HomeMy WebLinkAboutAgreement A-20-026 with CA Dept. of Public Health CHVP.pdfAgreement No. 20-026
Please enter the agreement or contract number for each of the applicable programs
CHVP #: CHVP 19-1 0
Update Effective Date : (only requ ired when submitting updates
The undersigned hereby affirms that the statements contained in the Agreement Funding Application
(AFA) are true and complete to the best of the applicant's knowledge.
I certify that this Maternal , Ch ild and Adolescent Health (MCAH) program will comply with all applicable
prov isions of Article 1, Chapter 1, Part 2, Division 106 of the Health and Safety code ( commencing with
section 123225), Chapters 7 and 8 of the Welfare and Institutions Code (commencing with Sections
14000 and 142), and any applicable rules or regulations promulgated by CDPH pursuant to this article
and these Chapters. I further certify that all MCAH related programs will comply with the most current
MCAH Policies and Procedures Manual , includ ing but not limited to , Administration . I furthe r certify that
the MCAH related programs will comply with all federal laws and regulations governing and regulating
recipients of funds granted to states for the California Home Visit i ng Program (CHVP) pursuant to the
Social Security Act , Title V, Section 511 (42 U.S .C . §711), as amended by Section 2951 of the Patient
Protection and Affordable Care Act of 201 0 (P .L.111148). Reauthorization and approp riation for FY16
provided through Medicare Access and CHIP Reauthorization Act (P.L. 11410) Social Security Act , T itle
V , § 51 1(c) (42 U .S.C . § 711(c)), as
amended by the Bipartisan Budget Act of 201 B(P .L.115123), Title VI, Subtitle A. program CFDA# 93 .870 .
I further agree that the MCAH related programs may be subject to all sanctions , or other remedies
applicable, if the MCAH related program violates any of the above laws, regulations and policies with
which it has certified it will comply.
Original signature of official authorized to commit the Agency to a CHVP Aqreement
Signature lineL __;f: 4 -¥ ~--
Name (Print) Ernest Buddy Mendes
ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County ro f FreSl"\O , S te of California
By ~
Deputy
Title_Chairman of the Board of Supervisors of the County of Fresno_ Date _1_\_7_,l~~-0~1-.o __ _
• '
Name (Print)_Rose Mary Rahn. _________ _
Page 2 of 2
CHVP Work Plan Timeline
Effective July 1, 2019
1
Goals and Measures for September 30, 2019 – September 29, 2023
Goal 1: Provide leadership and structure for implementation of the California Home Visiting Program (CHVP) at the Local Implementing Agency (LIA)
# Objective Activities Responsible Party Start and Completion
Dates Performance/Outcome Measures
Staffing Requirements
1.1
LIA will ensure
Maternal, Child,
and Adolescent
Health (MCAH)
Director and/or
designee
dedicate no less
than 5% Full
(A.) Provide oversight to LIA site
managers, supervisors, staff, and
various entities on all matters
related to the development,
implementation, operation,
administration, evaluation, and
reporting for local
implementation of CHVP.
• MCAH Program
Director/Equivalent
Designee
9/30/19 – 9/29/23 • Submission of Status Report
• Submission of Staffing Report
• Submission of Community
Advisory Board (CAB) Meeting
Materials
• Submission of Invoices
CHVP Work Plan Timeline
Effective July 1, 2019
2
Time Equivalent
(FTE) and no
more than 15%
FTE on the CHVP
budget and
staffing reports.
(B.) Attend monthly MCAH and
quarterly CHVP Directors calls.
Participate in ongoing local
community stakeholder groups,
site visits, meetings, and/or
conferences as directed.
Note: If the LIA has a
subcontractor, an LIA
representative from the
Department of Public Health
must be present during entire
site visit.
• MCAH Program
Director/Equivalent
Designee
9/30/19 – 9/29/23 • Submission of Status Report
• Submission of CAB Meeting
materials
1.2
LIA will
implement
home visiting
programs using
culturally
proficient
practices.
(A.) Participate in opportunities
designed to enhance cultural
sensitivity through webinars,
trainings, and/or conferences.
• Supervising Public
Health Nurse
(SPHN) or Program
Manager
• Home Visitors
9/30/19 – 9/29/23 • Submission of Training Log
(B.) Recruit and hire staff that
reflect the community served
and/or speak the language of
participants when possible.
