HomeMy WebLinkAboutSTATE Department of Health Care Services-Allocation Plan for Child Health Care Services_A-23-671.pdf ti coU� Count of Fresno Hall of Records,Room 301
Y 2281 Tulare Street
/ Fresno,California
Board of Supervisors 93721-2198
0 185 O Telephone:(559)600-3529
FREt'' Minute Order Toll Free:1-800-742-1011
www.co.fresno.ca.us
December 12, 2023
Present: 5- Supervisor Steve Brandau,Vice Chairman Nathan Magsig, Supervisor Buddy Mendes,
Supervisor Brian Pacheco,and Chairman Sal Quintero
Agenda No. 46. Public Health File ID:23-1265
Re: Approve retroactive submission of the FY 2023-24 California Department of Health Care Services
allocation plan for child health services under California Children's Services;and approve and authorize
the Chairman to execute the retroactive Certification Statement as required by the California
Department of Health Care Services,effective July 1,2023 to June 30,2024($7,738,562)
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco,and Quintero
Agreement No.23-671
County of Fresno Page 48
co
Board Agenda Item 46
O ls,6 o
FRE`'�
DATE: December 12, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive FY 2023-24 California Department of Health Care Services Allocation
Plan
RECOMMENDED ACTION(S):
1. Approve retroactive submission of the FY 2023-24 California Department of Health
Care Services allocation plan for child health services under California Children's
Services; and
2. Approve and authorize the Chairman to execute the retroactive Certification
Statement as required by the California Department of Health Care Services, effective
July 1, 2023 to June 30, 2024 ($7,738,562).
There is no additional Net County Cost associated with the recommended actions. Approval of the
recommended actions will allow the County to continue to receive non-competitive funding from
the California Department of Health Care Services (DHCS) to administer the California Children's
Services (CCS) program. Fresno County's allocation is 13% more than the prior fiscal year and
will cover anticipated FY 2023-24 CCS program costs. The estimated County match of$207,930
will be funded with Health Realignment. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions as the County is mandated under Health and Safety Code
(H&SC) Section 123850 to administer the CCS program. Should your Board not approve the
recommended action, the Department would not have sufficient funds to offset mandated program
costs.
RETROACTIVE AGREEMENT:
The Department received the FY 2023-24 CCS Program allocation from DHCS on October 26,
2023 and it is retroactive to July 1, 2023. This item is brought to your Board in accordance with
the agenda item processing timelines. The allocation plan, which is also known as Children's
Medical Services (CMS) Plan, is due to DHCS by December 25, 2023.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The FY
2023-24 non-competitive allocation of$7,738,562, which is primarily comprised of Federal and
State funding, represents an $882,533 or a 13% increase from the prior year adjusted allocation of
County of Fresno Page 1 File Number.23-1265
File Number:23-1265
$6,856,029. Sufficient appropriations and estimated revenues are included in the Department's
Org 5620 FY 2023-24 Adopted Budget. The allocation allows full recovery of indirect costs and the
Department's current indirect cost rate is 18.314%.
The CMS Plan identifies the required County match for CCS at$207,930. If the County's total
allocation is expended, the County match will be covered by Health Realignment.
DISCUSSION:
The CCS programs are administered as a partnership between county health departments and
DHCS, in accordance with H&SC Section 123800 et seq. The program provides medical case
management, diagnostic and treatment services to infants, children and youth under the age of 21
with CCS-eligible medical conditions such as congenital heart disease, cancer, cystic fibrosis,
chronic lung disease, serious birth defects, hearing loss and cerebral palsy. The recommended
allocation supports the following administrative activities performed by the county CCS program:
• Medical review, evaluation and determination of children and youth under 21 applying for
CCS benefits;
• Review and determination of residential and financial eligibilities of medically qualified
individuals;
• Authorize appropriate diagnostic services, treatment, therapy, specialized medical care and
related services eligible CCS clients;
• Medical case management to ensure eligible infants, children and youth receive the
authorized medical services;
• Review, authorize and purchase supplies and other services needed for treatment of the
eligible CCS medical condition;
• Assessments, interventions and coordination of care;
• Assistance, consultation and training to providers and hospitals on the CCS authorization
process;
• Support for family navigation through consultation and linking to community resources and
other family support organizations; and,
• Assessment, intervention and guidance to clients and families in developing transition plans
as the CCS client ages out.
