% No No 7 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Nave Job Has Civil FTE on Duties Service Job Title Incumbent Name CCS Admm Classification Budget Changed? Changed? (Yes or No) (Yes or No) Staff Nurse Tire Yang 100% No No Staff Nurse Anastacio Cruzat 100% No No Staff Nurse Chameka Howell 100% No No Staff Nurse Belinda Mayugba 100% No No Staff Nurse Darawadee Martin 100% No No Staff Nurse Jing Yang I 100% No No I Staff Nurse Joanne Thorne 100% No No Staff Nurse Joseph Burgess 100% No No Staff Nurse Julie McCaslin 100% No No i Staff Nurse Maribeth Jensen 100% No No Staff Nurse Marjelyn Ramiro 100% No No Staff Nurse Vvien Tagoe 100% No No Physical Therapist. Joy Conde 1000% No No Medical Social Worker Evangelina Lopez 100% No No 8 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 I Have Job Has Civil FTE % on Duties Service Job Title i Incumbent Name CCS Admtn Changed? Classification Budget (Yes or No) Changed? (Yes or No) Senior Admitting Interviewer I Sonya Mendoza 100% No No I Senior Admitting Interviewer Khamsay Vanhelsdingen 100% No No Admitting Interviewer Lee Garcia 100% No No. Admitting Interviewer Luz Reyes 100% No No Admitting Interviewer Gabriela Rodrigues-Reyes 100% No No i Admitting Interviewer Rebecca Lopez I 100% No No Admitting Interviewer Maria Escobedo 100% No No Admitting Interviewer Alicia Molina 100% I No No ___-T- Admitting Interviewer Keisha Arnmonds 100% No No Admitting Interviewer Bobbi Taylor 100% No No. Admitting Interviewer Antionette Luevanos 100% No No Admitting Interviewer Laurie Roberts 100% No No Admitting Interviewer Tiffany Acosta 100% No No Supervising Office Assistant Alibra Carter 100% No No 9 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR.: 2015-15 Have Job Has Civil FTE % on Duties Service Job Title Incumbent Name CCS Admin. Changed? Classification Budget (Yes or No) Changed? (Yes or No) Office Assistant Xavier Gonzalez 100% No No Office Assistant Teresa Valladolid 100% No No Office Assistant Angela Garcia 100% No No I Office Assistant Michelle Davis IOD% No No Office Assistant Margarita Pureoo 10.0%o No No Office Assistant Rick Jemison 100% No No Office Assistant Kristeena Flaherty 1 DO% No No Office Assistant Breanne Vazquez 100% No No Office Assistant Tamara Brown 100% No No i Office Assistant Mellissa Figueroa 100% No No Supervising Account Clerk Norma Zieska 100% No No Account Clerk Rodrigo De La Rosa 100% No No Account Clerk Kirana Bawana 100% No No Account Clerk Kenneth Shirley 10D% :1 No No 10 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 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 2014-15 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: 2015-16 FTE % on FTE % on Has Civil CHDP No CHDP FTE % in Have Job � Service Other Duties Job Title Incumbent Name County]City County/City Classification Programs Changed? Match Match Changed? Budget Budget (Specify) (Yes or No) (Yes or No) Supervising Public Health Julie Slaughter 60% No HCPCFC 40% No No Nurse, Deputy Director Public Health Nurse I Vacant 100% No No No No Public Health Nurse II Ankara Lee 100% No f No No No Public Health Nurse I Vacant 100% No No No No Health Education Specialist Tina Starks 65% No Child Ride No No Safe 35/o 11 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 FTE % on FTE % on Has Civil CHDP No CHDP FTE % in Have Job Service Other Duties Job Title Incumbent Name County] City County/City ,> Classification Match Match Programs Changed. Changed? Budget Budget (Specify) (Yes or No} (Yes or No) Supervising Office Assistant Lisa Renteda 100% No No No No fl Office Assistant III Gracie Velasquez 100% No No No No Office Assistant II I Martha Garcia 100% No No No No Office Assistant I Jamee Vang 100% No No No No Office Assistant I II Sonia Reyes 90% No Child Ride No No Safe 10/o Health Education Assistant Vacant 1000/0 No No No i No 12 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 State of California -Health and Human Services Agency Department of Health Care Services-Children's Medical Services Branch Incumbent List - Health Care Program for Children in Foster Care County/City: Fresno/Fresno Fiscal Year: 2015-16 FTE % on FTE % on FC Admin FTE % in Other Have Job Has Civil Service Job Title Incumbent HCPCFC County/City Match Programs Duties Classification Name Budget Budget (Specify) Changed? Changed? (Yes or No) (Yes or No) Supervising Julie 0 Public Health SlaughterO 40% No CHDPAdmin No No Nurse Public Health Kathy o Nurse II I Schmidt 100% No No No No Public Health Rosane 100% No No No No Nurse I Jordao 50% Foster Care Public Health Celia Lopez 50% No Program No No Nurse 11 Emergency Response 50% Public Health Jeri 50% No Foster Care No No Nurse II Guerrero Program Teen Focus Office Assistant I Thomas 100% No No No No Vllegas 13 Chlldren's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 County of Fresno Department of Public Health CCS Performance Measure 1 FY 2015-16 CCS Program staff conducts routine review 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 physlcian so their medical files can be .updated, Based on the entire active caseload as.of October 2015, the following findings are: • 82% of CCS clients in Fresno County have an identified primary care provider (PCP). 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. 14 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 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 Number of children in the Percentage of compliance primary care physician/ local CCS program Medical Home (Numerator) (ben:om(nator) 7339 8960 82%Q 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, 15 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 County of Fresno Department of Public Health CCS, Performance Measure 2 FY 2015-1 6 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 sampled 100 cases for Performance Measure 2. The findings are as follows: + 100, unduplicated new referrals (randomly selected) were reviewed for meeting medical eligibility determination within five working days: 27 cases out of 100 (27%) met this guideline. • 100 unduplicated new referrals were reviewed for financial and residential eligibility within 30 days: 86 out of 100 cases (86%) met the financial and residential guidelines. Of these, 63 cases were Full Scope Medi-Cal or TL1CP clients and 23 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. • Supervisors' monitoring of Admitting Interviewer staff performance indicated that Residential and Financial eligibility determinations met required periods, as 86% are typically no later than 30 days, • Fresno County CCS had an influx of new nurses from the sunset of a separate County program during the past year. These new nurses were not familiar with the CCS program and this led to many of the new referrals awaiting our medical consultant's review in order to determine medical eligibility while our staff was acclimated to the program. Management feels confident that next year's medical eligibility determination period average length of time will be much shorter and the majority of new referrals eligibility determination will be less than five days. 16 Children''s Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 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. G. 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). 17 Children's Medical Services Plan and Fiscal Guidelines FY 2015-11 COUNTY: Fresno FISCAL YEAR: 2015-16 Reporting Form: MEDICAL ELIGIBILTY Number of referrals Number of new Percentage determined medically unduplicated referrals of eligible within 5 days. (Denominator) compliance (Numerator) Medical eligibility determined within 5 days of receipt of all necessary 27 100 27% documentation PROGRAM Number of cases Number of new Percentage ELIGIBILITY determined eligible within unduplicated referrals of 30 days of receipt of compliance documentation needed to make the determination (Numerator) (Denominator) Financial eligibility FSMC /TLICP CCS.only FSMC /TLIC.P CCS only determinedd within 30 63 23 75 25 86% Residential eligibility determined within 30 days 86 100 86% 1$ Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 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 orflve 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 19 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Reporting Form - Part A: Category selected Number of children with Number of children Percentage of (cardiac, pulmonary, annual team report in with SCC compliance etc.) client's medical records authorization (Numerator) (Denominator) Cardiac, Renal, Neuro- musculoskeletal, 72 91 79% Pulmonary, Endocrine. Reporting Form - Part B: Category Number of Number of children Diagnostic Percentage selected children with with eligible medical Code Chosen of (cardiac, authorization to conditions that compliance pulmonary SCC require an etc.) authorization to a (Numerator) SCC (Denominator) Cardiac, Renal, Neuro- E10, E11, E70, musculoskeletal p 91 100 E71, c�o5, N18 91 a Pulmonary, Endocrine 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. 20 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR. 2015-16 County of Fresno Department of Public Health CCS Performance Measure 4 FY 2015-16 Fresno County updated its Transition Planning protocols for the CCS Program in January, 2013 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 14, 16, 18 and 20. 21 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 The FY 2015-16 Transition Planning Performance Measure includes the following findings: • Based on the results of a Business Objects report, Fresno County randomly selected a sample of 100 clients with an age of 14, 16, 18, or 20 who's CCS eligible medical condition appropriately required Transition Planning. • All non-MTP clients who turned 14, 16, 18 and 20 years old received Transition Planning after the implementation of the automated Transition Planning process. FY 2015-16 shows 100% of the selected sample received Transition Planning letters/information, • A Business Objects report was created to review all clients in the Medlcal Therapy Program. There were a total of 74 clients enrolled in the MTP for the age groups 14, 16, 18, and 20 whose condition requires Transition Planning. Out of the 74 clients identified 67 (90%) had transition planning. MTU staff understands the importance of transition planning and will continue to take necessary steps to improve the transition planning protocols. 22 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 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. 25 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Transition Planning Checklist Transition Documentation YES NO Comments 1. Client has an identified need for CCS transition planning is performed for long-term transition planning, x ail clients 14, 16, 18, and 20 years old. 2, Transition planning noted in Transition planning for clients with child's medical record. X appropriate DX is noted in clients Annual Medical Reviews and other Case Notes. 3. Transition planning noted in Most SCC's document transition planning SCC reports. X with client and are found in the Medical Social Workers' notes. 4. Vocational Rehab noted in X Noted only In 14, 16, 18, and 20 year child's reports. olds in the MTP. 5. Adult provider discussed or In all Transition Planning Case Notes, identified for children 17 years X discussion of the need for an adult of age or older. provider is included. 6. Transition planning noted in Schools begin noting transition needs at SELPA for those children that X age 16, are in the MTP. * Note: Not all of the items in the Checklist will be applicable for each chart review: 24 Children'.s Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Reportinq Form: Number of CCS charts Number with transition Percentage of compliance reviewed planning 100% 100 100 Number of MTP charts Number with transition Percentage of compliance reviewer! planning 90% 74 67 25 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 County of Fresno Department of Public Health CCS Performance Measure 5 FY 2015-16 This performance measure indicates the leve4 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, Between July 1, 2014 and June 30, 2015, CCS mailed out over 2,700 surveys. 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. 26 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 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 Yes No Comments CCS program. 