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Home My WebLink AboutAgreement A-16-634 with State Dept. of Health Care Services.pdfChildren’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Plan and Budget Required Documents Checklist MODIFIED FY 2016-17 County/City: Fresno/Fresno Fiscal Year: 2016-17 Document Page Number 1. Checklist Yes 2. Agency Information Sheet 1-2 3. Certification Statements A. Certification Statement (CHDP) – Original and one photocopy 3-4 B. Certification Statement (CCS) – Original and one photocopy 5-6 4. Agency Description A. Brief Narrative 7 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 8-16 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 17-42 6. Data Forms A. CCS Caseload Summary 43 B. CHDP Program Referral Data 44-45 7. Memoranda of Understanding and Interagency Agreements List A. MOU/IAA List 46 B. New, Renewed, or Revised MOU or IAA 47-63 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 64 2. Budget Worksheet 65-66 Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 County/City: Fresno/Fresno Fiscal Year: 2016-17 Document Page Number 3. Budget Justification Narrative 67-68 B. CHDP Administrative Budget (County/City Match) - Optional 1. Budget Worksheet N/A 2. Budget Justification Narrative N/A 3. Budget Justification Narrative N/A C. CHDP Foster Care Administrative Budget (County/City Match) - Optional 1. Budget Summary N/A 2. Budget Worksheet N/A 3. Budget Justification Narrative N/A D. HCPCFC Administrative Budget 1. Budget Summary 69 2. Budget Worksheet 70 3. Budget Justification Narrative 71-72 E. CCS Administrative Budget 1. Budget Summary 73 2. Budget Worksheet 74-76 3. Budget Justification Narrative 77 G. Other Forms 1. County/City Capital Expenses Justification Form N/A 2. County/City Other Expenses Justification Form N/A 9. Management of Equipment Purchased with State Funds 1. Contractor Equipment Purchased with DHCS Funds Form (DHCS1203) N/A 2. Inventory/Disposition of DHCS Funded Equipment Form (DHCS1204) N/A 3. Property Survey Report Form (STD 152) N/A Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 1 of 77 Agency Information Sheet County/City: Fresno/Fresno Fiscal Year: 2016-17 Official Agency Name: David Pomaville, Director Address: 1221 Fulton Mall 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: martida@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: martida@co.fresno.ca.us CHDP Director Name: Rose Mary Rahn Address: 1221 Fulton Mall P.O. Box 11867 Fresno, CA 93775 Phone: 559-600-6363 Fax: 559-600-7726 E-Mail: rrahn@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, 3rd Floor Fresno, CA 93721 Phone: 559-600-3529 Fax: 559-600-1608 E-Mail: bseidel@co.fresno.ca.us Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 2 of 77 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: 559-600-1298 Fax: 559-455-2412 E-Mail: RRChavez@co.fresno.ca.us Children's Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Certification Statement -Child Health and Disability Prevention (CHOP) Program County/City: Fresno Fiscal Year: 2016-17 ----------------------------------- I certify that the CHOP 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. further certify that this CHOP 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 CHOP 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 CHOP Program may be subject to all sanctions or other remedies applicable if this CHOP Program violates any of the above laws, regulations and policies with which it has certified it will Date 1gned /o/0~/ Date Slgned Signature and Title of Other -Optional Date Signed I certify that this plan has been approved by the local governing body. Date ATTEST: Page 3 of 77 Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 4 of 77 Children's Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Certification Statement-California Children's Services {CCS) County/City: Fresno Fiscal Year: 2016-17 ----------------------------------- 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. ·Signature of CCS ~drninistrator Signature of Date Sif}((ed Signature and Title of Other-Optional Date Signed I certify that this plan has been approved by the local governing body. Date Signed ' ATTEST: Page 5 of 77 Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 6 of 77 Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 7 of 77 CMS PLAN Fiscal Year 2016-17 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. Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 8 of 77 State of California - Health and Human Services Agency Department of Health Care Services - Children's Medical Services Incumbent List – California Children’s Services For FY 2016-17, 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: 2016-17 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Division Manager/Administrator Deborah Martinez 100% No No Administrative Assistant III Jennifer Miller 100% No No Staff Analyst II Brandon Heberer 100% No No Rehabilitation Therapy Manager Harsharn Dhillon 20% No No Systems & Procedures Analyst III Peter Jew 10% No No Senior Accountant Michael Chu 10% No No Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 9 of 77 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Medical Consultant Dr. Joshua Warolin 20% No No Public Health Physician Vacant 30% No No Public Health Physician Vacant 30% No No Supervising Public Health Nurse Nancy Sullivan (MCMC, IHO, RC) 100% No No Head Nurse Sherilee Lawson 100% No No Public Health Nurse I Hilary Davis 100% No No Public Health Nurse I Marla Bomgardner 100% No No Public Health Nurse II Elizabeth Manfredi 100% No No Public Health Nurse II Heather Woo 100% No No Public Health Nurse II Noel Almaguer 100% No No Public Health Nurse II Rene Martz 100% No No Public Health Nurse I Alexis Krise 100% No No Public Health Nurse (Extra Help) Vacant 100% No No Public Health Nurse (Extra Help) Amada Ozaeta 100% No No Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 10 of 77 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Public Health Nurse (Extra Help) Stella Jauregui 100% No No Staff Nurse I Kelly Stevens 100% No No Staff Nurse I Tim Yang 100% No No Staff Nurse I Vacant 100% No No Staff Nurse II Chameka Howell 100% No No Staff Nurse III Belinda Mayugba 100% No No Staff Nurse III Darawadee Martin 100% No No Staff Nurse III Jing Yang 100% No No Staff Nurse II Joanne Thorne 