Each county's annual allocation is based on the number of enrolled CCS clients. In FY 2022-23,
Fresno CCS caseload was 7530.
Beyond administration of the CCS program and in accordance with H&SC Section 123940, CCS
counties share with the State and Federal government financial responsibility for providing
medically necessary services such as diagnostics, treatment, medication and therapy to eligible
clients. The counties pay their share of cost on a quarterly basis.
Medical Therapy Program (MTP) which is a special program under CCS, provides medically
necessary occupational and physical therapy services for eligible children and youth. These
services are provided at the Medical Therapy Units located in three Fresno County public schools.
DHCS provides a separate allocation to fund the MTP however, counties are not required to
submit a plan or budget details.
To finalize the allocation process, DHCS requires your Board to certify approval of the
recommended CMS Plan and that the County will comply with applicable laws, regulations, and
County of Fresno Page 2 File Number:23-1265
File Number 23-1265
policies related to the CCS program. The recommended CCS allocation plan is retroactive to July
1, 2023 and serves in lieu of an agreement. Upon approval of the recommended actions by your
Board, no additional executed documents are required to receive funding.
REFERENCE MATERIAL:
BAI #40, January 24, 2023
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk- FY 2023-24 CMS Plan and Budget for CCS
CAO ANALYST:
Ron Alexander
County of Fresno Page 3 File Number:23-1265
Agreement No. 23-671
Plan and Budget Required Documents Checklist
MODIFIED FY 2023-24
County/City: Fresno Fiscal Year: 2023-24
Document Page Number
1. Checklist 1 - 2
2. Agency Information Sheet 3
3. Certification Statements
A. Certification Statement(CHDP)—Original and one photocopy N/A
B. Certification Statement (CCS)—Original and one photocopy 4
4. Agency Description
A. Brief Narrative 5
B. Organizational Charts for CCS, CHDP, HCPCFC, and PMM&O *Retain locally
C. CCS Staffing Standards Profile Retain locally
D. Incumbent Lists for CCS 6 - 10
E. Civil Service Classification Statements—Include if newly established, N/A
proposed, or revised
F. Duty Statements— Include if newly established, proposed, or revised N/A
5. Implementation of Performance Measures—Performance Measures for FY
2016-2017 are due November 30, 2017. N/A
6. Data Forms
Performance Measures 11 - 26
CCS Caseload Summary 27
7. Memoranda of Understanding and Interagency Agreements List
A. MOU/IAA List N/A
B. New, Renewed, or Revised MOU or IAA NIA
C. CHDP IAA with DSS biennially Retain locally
D. Interdepartmental MOU for HCPCFC biennially N/A
8. Budgets
A. CHDP Administrative Budget (No County/City Match)
1. Budget Summary N/A
1
County/City: Fresno Fiscal Year: 2023-24
Document Page Number
2. Budget Worksheet N/A
3. Budget Justification Narrative N/A
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—Base, PMM&O and Case Relief Administrative Budgets
1. Budget Summary N/A
2. Budget Worksheet N/A
3. Budget Justification Narrative N/A
E. CCS Administrative Budget
1. Budget Summary 31
2. Budget Worksheet 28 - 30
3. Budget Justification Narrative 32 - 33
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 N/A
(DHCS1203)
2. Inventory/Disposition of DHCS Funded Equipment Form N/A
(DHCS1204)
3. Property Survey Report Form (STD 152) N/A
2
Children's Medical Services Plan and Fiscal Guidelines
Agency Information Sheet
County/City: Fresno/Fresno Fiscal Year: 2023-24
Official Agency
Name: David Luchini, Director Address: 1221 Fulton Street
Fresno, CA 93721
Health Officer Dr. Rais Vohra, MD
(Interim)
Dr. Trinidad Solis, MD
(Deputy Health Officer)
CMS Director (if applicable)
Name: Address:
Phone:
Fax: E-Mail:
CCS Administrator
Name: Pilar Vasquez Address: 1221 Fulton Street
Division Manager Fresno, CA 93721
Phone: 559-600-6595
Fax: 559-455-4789 E-Mail: pvasguez(a)fresnocountyca.gov
Clerk of the Board of Supervisors or City Council
Name: Bernice Seidel Address: 2281 Tulare St, 31 Floor
Fresno, CA 93721
Phone: 559-600-3529
Fax: 559-600-1608 E-Mail: bseidel@ fresnocountyca.gov
Director of Social Services Agency
Name: Sanja Bugay Address: 200 W Pontiac Way, Bldg 3
Clovis, CA 93612
Phone: 559-600-2301
Fax: 559-600-2311 E-Mail: sbugay@ fresnocountyca.gov
Chief Probation Officer
Name: Kirk Haynes 3333 E American Ave, STE B
Fresno, CA 93725
Phone: 559-600-1298
Fax: 559-455-2412 E-Mail: khaynes@ fresnocountyca.gov
3
Children's Medical Services Plan and Fiscal Guidelines
Certification Statement-California Children's Services (CCS)
County/City: Fresno Fiscal Year: 2023-24
1 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 com ly.