1. Family members are offered an opportunity to Fresno County uses a parent provide feedback regarding their satisfaction with the survey and ensures services received through the CCS program by X maximum distribution to, and participation in such areas as surveys, group collection from, client's discussions, or individual consultation. families, 2. Family members participate on advisory committees or task forces and are offered training, X mentoring and reimbursement when appropriate. 3, Family members are participants of the CCS Special Care Center services provided to their child X through family participation in SCC team meeting and/or transition planning. 4. Family advocates, either as private individuals or as part of an agency advocating family centered care, which have experience with children with special X health care needs, are contracted or consultants to the CCS program for their expertise. Reporting Form: 27 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR; 2015-16 Criteria Performing Not Performing (26% for each criteria) 1. Family members are offered an opportunity to provide feedback regarding their satisfaction with the services received through the CCS 25% program by participation in such areas as surveys, group discussions, or individual consultation: 2. Family members participate on advisory committees or task forces and are offered training, 255% mentoring and reimbursement when appropriate. 3. Family members are participants of the CCS Special Care Center services provided to their child through family 25% participation in SCC team meeting and/or transition planning. 4. Family advocates, either as private individuals or as part of an agency advocating family centered care, which have experience with children with 25% special health care needs, are contracted or consultants to the CCS program for their expertise. Total 50% 50% 28 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 CHDP Performance Measure 1 - Care Coordination 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 initiated' 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. Regortincil Form: Element Number of Total number Percent (%) conditions of conditions of conditions coded 4 or 5 coded 4 or 5, where where follow- excluding follow-up care up care was children lost to was initiated Initiated contact within 120 days (Numerator) (Denominator) Conditions found on children eligible for fee-for-service Medi-Cal that required 308, 352 88% follow-up care Conditions found on children eligible for State-funded CHDP services only (Aid 8 12 67% code 8Y) that required follow-up care *01'thy:45 neaativoS,40 were successfully linked to Scnvlces after 120 days. ' Centers for Medicare and Medicaid Services,Publication#45,the State Medicaid Manual, chapter 6 EPSDT, Section 5310 A httr)://www.cros.00v/Regulations-and-Guidance/Guidance/Manuals/Parer-Based-Manuals-Items/CM1S^2'W.7 t,tml 29 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 CHDP Performance Measure 2 - New Provider Orientation 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. Reoortina Form: Number of New Providers who Completed Orientation (Numerator) 75 Number of New Providers (Denominator) 75 Percent (%) of New Providers Oriented ?Q°o Optional Local Program Data Tracking Form: Number of Numberof Non- Licensed Licensed Date of Staff in Staff in Provider Provider Location Orientation Attendance Attendance 1. 2. 3. 4. .30 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 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 docuimnted 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. Reaortina Form: Number of Completed Site Recertlflcations (Numerator) S1 Number of Active CHDP Provider Sites Due for Recertification (Denominator) 51 Percent (%) with Completed Recertifications 1000/0 Qatfonal Workload Data TrackingForm: (Other reasons for a provlderslte 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, facilltv_revie.w and/or other issueS.2 3. Medical record review. 4. Office visits for CHDP updates or In-service activities 5. Other Please Specify: - 'xic_site C hnica Sicrra Vista: Cyaston M.iddle School, Adventist Hcglth Community Care: Kcrman Cc:ntral,_ldvenlist health C_otT7iYuniry Cat'c, Kivevdaie 2 CHDP Provider Manual:Program,Eliglblllty,Billing and Policy. California Department or Health C;ai-Selvlces, Child Health&Disability Prevention(CHOP)Program, See website ftlr current updates. Local Program Guidance Manual.Chapter 10:Problem Resolution andlor Providor Dlsenrollment. Califomia Depadmonl of Health Care Services, Child Health&Disability Preventlon(CHDP)Program,May 2005. Both references avallable at* htti):l/www.dhci-caq—oYLLQr1 aubs/nuhliratinns/Passes/Ci IDPPubs.asjzx#c rap., 31 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 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. Repart�ilg Form: Dental Referral Lead Test or a Referral Number of I PM16.0s Number of w/Lead Test PM 1605 Total PM or Referral Total PM w/Dental at 160s at 1 year 160s 1 year exam Reviewed exam Reviewed Percent Provider (Numerator) (Denominator) compliance (Numerator) (DenQm)ridtor) Comptlance 1 A Iv,,irigr ilcalth 66 101 65%b 65 101 0 S,•Ima Ri;.q-q 64✓o 2. t'<,rniiy Cart: 347 385 9000 287 385 75Mo Providers 3• 17r. f�rr-m iin4li 622 623 99.80jO 458 623 73.5% 1 32 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 CHDP Performance Measure 5 — Desktop Review: BMI V ithin 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 < 51h %ile Underweight 85" - 94" %Ile Overweight 951h - 98►i, %Ile Obese 991h%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:gwww,d hes.ca.govlservices/chdo/Documents/Letters/chd Qnln0M.pdf 33 Chil.dren's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Reporting Form for Performance Measure 5 — Desktop Review: BMI Provider BMI percentile recorded on PM 160s for If BMI percentile is < 6 %, 86 - 94 %, or children ages 2 (two) and older z 95%, abnormal weight status category and/or related diagnosis listed in Comments Section Number of PM 160s with Number of abnormal PM 160s with Number of weight abnormal PM 160s status weight status with Number of category/ reviewed for, BMI %ile PM 160s diagnosis in diagnosis and recorded reviewed Comments follow-up Percent(%) Percent (.Numerator) (Denominator) Compliance (Numerator) (Denominator) Compliance ,lclve111,kr. 1.1<<akh SCi,n» 738 1203 61% 326 l22 37% r oq- 2ir"i11'' 1813 1983 91% 773 95 12% 3.Dr. Preen 364.9 3649 100% ' 0 1681 , 0% Singh 34 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 County of Fresno Department of Public Health CHDP HCPCFC Performance Measure 1 Care Coordination FY 2013-2014 The Health Care Program for Children in Foster Care PHNs performed desktop reviews of all PM 160s received for children in out of home care. PM 1603 are reviewed for quality assurance purposes. Follow-up is implemented for PM 160s coded with a 4 and/or 5 indicating abnormal findings requiring further diagnosis and/or treatment needed. The goal of this program is to assure follow-up care is accomplished within 120 days for all PM 160s that have a code 4 and/or 5. There was a total of 110 PM 160s with 99 positive closures and 11 negative closures and a compliance rate of 90% . The negative closures included 9 positive closures that were longer than 120. days and 2 negative closures. The negative closures were often due to not being able to obtain the information due to changes in placement and/or minors on runaway status (AWOL). 35 Chiidren's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 HCPCFC Performance Measure 1 - Care Coordination The degree to which the local HCPCFC 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 HCPCFC care coordination is measured by determining the percentage of health condition(s) coded 4 or 5 where follow-up care is initiated 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. Reporting Form: Number of conditions coded 4 or 5 where the follow-up care was 99 Initiated Within 120 days of receipt of the PM 160. (Numerator) Total number of conditions coded 4 or 5 on a PM 160, excluding cases 110 lost to no contact, (Denominator) Percent of conditions coded 4 or 5 where the client received follow-up 90% care within 120 days of receipt of the PM 160. Data Source: Child Welfare Services Case Management System (CWS/CMS), and county specific data for Probation Department 36 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 20 i5-16 County of Fresno Department of Public Health CHDP HCPCFC Performance Measure 2 — Health and Dental Exams for Children in Out -o.f-Home Placement FY 2013-2014 The data gathered for thl.s 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/cwscrosreports/methodolog ies/default.asi2x?report=CDSS5B The percentage of children with medical exams was 81%. The number of children with dental exams was 45% . The data Is only as accurate as the data entered into CWS/CMS HER 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. Information for a completed exam may not have been received from the medical or dental provider to be entered into the HER 2. Only the physical and dental exams that are entered into the HEP are included in this data. There is an explanation for the apparent disparity between completion rates for medical and dental exams: 3. Dental exams often are not received and/or are not entered into the HEP due to: a. Dental exams completed must be requested from the Dental Provider. The social worker/case manager is responsible for requesting and collecting needed data. The Case Manager must initiate the process and consults with PHN, or support staff, to request assistance with collecting the data (medical records) and entering it into the HER 4. Medical exams are more accurately reflected due to: a. PM 160s for CHDP exams completed for dependent children are received by DSS and SW through an agreement with HCPCFC and the CHDP Program. A process has been put in place for the PM 160s 37 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 to be forwarded to OSS, Support staff, OAs, SWAs, who have been trained by the PHN enter the data in the HEP and forward the PM 160 to the SW/CM, (The PM 160s requiring Care Coordination or HEP entry of diagnoses and/o.r problems are forwarded to the HCPC.FC PHNs). 38 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 HCPCFC Performance Measure 2 - Health and Dental Exams for Children In Out- of-Home Placement The degree to which the local HCPCFC program ensures access to health and dental care services for eligible children according to the CHDP periodicity schedule. Definition: This measure is based on characteristics 'that demonstrate the degree to which the PHN in the HCPCFC facilitates access to health and dental services as evidenced by documentation of a health and dental exam in the Health Education Passport. Numerator 1: Number of children in out-of-home placement with a preventive health exam, according to the CHOP periodicity schedule documented in the Health and Education Passport, and Numerator 2: Number of children in out-of-home placement with a preventive dental exam, according to the CHDP dental periodicity schedule documented in the Health and Education Passport. Denominator: Number of children in out-of-home placement during the previous fiscal year supervised by Child Welfare Services or Probation Department, Renortina Form: Element Number of Number ©f Percent of Children With Children Children with Exams (Denominator) Exams (Numerator Number of children in out-of-home placement with a preventive health exam 5977 7401 81% according to the CHOP periodicity schedule documented in the Health and Education Passport. (Numerator) _ Number of children in out-of-home placement with a preventive dental exam according to the CHOP dental periodicity 2680 5891. 45% schedule documented in the Health and Education Passport. Data Source/Issue. Child Welfare Services Case Management System (CWSICMS), and county specific data for Probation Department. 