• SPHN or Program
Manager
• Home Visitors
9/30/19 – 9/29/23 • Submission of Staffing Report
• Submission of Status Report
1.3
LIA will hire,
train, and retain
staff to comply
with selected
(A.) Participate in required
trainings as related to screening
tools, health assessments,
• SPHN or Program
Manager
• Home Visitors
9/30/19 – 9/29/23 • Submission of Training Log
• Submission of Training Plan
CHVP Work Plan Timeline
Effective July 1, 2019
3
home visiting
model
requirements
and CHVP
policies and
procedures.
reflective supervision, data
collection tools and software.
(B.) Maintain full staffing capacity
to serve home visiting program
participants and adhere to the
specific model-based guidelines.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of Staffing Report
Program Requirements
1.4
LIA will reach
and maintain
negotiated
Maximum
Caseload
Capacity (MCC).
(A.) Develop and sustain
relationships with appropriate
agencies to obtain home visiting
participant referrals.
• MCAH Director/
Equivalent
Designee
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Outreach activities listed on
NFP or HFA Referrals Tracking
Log
(B.) Develop a Referral Triage
Plan process for incoming home
visiting participants.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Production and submission of
Referral Triage Plan outlining
referral process (flow chart,
logic model, narrative, etc.)
CHVP Work Plan Timeline
Effective July 1, 2019
4
(C.) Home visitors funded at or
above 25% FTE will maintain and
monitor caseloads (referrals and
dismissals) and provide data for
all participants.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Sustain minimum of 85% MCC
on Monthly Caseload Report
• If below 85% MCC, submission
of Performance Improvement
Plan (PIP)
1.5
LIA will ensure
selected home
visiting model
fidelity and
quality
assurance.
(A.) Implement NFP and HFA
model requirements in
accordance with the NFP Model
Elements or the HFA Best
Practice Standards.
• MCAH Director/
Equivalent
Designee
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of accreditation
reports and/or proof of
application for affiliation
•
1.6
LIA will develop
and implement
home visiting
policies and
procedures.
(A.) Conduct an annual review of
LIA policies and procedures and
update as needed.
• MCAH Director/
Equivalent
Designee
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of policies in Status
Report
• Completion of policies and
procedures questions on Status
Report
(B.) Conduct an annual review of
CHVP policies and procedures.
• MCAH Director/
Equivalent
Designee
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Completion of policies and
procedures questions on Status
Report
1.7
LIA will
accurately
collect and
submit
(A.) Implement CHVP Guidance
400-10 Required Screening and
Assessment Tools into home
visiting practice.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of timely and
accurate data
CHVP Work Plan Timeline
Effective July 1, 2019
5
participant data
using selected
home visiting
model and
CHVP-required
documents.
(B.) Adhere to CHVP Policy 600-
10 Data Collection and
Standardization procedures.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of timely and
accurate data
(C.) Comply with NFP Quality
Framework and NFP Quality
Tools or CHVP HFA Data
Collection Manual.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of timely and
accurate data
Continuous Quality Improvement (CQI) Requirements
1.8
LIA will conduct
CQI projects and
activities that
align with CHVP
program
improvement
goals.
(A.) Participate in quality
improvement activities as
directed by CHVP.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Participation in Quarterly
Technical Assistance (TA) calls
• Submission of CQI plans, data,
and information as requested
by CHVP
(B.) Utilize the CAB to inform and
address quality improvement
projects and decisions.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Completion of CAB involvement
in CQI efforts in Status Reports
or as requested
(C.) Utilize data to inform and
improve program activities.
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of CQI plans, data,
and information as requested
by CHVP
• Completion of CQI questions on
Status Report
CHVP Work Plan Timeline
Effective July 1, 2019
6
1.9
LIA will
participante in
the CHVP 2020
Conference.
(A.) Travel to and attend the
CHVP 2020 Conference.
• Attendees To Be
Determined
9/30/19 – 9/29/23 • Completion of post conference
survey
Goal 2: Collaborate with Local Early Childhood System Partners
# Objective Activities Responsible Party
Performance/Outcome
Measures
2.1
LIA will
collaborate
with local early
childhood
system
partners.
(A.) Collaborate with local early
childhood system partners to
provide a continuum of services.
• MCAH Director/
Equivalent Designee
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Completion of CHVP-required
systems level data collection
surveys or reports
2.2
LIA will
maintain a CAB.