- \ 3'202-73.,
Signatur ol CCS Administrato Date .Signed
ti
(( �q 2 62-z
Si re of Di ector alth Officer Date Signed
Signature and Title of Other—Optional Date Signed
I certify that this plan has been approved by the local governing body.
as 3
Sig at e tL al Governing Body Chairperson Date Signed
ATTEST:
BERNICE E.SEIDEL
Clerk of the Board of Supervisors
County ofFresno,State offf California
By 7 �G�u Deputy
4
CMS PLAN
Fiscal Year 2023-24
Agency Description
Fresno County's California Children's Services (CCS) are located in the Fresno
County Department of Public Health under Children's Medical Services Division.
The CMS Division Manager functions as the CCS Administrator and reports directly
to the Director of the Department of Public Health. 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.
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Children's Medical Services Plan and Fiscal Guidelines for FY 2023-24
COUNTY: Fresno FISCAL YEAR 2023-24
County of Fresno
Department of Public Health
CCS
Performance Measure 1
FY 2022-23
CCS Program staff conducts routine reviews of all active cases to ensure CCS
clients have documented and up-to-date medical homes/primary care providers.
Staff contacts clients and their parents/guardians and works collaboratively with
Medi-Cal Managed Care plans, local hospitals and other local providers to
determine current primary care providers.
In addition, CCS Program staff conducts annual program eligibility reviews of all
clients to identify primary care physicians and/or medical homes. Additionally,
when families come to the CCS office, they are asked to identify their primary
care physician so their medical files can be updated.
Based on the entire active caseload as of July 2023, the following findings are:
• 99.7% of CCS clients in Fresno County have an identified primary care
provider (PCP). This represents a 1.7% increase from the previous fiscal
year.
• MSBI 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.
11
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
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: Based on the entire active caseload as of July 2023
Reporting Form:
Number of children with a Number of children in the Percentage of compliance
primary care physician/ local CCS program
Medical Home
(Numerator)
(Denominator)
71434 71456 99.7%
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.
12
Children's Medical Services Plan and Fiscal Guidelines for FY 2022-23
COUNTY: Fresno FISCAL YEAR: 2023-24
County of Fresno
Department of Public Health
CCS
Performance Measure 2
FY 2022-23
Client program eligibility was determined according to the guidelines established
by the Children's Medical Services Branch, California Children's Medical
Services Administrative Procedures Manual (July 2001 Revision). Fresno
County CCS utilized a report created in MSBI to select a sample of 100
unduplicated new referrals. The findings are as follows:
• A sample of 100 unduplicated new referrals was selected at random. Out
of the 100 new referrals, 92% had their medical eligibility determined
within the prescribed guidelines. This represents a 2% increase from the
previous fiscal year.
• A sample of 100 unduplicated new referrals was selected at random. Out
of the 100 new referrals 98% had their financial and residential eligibility
determined within the prescribed guidelines. This represents a 0% change
from the previous fiscal year. 73 cases were Full Scope Medi-Cal or
TLICP clients and 25 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.
13
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
CCS Performance Measure 2 — Determination of CCS Program
Eligibility
Children referred to CCS have their program eligibility determined within the
prescribed guidelines per Title 22, California Code of Regulations, Section 42000,
and according to CMS Branch policy. Counties will measure the following:
Numerators:
a. Medical eligibility within five working days of receipt of all medical
documentation necessary to determine whether a CCS-eligible
condition exists.
b. Residential eligibility within 30 days of receipt of documentation
needed to make the determination.