39 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 California Children's Services Caseload Summary Form A B _ GCS Caselod 0 to 21 Years 15 15 13-14 %of 14-15 %of Estimated %of Actual Grand Actual Grand Caseload Grand Caseload Total Caseload Total based on first Total V)ree quarters MEDI-CAL Average of Total Open T 1 (Active)Medi-Cal 7806 787.6% 7945 90% 8026 89.80/0 Children 2 Potential Case Medi-Cal 280 3,1% 285 3.2% 288 3.2% 3 TOTAL MEDI-CAL 8086 90.7% 8230 93.2% 8314 93% (Row 1 + Row 2) NON MEDICAL Healthy Families Average of Total Open 4 (Active) Healthy 40 .4% 0 0% 0 0% Families 5 Potential Cases Healthy Families 2 02% 0 0% a a% 6 Total Healthy Families 42 .5% 0 0% 0 0% (Row 4 + Row 5) Straight CCS Average of Total Open 7 (Active) Straight CCS 757 8.5% 675 6.5% 598 6.7% Children Potential Cases Straight $ CCS Children 27 3% 21 .2% 22 2% 9 Total Straight CCS (Row 7+ Row 8) 784 8.8% 596 6.8% 62Q 6.9% TOTAL NON MEDI-CAL 10 (Row 5 + Row 9) 826 9.3% 596 6.8% 620 6,9% GRAND TOTAL 19 (Row 3 + Row 10.) 8912 100% 8826 100% 8934. 100% 40 Children's Medical Services Plan and Fiscal Guidelines FY 2015-1-6 COUNTY: Fresno FISCAL YEAR: 2015-16 CHDP Program Referral Data Complete this form using the Instructions found on page 4-8 through 4-10. County/City: Fresno/Fresno FY 12-13 FY 13-14 FY 14-15 Basic Informing and CHDP Referrals 144,752 34,447 165,244 70,722 207,706 59,145 1. Total number of CaIWORKs/Medi-Cal cases informed Cumulative New Cumulative New Curnul:ative New and determined eligible.by Department of Social Services. Applications Applications Applications 2. Total number of cases and recipients in `1" requesting Cases Recipients Cases Recipients Cases Recipients CHDP services a_ Number of CaIWORKs casesrrecipients 32,164 84,870 16,787 44,175 15,647 41,512 b. Number of Faster Care cases/recipients. 4,274 4,274 4.180 4,180 4,663 4,663 c. Number of Medi-Cal only cases/recipients 38,703 113,333 15,938 42,475 25,202 77,749 I 3. Total number of EPSDT eligible.recipients and unborn, referred by Department of Social Services'workers who requested the following: I a. Medical and/or dental services 1 5,823 3;565 2,502 41 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-1.6 b. Medical and/or dental services with scheduling andlor 10,003 6,985 3,888 transportation c. lnformalion only (optional) 32.090 13,380 5,939 4. Number of persons who were contacted by telephone, home visit, face to=face,office visit,or written response to 4,903 4,333 2,so6 outreach letter Results of Assistance 5. Number of recipients actually provided scheduling and/or $7 73 56 .transportation assistance by program staff 6. Number of recipients in "5"who.actually received medical 79 72 34 and/or dental services 42 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 MOU/IAA List 1. Intea-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) 43 Children's Medical Services Plan and Fiscal Guidelines FY 2015.-16 COUNTY: Fresno FISCAL YEAR: 2015-16 COUNTY OF FRESNO, DEPARTMENT OF PUBLIC HEALTH INTRA-DEPARTMENTAL AGREEMENT CHILDREN'S MEDICAL SERVICES CHILD HEALTH AND DISABILITY PREVENTION PROGRAM AND CALIFORNIA CHILDREN'S SERVICES GOAL The primary goal of this Intra-Departmental Agreement is to state how staff work cooperatively to improve accessibility and coordination of California Children's Services (CCS) and Child Health and Disability Prevention (CHDP) services provided to each program's target population. The CCS Program agrees that: 1 . The CCS orientation for new staff and clients will include a CHDP informational segment, i.e., brochure, description of services. 2. CCS clients, eligible for CHDP, needing a preventive health care referral; will be given a CHDP brochure and/or CHDP Program location and telephone number. 3. CCS will have available to the CHDP Program current policies, procedures, informational brochures and referral forms. 4. CCS will inform the CHDP Program of problems with CHDP providers, i.e,, inappropriate referrals. 5. CCS will provide CHDP with information regarding the outcome and disposition of referrals and allow appropriate CHDP staff to review CCS records as part of their follow- up services to families. The CHDP Program agrees that: i. CHDP will provide to CCS an annual CHDP provider list and update periodically. 2. CHDP will inform CHDP families/patients of the availability of CCS services when a patient has a suspected CCS eligible condition. Client will be referred to CCS and a CCS Face Sheet (application) will be completed, 3. CHDP liaison will maintain current information about eligibility and caseload constraints of the CCS Program and will report changes at CHDP staff meetings. 4.. CHDP will furnish CCS brochures to CHDP providers and inform them of current CCS policies and encourage them to make referrals to CCS. 5. CHDP will follow-up on inappropriate referrals as reported by CCS. 44 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 6. CHDP will provide referral follow-up services for children referred to CCS as evidenced by the receipt of a PM160, identify existing barriers, and facilitate access to services. 7. CHDP will assist families in accessing the Healthy Families Program. Both programs agree that; 1. The CHDP and CCS Program administrators and/or their designated representatives will meet annually to review and update this agreement. 2. A liaison from each program will be appointed to facilitate the exchange of information, Liaisons will meet annually or more often, if necessary. 3. Each program will designate an individual to provide orientation to the staff of the other' program. 4. The staff of each program will be informed. of educational workshops, presentations, -etc,, of mutual interest. 5. The CHDP and CCS Programs will share in the distribution of their health education materials.and outreach pamphlets to both target populations, medical providers, and other relevant agencies. 6. The CHDP and CCS Programs will continue to use the existing referral procedure to refer eligible CCS children to the CHDP Program and encourage active and continuous participation in the CHDP program. This Intra-Departmental Agreement between the County of Fresno, Department of Public Health, Children's Medical Services, Child Health and Disability Prevention Program and California Children's Services Is to be reviewed annually and is entered into on July 1, 2014 and is to be effective through June 3.0, 2016 with an option to be automatically extended for one (1) additional twelve (12) month period, /X�/ 4., Rose Mary Garrone Date Deborah Ma �^ Date Public Health Nursing ivision Manager Division Manager Public Health Nursing Director Children's Medical Services California Children's Services Administrator 41ie Slaughter, SP HA Date Deputy Director Children's Medical Services Child Health and Disability Prevention Program 45 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 COUNTY OF FRES.NO INTER-DEPARTMENTAL AGREEMENT FY 2014-15 and 2015-16 I. Statement of Agreement: This statement of agreement is entered into between the County of Fresno, Department of Public Health (DPH), Department of Social Services (DSS), and the Probation Department (PD) to assure compliance with Federal and State regulations and the appropriate expenditure of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) funds in the Child Health and Disability Prevention (CHDP) Program. !I. Statement of Need: The following needs in the County of Fresno have been identified by the Department of Public Health and Department of Social Services as a focus for FY 2014-15 and FY 2015-16: A. Need for increasing the number of referrals for CHDP services using a variety of modalities including continuing staff education for the purposes of increasing referrals and Identifying children's health conditions for which to seek consultation and coordination by trained health professionals. B, Need for increasing the number of children ages 0 to 21 years receiving health assessments. C. Need for increasing coordinated, comprehensive, and culturally competent services for children living in foster care (relative/kinship, foster family homes, group homes, etc,) including CHDP health assessment services and needed diagnostic and treatment services. D. Continue efforts to decrease gaps in existing program which includes, but is not limited to the need to 1) improve the number of first graders. receiving health assessments and 2) motivate adolescents to utilize preventive health resources. E. Need for continuing staff education for the purpose of Increasing referrals to preventive health services and identifying health conditions in children for which to seek consultation and coordination by trained health professionals. F. Need for consultation and information about CHDP resources and general public health services in child care settings, G. The need to continue efforts to address,the review of immunization records when families apply for assistance, H. Need for evaluation of data reporting systems relating to the PM 357 referral process. I. Need for coordination with local Medi-Cal managed care plans. 46 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 J. Need to keep abreast of changes in State and/or Federal regulations and share that information with staff during training sessions. Ill, Organizational and Functional Relationships A. The exchange of information about persons applying for or receiving Medi-Cal, with or without linkages to other social services programs as outlined in this document, is permitted by State and Federal law and regulations, and is to be maintained in a confidential manner. B. The attached organizational charts display important points of interface between CHDP, the Department of Social Services programs and personnel, 1. Attachment A shows the relationship between the CHDP program, administrative staff and other Departments. 2. Attachment B shows the interrelationships between the Human Services Departments. and Probation Department. 3. Attachments A and B shows the Department of Social Services relationship to the Probation Department as well as the relationship between the EPSDT units) and said Departments, 4. Attachment C reflects the current Department of Public Health organization chart, which includes the CHDP Administrative Unit. 5. Attachment D shows the reporting channel .of the EPSDT unit to the CHDP Director, 6. Kiran Sandhu, Program Manager is the liaison from the Department of Social Services — Medi-Cal section. Her address is 3151 N. Millbrook Ave,, Fresno, CA 93726. Julie Slaughter, Supervising PHN, CHDP Deputy Director, is the liaison from the Department of Public Health. Her address is 1221 Fulton Mall, Fresno, California 937`21. 7. Health Care Program for Children in Foster Care C. Attachment F, shows flow charts that depict the CHDP process of informing, beginning with the availability of health care, preventive care, and continues through to diagnosis and treatment. I. California Work Opportunity and Responsibility to Kids (CalWORKs) Families, In-person Application/Annual Re-determination 2. Medi-Cal a. In-person Application/Annual Re-.determination (if requested) 47 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR,: 2015-16 b. Mail-in Application/Re-determination 3. Children Placed in Foster Care IV. Department of Social Services Responsibilities and Activities A. Basic Informing and Documentation of Informing for CaIWORKs or Medi- Cal. Following are the requirements for Basic Informing and Documentation of Informing by Eligibility Determination staff of persons applying for, or receiving CalWORKs or Medi-Cal; Procedure for informing the responsible adult who is handicapped is as follows: Blind - information is read aloud to the responsible person; Deaf- information is written and shown to the responsible person, Illiterate - information is read aloud to the responsible adult: Lack of understanding of the English language - interpreters are available to provide interpretation services in several languages, 1. In-person/Phone Interview Application/Annual Re-determination where screening questions are present a. In the requested face-to-face eligibility intake interview or at the time of the annual re-determination, the appropriate adult(s) responsible for Medi-Cal eligible persons, including unborn, and persons under 21 years of age will be: (1) Given a state-approved brochure about the CHDP program (PUB 183). (2) Given an oral explanation about CIIDP including: ('a) The value of preventive health services and the differences between episodic and wellness care; and (b) Availability of health assessments; and (c) Availability of dental services; and (d) The need for prompt diagnosis and treatment of suspected conditions to prevent disabilities and that all medically necessary diagnosis and treatment services will be paid for by Medl-Cal; and (e) The nature, scope, and benefits of the CHDP program. 