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HomeMy WebLinkAboutC11-269 Children with Special Needs for Care Coordiantion HEALTH & HUMAN SERVICES Economic Services (970) 328 -8840 Children and Family Services FAX: (855) 455 -8828 Public Health and Aging Services www.eaglecounty.us Finance and Operations EAGLE COUNTY. COLORADO Health Care Program for Children with Special Needs Care Coordination and Local Systems Development Scope of Work The Health Care Program for Children with Special Needs (HCP) at the Colorado Department of Public Health and Environment (CDPHE), Children and Youth Branch seeks to ensure statewide access to integrated, family- centered, community -based programs and services. HCP works with State and community partners to develop a system of coordinated services and supports for children with special health care needs. To that end, HCP seeks to enter into an agreement with Local Health Agencies (LHAs) to provide care coordination and help develop systems at the local level for children with special health care needs and their families. Statement of Work Definitions • CSHCN- Children with Special Health Care Needs • CYSHCN ( "shin ") Database - Children and Youth with Special Health Care Needs Database available on October 1, 2011 • CRCSN- Colorado Responds to Children with Special Needs • HCP - Health Care Program for Children with Special Health Care Needs • Medical Home Team Approach -A patient- centered medical home team integrates patients as active participants in their own health and well- being. A medical home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care including all providers involved in a child's care. A medical home is defined as primary care that is accessible, continuous, comprehensive, family- centered, coordinated, compassionate and culturally effective. A. Contractor Responsibilities 1. The Contractor will perform this Statement of Work in accordance with the policy, procedure and guidance documents found in the Resources Section on the HCP Website [control +click to open link] for the term of this agreement. 2. The Contractor will work collaboratively with the State HCP Office and HCP Regional Office (if applicable) for consultation, technical assistance, orientation and training on using the CYSHCN Database for documentation of HCP Care Coordination. 3. The Contractor will adhere to the CDPHE electronic security policy and procedures document found on the CYSHCN Database. 4. The Contractor will attend scheduled State training to promote learning and increase skills for HCP staff including HCP Care Coordination and CYSHCN Database Training. 5. The Contractor will adhere to the same guidance as the State when considering food and beverage purchases. Food or beverages may be purchased for events related to training, community meetings or events that engage external stakeholders. Title V and State General funds may not be used to purchase food or beverages while conducting routine staff meetings and clinics. Old Courthouse Building, 551 Broadway, P.O. Box 660, Eagle, Colorado 81631 -0660 1 HEALTH & HUMAN SERVICES Economic Services (970) 328 - 8840 Children and Family Services FAX: (855) 455 Public Health and Aging Services www.eaglecounty.us Finance and Operations EAGLE COUNTY. COLORADO B. Care Coordination 1. The Contractor will provide HCP Care Coordination to ensure a medical home team approach for CSHCN residing in the counties the agency is contracted to serve. 2. Contractor will complete required data documentation in the CYSHCN Database for HCP Care Coordination Services. 3. Contractor will provide follow -up and documentation in CYSHCN Database for monthly Colorado Responds to Children with Special Needs ( CRCSN) Notifications according to HCP CRCSN Notification Follow Up- Policies and Guidelines C. Systems Development 1. The Contractor will collaborate with community partners to identify service and systems barriers to improve community services for families of CSHCN. D. Family Participation 1. The Contractor will utilize CSHCN and their families as the consumer voice when serving the CSHCN population according to guidance referenced at HCP Resources - Family Leadership on the HCP Website. E. Specialty Clinics (for those agencies that facilitate and coordinate Specialty Clinics) 1. The Contractor agrees to schedule and facilitate HCP Specialty Clinics according to the policies, procedures and guidance documents located at HCP Resources - Specialty Clinics . F. CDPHE Responsibilities 1. The policy, procedure and guidance documents are subject to change periodically. CDPHE will notify the contractor by email when updates /revisions are made. The contractor is responsible for complying with any updates /revisions. 