C. Financial eligibility within 30 days of receipt of documentation
make the determination.
Denominator: Number of CCS unduplicated new referrals to the CCS program
assigned a pending status in the last fiscal year.
Data Source: 10% of the county CCS cases or 100 cases (which ever number is
less).
14
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
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 92 100 92%
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/TLICP CCS only
determined within 30 98%
days 73 25 74 26
Residential eligibility
determined within 30
days 98 100 98%
15
Children's Medical Services Plan and Fiscal Guidelines for FY 2021-22
COUNTY Fresno FISCAL YEAR 2023-24
County of Fresno
Department of Public Health
CCS
Performance Measure 3
FY 2022-23
Part A: Annual team Report
Fresno County CCS generated an MSBI report which identified 100 random clients
(greater than 10%) out of the total list of clients with a diagnosis or condition that
requires referral to a Cardiac, Renal, Pulmonary, Neurological or Endocrine Special
Care Center, per NL 01-0108.
Review of the random sample of 100 children who received a SCC authorization yielded
the following:
• 99% compliance for Annual Team Reports of SCC authorized clients. Out of 100
children with a SCC authorization, 99 had an Annual Team Report in their
medical chart, 1 did not.
Part B: Authorization of Child to SCC
CCS generated an MSBI report which identified 100 children with a CCS
diagnosis or condition that requires referral to Cardiac, Renal, Neuro-
musculoskeletal, Endocrine, or Pulmonary Special Care Centers, per NL 01-
0108.
• Of the 100 children who had a condition that required authorization to a
SCC, 100 were in fact authorized for a SCC.
• Fresno County is 100% compliant with appropriately authorizing SCC for
children with eligible medical conditions.
16
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
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.
17
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
Reporting Form - Part A:
Category selected Number of children with Number of children Percentage of
(cardiac, pulmonary, annual team report in with SCC authorization compliance
etc.) client's medical records
(Denominator)
(Numerator)
Cardiac, Renal, Neuro-
musculoskeletal, 99 100 99%
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, o
musculoskeletal, 100 100 E71, Q05, N18 100 /o
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.
18
Children's Medical Services Plan and Fiscal Guidelines for FY 2023-24
COUNTY: Fresno FISCAL YEAR: 2023-24
County of Fresno
Department of Public Health
CCS
Performance Measure 4
FY 2022-23
Fresno County updated its Transition Planning protocols for the CCS Program in
January 2015 for clients who turn 14, 16, 18 and 20 years of age in the calendar
year. Because of staffing constraints, we developed a relatively automated
Transition Planning Process that generates age-focused Transition Planning
packets of information for all clients with a medical condition that warrants
Transition Planning. Fresno County understands the importance of Transition
Planning on the overall health needs of our clients. Transition Planning packets
include the following:
• A Transition Planning letter addressed to the parents for 14 and 16 year
olds and addressed to the clients who are 18 and 20 years old. The letter
addresses the importance of client-based understanding of their medical
needs, encourages discussion with the medical workers about transition
planning, and underscores the importance of finding an adult care provider
for when they become adults.
• A Health care skills worksheet to be discussed with the Primary Care
Physician.
• Community resource contact list.
• HIPAA forms (as appropriate)
o Acknowledgment of Receipt of Privacy Rights under HIPAA
o Authorization for Use and Disclosure (for 18 year olds who want to
continue including their parents/guardians in their health care
decisions).
Together, these steps have helped Fresno County shore up Transition Planning
outreach and engagement, helped reduce some of the paperwork of case
managers, and most importantly contributes to the on-going medical needs of our
CCS clients.
Fresno County's CCS Medical Therapy Program continuously provides transition
planning for children at ages 3, 14, 16, 18 and 20.
The FY 2022-23 Transition Planning Performance Measure includes the
following findings:
• Based on the results of an MSBI report, Fresno County randomly selected
a sample of 1100 clients with an age of 14, 16, 18, or 20 who's CCS
eligible medical condition appropriately required Transition Planning.