48 Children's Medical Services Ilan and Fiscal Guidelines PY 2015-16 COUNTY: Fresno FISCAL YEAR.: 2015-16 (3) Asked questions to determine whether; (a) More information about CHDP program services Is wanted; and (b) CHDP program services--medical and/or dental -- are wanted; and (c) If appointment scheduling and/or transportation information are needed to obtain requested CHDP medical and/or dental services. b. The Eligibility Determination staff will document in case comments, using non-automated systems, that face-to-face informing occurred: (1) Explanation and brochure given; (2) Date of the explanation and giving of the brochure; and, (3) The individual responses to the CHDP service .questions. C. Any "Yes" response to the CHDP questions or offer of services through face-to-face or phone encounters requires a referral on the CHDP Referral Form (PM 357). 2. Medi-Cal Applications, Annual Re-determinations — that do not require interviews and where screening questions are not present a. Responsible adult(s) for Me.di-Cal eligible persons under 21 years of age who apply by mail will do so through a state-approved Medi-Cai Application/Annual Re-determination form. The Application/Annual Re-determination process includes the mailing of a state-approved brochure (PUB 183) about the CHDP program to the applicant. The state-approved brochure about the CIlDP program '`Medical & Dental Health Check-Ups" informs the family of where to call or write if: (1) More information about CHDP program services is wanted; or (2) Help with getting an appointment and transportation to medical care is needed, b. The Eligibility Determination staff will document in case comments informing occurred. Should clients need CHDP services they will be required to contact Public Health. 49 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 C. If applicant is not given the opportunity to indicate services from CHDP, DSS will mail a state approved brochure (PUB 183) about the CHDP program. B. Basic Informing and Documentation of Informing for Children in Foster Care Program Placement Following are the requirernents for basic informing and documentation of informing by staff responsible for placement of children in foster care, including placements controlled by the Probation Department, Licensed Adoption Agency, and/or Placement Agencies: 1, Within thirty (30) days of placement, the staff responsible for placing the child (i,e,, social worker, probation officer) will document the need for any known health, medical, or dental care services. Staff will ensure that information is given to the payee, hereafter referred to as the out-of-home care provider, about the needs of the eligible person and the availability of CHDP services through the CHDP program. In the case of an out-of- state placement, the social worker shall ensure that inforration is given to the out-of-home care provider about the Federal EPSDT services. The care provider and/or child will be: a. Given a State-approved brochure about CI-IDP services and information about the child's need of preventive health care; and b. Given a face-to-face oral explanation about CHDP, including: (1) The value of preventive health services and the differences between episodic and wellness care; (2) The availability of health assessments according to the CHDP periodicity schedule, and how to obtain health assessments at more frequent intervals if no health assessment history is documented or the child has entered a new foster care placement; (3) The availability of annual dental exams for children one (1) year of age and older; (4) The need for prompt diagnosis and treatment of suspected conditions to prevent disabilities and that all medically necessary diagnosis and treatment services will be paid for by Medl-Cal; and (5) The nature, scope, and benefits of the CHDP program. C. Ask questions to determine whether: (1) More information about the CHDP program is wanted; s0 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL Y FARO: 2015-16 (2) CHDP program services--medical and/or dental--are wanted, and (3) If appointment scheduling and/or transportation assistance Is needed to obtain CHDP medical and/or dental services. 2. The Department .of Social Services staff, responsible for placement, will document the care provider's response to the questions In the CHDP program area of the Identification Page in the Placement Notebook in the Placement Management Section in the Client Services Application on the Child Welfare Services/Case Management System (CWS/CMS); a. Date care provider was Informed of the CHDP program and brochure given; and b. Care provider's request for CHDP services. 3. The Probation Department, Licensed Adoption Agency, or other Placement Agency staff responsible for placement will document the care provider and/or child's response to the CHDP questions on the CHDP Referral Form (PM 357) and maintain a copy in the case record. 4. A "payee," referred to as the. "out-of-home care provider" or 'care provider," is defined as the foster parent(s) in a foster home, the officially designated representative of the payee when the child in the foster care program, or a Medi-Cal eligible child is residing in a group home, residential treatment center, or any other out-of-home care facility, 5. The Department of Social Services staff responsible for the child in a foster care placement will complete annual informing of the care provider/child. They will include information about CHDP preventive health services, unmet health cafe needs requiring follow up, and a review of the child's access to a primary care provider according to the process outlined for initial Informing in Sections IV,B.1.a-c of this Agreement, and will document the results of informing in the case plan update. 6. The Probation Department, Licensed Adoption Agency, or other Placement Agency staff responsible for placement will complete annual informing and the documentation of that informing according to the outline in Sections IV,6.1. and IV.B.3. of this Agreement. 7, Informing requirements described in Sections IV.B.1 through IV,B.3, of this Agreement apply to placements controlled by the Probation Department or placement agencies. For children who are wards of the court, the Probation Department staff fills out a PM 357 and sends it to the Eligibility Worker, who is part of the Foster Care Unit, along with the eligibility forms. When certified, the Eligibility Worker will verify the 51 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 address and the PM 357 shall be sent to the EPSDT Unit in the CHDP Program.. 8. The social worker placing the,child will provide the Informing of the need. for a CHDP exam .and the health status of children when out-of-home placement is made with a relative, following the informing requirements described in Sections IV.B.1 through IV.6,3, of this Agreement. Documentation occurs in the child's record as well as the CWS/CMS System. 9. The social worker responsible for placement of out-of-county foster care shall follow the informing requirements as described in Sections IV,8.1 through IV.B.3. of this Agreement. Documentation shall occur as stated in Section IV,B.8, hereinabove. C, Referral to the EPSDT Unit of the CHDP program 1. All "Yes" responses to the offers of more information about CHDP, CHDP medical/dental services, and appointment scheduling/ transportation assistance will be documented on a CHDP Referral Form (PM 357) or a state-approved alternate form, The Referral Form is sent to the EPSDT Unit of the CHDP program. This action is required to ensure these services are received and that any necessary diagnostic and/or treatment services are initiated within 120 days of the date of eligibility determination for persons receiving assistance through CaIWORKs or Medi-Cal, and within 120 days of the date of request for children in foster care placement. 2. When a child is a member of a Medi-Cal Managed Care Plan, the same process is followed as described in Section IV.C.1. hereinabove. If a care provider is unaware of an assigned primary medical care provider, assistance is offered to help identify the child's medical provider. Dental referrals are unchanged and names of a minimum of three (3) dentists shall be given to the care provider. Transportation assistance is also unchanged. If the Plan offers transportation assistance, the phone number to obtain services is given. 3. When a child in foster care is placed out of the County and a referral is received, the PM 357 is sent to the CHDP Program in the County of residence. The EPSDT Unit in that County refers the child for CHDP services and the completed PM 357 is returned to our office to file. 4. Referral requirements described in Sections IV.C.1. and IV.C.2. hereinabove also apply to children in foster care placement controlled by the Probation Department, licensed adoption agency, and/or a placement agency. D. Information Provided by Department of Social Services Staff on the CHDP Referral Form, PM 357 or State-Approved Alternate Referral Form 52 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 The following will be included on the, referral form when any "Yes" response is given, written or verbal, to the offer of services: 1. Case Name and Medi-Cal Identification Number, 2. Type of services requested: a. Additional information b. Medical services C. dental services d: Transportation assistance e. Appointment scheduling assistance 3. Source of referral: a. New application b.. Re-determination C. Self-referral 4, Case type: a. CalWORKs (on existing form as AFDC) b. Foster Care C. Medi-Cal Only (Full Scope, Limited Scope with or without a Share- of-Cost) 5. Complete listing of members in case with birth dates including unborn and the estimated due date. 6. Listing of the payee/out of home care provider and child in foster care 7. Residence address and telephone number 8. Worker name or "Service Center" 9, Date of eligibility determination for CalWORKs and Medi-Cal only cases or date of request for children in Foster Care and self-referrals E. Case Management for Children in Foster Care 1. The staff responsible for placement of the child will ensure that the child receives medical and dental care that places attention on preventive 53 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 health services through the CHDP program, or equivalent health services in accordance with the CHDP program's schedule for periodic health and dental assessments, More frequent health assessments may be obtained for a child when the child enters a new placement. For example, if there is no record documenting a health assessment during their previous placement, if they are not performing age-expected developmental skills, or they have been moved to an area with a new provider; another health assessment may be claimed through CHDP by entering "New Foster Care placement" in the Comments/Problems area of the Confidential Screening/Billing Report (PM 160). 2, The staff responsible for placement of the child will ensure that arrangements are made for necessary diagnosis and treatment of health conditions suspected or identified. 3. Medical records, including but not limited to, copies of the CHDP Confidential Screening/Billing Reports (PM 160) or results of equivalent preventive health services for any child in foster care will be kept in the child's case record. Case. records for children age three (3) and over must also contain the result(s) of dental visit(s). 4. The case plan will contain a plan which ensures that the child receives medical and dental care which places attention on preventive health services through the CHDP or equivalent preventive health services in accordance with the CHDP program's schedule for periodic health and dental assessments. V. BPS.DT Unit of the CHDP Program Responsibilities and Activities for Referrals A. The EPSDT Unit Is located in the Department of Public Health, at 1221 Fulton Mall, Fresno, California 93775. B. See Attachment F, Job Duty Statements of unit personnel. C. Overall medical supervision Is provided by Kenneth Bird, M.D., M.P.H,, Interim Health Officer. The CHDP Administrative Unit is supervised by the Children's Medical Services Division Manager and program supervision is provided by a Supervising Public Health Nurse (CHDP Deputy Director), a Health Educator and a Supervising Office Assistant, D. CHDP will accept and take appropriate action on all referrals of Medi-Cal eligible persons under 21 years of age, including unborn, and will; 1. Intensively inform those requesting more information and offer scheduling and transportation assistance to those who request CHDP medical and/or dental services. 