100% No No Staff Nurse III Joseph Burgess 100% No No Public Health Nurse I Megan Brown 100% No No Staff Nurse III Maribeth Jensen 100% No No Staff Nurse III Marjelyn Ramiro 100% No No Staff Nurse III Vivien Tagoe 100% No No Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 11 of 77 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Physical Therapist III Joy Conde 100% No No Medical Social Worker I Daniela Saavedra Castellanos 100% No No Senior Admitting Interviewer Sonya Mendoza 100% No No Senior Admitting Interviewer Bobbi Taylor 100% No No Admitting Interviewer II Khamsay Vanhelsdingen 100% No No Admitting Interviewer I Samantha Chandler 100% No No Admitting Interviewer I Rudy Constantino 100% No No Admitting Interviewer I Anita Tristan 100% No No Admitting Interviewer II Lee Garcia 100% No No Admitting Interviewer II Luz Reyes 100% No No Admitting Interviewer I Laura Lee Johnson 100% No No Admitting Interviewer I Marcy Nava 100% No No Admitting Interviewer II Maria Escobedo 100% No No Admitting Interviewer II Alicia Molina 100% No No Admitting Interviewer I Tiffany Acosta 100% No No Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 12 of 77 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Admitting Interviewer I Bernard Thao 100% No No Admitting Interviewer II Antionette Luevanos 100% No No Admitting Interviewer I Laurie Roberts 100% No No Admitting Interviewer I Joni Still 100% No No Admitting Interviewer I Xavier Gonzalez 100% No No Admitting Interviewer I Michael Vue 100% No No Admitting Interviewer I Carrie Laney 100% No No Supervising Office Assistant II Alibra Carter 100% No No Office Assistant I Angelica Rodriguez 100% No No Office Assistant III Teresa Valladolid 100% No No Office Assistant I Yvette Salas 100% No No Office Assistant II Jovanna Dominguez 100% No No Office Assistant III Margarita Kellerhals 100% No No Office Assistant I Rick Jemison 100% No No Office Assistant I Kristeena Bump 100% No No Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 13 of 77 Job Title Incumbent Name FTE % on CCS Admin Budget Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Office Assistant Vacant 100% No No Office Assistant III Tamara Brown 100% No No Office Assistant III Mellissa Figueroa 100% No No Supervising Account Clerk II Norma Zieska 100% No No Account Clerk II Rodrigo De La Rosa 100% No No Account Clerk I Kimberly Horton 100% No No Account Clerk I John Vargas 100% No No Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 14 of 77 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 2016-17 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: 2016-17 Job Title Incumbent Name FTE % on CHDP No County/ City Match Budget FTE % on CHDP County/City Match Budget FTE % in Other Programs (Specify) Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Supervising Public Health Nurse, Deputy Director Julie Slaughter 60% No HCPCFC 40% No No Public Health Nurse II Jeri Guerrero 50% No HCPCFC 50% No No Public Health Nurse II Ankara Lee 100% No No No No Health Education Specialist Tina Starks 65% No Child Ride Safe 35% No No Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 15 of 77 Job Title Incumbent Name FTE % on CHDP No County/ City Match Budget FTE % on CHDP County/City Match Budget FTE % in Other Programs (Specify) Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Supervising Office Assistant Lisa Renteria 100% No No No No Office Assistant III Gracie Velasquez 100% No No No No Office Assistant III Martha Garcia 100% No No No No Office Assistant I Pa Xiong 100% No No No No Office Assistant III Sonia Reyes 90% No Child Ride Safe 10% No No Health Education Assistant Brendon Matsumoto 100% No No No No Children’s Medical Services Plan and Fiscal Guidelines for Fiscal Year 2016-17 Page 16 of 77 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 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: 2016-17 Job Title Incumbent Name FTE % on HCPCFC Budget FTE % on FC Admin County/City Match Budget FTE % in Other Programs (Specify) Have Job Duties Changed? (Yes or No) Has Civil Service Classification Changed? (Yes or No) Supervising Public Health Nurse Julie Slaughter 40% No 60% CHDP Admin No No Public Health Nurse II Kathy Schmidt 100% No No No No Public Health Nurse II Lupe Wade 100% No No No No Public Health Nurse II Celia Lopez 50% No 50% Foster Care Program Emergency Response No No Public Health Nurse II Jeri Guerrero 50% No 50% CHDP No No Office Assistant I Vacant 100% No No No No Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 17 of 77 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 physician so their medical files can be updated. Based on the entire active caseload as of August 2016, the following findings are: • 73% 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. Plan to Improve Compliance • A Business Objects report will be run on a quarterly basis to identify clients with a missing/wrong PCP/Medical Home and will be contacted to obtain the correct information; and • Each time a client is contacted by a case manager and/or when a client contacts CCS the designated staff member will ensure that the PCP/Medical Home is current and/or updated. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 18 of 77 CCS Performance Measure 1 – Medical Home Children enrolled in the CCS Program will have documented Medical homes/primary care providers. The goal is to have 100% compliance. Definition: Children in the CCS program will have a designated primary care physician and/or a physician who provides a medical home. Numerator: The total number of children with a completed field with identification of a primary care physician and/or a physician that provides a medical home. Denominator: The total number of children in the local CCS county program. Data Source: Sample of 100 charts or 10% of caseload if caseload under 1,000. Reporting Form: Number of children with a primary care physician/ Medical Home (Numerator) Number of children in the local CCS program (Denominator) Percentage of compliance 6489 8857 73% * 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. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 19 of 77 County of Fresno Department of Public Health CCS Performance Measure 2 FY 2015-16 Client program eligibility was determined according to the guidelines established by the Children’s Medical Services Branch, California Children’s Medical Services Administrative Procedures Manual (July 2001 Revision). Fresno County CCS utilized the CCS Performance Measure 2 report within CMS Net to determine compliance. The findings are as follows: • Total unduplicated new referrals were used for quarters 1, 2, and 3 (4th quarter was not available) to calculate the medical eligibility determination compliance. Out of a total of 1,629 new referrals, 62% had their medical eligibility determined within the prescribed guidelines. This represents a 130% increase from the previous fiscal year. • Total unduplicated new referrals were used for quarters 1, 2, and 3 (4th quarter was not available) to calculate the financial and residential eligibility determination compliance. Out of a total of 1,629 new referrals, 96% had their financial and residential eligibility determined within the prescribed guidelines. This represents a 12% increase from the previous fiscal year. 1,610 cases were Full Scope Medi-Cal or TLICP clients and 19 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 96% 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 fiscal year 2013-14. 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. New training procedures and productivity tracking have been implemented and compliance has been dramatically increased as a result. After experiencing an improvement from 27% in FY 14-15 to 62% in FY 15- 16 (130% increase) management feels confident that next year’s medical eligibility determination period average length of time will be much shorter and the vast majority of new referrals eligibility determination will be less than five days. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 20 of 77 CCS Performance Measure 2 – Determination of CCS Program Eligibility FY 2015-16 Children referred to CCS have their program eligibility determined within the prescribed guidelines per Title 22, California Code of Regulations, Section 42000, and according to CMS Branch policy. Counties will measure the following: Numerators: a. Medical eligibility within five working days of receipt of all medical documentation necessary to determine whether a CCS-eligible condition exists. b. Residential eligibility within 30 days of receipt of documentation needed to make the determination. c. Financial eligibility within 30 days of receipt of documentation make the determination. Denominator: Number of CCS unduplicated new referrals to the CCS program assigned a pending status in the last fiscal year. Data Source: 10% of the county CCS cases or 100 cases (which ever number is less). Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 21 of 77 Reporting Form: MEDICAL ELIGIBILTY Number of referrals determined medically eligible within 5 days (Numerator) Number of new unduplicated referrals (Denominator) Percentage of compliance Medical eligibility determined within 5 days of receipt of all necessary documentation 1,015 1,629 62% PROGRAM ELIGIBILITY Number of cases determined eligible within 30 days of receipt of documentation needed to make the determination (Numerator) Number of new unduplicated referrals (Denominator) Percentage of compliance Financial eligibility determined within 30 days FSMC /TLICP 1,546 CCS only 18 FSMC /TLICP 1,610 CCS only 19 96% Residential eligibility determined within 30 days 1,564 1,629 96% Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 22 of 77 County of Fresno Department of Public Health CCS Performance Measure 3 FY 2015-16 Part A: Annual team Report Fresno County CCS generated a Business Objects report which identified 265 clients with a diagnosis or condition that requires referral to a Cardiac, Renal, Pulmonary, Neurological or Endocrine Special Care Center, per NL 01-0108. Review of a random sample of 100 children who received a SCC authorization yielded the following: • 64% compliance for Annual Team Reports of SCC authorized clients. Out of 100 children with a SCC authorization, 64 had an Annual Team Report in their medical chart, 36 did not. • Of the 36 without an Annual Team Report, one client had a scheduled appointment but failed to attend and another client was deceased. • As part of the Nurse Case Manager’s Annual Medical Review process, the requirement to document the existence, or lack thereof, of an Annual Team Report in the client’s file will be enforced and subject to review by their supervisors. • Fresno County CCS will inquire from the noted SCC’s as to why the clients do not have a noted Annual Team Report and work with them to ensure future progress. Table 1. contains the breakdown of the status of the Annual Team Reports per diagnosis code: SCC Category ICD-10 No. of Clients No. with Annual Team Report No. without Annual Team Report Cardiac Q23.0- Q23.8 22 9 13 Endocrine E11.00- E11.9 28 19 9 Pulmonary E84.00- E84.9 15 10 5 Neuro-Muscular Q05.1- Q05.9 35 26 9 Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 23 of 77 Part B: Authorization of Child to SCC CCS generated a Business Objects report which identified 256 children with a CCS diagnosis or condition that requires referral to Cardiac, Renal, Neuro-musculoskeletal, Endocrine, or Pulmonary Special Care Centers, per NL 01-0108. • Of the 256 children who had a condition that required authorization to a SCC, 235 were authorized for a SCC. • Fresno County’s compliance with this measure is 92% and are appropriately authorizing SCC’s for children with eligible medical conditions. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 24 of 77 CCS Performance Measure 3 (A & B) – Special Care Center This Performance Measure is evaluated in two parts. Part A: Annual Team Report Definition: This performance measure is based on the CCS requirement for an annual team report for each child enrolled in CCS whose condition requires Special Care Center services and has received an authorization to a Special Care Center. County CCS programs will evaluate this measure by the presence of an annual team conference report in the child’s medical file. Numerator: Number of children that received a Special Care Center authorization and were seen at least annually at the appropriate Special Care Center as evidenced by documentation and completion of the interdisciplinary team report. Denominator: Number of children enrolled in CCS whose condition as listed in categories defined in Numbered Letter 01-0108 requires CCS Special Care Center services and has received an authorization to a Special Care Center. Data source: 10% of the county CCS cases authorized to SCC or 100 cases (which ever number is less). Part B: Referral of a Child to SCC Definition: This measure is based on the CCS requirement that certain CCS eligible medical conditions require a referral to a CCS Special Care Center for ongoing coordination of services. Numerator: Number of children in CCS, with medical conditions in the categories as listed in Numbered Letter 01-0108 requiring a Special Care Center Authorization, who actually received an authorization for services. Denominator: Number of children enrolled in CCS, with medical conditions, requiring Special Care Center Authorizations. Data source: Counties shall identify and use four or five specific diagnosis categories (cardiac, pulmonary, etc) as listed in the Special Care Center Numbered Letter 01-0108 as it relates to the SCC(s) identified for your client population. The county shall identify one or more diagnostic codes and use the diagnosis codes indicated for the SCC categories selected for this PM. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 25 of 77 Reporting Form - Part A: Category selected (cardiac, pulmonary, etc.) Number of children with annual team report in client’s medical records (Numerator) Number of children with SCC authorization (Denominator) Percentage of compliance Cardiac, Renal, Neuro- musculoskeletal, Pulmonary, Endocrine 64 100 64% Reporting Form - Part B: Category selected (cardiac, pulmonary etc.) Number of children with authorization to SCC (Numerator) Number of children with eligible medical conditions that require an authorization to a SCC (Denominator) Diagnostic Code Chosen Percentage of compliance Cardiac, Renal, Neuro- musculoskeletal, Pulmonary, Endocrine 235 256 E10, E11, E70, E71, Q05, N18 92% * 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. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 26 of 77 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; • Conservatorship information; and • 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. The FY 2015-16 Transition Planning Performance Measure includes the following findings: • A Business Objects report was created to review all clients enrolled in CCS who turned 14, 16, 18 and 20 years old. A total of 1,144 clients were identified and 1,035 (90%) received Transition Planning after the implementation of the automated Transition Planning process. • A Business Objects report was created to review all clients in the Medical Therapy Program. There were a total of 168 clients enrolled in the MTP for the age groups 14, 16, 18, and 20 whose condition requires Transition Planning. Out of the 168 clients identified 160 (95%) had transition planning. MTU staff understands the Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 27 of 77 importance of transition planning and will continue to take necessary steps to improve the transition planning protocols. • Discrepancies in the query of the Business Objects report used to identify the clients in question have been identified and improvements on the report have been made to ensure that 100% of the identified population will receive Transition Planning in the future. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 28 of 77 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. Reporting Form: Number of CCS cases reviewed 1,144 Number with transition planning 1,035 Percentage of compliance 90% Number of MTP cases reviewed 168 Number with transition planning 160 Percentage of compliance 95% Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 29 of 77 County of Fresno Department of Public Health CCS Performance Measure 5 FY 2015-16 This performance measure indicates the level of family participation in the CCS program. Narrative for each criterion follows: 1. CCS uses an existing CCS parent survey developed in February 2011 and updated in 2014. This survey is distributed widely in order to gauge parent/client satisfaction with CCS services. The survey was written at an elementary reading level in both English and Spanish. Between July 1, 2015 and June 30, 2016, CCS mailed out over 4,300 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. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 30 of 77 CCS Performance Measure 5 – Family Participation The degree to which the CCS program demonstrates family participation. Definition: This measure is evaluated based on each of the following four (4) specific criteria that documents family participation in the CCS program. Counties need to indicate the score based on the level of implementation. Checklist documenting family participation in the CCS program. Yes No Comments 1. Family members are offered an opportunity to provide feedback regarding their satisfaction with the services received through the CCS program by participation in such areas as surveys, group discussions, or individual consultation. X Fresno County uses a parent survey and ensures maximum distribution to, and collection from, client’s families. 2. Family members participate on advisory committees or task forces and are offered training, mentoring and reimbursement when appropriate. X 3. Family members are participants of the CCS Special Care Center services provided to their child through family participation in SCC team meeting and/or transition planning. X 4. Family advocates, either as private individuals or as part of an agency advocating family centered care, which have experience with children with special health care needs, are contracted or consultants to the CCS program for their expertise. X Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 31 of 77 Reporting Form: Criteria Performing (25% for each criteria) Not Performing 1. Family members are offered an opportunity to provide feedback regarding their satisfaction with the services received through the CCS program by participation in such areas as surveys, group discussions, or individual consultation. 25% 2. Family members participate on advisory committees or task forces and are offered training, mentoring and reimbursement when appropriate. 25% 3. Family members are participants of the CCS Special Care Center services provided to their child through family participation in SCC team meeting and/or transition planning. 