19
Children's Medical Services Plan and Fiscal Guidelines for FY 2023-24
COUNTY: Fresno FISCAL YEAR: 2023-24
• The random sample (951 Cases) of all non-MTP clients who turned 14,
16, 18 and 20 years old was created to see if they received Transition
Planning after the implementation of the automated Transition Planning
process. FY 2022-23 shows 98% of the selected sample received
Transition Planning letters/information. This is 1% less than the
percentage compliance in FY 2021-22.
• The random sample (149 Cases) of all MTP clients who turned 14, 16, 18
and 20 years old shows 100% of the selected sample received Transition
Planning letters/information. This is a 1% increase from FY 2021-22.
20
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
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.
21
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
Transition Planning Checklist
Transition Documentation YES NO Comments
1. Client has an identified need CCS transition planning is performed
for long-term transition X for all clients 14, 16, 18, and 20
planning. years old.
Transition planning for clients with
2. Transition planning noted in X appropriate DX is noted in client's
child's medical record. Annual Medical Reviews and other
Case Notes.
3. Transition planning noted in Most SCC's document transition
SCC reports. X planning 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
identified for children 17 X Notes, discussion of the need for an
years of age or older. adult provider is included.
6. Transition planning noted in Schools begin noting transition
SELPA for those children X needs at age 16.
that are in the MTP.
Note: Not all of the items in the Checklist will be applicable for each chart review.
22
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
Reporting Form:
Number of CCS charts Number with transition Percentage of compliance
reviewed planning
98%
951 932
Number of MTP charts Number with transition Percentage of compliance
reviewed planning
100%
149 149
23
Children's Medical Services Plan and Fiscal Guidelines for FY 2022-23
COUNTY: Fresno FISCAL YEAR: 2023-24
County of Fresno
Department of Public Health
CCS
Performance Measure 5
FY 2022-23
This performance measure indicates the level of family participation in the CCS
program. Narrative for each criterion follows:
1. CCS uses an existing CCS parent survey developed in February 2011 and
updated in 2014. This survey is distributed widely in order to gauge
parent/client satisfaction with CCS services. The survey was written at an
elementary reading level in both English and Spanish. The survey
provides CCS with information on how we can improve upon services,
asking yes or no questions and providing opportunity to comment.
Surveys are reviewed and CCS Administration employs every effort to
improve upon areas of family participation.
2. On-going challenges exist in the areas of family participation. Currently,
there are no advisory committees or task forces for family participation,
nor is there a County policy to facilitate reimbursement for child care or
transportation to such meetings, due to multiple years of budgetary
cutbacks and staffing cuts that have only recently begun to rebound, albeit
slowly.
3. Family members regularly participate in CCS Special Care Center
meetings for care planning and transition planning.
4. Fresno County CCS has no family advocates under contract or as
consultants to the program.
Fresno County CCS Administration will explore opportunities for increasing family
involvement, as dictated by Program considerations, including staffing and
budgeting constraints.
24
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
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.
25
Children's Medical Services Plan and Fiscal Guidelines
COUNTY: Fresno FISCAL YEAR: 2023-24
Reporting Form:
Criteria Performing Not Performing
(25% 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, 25%
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 255%
special health care needs, are
contracted or consultants to
the CCS program for their
expertise.