2. Provide all requested scheduling and/or transportation assistance so that medical and/or dental services can be received from a managed care plan or provider of 'the requester's choice. These services will be 54 Children's Medical Services Pian and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 provided and diagnosis and treatment initiated within 120 days of the person's date of eligibility determination or re-determination, and within 120 days of a request if by self-referral or for children in Foster Care unless: a. Eligibility is lost; or, b. Contact with person is lost and a good faith effort was made to locate the person as defined in Section VII of this Agreement; or, C. Failure to receive services was due to an action or decision of the family or person. Family contacts are asked if they are in a Medi- Cal Managed Care Plan. If they are, they are asked the name of the primary care provider (PCP) for the child. Assistance is given to the family,; if needed, to, locate the PCP. 3. Ensure that persons asking for health assessment procedures, not furnished by their provider, are referred to another provider for those. procedures so that all requested CHDP services are received within 120 days of the initial request. 4. Follow up on persons requesting appointment scheduling and transportation assistance to: a. Re-offer scheduling and transportation assistance to those persons whose failure to keep appointments was not due to an action or decision of the family or person. b. Offer and provide requested assistance to those for whom further diagnosis and treatment is indicated. C. The phone number to the Managed Care Member Services Department Is given to the member requesting scheduling or transportation services if the. child Is a new or established Medi- Cal Managed Care member. E. Health Assessment reminder cards with current addresses will be generated and mailed by the State CHDP Program for all children twenty-seven months of age and younger who are receiving Medi-Cal through the Fee-For-Service system. F. The following will be documented on the CHDP Referral Form (PM 357) or an alternate, State-approved form for each eligible person listed: 1. Type of transportation assistance and date given. 2, Appointment scheduling assistance and date given. 3. Date(s) of appointment(s) and name(s) of provider(s). 4. Confirmation of CI-IDP services: a. Health assessment requires a PM 160 on file or provider certification of provision of service. 55 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 b. Dental services require family, provider, or child verification. 5. Follow up to needed diagnosis and treatment: a. Response to offer of appointment scheduling and transportation assistance, b. Type of transportation assistance and date given. C. Date(s) of appointments) and name(s) of provider(s). d. Confirmation of care - PM 161 or similar form of certification by provider. 6. Date appointment scheduling and/or transportation assistance was declined and by whom. 7. Disposition of case: appointment kept or not kept, eligibility lost, family declined further services, or family/person lost to contact and Good Faith Effort was made to locate the person as defined in Section VII of this Agreement. G. Dates periodic notice of appointments sent and any response received will be documented. This. information Is documented on the back of the PM 357. H. A quarterly report will be submitted by the fifteenth (15'h) day following the end of each quarter to the California Department of Health Care Services showing the number of CalWORKs and Med'I-Cal Only persons requesting CHDP services, VI. CHDP Program Responsibilities and Activities A. An adequate number of medical providers will be available to meet County needs and Federal regulations in regard to allowable time frames. B. The County will make all possible attempts to ensure an adequate number of dental providers to meet County needs and Federal regulations. C. An adequate supply of the following materials will be available to meet other county needs: 1. State-approved informing brochure with the address and phone number of the local CHDP program. 2. Current list of CHDP medical and dental providers. 3; Other informational material, e.g,, CHDP poster. D. When eligible persons, still needing CHDP services, move to another county, the new county will be notified and appropriate information sent. 56 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 1. A copy of the PM 357 will be sent to the CHDP program in the County where the child now resides, E. Copies of PM 160s for services given to children In foster care will be sent to the responsible social services department. 1. The PM 160 for children in foster care will be sent to the responsible county's CHDP program. 2. A request will be made to forward the PM 100 to their social services department. F. All persons eligible for Title V services will be informed of availability of these services and referred as requested, VII, Joint Social Services/CHDP Responsibilities A good faith effort will be made to locate all persons lost to contact. The EPSDT Unit/CHDP program will query the DSS for current addresses, telephone numbers, and Medi-Cal status of these persons. Upon request, the DSS will share this information. The exchange of this confidential information is based on Federal and State regulations, A "good faith effort" includes at least one documented attempt to trace the person through local welfare departments by obtaining a.current address and telephone number and to contact the family at their current address/telephone number. Vill. Staff Education A. Within ninety (90) days of employment by the Department of Public Health and the Department of Social Services, all new staff with responsibility for placement or eligibility determination Will have completed orientation regarding the CHDP program. This orientation Will include information detailing their, role and responsibilities for informing persons. about CHDP services and referring for services. The Department of Public Health CHDP Health Education staff are responsible for this training. Other CHDP/Foster Care staff will assist as needed. B. Within ninety (90) days of employment by the Probation Department or licensed adoption agency, staff responsible for placement will have completed orientation regarding the CHDP program and their roles and responsibilities for informing persons about CHDP services and referring for services. The CHDP Health Education staff Is responsible for this training. C. Upon licensure, renewal and during Foster Pride training, foster parents and group home, residential treatment center, and other out-of-home care facility staff will complete orientation regarding nature, scope, benefits, and availability of CHDP program services, D. All appropriate Department of Public Health staff will receive orientation and an annual update regarding the CHDP program. 57 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-15 E. The local CHDP Program will provide an annual update to all placement and eligibility determination staff regarding the CHDP program. F. Additional staff in-service education needs will be identified and trained upon when there is a: 1. Need identified due to regulatory changes, 2. Need revealed through program evaluation/reports. 3. Need revealed through task force/problem solving meetings. 4. Use of a formalized education needs assessment tool. IX, Management Information and Program Evaluation A. The following information will be compiled and shared between Departments. Currently, the CHDP Deputy Director shares the information with the Children's Medical Services Division Manager at regularly scheduled meetings. CHDP Program staff review the data at their bi-monthly staff meetings. The Health Education staff involved In training the Eligibility Workers and Social Workers share liMited information at this training. 1. The information shared includes numbers of. a. Eligibles - intake/re.determination, Including the number of children in foster care placement. b. Requests for CHDP services. C. Requests for more information. d. Requests for scheduling and/or transportation assistance. e. Medical assessment services requested and received. f. Dental services requested .and received, g. Referrals to diagnosis and treatment. 2, A quarterly newsletter ("Hand N Hand") that includes information on Section IX.A.1(a-g), current issues, concerns, and CHDP activities is provided to DSS and Probation. B. Program evaluation is conducted as follows: 1. The CHDP Deputy Director meets periodically with the Medi-Cal (EPSDT) Liaison who is a Program Manager in the Medi-Cal Unit of the 58 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Department of Social Services to determine if the County is in compliance with state regulations. 2. EPS.DT records are reviewed in the Department of Public Health as well as the Department of Social Services. 3. Program procedures are reviewed regularly to ensure compliance and to make any necessary changes in the current process. 4. Case management reviews. of CHOP process/system within each Department. a, The PM 357 provides information to the EPSDT Unit. It is initiated by the eligibility staff at DSS and is kept on file at the CHDP office. b. Data from the PM 357 is tabulated manually and reports are compiled by the EPSDT clerical and administrative staff. C. The CHDP Deputy Director and the Supervising Office Assistant review the process in the Department of Public Health. 5. CHDP Administrative staff will meet annually with staff from the other Departments involved in the agreement to review changes and update the process. X. Compliance Certification In signing this agreement, we hereby certify that the CHDP program in our community will meet the compliance requirements and standards pertaining to our respective departments contained in the following: A. Enabling legislation of the CHDP program Reference: Health and Safety Code Sections 124025 through 124110 and Section 24165.3. B. CHDP program regulations that implement, interpret, or make specific the enabling legislation. Reference: California Code of Regulations, Title 17, Section 6800 through W4. C, Medi-Cal regulations pertaining to the availability and reimbursement of EPSDT services through the CHDP program. Reference: California Code of Regulations, Title 22, Sections 51304(c), 51340 and 51532. D. Regulations defining County Hurnan Services Department responsibilities for meeting CHDP/EPSDT program requirements. 59 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 1. Social Services Regulations Reference: (a) Staff Development and Training Standards--Manual of Policies and Procedures (MPP) Sections: 14-530, 14-610. (b) Civil Rights--MPP Section 21-101, 21-107, 21115. (c) Eligibility and Assistance Standards--MPP Sections: 40- 107,61, 40-131,3(k), 40-181.211, 45-201.5. (d) Child Welfare Services Program Standards=-MPP Sections: 31-002(c)(8), 31-075.3(h)(1), 31-075.3(h)(2), 31- 205.18, 31-206.35, 31-206.351, 31-206.352, 31-206.36, 31-206.361, 31-206.362, 31-206.42, 31-206.4.21,, 31- 206,422, 31-330.111, 31-401.4, 31-4.01.41, 31-401.412, 31-401 .413, 31-405.1(f), 31-405,1(g), 31-405.1(g)(1). (e) Intea and interagency relations and agreements Chapter 29-40.5 and Chapter 29-410. 2. Medi-Cal Regulations Reference: (a) California Code of Regulations, Title 22, Sections: 500311 50157(a), (d), (e), (f), and 50184(b). (b) Other Title 22 regulations governing DSS programs regarding adoptions and referring parents to community services, including CHDP Pre-placement Advisement, California Code of Regulations, Title 22, Section 3509.4.2 and Advisement of Parents Whose Child has not been Removed from Parent's Care, Section 3"5129.1 E. Guidelines defining requirements of the agreement between DSS and DPH. Reference: DHCS Publication CMSPFG1314 (or most recent year) "Children's Medi-Cal Services Plan and Fiscal Guidelines Manual", Section 05 — Memoranda of Understanding and Inter/lntra-Agency Agreements, http://www.dhcs.ca.gov/formsandpubs/publications/Pa es/CMSPFG.as x F. Current interpretive releases by State Health Services and Social Services Departments, 1, Children's Medical Services (CMS Branch)/CHDP program Letters and Information Notices - Health Services. 