25 % 4. Family advocates, either as private individuals or as part of an agency advocating family centered care, which have experience with children with special health care needs, are contracted or consultants to the CCS program for their expertise. 25% Total 50% 50% Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 32 of 77 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 initiated1 within 120 days of local program receipt of the PM 160. Numerator: Number of conditions, coded 4 or 5, where the follow-up care was initiated within 120 days of receipt of the PM 160. Denominator: Total number of conditions, coded 4 or 5, on a PM 160, excluding children lost to contact. Data Source: Local program tracking system. Reporting Form: Element Number of conditions coded 4 or 5 where follow - up care was initiated (Numerator) Total number of conditions coded 4 or 5, excluding children lost to contact (Denominator) Percent (%) of conditions where follow-up care was initiated within 120 days Conditions found on children eligible for fee-for-service Medi-Cal that required follow-up care 194 199 97% Conditions found on children eligible for State-funded CHDP services only (Aid code 8Y) that required follow-up care 4 5 80% *Of the 5 negatives, 1 was successfully linked to services after 120 days. Of the postives, 7 are actually still pending; however we expect them to close positive within the 120 days (we are turning the numbers in before the 120 day timeline). 1 Centers for Medicare and Medicaid Services, Publication #45, the State Medicaid Manual, Chapter 5 EPSDT, Section 5310 A http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021927.html Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 33 of 77 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. Reporting Form: Number of New Providers who Completed Orientation (Numerator) 32 Number of New Providers (Denominator) 32 Percent (%) of New Providers Oriented 100% Optional Local Program Data Tracking Form: Provider Number of PM 160s reviewed Head Circumference recorded on Children under 2 years of age Percent Compliance 1.Prem Singh 2878 2739 95.2% 2.Family Care Providers 2797 2522 90.2% 3.Rose Clinic, Selma 501 305 60.9% Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 34 of 77 CHDP Performance Measure 3 - Provider Site Recertification The percentage of CHDP provider sites (excludes newly enrolled providers) who have completed recertification within the past fiscal year. Provider site visits may occur for other reasons. These can be documented for workload activities. The purpose of this performance measure is to ensure that all providers are recertified at least once every three (3) years. This performance measure is a benchmark to ensure that providers are recertified using the Facility and Medical Review Tools. These tools ensure that providers maintain CHDP standards for health assessments. Definition: An office visit which includes a medical record review and a facility review or Critical Element Review with a Managed Care Plan. Numerator: The number of CHDP provider sites who have completed the Recertification within the past fiscal year using the facility review tool and medical record review tool. Denominator: The number of active CHDP provider sites in the county/city due for recertification within the fiscal year. Data Source: Local program tracking system. Reporting Form: Number of Completed Site Recertifications (Numerator) 36 Number of Active CHDP Provider Sites Due for Recertification (Denominator) 36 Percent (%) with Completed Recertifications 100% • Total of 63 site visits made (including follow-up visits) Optional Workload Data Tracking Form: (Other reasons for a provider site visit by local program. This identifies workload.) Other reasons for provider site visits: Number of Visits 1. Provider change in location or practice 2. Problem resolution such as, but not limited to, billing issues, parental complaints, facility review and/or other issues.2 3. Medical record review. 4. Office visits for CHDP updates or in-service activities 5. Other Please Specify: 2 CHDP Provider Manual: Program, Eligibility, Billing and Policy. California Department of Health Care Services, Child Health & Disability Prevention (CHDP) Program. See website for current updates. Local Program Guidance Manual Chapter 10: Problem Resolution and/or Provider Disenrollment. California Department of Health Care Services, Child Health & Disability Prevention (CHDP) Program, May 2005. Both references available at: http://www.dhcs.ca.gov/formsandpubs/publications/Pages/CHDPPubs.aspx#dgmp. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 35 of 77 CHDP Performance Measure 4 - Desktop Review: Dental, Lead Within the past fiscal year, identify the percentage of PM 160s with documentation indicating compliance with the CHDP Periodicity Schedule and Health Assessment Guidelines. Local programs may choose to evaluate the same provider sites over the 5-year Performance Measure cycle, or select different provider sites each year. Definition: A targeted desktop review for three high volume providers within the county/city by determining the percent of PM 160s that have documentation for: • Referral to a dentist at 1 year exam (12-14 months of age) • Lead testing or a referral for the test at 1 year exam (12-14 months of age) Numerator: The number of PM 160 elements recorded correctly per selected providers for the specific ages. Denominator: The total number of PM 160s reviewed per selected providers for the specific ages. Data Source: Local program tracking system. Reporting Form: Dental Referral Lead Test or a Referral Provider Number of PM 160s w/ Dental at 1 year exam (Numerator) Total PM 160s Reviewed (Denominator) Percent (%) Compliance Number of PM160s w/ Lead Test or Referral at 1 year exam (Numerator) Total PM 160s Reviewed (Denominator) Percent (%) Compliance 1. Adventist Health Selma Rosest 42 109 38.5% 77 109 70.6% 2. Family Care Providers 303 344 88.1% 328 344 95.3% 3. Dr. Prem Singh 598 664 90.1% 664 664 100% Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 36 of 77 CHDP Performance Measure 5 – Desktop Review: BMI Within the past fiscal year, identify the percentage of PM 160s with documentation indicating compliance with the CHDP Periodicity Schedule and Health Assessment Guidelines. Local programs may choose to evaluate the same provider sites over the five-year Performance Measure cycle, or select different provider sites each year. Definition: A targeted desktop review for three (3) high volume providers within the county/city by determining the percent of PM 160s that have documentation for: • Body Mass Index (BMI) Percentile for ages two (2) years and over. • If BMI Percentile is abnormal, the description of weight status category3 and/or a related diagnosis are listed in the Comments Section. BMI percentile Weight status category < 5th %ile Underweight 85th - 94th %ile Overweight 95th - 98th %ile Obese ≥ 99th %ile Obesity (severe) Numerator: The number of PM 160s BMI-related elements correctly documented for ages two (2) years and over. Denominator: The total number of PM 160s reviewed per selected providers for ages two (2) years and over. Data Source: Local program tracking system. 