2. CDPHE will reimburse the Contractor $13.622.00 for work under this agreement according to the approved submitted budget. 3. CDPHE will provide technical assistance, consultation, training and guidance for the Contractor as needed. G. Budget 1. The Contractor shall submit a budget along with the signed Statement of Work that details how the appropriated funding will be allocated for the term of this agreement. The budget planning form is provided in Attachment A. H. Reimbursement 1. To receive compensation under this agreement, contractor shall submit reimbursement statements quarterly. 2. Final billings under this agreement must be received by the State HCP Office within a reasonable time but in no event later than sixty (60) calendar days from the effective expiration or termination date of this agreement. Sub - contracted agencies shall not receive payment for billings that exceed the sixty (60) calendar day's period. 3. Expenditures shall be in accordance with the Statement of Work and budget as per this agreement. 4. Reimbursement Statements shall: a. Reference this Agreement by its Purchase Order number b. Show names and hours of work where applicable c. Be accompanied by a copy of the supporting agency ledger d. Show the total requested payment Old Courthouse Building, 551 Broadway, P.O. Box 660, Eagle, Colorado 81631 -0660 2 HEALTH & HUMAN SERVICES Economic Services (970) 328 -8840 Children and Family Services FAX: (855) 455-8828 Public Health and Aging Services www.eaglecounty.us Finance and Operations ry EAGLE COUN1 Y COLORADO 5. Payment during the term of this Agreement shall be conditioned upon affirmation by the State that services were rendered by the Contractor in accordance with the terms of this Agreement. 6. Reimbursement Statements shall be sent via email (signed, dated and scanned), fax or U.S. mail to: Health Care Program for Children with Special Needs Colorado Department of Public Health and Environment PSD -CYB -A4 4300 Cherry Creek Drive South Denver, CO 80246 -1530 303 - 692 -2414 stephanie.lauerftstate.co.us Old Courthouse Building, 551 Broadway, P.O. Box 660, Eagle, Colorado 81631 -0660 3 HEALTH & HUMAN SERVICES Economic Services (970) 328 -8840 Children and Family Services FAX: (855) 455 -8828 Public Health and Aging Services www.eaglecounty.us Finance and Operations EAGLE COUNTY, COLORADO Health Care Program for Children with Special Needs Care Coordination and Local Systems Development October 1, 2011 through September 30, 2012 Keith Montag Signature Printed — 'gnature County Manager Title ////// Date Old Courthouse Building, 551 Broadway, P.O. I3ox 660, Eagle, Colorado 81631 -0660 4 Health Care Pro ® ram for Children with S ecjaJ Needs -, Loci) H Ageey Bud el FY .2 Agency: Eagle County Public Health Agency Date Completed: August 15, 2011 ' Q Y e .,4ciril O !to t .. .....°. ...t, k r: Ft9 4t ar ta'4i Apprg i i► 2 ,,_ . Name: Jennie Wahrer, RN Name: Rita Woods Title: Maternal & Child Health Manager Title: Deput Director HHS Phone: 970- 328 -2604 Phone: 970- 328 -8817 Email: jennie.wahrer @eaglecounty.us Email: rita.woods(a_eaglecounty.us Due Date: ' September 9, 2011 (for the period of Oct. 1 2011 through Sept. 30, 2012) Instructions: Refer to instructions for completion of this form. Enter numbers in yellow highlighted areas below. Total columns will calculate automatically. s",:,�.;r ..trip. s :- rr *.mea aka.,.. t:, <as„" -m ,.°` xi <t0 .-. � s ,� € ..� , + ,,,a, PERSONNEL SERVICES Names & Titles : ' '� Brianna Hiland, RN $52,499 0.19 � �, = —mow Jennie Wahrer, RN MCH Manager $85,010 0.01 r " "�: ' 't m = 44.-ii;SOTC::%7Ii 0 SUBTOTAL - -- - -- $10,562 Fringe Benefits: Rate = 25.00% N/A N/A f t a ' r `;`A., .0' ? s4,, . "'a' *c.A t2S, , s, vim. a:s: .,a8 .Ai 7k 1Z ... 