2. All County Letters - Social Services. 60 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 3. See Attachment H, Joint Letters--Health Services and Social Services. 4. CMS Branch/CCS Numbered Letters pertaining to the CHDP program - Health Services. This Inter-Departmental Agreement shall be in effect from July 1, 2014 through June 30, 2016 unless revised by mutual agreement. NOTE: In the event that changes in Federal or State legislation impact the current Inter- Departmental Agreement, the County of Fresno agrees to renegotiate the pertinent section within ninety (90) days of receiving new language or instructions from the State. IN WITNESS WHEREOF, the parties hereto have caused this Inter-Departmental Agreement to be executed by the signatures below: Kenneth Bird, WD,, M.P.H., Date Health Officer, Department o ublic Health Director, Child ' alth and Disability Prevention Program 1Z,6 1 114 David Pomaville, Direc or Date De rtment of Public Health f el �n ' ,e1' ;rector Date Dewme of$octal rvices Rick Chavez, Chief Probation Officer Date Probation Department I a 61 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 CHDP Administrative Budget Summary for FY 2015-16 No County/City Match County/City Name: Fresno/Fresno 1 Column I 1 2 3 4 , 5 Total Budget Total Total Medi-Cal Enhanced State/Federal Nonenhanced Category/Line Item (2 + 3) CHDP Budget Budget (25f75) State/Federal (4 + 5) (50150) I,. Total Personnel ! - Expenses _ $913,886 $6,436 $907,450 $465,168 $442,282 II. Total Operating Expenses $61,600 $433 ' $61,167 $3,665 $57,502 Ill. Total Capital Expenses $0 so , $0 $0 IV. Total. Indirect Expenses $134,122 $945 $133,177 $133,177 V. Total Other Expenses $0 s0 $0 $0 Budget Grand Total $1,109,608 $7,814 $1,101.,794 $468,8331 $632,961 Column 1 2 I 3 4 5 Total CHDP Total Medi-Cal Nonenhanced. Source of Funds Total Funds Budget Budget Enhanced State/Federal State/Federal State General Funds $7,814 $7,814 Medi-Cal Funds: $1,101,794 $1,101,794 State $433,688 $433,688 J $117,208 $316,480 Federal (Title XIX $668,105 $668,105 $351,624 $316,481 (559) 600-3330 axa avath fresflo..ca.us Prepared By ( nature) bate Prepared Phone Number Email Address. 559) 600-6592 "slauahter co.fresno.--a.us QHDP Director.ot Deputy Date Phone Number Email Address Director (Signature) 62 1 { Total Budget Personnel Expenses ,3. Public Health Nurse 11(A..Lee) r9_707fifice Assistant IR(M. Garcia) 11' • � 11 � 1 � 11 WASIMMEN NIS \\0� :11. •. N\\\\\\\N,IMMI \\\\\\\\\\\\\\\\`\\\\\ '��0\�\�s �� \\\\\\\\�`c \\\\\�\\\\ .�\\\`�\\\\\� N\\\\\\• `Z lma�\\ \`\� Children's Medical Services Plan and Fiscal Guidelinps_FY 2015-16 II.Total Operatrng Expenses 1;600 $433 $6i,167 $3-6fi5 $57,502 III.Capital Expenses \ II.Total Capital Expenses y0 $0 $0 $0 IV. Indirect Expenses \;\ \ \\\ 1. Intemai(specify%) 14:35°fo $:31.,143 -924 \ $130,219 5130.219 2. external(Specify 10.33% $2,979 S21 \ $2.W $2 958 TV.TotallndirectExpenses $134,122 S945 S133, S133.1 T7 V. Other Expenses \ \ \ �. , \ $0 V.Total Other Expenses $0 30 \ SO \ \ $0 Budget Grand Total \ $1,109,607 \ $7,814 \ \ $1,101,(93 .a&33 \\\\ S632,961 (559)6O -3330 ax..jaeeth@co.fresno.ca_us Drepared By(Signal ) /Wt4j�Prepared ) Phone Number Email Address (559)6"JO� islaughter(cDeo.fresno-ca.us �� CNDP it or r Date Phone Number Email Address Deputy Direc 64 Children's Medical Services Plan and Fiscal Guidelines FY 2016-16 COUNTY: Fresno FISCAL YEAR: 20 15-16 FRESNO COUNTY CHILD HEALTH AND DISABILITY PREVENTION (CHDP) PROGRAM BUDGET FY 2015-16 BUDGET JUSTIFICATION I. PERSONNEL EXPENSES Total Salaries: $508,908 Total Benefits: $404,982 TOTAL PERSONNEL EXPENSES: $913,885 All PHN positions at 100%. Benefits increased from 75.4% to 79.58% 'due to permanent positions filled by staff with Increased retirement benefits, II. OPERATING EXPENSES Travel: $5 000 Mileage (@ 56 cents/mile) associated with provider visits, and travel to state sponsored meetings and conferences. Training: $2,200 Cost of tuition & registration fees for staff to attend state sponsored training, and other tralnings to enhance knowledge and skills. Communication: $3,163 Reduction of$37 reflections projection based on expenditures during previous fiscal year. Household Expense: $4,372 Cost of janitorial contract and cleaning supplies made available to program, e.g. paper towels, light bulbs, proportional to FTE staffing and sq. footage of office space. Decreased by $128. Mtce. - Equipment, Buildings, & Reflects copier maintenance costs, Security: $4,521 storage container costs and building security. Reflects a $479 decrease from FY 20`14-15 Office Expense: $5,000 Increase of$500 from FY 2014-15 which reflects actual expenditures for supplies, including paper supplies, computer supplies, publications, legal notices, pamphlet's and brochures for providers, client, schools and community agencies, 65 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 etc. Postage: $7,000 Cost for mailing information notices to providers and letters to clients. Expense decreased from previous year. Decreased by $1,000 In anticipation of savings resulting from more efficient outreach. Professional & Specialized Services: $1,050 Translation cost for client visits and, translating health education material into threshold languages, Also includes hearing and vision testing class, and recruitment activities for needed SPMP staff. Projection based on prior year actual costs. Special Departmental Expense; $1,950 For the purchase of health education material for providers and target population. Also includes.recruitment for SPMP staff. Increased by $200 from prior year based on projected need. Facility Services Rent/Utilities: $27,344 Utility rates for building where CHDP staff are housed. Projection based on prior year actual costs, A decrease of$2,656 from previous year. TOTAL OPERATING EXPENSES: $61,6.00 III. CAPITAL EXPENSES NIA $0 TOTAL CAPITAL EXPENSES: $0 IV. INDIRECT EXPENSES a. Internal @ 14,350% $131,143 b. External @ .326%: $2,979 TOTAL INDIRECT EXPENSES: $134 122 ' Fresno's internal indirect rate is 14.70% which is approved for use by Fresno County's Auditor Controller/Treasurer-Tax Collector. Internal rate decreased from 15,062% to 14,350% . External rate decreased from .463% to .326%. V. OTHER EXPENSES NIA $0 TOTAL OTHER EXPENSES: $0 BUDGET GRAND TOTAL: $1,109,607 66 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 HCPCFC Administrative Budget Summary Fiscal Year 2015-16 r County/City Name: FRESNO I� Column 1 2 3 1 Nonenhanced CategorylLine Item Total Budget Enhanced State[Federal State/Federal (2 + 3) (25175) (50/50) I. Total Personnel Expenses $479,902 $369,129 $1101773 11. Total OperatingExpenses $9,700 $7,461 I $2,239 111. Total Capital Ex enses IV. Total Indirect Expenses $70,430 $70,430 V. Total Other Expenses MEN Budget Grand Total $560,032 $376,590 $183,442 Column 1 2 3 Enhanced Nonenhanced Source of Funds Total Funds State[Federal State/Federal (25175) (50/50) State Funds $185,869 $94,148 $91,721 Federal Funds (Title XIX) f $374,164 $282,443 $91,721 Budget Grand Total $560,033 T - (559) 600-3330 axayavath@co.fresno.ca.uS Prepared By (Signature) Date Prepared Phone Number Email Address r, ti (559) 600-6592 islawhter0co.fresno.caus fCHDP irect(or Deputy Date Phone Number Email Address P. Director (Signature) 67 a 1 : • 1 So DIVA ON REMMMON NOMMER IMME IN \t�`\\ \`\\\\INEXENOMMEN \�\�\"\`\"�IMMMXMNMM \\\\`�\\�`\ \`\\\\\`.\\\\\\\\``\\\\\\\\\ \\\ \\\\\\\\ :I\\M\\\NN\\M \\t\\\\\ Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 2. Exte rn a I IV. Total Indirect Expenses $70,430 S70,430 V. Other Expenses Z V. Total Other Expenses Budget Grand Total $560,032 $376,590 $183,442 (559) 600-3330 axayavatngco.fresrio,oa:us Prepared L2y (Signature) Date Phone Number Email Address prepared (559) 600-6592 islaughtert'@co.fresno.eaus CHDP;Director or Deputy Director Date Phone Number Email Address (Signature) 69 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 FRESNO COUNTY CHILD HEALTH AND DISABILITY PREVENTION (CHDP) PROGRAM BUDGET HEALTH CARE PROGRAM FOR CHILDREN IN FOSTER CARE FY 2015-16 BUDGET JUSTIFICATION I, PERSONNEL EXPENSES Total Salaries; $266,627 Total Benefits: $213,275 TOTAL PERSONNEL EXPENSES: $479,902 Staff Benefits are calculated at 79.99%, which Is based on actual costs of retirement, health insurance, OASDI, Unemployment Insurance, and Benefits Administration, II. OPERATING EXPENSES Travel: $1 ,000 Training; $8,700 TOTAL OPERATING EXPENSES: $9,700 Private auto mileage reimbursement for up to six professional staff for in-state and in-county travel to complete program activities and attend state-called meetings, including regional meetings, sub- committee meetings, and training specific to job duties. Mileage is,t`elmbursed at a rate of 67.6 cents per mile. Registration cost for Public Health Nurses to attend state recommended training and workshops to.maintain professional competence and gain program specific skills. Training also includes ancillary costs related to attending training and state convened meetings. 70 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY.- Fresno FISCAL YEAR: 2015-16 III. CAPITAL EXPENSES N/A $0 TOTAL CAPITAL EXPENSES: $0 IV. INDIRECT EXPENSES a. Internal @ 14.68% : $70,430 b. External, None $0 TOTAL INDIRECT EXPENSES: $70,,430 Fresno's internal indirect. rate is 14.68%. as approved for use by Fresno County's Auditor Controller/Treasurer-Tax Collector. V. OTHER EXPENSES NIA _ _ $0 TOTAL OTHER EXPENSES: $0 BUDGET GRAND TOTAL: $560,032 71 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Percent of Actual Total CCS CCS CASELOAD Caseload Caseload STRAIGHT CCS - Toaight'Cases CSChilen(Active) 593 6:93°6i CCS Administrative Budget Summary Strai ht CCS Children OTLICP- Total Cases of Open(Active) 756 8:77%a OTLICP Children Fiscal Year: Quarter 1 / 2,015-16 MEDI-CAL- Total Cases ot.Open (AcRve)Medi- 7270 94.30% Cal ncn-OTLICP)Children County: Fresno I TOTAL CCS CASELOAD 8624 I 100% Col 1=col Straight CCS OTLICP Medi-Cal(non-OTLICP) (Column 4= 2+3+4 Columns 5+6) Column 1 2 3 3A 36 4 5 6 Optional Optional Targeted Optional Targeted Non- Targeted Low Lowlncome Low Income Enhanced Enhanced Straight CCS Income + Children's Children's Medi-cal Medi-Cal Medi-Cal Category/Line Item Total Budget County/State Children's Program(OTUCP) Program(OTUCP) State/Federal StatelFederal StatelFede (50J5o) Program Cor'StatelFed CofState4Fed ral (OTLICP) Enhanced Non-Enhanced (2 � ColStatefFed (12.&12.5r'15) (17.5117,5165) (501b0) I. Total Personnel Expense77� 11280,285 88.776 112,233 52,352 59.873 1,079,27t 503.543 575,728 II_ Total Operatin Expense 110,000 7,628 9,643 42 9,601 S2,726 392 92,334 111.Total Capital Expense 0 6 0 _ 0 0 0 IV,Total Indirect Expense 187,946 13,032 16,47-5 16,475 158.438 158,438 , V. Total Other Expense 17,000 1,179 1,490 1,490 14,331 14,331 Budget Grand Total 1,595,231 110.615 139,841 52,394 87,439 1,344,766 503,935 840,831 72 Children' Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR.: 2015-16 Col 1 =Col Medi-Cal(non-OTLIC-P)- (Golumn 4= 2+3+4 Straight CCS OTLiGP Columns 5+6) Column 1 2 3 3A 3B. 4 5 5 Optional Optional Targeted Optional Targeted NiDn_ Targeted Low Low Income Low Income Straight GCS Income Children's Children's Enhanced Enhanan ced Source of Funds Total Budget County/State Children's Program(OTLICP) Program(OTLECP) Me/Fede-Cal I elFede Mee/Fed (50150) Program Co/State[Fed Co/State/Fed Non State/Federal Sta(25RSeral Statral (OTLICP) Enhanced Enhanced (25I75) Co/State[Fed (12.5/12.5/75) (17.5M.5l65) (50150) Strai ht CCS State 55.307 55,307 County 55.308 65,308 OTLICP y I State 21,851 21,851 6,549 15,302 _ County 21,851 I 21,851 6,549 15,302 Federal(Title XXI) 96,131 96.131 39,296 56,835 _ Medi-Cal - state 546,400 i -- 546,400 125,984 42D,4?6 Federal(Title XlX) 798-366 I 798,366 377,951 420.415 Brandon Heberer, Staff Analyst bheberer@coftesno-Ga.us co.fresno_ca.us Prepared By(Signature) Prepared By(Printed Name) Email Address - Deborah Martinez, CMS Division Manager martida@co.fresno.ca.us CS Adrnin�strator(Sigra GCS Adminislrato.