3 CHDP Provider Information Notice No.: 07-13: Childhood Obesity Implementation Guide from the Expert Committee Recommendations on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity- 2007. http://www.dhcs.ca.gov/services/chdp/Documents/Letters/chdppin0713.pdf Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 37 of 77 Reporting Form for Performance Measure 5 – Desktop Review: BMI BMI Desktop Review Flow Diagram: Denominator 1 Select sample of PM 160s from each of three high volume CHDP providers. Numerator 1 Count number of PM 160s with BMI percentile documented correctly. Record on Reporting Form Calculate compliance and record on Reporting Form. Denominator 2 Of these PM 160s, select those PM 160s in the sample with BMI-for-age: < 5th %ile 85th- 94th %ile ≥ 95th %ile Numerator 2 Count number of PM 160s with abnormal weight status or associated diagnosis listed in comments section. Record on Reporting Form Calculate compliance and record on Reporting Form. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 38 of 77 Reporting Form for Performance Measure 5 – Desktop Review: BMI Provider BMI percentile recorded on PM 160s for children ages 2 (two) and older If BMI percentile is < 5 %, 85 - 94 %, or ≥ 95 %, abnormal weight status category and/or related diagnosis listed in Comments Section Number of PM 160s with BMI %ile recorded (Numerator) Number of PM 160s reviewed (Denominator) Percent (%) Compliance Number of PM 160s with abnormal weight status category/ diagnosis in Comments (Numerator) Number of PM 160s with abnormal weight status reviewed for, diagnosis and follow-up (Denominator) Percent (%) Compliance Adventist 1.Health Selma Rose 769 849 90.6% 23 323 7.1% 2.Family Care Providers 2189 2256 97% 133 999 13.3% 3. Dr. Prem Singh 4285 4292 99.8% 0 1776 0% Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 39 of 77 County of Fresno Department of Public Health CHDP HCPCFC Performance Measure 1 Care Coordination FY 2015-16 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 160s 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 69 PM 160s with 69 positive closures and a compliance rate of 100%. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 40 of 77 County of Fresno Department of Public Health CHDP HCPCFC Performance Measure 1 - Care Coordination The degree to which the local HCPCFC program provides effective care coordination to CHDP eligible children. Definition: CHDP health assessments may reveal condition(s) requiring follow-up care for diagnosis and treatment. Effective CHDP care coordination is measured by determining the percentage of health condition(s), coded 4 or 5, where follow- up care is initiated1 within 120 days of local program receipt of the PM 160. Numerator: Number of conditions, coded 4 or 5, where the follow-up care was initiated within 120 days of receipt of the PM 160. Denominator: Total number of conditions, coded 4 or 5, on a PM 160, excluding children lost to contact. Reporting Form: Number of conditions coded 4 or 5 where the follow-up care was 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 lost to no contact. (Denominator) Percent of conditions coded 4 or 5 where the client received follow-up 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 Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 41 of 77 County of Fresno Department of Public Health CHDP HCPCFC Performance Measure 2 – Health and Dental Exams for Children in Out -of-Home Placement FY 2015-16 The data gathered for this Performance Measure was obtained from the Child Welfare System/Case Management System (CWS/CMS) Health and Education Passport (HEP) using the methodology explained here: http://cssr.berkeley.edu/cwscmsreports/methodologies/default.aspx?report=CDSS5B The percentage of children with medical exams was 82%. The number of children with dental exams was 52%. The data is only as accurate as the data entered into CWS/CMS HEP. Processes have been 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 HEP. 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 HEP. 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 to be forwarded to DSS. 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/or problems are forwarded to the HCPCFC PHNs). Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 42 of 77 County of Fresno 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 CHDP 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. Reporting Form: Element Number of Children With Exams (Numerator) Number of Children (Denominator) Percent of Children with Exams Number of children in out-of-home placement with a preventive health exam according to the CHDP periodicity schedule documented in the Health and Education Passport. (Numerator) 2605 3178 82% 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. 1652 3178 52% Data Source: Child Welfare Services Case Management System (CWS/CMS), and county specific data for Probation Department. Excludes children in non-dependent legal guardianships and those who returned home for a trial visit for more than six months. The percentages provided from CWS were those children open in quarter 2 and were averaged for the fiscal year. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 43 of 77 County: Fresno Fiscal Year: 2016-17 CCS Caseload Summary CCS Caseload 0 To 21 Years 14-15 Actual Caseload % of Grand Total 15-16 Actual Caseload % of Grand Total 16-17 Estimated Caseload Based on % Increase form 14/15-15/16 % of Grand Total MEDI-CAL Average of Total Open (Active) Medi-Cal Children 7945 90% 8293 89.8% 8658 89.6% Potential Case Medi-Cal 285 3.2% 288 3.1% 291 3% TOTAL MEDI-CAL (Row 1 + Row 2) 8230 93.2% 8581 92.9% 8949 92.6% NON MEDI-CAL Healthy Families Average of Total Open (Active) Healthy Families 0 0% 0 0% 0 0% Potential Cases Healthy Families 0 0% 0 0% 0 0% Total Healthy Families (Row 4 + Row 5) 0 0% 0 0% 0 0% Straight CCS Average of Total Open (Active) Straight CCS Children 575 6.5% 632 6.8% 695 7.2% Potential Cases Straight CCS Children 21 .2% 22 .2% 23 .2% Total Straight CCS (Row 7 + Row 8) 596 6.8% 654 7% 718 7.4% TOTAL NON MEDI-CAL (Row 6 + Row 9) 596 6.8% 654 7% 718 7.4% GRAND TOTAL (Row 3 + Row 10) 8826 100% 9235 100% 9667 100% 1 2 3 4 5 6 7 8 9 10 11 Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 44 of 77 CHDP Program Referral Data Complete this form using the Instructions found on page 4-8 through 4-10. County/City: Fresno/Fresno FY 13-14 FY 14-15 FY 15-16 Basic Informing and CHDP Referrals 1. Total number of CalWORKs/Medi-Cal cases informed and determined eligible by Department of Social Services 165,244 70,722 Cumulative New Applications 207,706 59,145 Cumulative New Applications Cumulative New Applications 2. Total number of cases and recipients in “1” requesting CHDP services Cases Recipients Cases Recipients Cases Recipients a. Number of CalWORKs cases/recipients 16,787 44,175 15,647 41,512 15,620 42,092 b. Number of Foster Care cases/recipients 4,180 4,180 4,663 4,663 4,945 4,945 c. Number of Medi-Cal only cases/recipients 15,938 42,475 25,202 77,749 6,623 17,966 3. Total number of EPSDT eligible recipients and unborn, referred by Department of Social Services’ workers who requested the following: a. Medical and/or dental services 3,565 2,502 2,312 b. Medical and/or dental services with scheduling and/or transportation 6,985 3,888 3,531 Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 45 of 77 c. Information only (optional) 13,380 5,939 9,914 4. Number of persons who were contacted by telephone, home visit, face-to-face, office visit, or written response to outreach letter 4,333 2,566 2,987 Results of Assistance 5. Number of recipients actually provided scheduling and/or transportation assistance by program staff 73 56 26 6. Number of recipients in “5” who actually received medical and/or dental services 72 34 20 Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 46 of 77 MOU/IAA List 1. Intra-Departmental Agreement: CHDP and CCS 2. Inter-Departmental Agreement: Department of Public Health (DPH), Probation Department (PD), and Department of Social Services (DSS) for Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 47 of 77 COUNTY OF FRESNO INTER-DEPARTMENTAL AGREEMENT FY 2016-17, 2017-18, and 2018-19 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 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. II. Statement of Need: The following needs in the County of Fresno have been identified by the DPH and DSS as a focus for FY 2016-17, 2017-18 and 2018-19: 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. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 48 of 77 J. Need to keep abreast of changes in state and/or federal regulations and share that information with staff during training sessions. III. 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 DSS programs and personnel, and the PD. 1. Attachment A shows the relationship between the Human Services Departments, which includes the EPSDT unit(s), and PD. 2. Attachment B reflects the current DPH organization chart, which includes the CHDP Administrative Unit. 3. Attachment C shows the reporting channel of the EPSDT unit to the CHDP Director for CHDP and Health Care Program for Children in Foster Care (HCPCFC). 4. Attachment D, 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. a. California Work Opportunity and Responsibility to Kids (CalWORKs) Families, In-person Application/Annual Re-determination b. Medi-Cal (1) In-person Application/Annual Re-determination (if requested) (2) Mail-in Application/Re-determination c. Children Placed in Foster Care 5. Kiran Sandhu, Program Manager is the liaison from the DSS – 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 DPH. Her address is 1221 Fulton Mall, Fresno, California 93721. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 49 of 77 IV. Department of Social Services Responsibilities and Activities A. Basic Informing and Documentation of Informing for CalWORKs 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 CHDP 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 Medi-Cal; and (e) The nature, scope, and benefits of the CHDP program. (3) Asked questions to determine whether: (a) More information about CHDP program services is wanted; and Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 50 of 77 (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 Medi-Cal eligible persons under 21 years of age who apply by mail will do so through a state-approved Medi-Cal 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 and the DSS Service Center CHDP Program Request form (0444A) requesting services to the applicant. The state-approved brochure about the CHDP 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 that informing occurred. c. Should clients need CHDP services they can either do so by contacting DPH directly, or by completing and returning the DSS Service Center CHDP Program Request form (0444A). Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 51 of 77 d. A returned DSS Service Center CHDP Program Request form will require Eligibility Determination staff to initiate a CHDP Referral Form (PM 357). B. Basic Informing and Documentation of Informing for Children in Foster Care Program Placement Following are the requirements for basic informing and documentation of information by staff responsible for placement of children in foster care, including placements controlled by either DSS or the PD, a 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 information 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 CHDP 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 Medi-Cal; and (5) The nature, scope, and benefits of the CHDP program. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 52 of 77 c. Ask questions to determine whether: (1) More information about the CHDP program is wanted; (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 DSS 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 PD, 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 DSS 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 care 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 PD, 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.B.1. and IV.B.3. of this Agreement. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 53 of 77 7. Informing requirements described in Sections IV.B.1 through IV.B.3. of this Agreement apply to placements controlled by the PD or placement agencies. For children who are wards of the court, the PD 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 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.B.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 in out-of-county foster care shall follow the informing requirements as described in Sections IV.B.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. Any “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 CalWORKs 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. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 54 of 77 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 PD, 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 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 Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 55 of 77 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 10. In the event that a referral generated by DSS is incomplete, DPH will proceed in contacting the client. DPH will notify Kiran Sandhu (Program Manager) and/or designated Medi-Cal Program Specialist staff of recurring issues and/or other significant problems that pertain to received 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 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). 5. 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. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 56 of 77 V. EPSDT 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 E, Job Duty Statements of unit personnel. C. Overall medical supervision is provided by Kenneth Bird, M.D., M.P.H., Health Officer. The CHDP Administrative Unit is supervised by the Public Health Nursing 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 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: Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 57 of 77 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 CHDP services: a. Health assessment requires a PM 160 on file or provider certification of provision of service. 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 appointment(s) 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 Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 58 of 77 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 (15th) day following the end of each quarter to the California Department of Health Care Services showing the number of CalWORKs and Medi-Cal Only persons requesting CHDP services. This report and/or excerpts or a summary of this data will also be forwarded to the DSS Program Manager liaison on a quarterly basis. 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. C. When eligible persons, still needing CHDP services, move to another county, the new county will be notified and appropriate information sent. 1. A copy of the PM 357 will be sent to the CHDP program in the county where the child now resides. D. 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 160 to their social services department. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 59 of 77 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. VIII. Staff Education A. Within ninety (90) days of employment by the DPH and the DSS, 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 DPH CHDP Health Education staff is responsible for this training. Other CHDP/Foster Care staff will assist as needed. B. Within ninety (90) days of employment by the PD 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 DPH staff will receive orientation and an annual update regarding the CHDP program. 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. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 60 of 77 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 Public Health Nursing 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/redetermination, 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 “Newsflash” will be distributed to the DSS CHDP Program Manager liaison and/or Medi-Cal Program Specialist, and shall contain any changes or important information/updates about CHDP. 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 DSS to determine if the County is in compliance with state regulations. 2. EPSDT records are reviewed in the DPH as well as the DSS. 3. Program procedures are reviewed regularly to ensure compliance and to make any necessary changes in the current process. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 61 of 77 4. Case management reviews of CHDP 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 DPH. 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 6874. 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 Human Services Departments’ responsibilities for meeting CHDP/EPSDT program requirements. 1. Social Services Regulations Reference: (a) Staff Development and Training Standards--Manual of Policies and Procedures (MPP) Sections: 14-530, 14-610. Children’s Medical Services Plan and Fiscal Guidelines for FY 2016-17 Page 62 of 77 (b) Civil Rights--MPP Section 21-101, 21-107, 21.115. (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, 31-206.421, 31-206.422, 31-330.111, 31-401.4, 31-401.41, 31-401.412, 31-401.413, 31-405.1(f), 31-405.1(g), 31-405.1(g)(1). (e) Intra and interagency relations and agreements Chapter 29- 405 and Chapter 29-410. 2. Medi-Cal Regulations Reference: (a) California Code of Regulations, Title 22, Sections: 50031; 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 35094.2 and Advisement of Parents Whose Child has not been Removed from Parent’s Care, Section 35129.1 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/Intra-Agency Agreements. http://www.dhcs.ca.gov/formsandpubs/publications/Pages/CMSPFG.aspx 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. 3. CMS Branch/CCS Numbered Letters pertaining to the CHDP program - Health Services. 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