(A.) Coordinate quarterly CAB
meetings for the purpose of
establishing appropriate linkages
to referral/service systems and
other community supports,
including statewide and local
early childhood partners.
• MCAH Director/
Equivalent Designee
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of CAB Meeting
Materials (CAB Roster, Agenda,
and Minutes) with Status
Report
• Completion of CHVP-required
systems level data collection
surveys or reports
CHVP Work Plan Timeline
Effective July 1, 2019
7
2.3
LIA will pursue,
develop, and
maintain
relationships
with local
service
agencies,
hospitals, and
referral
resources to
facilitate the
coordination of
services and
recruit
participants.
(A.) Develop Memorandum of
Understanding (MOU)
agreements and/or informal
written agreements (e.g., letters
of support) with community
agencies and service providers.
• MCAH Director/
Equivalent Designee
• SPHN or Program
Manager
9/30/19 – 9/29/23 • Submission of formal or
informal agreements with
community agencies and
services providers with Status
Report
• Submission of Annual CHVP
Service Provider Survey
• Submission of Outreach Log
Goal 3: Collect data for federal reporting requirements
# Objective Activities Responsible Party
Performance/Outcome Measures
3.1
LIA will collect
and submit all
information
required for
(A.) On an ongoing basis,
complete all model issued forms
and assessment tools entirely.
Forms and assessment tools are
defined by CHVP and respective
• SPHN or Program
Manager
• Home Visitors
• Data Clerk
9/30/19 – 9/29/23 Submission of data for the
following federal reports:
CHVP Work Plan Timeline
Effective July 1, 2019
8
HRSA/MIECHV
reporting.
model issued data collection
manual(s).
• Demographic, Service
Utilization, and Select Clinical
Indicators (Form 1)
• Performance Indicators and
Systems Outcomes (Form 2)
• Quarterly Performance Report
(Form 4)
• Submission of NFP Priority
Population Survey on Status
Reports
(B.) Collect federally required
priority population data for all
participants served on an annual
basis, entered directly into the
data system (HFA) or collected
and data aggregated into a CHVP-
provided Excel spreadsheet
(NFP).
• SPHN or Program
Manager
• Data Clerk
9/30/19 – 9/29/23
3.2
LIA will maintain
clean and
compliant data
for all home
visiting activities
(A.) Ensure accuracy and
completeness of data input into
designated data systems using
data quality reports and
monitoring.
• SPHN or Program
Manager
• Home Visitors
• Data Clerk
9/30/19 – 9/29/23 • Demonstrated compliance with
data-related policies and
program quality measures
• Evidence of data cleaning on a
monthly and quarterly basis
using the CHVP data cleaning
schedule (HFA) or model
supplied data exception reports
(NFP)
CHVP Work Plan Timeline
Effective July 1, 2019
9
and
participants.
(B.) Collect and enter the
participant data into secure and
designated data system within
seven working days of data
collection and as required by NFP
or HFA models.
• Home Visitors
• Data Clerk
9/30/19 – 9/29/23 • Evidence of data cleaning on a
monthly and quarterly basis
using the CHVP data cleaning
schedule
• Evidence of data submission
within seven working days of
data collection
• Evidence of signed participant
consent forms
CHVP Work Plan Timeline
Effective July 1, 2019
10
Program, Data, and Evaluation Required Reports (Monitoring Channels) Frequency
1. Priority Population Survey
2. CHVP Service Provider Survey
3. Outreach Log
4. Performance Improvement Plan (Below 85% MCC Action Plan)
5. Staffing Reports
6. CAB Meeting Materials – Minutes and Agendas
7. CAB Roster
8. Status Reports (Includes: Training Log, Training Plan, Formal and
Informal Agreements, and Referral Tracking Log Progress)
9. Policies and procedures
10. Referral Triage Plan
11. HFA Accreditation Report (if applicable)
12. Fiscal Invoices
13. CQI Plan (if applicable)
1. Biannually
2. Annually
3. Biennially
4. Monthly Review
5. Quarterly
6. Biannually
7. Annually
8. Biannually
9. Annually
10. Annually
11. Upon Completion
12. Quarterly
13. Annually
Agreement Funding Application Between the County of Fresno and the
California Department of Public Health
Agreement Name: CDPH California Home Visiting Program Grant Agreement No.
CHVP 19-10
Fund/Subclass: 0001/10000
Organization #: 56201718
Revenue Account #: 4382