(Printed Name) Email Address 73 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Drlual TOUICGS CCS Cd510AD Case'wa to_"WO STRAIGM CCS- I X,:G-ul-Cyen r,:ce.c:saga=taarr„ 59e 'c 9i} CCS Administrative Budget Worksheet GTLICp a, Fiscal Year. Quarter 1 121Y.5-16 IDIED(-CAL- 7270 2+±01• LL rnr=n County. Fresco TOTAL CCS CASELOAD 21624 st"F<!CCS Gptl n rrargewd L,-Incen 1,1- IOTLICF'j r2eGi-G.f(w-,0TUCP, C0l- 1 2 3 4A 4 SA 5 38 Sc SO- SE Eh 6 7A 7 2A 8 y ormrorul TragEtnst S 6lhvrr6d Neel blhanootl Hd dinraA Ner�Enti.-e-•Tc halal Bodge: S<r�.Tn[:GS Lvv..��.nn¢ y,,,. 0.nnoa! .1a4 Caa:.l_.0 En�,v-•aY OTLICP GTiICPl ,rvn•�e; rie tllfal Medl-C-al {segoryf.ne*.em ?y�E It.7 nr- C:•urltl.S.rre Ch4.irxns rni,,..c••aa - .cam Sa u9 .. FTE SIaO95eAlT91 S1acelFedeT:1 "� StTIL IF�dCral FIE Sla:q.Fed¢ral clam s-e dC<af 4<5 4.71 (59144j -Pr04<am(OTL1CPr FTc - .11: ,T24127r7}, (I7.5':T 3lSsl [2Ef)51 (5II'3ll Coi$late!:eC - L Pen Dane I E;.�nse { It- I o•o3rarn Admssctralbn I - _ - I - -. -_ _.- _ I J.IAa ln-^.hp6f•,27R�.-,.ea'Cl2GOp::yJL;GE2 25.00`:: 87.572 21016 h0'!» 1,520 8.T:1 _�GI 7CO:CQK 192� 8420'T :6::7 5C.'•C:R•-� •64 1 J.kw,.Aprt4STPAWE AS&ST.A1479 25009: I 0.7 o '0927 -Im% 758 6.77:E 1C00094 9,211 ..R.-Eb16,STAF-4,r4AIVS"I 25 C4w 425541 1C°89 ssr3-s 734 8-M. -92E teG.OG:i 92.5 �A2Es: i 8 ICD CP'A e.?5 4_H Tlla'.F�A+BL'TATppl Tte?AFY 7AiM:GH4 5s"4Y 98,Y? 49<30 S9I'S 342 8.77% IY.D::e 432 4 20%. 5_F.iw,S"9&PKCAV1_v2T 11 2SUti :a3:C4 1,L35 ;9W 127 377% IY'4- 161 54.9-A;. t,;R IM90% 1,5c S.MCkd,ACOCYP.AWT 2S a,876 1,WT 6S3?i ICO t{ e.^5E :27 'C-0054 T27 :4. lr IOP c0i4 :.30 Sirl�oal I 59L 5-,S46 3.5?'I c,-2, _ 4.52: _ 43,'Si7 Mad-)Cass ite Or-I - ---I 1 VACAM.,FtELCJ IEA I'-..WS1C'All(EM_H=p) :•07S •`ccn 0 6;n% 8 MA- 0 _"CC„ C 4UV% 0 I 84 3 5 D{ 57 OC!•'_ 2 V.4CJ,%q r•JE,C 1FALT'•i lH'S^r61N 1E•'r4 FEfi1 0 C'J`1. 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'"G t:;.i?;:, 4,9Y 1DC.DY,_ Sam a_Fw^sft-O slrerrLl tm-. - _ 7G5:0 £' S77i 97A 100 OV, 2:0 R43:P2 •_.8_'t k W yr; 3?_1 S,Gcmru Tcn 4.7'_0 F2.?l. :u9 1171'. dlc IUD W., 4,6 iN:iih1= 40:+' '00DES 4pp4 1C.3:cua Gp:F-P-1 4.51-0 64l'ti 3--1 1-.N. 394 108 AOX 1-_4� 843T•. S.y33 !006m- 3791 11.-ata R_a=es_:`r4 575E0 6?TN 3957 SM. 5,!4I ICD CD`+1 SDa:f 843:f._ eS e?2I 50u nfr: :¢:7 12 - nalelie,Setyces. 7K 6--m 52 r. J. 06- tCe:N 56 4 n C000? L TGa Cp.aGn�Epensa 1'C05i 1.622 cx43 - 46rl' 92:t a C 4Cu1&pens - - Ii LTo1WC,pha184-m - -- I 0 0 C L 3 0 IV-lnd-er fap- rlari„ 14.359C �- 182,F21 6,C"y-:3 12.719 6,1� J 100-DY•'. 16sC5 1:43 i54 cis I}: £:•. 2.9ema 0?3ti L� _ 4.;7, fiSei 237 32i _ 100-ODW- 17G -84S-G 3.So2 -_ ICr>•:•.=;-I_ 3562 A'"Total hdi.-a Expeasx 187.946 13A3r.- 16 4 T 5 16,475 .S$-26 1 1M5 4.2 V_Other&p- i ►ml-- a 771. '490- ICO::C": 14'•.. Z c',9^-5: G STiH D 1:C:4t\ C, ..=3w., O lOD9DA. J _915': 0 BJ"yrr.' C. ::C_:Qti C Ew 301.4 _ s00.OD:i 4 w93^» 0 A77 0 •7;.Ir" L42O1 = i40.a" 0 S. 621% 0 'T7\ '0:.0:'C. C 14.14% 1 ICCICC3G 0 Y;To71 M.,ex-se 77,ap ',179 1.40?' - IA9G 14,2s'! 14,AI 3odgu�rrd Toaal 1;_9rS,211I 110.61e 139,Zt1 -" --- Sc 3i4 87J.99 t,;sL,7Bf• Y_3?�5. M-:,EJ1 1 _ Brandon He5eref•Staff Anatyst 12 J2015 559 OC-6521 Repvc -1 Fr-dEy 'F-j 1�h Vsslesf P'4ve Ma'UA l / ^,chorah htart]nez,C14S Division Mana eT 559" -6595 aewll CS o,drireles:rr lP.rlA:>S-e;• C6�`rV'•e Rrn�ILotw 76 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Percent of Total CCS CASELOAD Actual Caseload CGS Caseload I STRAIGHT CCS - Total Cases of Open(Active)Straight 598 6.93% CCS Children CCS Administrative Budget Summary OTLICP- Total Cases of Open (Active)OTLICP 756 8.77% Children Fiscal Year: Quarter 2, 3, & 4/ 2015-16 ^MEDI-CAL- Total Cases of Open(Active)Medi-Cal 7270 84.30% non-OTLICP)Children County: Fresno TOTAL CGS CASELOAD i 8624 100% Cal 1 =Col 2+3+4 Straight CCS OTLICP Medi-Cal(non-OTLICP) (Column 4= iColumns 5+6) Column 1 2 3 4 5 I 6 Optional Targeted Low Mon-Enhanced StraightCCS Income Children's Enhanced Medi-Cal Ntedi-Cal Medi-Cal CategoryfLine Item Total Budget CountytState Program(OTUCP) State/Federal OW50) ColStatelFed StatefFederal (2W5) Staeral (50r5o) (6.016.0188)-OZ Q3.Q4 (50r50 I. Total Personnel Expense 4,268.250 295,967 374.165 3,598,118 I 1,623.651 1,974,467 11. Tota10 ratin Expense 330.000 22,881 n,926 278,188 11140 2-77.046 11.Total capital Expense o I 0 0 0 0 IV.Total Indirect ease 626,579 41448 54,928 528,204 528-204 V_ Total Other Expense 51,007 3.536 4.471 42,9°.,3 42,993 Budget Grand Total 5.275,829 363,832- 462;490 4,447,503 1,(i24,791 2,822,712 77 Children`s Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Col 1=Col 2+3+4 Straight CCS OTLICP Med-Cal(non-OTLICP) (Column 4=Columns 5+6) I Column 1 2 3 4 5 ) 6 Optional Targeted Low Non-Enhanced Straight CC$ Income Children's Enhanced Medi-Cal Medi-Cal Medi-Cal Source of Funds Total Budget CountylState Program(OTLICP} StatefFederal (50150) CaState/Fed StatelFederal (25f75) Sta(5060) eraJ (6.016.0188)-02,Q3,Q4 5D150 Straight CCS State. 182.916 182,916 County 182 916 182,916 OTLICP _ state 27.749 27,749 County 27,749 27,749 Federal(Title XXl) 406,992 — 406,992 - Medl-Cal State 1,817,554 1 -- 1.817,554 406.198 1 1,411,356 Federal rtJe)W 2,629,948 I 2,629.949 1,218,593 1,411,356 Brandon Heberer, Staff Analyst bheberer@coJresno.ca.us Preparedyl (5ignature} Prepared By(Prfried Name) Email Address e-bGrah Martinez, CMS Division Manager martida@co.fresno.ca.us AdminLstrator(Signature) CCS Admir.;skator(Printed Name) Email Address 78 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Percent of Actual TotaF CCS CCS CASELOAD Caseload Caseload STRAIGHT GCS- 59.8 ;9% Total Ca_�ar oaer,;Ar-.-jelS"g-1 O:S Chk-fen CGS Administrative Budget Worksheet OTLJ CP. Totaj Cases-a 1"n{AUr?feIOTLY'PGild?ert 755 G7r% Fiscal Year: Quarter 2,3,&4 1 201 5-16 V ECI-CAL- Tota t as_s(A Open[Ac?v e;Ned tal 7270 94 20% *❑�7Lyfi 09- County: Fresno TOTAL CCS CASELOAD 8624 1 1004t Optional w"ted Law Income i - I - --- - Sri'aigdtCCS Ch;ldren's Prog-(OTLJ�CPy Med:�a1 (Mar.-CTfL1CP) Calunm 1 2 3 4A 4 SA 5- a-!A 6 7A 7 M E Optional Targeted T01alBudgzt StragFitCCS Low. pi lncorne Enhanced ND-Enhanced on. Anntrdl Caseload Cass load Child re n'S caseload Medi-Cal En.a nceJ Wed'-Cal Ikedi-Cal -Ca?egor/lLin a-Hern 9b - (1x2or County!Stat r. - EnF r -Salary 4+-5+5+7) � (�5d1 ti Program LICPy{OT *', StatclFederai' '-�E State.'Fedrral ,.,�TE SatelFederal CNstate.TF-d I Z5)75) (501501 {fiJ]5:fa'88y-cz ir,O4 I.Personnel Expeese 1 Program AQrnin3swat5on T D-MaMnez,&VIN57PATOROVISIDN l/A1,46.CER -5-01% 67,6:2 65 75,4 93% 4.51-,3 -. 5.764 69.rJ 5:,433 ^0200 3 55.430 J.7`fIN.-k17h11+ISTRATNE.A&S6TA.NTf1 75.D)% 43,7ce 32-80 Et90% 2213 5 71A 2&T4 6a.W% 27,632- <OnroSS 2Y,633 3. 5143Lerer-STAFF AIZgLYSTi 75.03% 42.354 31%66 6.93% 2Z3 677ti 2,7555 84,-A6 25,7'+9 1GD.;A% 26,779 4. -1-CYi4-n.FEMS11-RATON'THERAPY 1`4*14G�R 15.OD% 85,5re �.789 6.93% 1,025 8 e 1 84:30% 12467 124:: . 5 ?._er-SYS&PROCAPI4L"S'I1 7,50% 73,393 ,5.5-5 6.53% 352 6-f % 4631 B430% 1 4.e41 1;.UA:.A'4. 4.641 6. V,ChLLACGOLNTA.NT11 7.5 n =676 4.341 693% 3D1 8.779i 381 84_-V% 3,S'9 1DOK-1ti. 3fi.'_+! SLetrital U'3,598 184,g35 17,7&3 13'83 13C,609 '3�609 Medical Case Itanagement LVF.CA1+Fr,PU3l]C HEAL''.'i P-[YS[GL4A!(Fa:Ua ht:lr) is:A`+. 156,OCC! 23.400 59�b 623 8.7736 2051 54.379E 19.7261 "7 C10% 1114= 43.CJ'.E G,a192 2.VACAW,ML1CclA4 -.-4RNSi4Ud(Extra l�{p) 3j.'Il% 155Cioxj 46500 Z=Z% 3;245 8.77% =.•03 FA.3,M 39.452 57.Co% 2z4alq 43c^, !0.564 3.VAC:41.7.R1BL1;1,E4LTHPHYSi:!r`.N(Ex-•a-�!p) 39.DC11', 156.000 4S,a,D 69.3% 3.245 B.77-A 4.10 Ei3.N'°t, 35.4,2 5?-D0% 22c28 3:3.Cn'k 1S.-64 4.N Sul real,SLFUNISNG PU3UC I-EA-LTH NLRSE 15:0:;% 971.36 72.6-r^_ 5.0`2 6775i 6.3% 134.3C,% 61414 53 CC% 38,531 37 Cu% 2,723 5.-S.Lew scrc 1-641)W:M"E 75.0% 1u3%ti53 132 38,A 6;9S% "3 8.77% 7,222 84.3r% 69,453 7-9OC,6 50,0,6 26 M% 1 f9,447 6.AAtae`Pt1BLICHE417KWUME-I 75_JD'i5 60:502 e5.377; F.9'_i°k. 2.1 8-77% 3,9Pd 8420% 38253- eaor," 12''OSi 4,59C T.E!lhrtfreuL PUBLID HEkLTHrfM--I 75.00% 85;748 6;.3:1 E.9G% 4459 8.774 5,639 84-30`Ia 54,2r4 75,0'.f4, 5_t66- 25.00% 13.5-R; 8.H 1'�U=,RJBL1CHEf;_-1 WRSE li 76 Zo 67,028 53,271 6.9',r16 3_486 877% 4,d07 8t_30% 42.378: 641?D% 27 122 3Ei 00% 15.255 3.NA.htaapier,PUBLIC,HEALTHNURSED 75'_' % 71,22- 5346'9 SS3% 3?08 8:7?av 4.E87 8;:90% 4ri3O%4 76.CCK. 35.'5E 22.D3'YY, 10-R lnzs',z-PUBLIC W-AMNURS'c9 7&DD% E5 748 1 64 si? 5 o-�5 4,459 &771A 51.C34 54.303% 54,2":4 85v;'.n 490-2- 'S_ODI-* °1 '1.5 Jo raguJ P BLO HEAL-1111 WRSg(EXTRA HMFk - r5.0,% 23.643 1 r-a2 $33% 1.230 8.77% 1.564 B4.33% 14,g<2 ?Z x3% S D,-7E3 2aJ1:196 4.'35. 2 T.:•'zrso-,K PLIaWFIFi4�,TH NLE3SE 1 75-00% 71?9? 53.468 6.935E 3,7L8 6.77% 4.5.37 64 30% 26.594 'it 00 k 16,420 13-H Gwca PUSUC FE41_7H MRSE(a--iae4p! 75.09% 23623 :7,M 6.W3' 1.2'+D B.17'% 1,654 64.30% 148K9 ?230;; -0,763 1 2?.o0°a L d,185 79 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 14.F1?ars, PUBLACHEALTH RLP�;E I 73.DO-P. SB,6.S6 23.592 51% 3-050 8:77!F. 3.856 84.20% 37,C85 72.00°:o l 26,7rl 28.00% 10,2.°4 15.A.Gzaela,PLIPAC FE-.LTH NLR= ,'&:tra Fh{:l 75-DC", 23.643 17.7322 6 393% 1.230 6.77`J: I 1 554 rta 301.•i 14;948 7 2-00% :0.7e3 %+?.KA ='°5 16. Va;ar1.PUKE-FEYL:T:N_IR„SE 75.W% 53.6F% 43;992 5.C55 3.050 6.77',S 3.85- 84 20;S 37,055 72-W% 26.7 n cu% 40.3-'_4 17 T Ya1g.STAFF-.WRSE- 75A7% 66,978 l 41,934 6.Se% 2.911 8:ir'X. 3,6E- a4 35.'3`42 94.Z0/5 18.A.G'_trt.STAFF NLRU 1 75.0% 56,978 41.934 6.93% 2911 8:77% 3.68C -84 J.7% 36,392 87--0% cr.791 13:Q'.b -.�Y.11 TR C.H(yNe1.STAFF NIFISE! -1S.WN 63.492 47.619 633% 3,302 8.77% 4,174 B4.:0Q% 40.143 77:3C. 31-_9'C 2sC.0% 9.23,2 20.&If uyba;STAFF N CRSE 11 75-MV 65.74E 64.311 6.8% 4.4% 8.177% 5635 `J6 Sq.2'4 S9 00% 53,6-2 1.03% 542 21_D.N6151,STr',FF ML4r3E lI 750D'k 8574r• 64.311 6 u?5E 4.4S9 8:77% 5.63 _ :�-% 54.2:4 932C;i 50,419 ..Or^ 3.-- 2[..J.Yarg.5f.vrF 1a.RSE 11 75.00'k 85.74::. 6w-311 6:93% 4.459 8.79e 5,6r-S _ 3% 54,2'4 -.-9 X% 42.82z i, 2`✓'O% '1 3�5 23_J.T11orrr,-.STAt-F W-IRSE 11 75.100% ab.743 64.311 6.sa% I 4.459 a;n% 5.638 F4 3C% 54.214 tzi X,% 36,323 1 33.CD°% 17.891 2e J-5.rWSS,STAFF 1'1.iF5E I 75-OD% dd t.748 54,3'1 6.931% 4.454 8.77% 5:a?6 64.3-v% 54.214 41,X% 22.22* So=0% 31:966 25 J=tGasn.STAFF MME11 75.CO% ?5,746 *,3'1 6.53% 4,45s 8.77% b638 EA3J% 54.214 7d..T}'4 --76 27 00% 14,62a ?5 ht.Jane:%STAFF NJRSE 9 75f_0% $6,748 64,3'1 6.93% 4,499 8.77% 5,528 84 3:% 54 214 87.M`i :7.i T 13.03a '7,048 27.R Ramio,STAFF ALRSE II 75-.0% &5,748 64;311 6.SsS5 4459 &77% 5.w-e 6'4.we% 54')14 79.0% i..'c29 21,W 51.355 28-V'lag7e,STAFF^J11R'Sc 3 75_0% K.748 K21' a93% a 4e 9 F-771 5,0 8 34.20% 54 714 62.0,-& 3:613 3800% 2L1601 .9._ code,PHYSCAL"n-�APtST I. 7?IrI;. +•;.'I`3 7a.590 6.9Gi4 =.635 S.^Si 6.18$ °rt JOSS 59 5�r 7U-CC4t 41.1155 30 Ci_'Si 17.352 Sutno1 lJ 2.346,137 i.525-604 _106.785 I la?.-f'_'8 I2a6.5:'6 9.45'67 3C7S11 001er Health Cafe Profes-sionals 1- ELnrez GEDF4L8C1Ck+.L1'.L�Ra.HR 7'D-tip -G:-762 27.:�3 6:92hi 2.5E3 6.7'9E 3274 :!�]9L -'1,.-D ID-+'i6 I S15 Sfl.d;'ah 31 165 S Mr1� <9?9 37„i43 2. S9- 5.274 31?aO I 315 3^165, Anollary Support 1.. S it-nWza.SEPll�4ii0f.LlTPk:a ltlT�S/L:i1(r�I 75.00% 44,772 33;5?9 6.93% 7 22a 8.77% 7..-�4 b4.�-�< 2a.307 `0:,.�A3G 26.307 i KVa-1i 6d+ ,SEh1ORACINUMGRt�lrB•rERI 75�-0% 44,772 33.3N &0..f3% 2325 8:7% 2+:< 64KN. 28,307 100M% 28.O7 3. L.GO*-v--ADM.-T KdG WERVS%IR I -z-203i 38.922 -.192 &IW 2.024 c 77 F> 2.559 64.32MC 24:609 :00.00% 1 21.5rA 4 L.F�:-f A3V71 T1GWTERVEAERU 76-0'% 38.222 29.192 4&96SS 2-024 57755 2.5591 84.3D% 24609 100`leju 24.609 5- G R,xrue-s-Reyes,A011EMS.'WERVOWRP I 75. 00:% 3:..420 2Z.515 6.93% 1,582 517,: 2.0 0 1 843055 19233 1CO.00% n- ?Lcpez.ACIAM-GF4T6RVE•1A62f 75-0% 33-.046 24,785 8.93% 1,71,9 817'i Z1131 84.39% 20.844 1CDDD% 26,ert-9 7. M Esc*beia,ADNV-1 fV4G OfFO W-eHER 1 75.TA 32c4,0 22.815 6.934 1.5K 77% 2,0X 84-W% 19.23s 100.0 .q.n3 8- A.McK,ADATTV.K-Mn9:Zkr6 R6 7�.C:�R; 38,n 29.1921 6.93A, e.C24 8.77% 25 = 84.30% 24;5-11 1W.0m 2CC09 9. K.Amwcros.A-)I4Tif4G ME-VElNWi 75.0D,% 32.37D 24.718 6.9- i.Ew 3.T.7% 2125 84'_rS% 21C4 6} 1.7C.0Cft 2-0466 :0. 8-Ta-.or,ACR f`TNG 1h-E V .J N II 7511054 31.232 23.537 &53% ?632 8 T,,% 2 &' F-'a3% 39.84i I 1IX.009 19.Ss2 11. A.LLre-van_^s,ADOAT-14W ERVEKER 75DO% 30.134 22760'. -893i5 1,567 87"AS30% 15.O�S''t 10C.COi• 19Cu3 12. L.1t1b-rLs,AD PW-,WTEZ'.IFAE21 75:A,S: 29.649 22,M 0.93% 1.532 577% 1.936 E4-3J% 1E,81c =C:.0035 18.619 13. T Acosta A_NIITTi1JGA n5ZVEV,E 1 r 30% 30.36E 1 22775 &SG% 1.579 8`SS 1,9-`7 &1-3;lS'o 19-1Ec- 'DD00% :U.i99 14_ Va:art,ADW.rf19JC-TJTEZVERAERI ia:0-h. I 32.370 24,278 6.93% 1,683 8 212a 94 0% 20466 1L@CC I 2C.