Total 50% 50%
26
Children's Medical Services Plan and Fiscal Guidelines
California Children's Services Caseload Summary Form
County: Fresno Fiscal Year: 2023-24
A B
23-24
CCS 21-22 %of 22-23 %of Estimated %of
Caseload 0 Actual Grand Actual Grand Caseload Grand
to 21 Years Caseload Total Caseload Total based on first Total
three months
MEDI-CAL
Average of Total Open
(Active)Medi-Cal 6649 88% 6718 88% 6516 87%
1 Children
Potential Case Medi-Cal 21 0.3% 34 0.4% 30 0.4%
2
TOTAL MEDI-CAL 6670 88% 6752 89% 6546 87%
3 (Row 1 + Row 2)
NON MEDI-CAL
OTLICP
Average of Total Open
4 (Active)OTLICP 626 8% 592 8% 679 9%
Potential Cases 3 0.04% 4 0.05% 2 0.03%
5 OTLICP
Total OTLICP (Row 4 629 8% 596 8% 681 9%
6 + Row 5)
Straight CCS
Average of Total Open
(Active)Straight CCS 200 3% 178 2% 243 3%
7 Children
Potential Cases Straight 71 0.9% 71 0.9% 63 0.8%
g CCS Children
Total Straight CCS 271 4% °
9 (Row 7 + Row 8) 249 3/ 306 4/0
TOTAL NON MEDI-CAL 900 12% 845 11% 987 13%
10 (Row 6 + Row 9)
GRAND TOTAL
11 (Row 3 + Row 10) 7570 100% 7597 100% 7533 100%
27
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Children's Medical Services Plan and Fiscal Guidelines for Fiscal Year 2023-24
California Children's Services
Fresno County
Budget Narrative
FY 2023-24
I. Personnel Expenses
Total Salaries: $ 3,645,649
Staff benefits represent an estimated 72%of salaries;this is a decrease of 12%
Total Benefits: $ 2,624,867 from the previous fiscal year.This estimate was reached by using an average of the
actual County benefits budgeted for this fiscal year.Anticipated salary adjustments
and promotions are included.
Total Personnel Expenses: $ 6,270,516
Staffing Changes
Public Health Physician Represents a.80 FTE positions. This is an.5 FTE increase from previous FY.
Represents a 6 FTE positions. This is an.63 FTE increase from previous FY.
Public Health Nurse
Staff Nurse Represents a 10.55 FTE positions. This is an 1.7 FTE decrease from previous FY. Vacancy is expected
to be filled by April 2024.
Medical Social Worker Represents 2 FTE position. This is an.7 FTE increase from previous FY.
Admitting Case Worker Represents 13.85 FTE positions. This is an 3.2 FTE increase from previous FY. Vacancies are expected
to be filled up by February 2024.
II. Operating Expenses
Travel $ 3,000.00 Based on expenditures:Mileage,Meals,Lodging, Freight, Parking, Garage Fees,
etc., this is a 67%increase from previous FY.
Training $ 2,500.00 Based on anticipated update trainings,this is a 0.8%increase from previous FY.
Office Expenses $ 19,795.00 Represents a 38%increase from previous FY based on anticipated expenditures.
Postage $ 22,000.00 Represents a 25%decrease from previous FY based on anticipated expenditures.
Small Tools $ 3,692.00 Represents a 62%increase from previous FY based on anticipated expenditures.
Household Expenses $ 13,612.00 Represents a 7%increase from previous FY based on anticipated expenditures.
Maint-Equip,Bldg,&Security $ 27,045.00 Represents a 33%decrease from previous FY based on anticipated expenditures.
Facility Services(rent,utilities) $ 115,680.00 Represents a 11%increase from previous FY based on anticipated expenditures.
Combining Data Processing and Communications,this represents a 27%increase
Data Processing including Comm $ 72,640.00 from previous FY based on anticipated expenditures.
Translation Services $ 3,000.00 Based on expenditures,no change from previous FY.
Total Operating Expenses: $ 282,964.00
III. Capital Expenses
Total Capital Expenses: I $ INo amount budgeted in previous FY.
32
Children's Medical Services Plan and Fiscal Guidelines for Fiscal Year 2023-24
California Children's Services
Fresno County
Budget Narrative
FY 2023-24
IV. Indirect Expenses
Represents a 35%increase from previous fiscal year due to higher Indirect Cost
Rate.Fresno's approved indirect rate for 2023-24 is 18.314%.
Internal @ 18.314% $ 1,148,382.00
External @ 01 $ _ No amount budgeted in previous FY.
Total Indirect Expenses: $ 1,148,382.00
V. Other Expenses
Maintenance&Transportation $ 30,000.00 Represents a 100%increase from previous FY based on anticipated expenditures.
CRISS Council Membership $ 6,700.00 Based on expenditures, no change from previous FY.
Total Other Expenses: $ 36,700.00
Budget Grand Total: $ 7,738,562.00
33
FY 2023-24 Retroactive California Department of Health Care Services Allocation
for Fresno County California Children's Services (CCS) Program
Allocation: FY 2023-24 CMS Plan and Budget for CCS
Fund/Subclass: 0001/10000
Organization: 56201600
Revenue Account No.: 3505, 4380