9 • 7 I X' w is are not part o ins erect TRAVEL EXPENSES $419 T CtItk M v:°_ . w E of k a . , . _ M :p . },,,.., T _ .. , _4 li ..Z, r. , _ 2X41# xT . :,,: ? ; ... .a : 1. - ®.` 9 ' r .. *J . I D= 2, ,g . , t f I :ir °.: , A., 702 ` INDIRECT COST: Rate = TQTAt_ ND! 79,ST . a fi:,.. , , - ry xQ TOTAL Pl ..,JE . cgsr , . . _ , - . -_, .. ,. . ' . 5 :,Z4 MCH Planning Budget FY11.xls Updated 05/10/2010 Health Care Program for Children with Special Health Care Needs (HCP) Budget Narrative FY12 Agency: Eagle County Public Health Agency Date Completed: August 15, 2011 Program Contact Person Fiscal Contact Person Name: Jennie Wahrer, RN Name: Rita Woods Title: Maternal & Child Health Manager Title: Deputy Director HHS Phone: 970 - 328 -2604 Phone: 970 - 328 -8817 Email: jennie.wahrer @eaglecounty.us Email: rita.woods @eaglecounty.us Due Date: September 09, 2011 General Instructions: The purpose of the Budget Narrative is: > To describe how each line item in your budget relates to your agency's HCP Scope of Work > To explain how you arrived at each cost. The Budget Narrative should provide a clear and reasonable rationale for the costs associated with implementing the HCP Scope of Work. The HCP Scope of Work, budget, and budget narrative should all be aligned. Be sure to describe how you arrived at each line item in the budget by providing detailed and specific information for EACH line item. The Budget Narrative should reflect the HCP SOW period from October 1, 2011 through September 30, 2012. Please provide narrative for each cost category in the spaces below. Examples are included for each category. by your agency), annual salary and Full • List the name and title of each staff member (employed ry Personnel Services. d Y Y 9 Y)� Time Equivalent (FTE) that the staff member will commit to the HCP SOW. Briefly describe the role of the staff member and identify the components of the SOW that this person will be responsible for completing. Brianna Hiland, Registered Nurse, annual salary rate at $52,499, 0.19 FTE (19 %) for $9,712, provides HCP Care Coordination with a limited number of families, coordinates the neurology clinic 4 x /year, coordinates the cardiology clinic 2 -4 x /year, coordinates the Shriner's Clinic 2 x /year, completes documents in HCP CYSHCN Database and collaborates for local community systems development at the local level for children with special health care needs (CSHCN) and their families. Jennie Wahrer, Maternal and Child Health Manager, annual salary rate at $85,010, 0.01 FTE (1 %) for $850. Provides oversight and supervision of HCP staff and budget allocation, and works with the state and HCP Regional Office to ensure HCP Policy and Guidelines are followed. Operating Expenses: Include expenses that are not included in the indirect rate for your agency: Examples: office supplies, copies, postage, telephone, computer network fees, project supplies and materials, professional development and /or training registrations. With limited funding, these expenses should be balanced with personnel costs to provide HCP services. Provide a brief explanation to justify the need for each line item for fulfilling the HCP SOW. None Travel Expenses: Travel costs to be incurred while implementing the HCP SOW and /or travel to attend trainings. Travel costs are estimated at .55 cents /mile. Mileage for neurology and cardiology clinics, meetings and outreach = $419 Indirect Costs: Provide your indirect rate. An indirect rate crap will be applied. The caps are as follows per CDPHE agreement: 25% of total direct costs; 27% of total direct salaries and /or fringe; 30% of total direct salaries and fringe where no other direct costs are charged. If your rate exceeds the indirect rate caps, identify those indirect costs above the allowed rate as match or in -kind contributions. Example: Your indirect rate is 34.93% of total direct Salaries /Fringe. 27% can be recognized in your request and 7.93% must be recognized as match or in -kind. Example: Your indirect rate is 19% of total direct costs. The rate is within the 25% cap; 19% can be recognized in your request. None Revised 8/09/2011