-66 15. Vac;ani,ADWfl-W4r,F4113kIEI/kER 1 75.011% 3Z37L 24.276 6.93% l •..2 6 5< 2.1218 8 AN% 2RA6o 1C0.0c% 2c.4.`43' 16 Var,-crd.AtWMIJ3WTE LIME21 75.0� 32.370 24.278 6.93% 4,6w-1 e.T"ti 2128 'o4.;:DyS 20.466 100.00+F 2C.11� 17. V2r2M AD1TTTCk3 WTEM'ENER 1 75C^35 3,'_.370 -2A,278 6.9 xh i.C83 2 i % ZI'2S 84.301A M.466 1w.00% d1:,4FC; S.#itoS .53.W1 437.535 30.3W 38.,L55 338.644 3o3,8Gq 80 Children's Medical Services Plan and Fiscal Guidelines FY 2015•-16 COUNTY: Fresno FISCAL YEAR: 2015-16 Cie Ocal and Claim s:Suppor-t A QW-1er SUPMVtSNG0FMEASS67AYi I 75._0% ?9;15= 23,616 6.931E -.98ti 2.771;, 2.511 84.39% 2-+48 0 IW.00% 241c5 2. X..G0,&a Z,QFFY'FASSISTANT I 1 75_005& 23.5-% V.667 6.93% '225 aTf',4 1.549. 84 30-k F"s:3 0 10 0cm 14"33 3. T.L'al!Wokk OPICEASSSTANT 0 75M% 35;.WO I 27 45Y c"Cz1% '!ON _ % 2.407 84 30% 23,145 0 1 W.CQi: 23-45 4. A.Garcia 0r%r-EASSSTANTI 75.D;r°6 I 23,a.,f 17667 693 1-225 5.Tr% i,x� 8430% '4;13M 0 10-_�C0% 14.8'33 5,MQ3v- OFF-CEASSETANTI 75.0:�4v 0.3DO 20475 :93% 1.420 677% ',795 8;.7A% 17.250 0 'vcw's 17� S. )A Fveco, ASSISTANT;. 75.01?% 22854 S.93% 1.189 577% 'a03 ?f 3D'F -4,450 u "09 MA 7.R.Jrsnison. PF10EASSISTAI'M 75.OD% 2ic"5 i1,14': 8.93% 1.189 6.77% :;503 E'•3G% 14.4<0 0 `c--GO i 14.450 S. T.Bruvn.CEFICEASSISTANT11 75.0 %. W.6U5 -2.4=5 &93% 1,904 8.77% 7.407 °�W1% 4145 0 :DD_"0� 23.'.45 3. 61 Pgwroa,.OFFJCEASSS3 NT11 75.00% z;e05 .27,=56 6:93% 1.9_'d .6.17% 2407 S'301% 2?,14- I 0 100.w.,A 23.145 10. Vaca^l CFFICEASSSTAN71 7 0M a-.554 17,141 f 6. % 1.169 1 8.77% i C3 F-1.30-1h 14 45C. G( 100:00% i .4.450 11. VacaltCFF'r;EA META R111 7500% .22,654 17.141JI 6.93% 1.1w .e.77% 1.`03 14a57.• C{ 100W4 I '4,450 17- N Zi:--1a,SLPMV 17>W.AC ,MCLEW 11 Si 15' S?.396• 6:93% 2.652 .8-77% 3.366 5.4.30% 3Z: a IGO..D:% I 32.368 13. RDeLa%,sA ACCOUNT CLl3iK1 75,00% Z5012 1.6,7Ea em% '301 8.77% 1•Z44 84,30% 15814 -0 1CADM 15;8'= 14, {Ea.wana.ACCCUt.:CL9Z1{1 I 75 Wli 25.012 15,795 6954% ',301 -S.77% 1.644 84.30% 15814 O icaoO-i, 15:814 15. ftC.P=y.ACCt YKF CLEW I 75_W-i 2S,0'2I 1e759 &G3% 110, 8.7735 1:644 84-30% 15,814 0 100:07K. 15,6'4 S_•bi" 44^,076 3W 360 22.6W 28;9r•=I 2T8---kQ C 273,239. i ToW Satilias an_14%es I 2.�*5.481 6.m% i72.347 6 75i 217,8ri' 3430% 2,0-%.2_`d 451?1% 545.482 54.671A SW,l Bete?J.s(s9eca",%) 1.TE2.769 153,282 .34 30% t,502,8`y i 678 4.69 K4.69= I.-Total Personnel Expense 4,268:25C 6.93`•m 296.937 677% 374.165 E�-&!% 3.'92,1Is 1.62L-S5 1 0 4467 IL Operating Euper e travrJ •.:;,W F.9,";°k 104 8.57'% '3, 84-3D% '.264 45'a% 570 54.37% 1541 1tar4ria Xr c. 3d '04 277%. '31 64-39% i 154 45'3i5 SO 54.8✓-% 1534 3 0ML,Expenses ! 25150 1 15 e3% 2026 E77..i 2,5E-4 84.3D°k 24.65E I 100.J0% 24;658 g Isla e j 16-5po Rss3% 1,144 0-77% 1.-48 84-30% I 13X-9 1CO:OQ4i :3,9 9 5. Smail Tools 3:750 6.93.%i 2 O B-77;5 329 84.20% -3,161 iCO.CKY`k 3.1•1 B. FbLsehoOEm eases 8.2501 6.93-,, 2 6.r;% 729- a4?9% 6.%5 X(l.03% 6,95E 7. bUirmsn xe-Epitipmeni.9ldg,5-S.`ee-nty 35525r i 6.n% 1444 i 9.77`:€ 3.C90 8a 20% 29.7,rt 100.00% 2^,'16 9. Fa.-RyS&Yces;nnl.>JWas) 31.,-,Cf� 693% ^�184 8r7% 2i6' c-.3An: 265y1 10p.01,% 26,5541 Co mw alien 14,250 6.S3% SB3 8 7?% 1249 6-s_b 12 013 I 1 D3.00% 112 013 10_ Special Dw-Epsbes 13.500 3-:31.5 2G5 3771A 1.19a 84.1% 1'.38C 1 De.rm 1.?.?80 1 i.Data Rpce5_syy 1 172;J70 6.W, 11.961 1377% 15,122 1 64:39�% 146417 100.00% 145A 17 1.2,TraiselnnSa-vices 2,250 S,ga% 1;6 87(% 197 84:30"TS `:3&7 10-0.CO% 1,567 81 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 9.Totai Operating Expense 333_00 228951 28926 Va.IIs 1,14C 2n.D48 III.CapitalExpen e 1. 6.90! 0 B.77% D I}+.. "i C 0 2. 6 93% 0 8.7% Z. EA.YA C 0 3 6.93`& C 8.7-1% 5 5 4.3--% 0 0 1 IIL Total Capda!Experse 0 0 0 C 0 M Indirect EKpens0 i :Aernal 14_15% '61.2,4.?0 6.9Z% ! -2.471 8.77`A, :3: 3 64.3-� 51e=sue• 100,rr-% 516,330 2. &.1ama1 A3315 14.Ot% 6:9<+°k f St'? 2.7 1-125 84.37% f 1'a74 1 11.974 IV.TotallnditeetEmensa 62C.579 43,445 6452E 52e,204 V.Other Expense 1.r0anlenarce Trzfvspertabicn 6:�'�"., 's_`3i 877i> 4,=71 84?0v �42s6:a 1:O.1:1;`k 1F,2990 U.77% -0 a4.W% D 100-NN 0 3- 5.ca s D 57755 C• a4-n% 0 1',.Q.D736 0 9. ! 6 aC15s .0 8 7751 C j 84,W% 0 100.00% 11 5- 6.93% D 677% Q, 84:-.OYr 0 100.0m 3 V.Total Other Expense 51,D70 3;5u 4,471 42,933 42.993 fidget Grand Total 5.27sx9 3a4.6'i2 46Z49n 4.4i7.5C3 1.62-.79� 2.5Z712 Brandon Heberer,Staff Ariaiyst 1217115 559-&30-6.%21 P+epmed 8•y;Sgnartuel Premed By(Prn-,ed Nacre; DrE rmparei Phone ndmcer _---beborah Martinez,CMS Division Manager /�/ j! ��'c y ;. ssMoc-6595 CCS Atlr+.s�awr(1-S.g7w-rz) OCS ke'rnrt'1alc(iPrV.ted Nine) sy-ne_ Ptar2 wrbzr 82 iChildren's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 otai CCS CASELOAD Actual CaseloadT�Pe�rcent Gad STRAIGHT CCS- Tctal Cases of Open(Active)Straight CCS 598 6.93% Chi,.Krer CCS Administrative Budget Summary OTLICP - Four Quarters Total.I Total Cases of Open(Active)OTUC.P 756 a.T7% Children Fiscal Year: 2015-16 i MEDI-CAL- Totai Cases of Open (Active)Medi-Cal 7270 84.30% (non-OTLICP)Children County: Fresno f_ TOTAL CCS CASELOAD 8624 100% Col 1 = Straight CCS Optional Targeted Low Income Children's Medi-Cal(non-OTLICP) (Column 4=Columns Col 2C., Program (OTLICP) 5+6) I Column I 1 2 3 _ I 4 I 5 6 ' Optional Optional Optional Targeted Low Optional Targeted Targeted Targeted Low Medial Medi-Cal Income Low Income Low Income Enhanced Noo- Total IncomeChildren's Straight CCS Children's Children's Children's Enhanced CategoryfUne Item Coun ty/State Program Program(OTLICP) Program Medi-Cai Budget 5(.U50 Program State/Federal StatelFederal ( ) (OTLICP) (OTLICP) ColstatelFed (OTLICP) (25175) StatelFederal Co/State/Fed ColStatelFed Q 1 Non-Enhanced ColStatelFed (50150) Enhanced Q 1 (17.5117.5165) (6.016.ofm)- (12.5112-5175) Q2,Q3;Q4 i I_ Total Personnel Expense 5,648.535 384,743 486,390 52,352 59.873 374,165 , 4,677,389 2,127,194 2,550,195 It. Total Operating Expense 440,0.00 30,509 38,569 42 9501 1 28,926 370,914 1532 369,382 tIL Total Capital Expense 0_ 0 0 0 1 0 0 _ 1 0 IV.Total Indirect Expense 814,525 I 56,480 71,403 16.475 { 54,928 696,642 686,642 V. Total Other Expense 68,000 4,715 5,967 1,490 4,471 57,a24 57,324 Budget Grand Total 6,871,060 476,447 692,323 52,394 87439 462,49D 5,792,269 2,128,726 3:663;543 83 Children's Medical Services Plan and Fiscal Guidelines FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-9 6 Col 1 = Col Straight CCS OTUCP Medi-Cal(non-OTLICP) (Column 4=Columns 2+3+4 1 5+6) Column_ � 1 2 3 I 4 5 8 Optional Optional Optional Targeted Low Optional Targeted Targeted Income Low Income Low Income Non- Targeted Low Enhanced Straight CCS Children's Children's Children's Enhanced Total Income Children's Medi-Cal Medi-Cal Source of Funds County/State Program Program(OTLICP) Program Medi Cal Budget (50150) Program (OTLICP) Co/State/Fed Non (OTUCP) StatelFederal State/Federal al StatelFederal Co/StalelFed ColState/Fed Enhanced Co/State/Fed {25l75) (50150) Enhanced (17.5117.5165) (6.016.0188)- (12.5112.5175) _ Q2,Q3,Q4 Straight CCS I I I State 238.223 238,223 _ 1 County 238,224 238.224 OTLICP State 49. 0G 49,600 6,549 15,302 27,749 _ — f County, 1 4.9,600 49,640 6.549 15,302 27.749 Federal(Title XXq 503,123 503,123 39.296 56,835. 406.992 14Med-Cal state 2,363.954 I 2,363r954: 532,182. 1,631,772 Federal(Title XIX) 3,428,315 I 3,428,315. 1,596,544. 1;831,771 Brandon Heberer, Staff Analyst bheberer@co.fresno.ca.us Prepared By (Signature) Prepared By (Printed Name) Email Address D Borah Martinez, CMS Division Manager martida@co.fresno.ca.us CCS Administrator(Signature) CCS Administrator(Printed Name) Email Address 84 Children's Medical Services Plan and Fiscal Guidelines. FY 2015-16 COUNTY: Fresno FISCAL YEAR: 2015-16 I. Personnel Ex enses Total Salaries: $ 3,216.520 Total Benefits: $ 2,332,015. Staff benefits represent,en estimated 77%•.of salaries;this is an IndreaSp of i.6%from the previous fiscal year. Total Personnel Expenses: $ 6,648.535 Staffing Changes Public Health Physician Represents a 1.0 FTE from(3) Extra Help positions.°rhls is a 1.8 FTE decrease from the previous FY duo to recent vacancies. Public Health Nurse Represents an 8.2 FTE with 1 Vacancy.This is 0.8 decrease from the prOvlous FY. Staff Nurse Represents a 12.0 FTE This is an Increase of 3.0 FTE from previous FY to butler match Staffing.Standards Medical Social Worker Filled vacancy;represents 1.0 FTE. Meets Staffing$landards. Admitting r!e vie:ve Represents 15.0 FTE(Same as previous FY)with (4)vacancies, IL Operating Expenses ravel $ 2,000.00 Based on expenditures: Mileage, Meals, Lodging,Freight,Parking,Garage Fees,etc. ($3,000 reduction from previous FY) Training ! 2,000.00 Includes registration and/ortuition tees for COS trainings,seminars,conferences,etc.This Is a 75%roduction from the previous FY based on expenditures. Office Expenses $_ 3.9,000.00 Remains the same as previous FY. Postage $ 22,000.00 Based on expenditures from previous FY this represents a 51%reduction due to rmproved communication methods. Small Tools 000 00 _ Represents a 54%decrease from previous FY based on expenditures. Household Expensos $$ 11,00L100 Represents a 22%Increase from previous FY based on expenditures Magri-Equip. Bldg, 8 $ 47,000.00 Represents a 28%decrease from previous FY based on expenditures. _Security — Facility Services(rent, $ 42,000.00 Represents a 22%increase from previous FY based oh expenditures. utilities _ Communicatlon $ 19,000..00 Represents a 5%decrease`rom previous FY based on expenditures. Special Dept. Expenses $ .8,000.00 Represents a 260%increase from previous FY based on expenditures, Data Processinc $ 230,000.00 Represents an 11%decrease from previous FY based on expenditures. Translation.Services $ 3,000,C--' Represents a 200%increase from previous FY based on expenditures. Total Operating $ 44Q000.00 Expenses: IIE, Capital Expenses Total Capital Ex enses: $ None' IV. Indirect'Expenses internal Q 14.35% $ 796.215,00 Department approved Internal Rate, Exh_imal a 0.350/6 $ 18,310.00 De ar!,1•e'i!approved External Rate. Total Indirect Expenses; $ 614,626,00 V. Other Expenses _ Maintenance 8, $ 68,000.00 c Transportation Represents a 2010 decrease from previous FY based on expenditures.Reimbursemonts and payr`hentS to families for travel,lodging and meels incurred while obtaining CC$authorized services allowing for special ciroum'stan_ces and other contingencies. Total Othar Exponses_ 1S 68,000,00 Budget Grand Total- 6,871,060,00 85 Children's radical Services Plan and Fisc , Suidelines COUNTY: Fresno FISCAL YEAR: 2015-16 Certification Statement - Child Health and Disability Prevention (CHDP) Program County/City: Fresno/Fresno Fiscal Year: 2015-16 I certify that the CHDP Program will comply with all applicable provisions of Health and Safety Code, Division 106, Part 2, Chapter 3, Article 6 (commencing with Section 124025), Welfare and Institutions Code, Division 9, Part 3, Chapters 7 and 8 (commencing with Section 14000 and 14200), Welfare and Institutions Code Section 16970, and any applicable rules or regulations promulgated by DHCS pursuant to that Article, those Chapters, and that section. I i further certify that this CHDP 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 CHDP 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.). I further agree that this CHDP Program may be subject to all sanctions or other remedies applicable if this CHDP Program violates any of the above laws, regulations and policies with which it has certified it will comply. - `[ - Signature o CH P Director Date Signed Signature of Director or H alth Officer Dare Sj ned { Signature and Title of Other-Optional Date Signed I certify that this plan has been approved by the local governing body. l -d17- 1 LP Signature of Local Governing Body Chairperson Date ATTEST: BERNICE E.SEIDEL,Clerk Board of Supervisors By -SUS&,% IJ 1 SXIc-C� Deputy 3 Children1 s(O"'Idical Services Plan and Fisc�uidelines i COUNTY: Fresno FISCAL YEAR: 2015-16 Certification Statement -California Children's Services (CCS) County/City: Fresno/Fresno Fiscal Year: 2015-16 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. Cg—nature—of CCS Administr ate Signed i J iL Signature of Dir ctor or Heap/officer Date ign Signature and Title of Other— Optional Date Signed I certify that this plan has been approved by the local governing body. 1 • Lo Signature of Local Governing Body Chairperson Date Signed ATTEST: BERNICE E.SEIDEL,Clerk Board of Supervisors By �l�lS OEM L�l J1f, Deput 4