HomeMy WebLinkAboutC97-231 Colorado Department of Public Health and Environment14X) 697 2 S 1 !� STATE OF COLORADO Roy Romer, Governor Patti Shwayder, Executive Director Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr. S. Laboratory and Radiation Services Division Denver, Colorado 80222-1530 8100 Lowry Blvd. Phone (303) 692-2000 Denver CO 80220-6928 (303) 692-3090 Exhibit G Contract Renewal Letter Date: June 6, 1997 Routing No.: 9807175 To: The Eagle County Commissioners, Eagle County P.O. Box 850 Eagle, CO 81631 Colorado Department of Public Health and Environment )EIaSO 7— The Colorado Department of Public Health and Environment hereby notifies The Eagle County Commissioners, Eagle County ,that pursuant to paragraph 18 of contract number EPS960081, the State will exercise its option to renew this contract for an additional one year period July 1, 1997 through June 30, 1998. The new contract amount in paragraph 11 shall read eleven thousand nine hundred fifty-eight dollars, ($11,958). Attached revised Exhibit A and revised Exhibit B shall now constitute the budget and program requirements for this contract. The State Controller is requiring that the following paragraph be added to all state contracts for Fiscal Year 1998 and is incorporated into your contract by this reference and shall be added as paragraph 20 of this contract. "Pursuant to CRS 24-30-202.4 (as amended), the state controller may withhold debts owed to state agencies under the vendor offset intercept system for: (a) unpaid child support debt or child support arrearages; (b) unpaid balance of tax, accrued interest, or other charges specified in Article 22, Title 39, CRS; (c) unpaid loans due to the student loan division of the department of higher education; (d) owed amounts required to be paid to the unemployment compensation fund; and (e) other unpaid debts owing to the state or any agencythereof, the amount of which is found to be owing as a result of final agency determination or reduced to judgment as certified by the controller." The number of estimated number of eligibles in paragraph 4 is unchanged. This contract renewal letter is intended to be effective July 1, 1997, but in no event shall it be deemed valid until it is approved by the State Controller or his designee. Please sign and return all copies of this notification. A fully executed copy will be returned to you. Sincerely, 4 4 r4c4-� Lee Thielen, Assistant Director Colorado Department of Public Health and Environment P ogr ppro al Af,AGI c� 611 17, - By Jamear E. Johrison, Jr. Title Chairman, Eagle Board of County Commissioners Approved StateC ntroller, Clifford W. Hall Bye_ _ % ■�� . _ ■ E8> i\�{ &— 2 [ a|I 0 J § k!■ 7sIn FT P P �i7E 2 ¢k; —EE Uwe ƒ g� �S§| crM0 fM� ISE 2K2 K ° � G 003! S U' ■ �� \� � ---- -4c � 02°o .. } W, -�L-�- ■[ . - a 0 | Ir to (� 0 ■� Zz 0E k 2 m0 § /0 - § �\ —# ® M �� � .. �_ .. } W, -�L-�- . - J | I zt § 2 2¢ g -4 -- � 2t 2 t 2 � -- � ZIn � .© jo 0 01- � -- - �3 E MIBIT B The following definitions and functions are intended to serve as guidelines for contracting agencies to utilize in meeting their required EPSDT administrative outreach and case management functions. I. DEFINITIONS A. At -risk client: The EPSDT-eligible client with identified actual and/or potential heath care needs, which may require outreach and case management efforts more intensive than non -at -risk EPSDT eligible clients. The at -risk or priority clients may include clients in families with no established linkage to health care and/or assistance with provider selection, .newborns and infants up to age two, teenagers, pregnant EPSDT-eligible clients, refugee children in need of EPSDT administrative and case management services, children and youth requiring preventive health and corrective treatment services or assistance with referral services for children with special health care needs and pregnant women eligible for enhanced prenatal services. B. EPSDT outreach and administrative case management: The EPSDT administrative outreach and case management services provided by the EPSDT Outreach and Case Manager which are complementary to the health care services provided by the Medicaid provider. The services are aimed at the promotion of health, the prevention of disease and improved access to health care services. The EPSDT administrative service includes, but may not be limited to: (1) contacting EPSDT-eligible clients to provide in-depth explanation of the EPSDT Program and its importance and the medical benefits which are available; (2) offering assistance and information to the EPSDT-eligible client which will facilitate overcoming barriers which might impede the client's access to the provision of the EPSDT services; (3) clarifying, if needed, the role of the primary care provider and when appropriate, the managed care/prepaid health plan, including Health Maintenance Organizations; (4) the client's obligation to maintain the linkage between the child/youth and the primary care physician; (5) maintaining periodic contact, as needed and feasible, with the EPSDT client to encourage the utilization of EPSDT services needed or promoted by referrals and assisting with referrals as needed; (65) initiating collaborative activities with other child -related health and social agencies within each county and referring EPSDT clients as needed to those agencies and services. In addition, in selected counties, services provided by the EPSDT outreach and case manager shall include assistance with the EPSDT and managed care inform process at the time of application for Medicaid in local social service agencies and presumptive eligibility sites. C. EPSDT Outreach and Case Manager: The individual responsible for providing the EPSDT Program administrative services of outreach and case management to EPSDT-eligible children and their families. D. EPSDT-eligible client: Any individual under the age of 21 who is currently eligible for Medicaid. E. Managed Care/Prepaid Health System: Any managed care organization that has a contract with Medicaid to provide comprehensive medical care to eligible Medicaid clients on a capitated basis. Managed Care/Prepaid Health System physicians agree to serve as gatekeeper for comprehensive health services, including EPSDT services, as provided to Medicaid recipients. F. Managed Care Inform Process: That process which occurs at the time of -application for Medicaid, and at each eligibility redetermination, in the local county social service office or presumptive eligibility site. The process includes: provision of information regarding the basic principles, benefits and requirements of the Colorado Medicaid Program, including where applicable, information concerning Medicaid managed care/prepaid health systems (including HMO's) and options; explanation of the client's rights and responsibilities with respect to selecting a managed care provider, including information that failure to select a provider may result in mandatory assignment of a provider; distribution of applicable brochures, including the Colorado Medicaid brochure, the Primary Care Physician Program (PCPP) brochure and, if applicable, managed care/prepaid health system, including Health Maintenance Organization (HMO), brochures which may be specific to the county' and, where applicable, assistance in selecting a managed care provider and promoting initial contact th the provider. G. Medicaid Provider/vendor: Any entity or individual who has met the certification requirement established by the State to participate in the Colorado Medicaid Program, and who provides covered EPSDT medical/dental services, goods and/or devices in accordance therewith. H. Prenatal Plus Program: The health care program option which includes ,a package of enhanced Medicaid prenatal services addressing nutritional and psychosocial behaviors that could impact pregnancy outcome. I. Primary Care Physician (PCP): A Colorado Medicaid enrolled physician who has agreed to serve as the "gatekeeper" for all medical care received by Medicaid recipients, who have chosen him/her within the Primary Care Physician Program or Health Maintenance Organization. EPSDT medical screenings are conducted by the selected primary care physician or a qualified provider upon referral from the PCP, when applicable. J. Primary Care Physician Program (PCPP): The health care program option in which EPSDT-eligible clients select a physician who agrees to enroll or has enrolled in the Primary Care Physician Program. Under this program the physician accepts the responsibility of the clients' health care, guaranteeing a 24 hour access arrangement. Under this program the physician will also refer the EPSDT eligible client to other Medicaid providers, for medical care, and other health care services as needed. K. Provider Interface: The responsibility of the EPSDT Outreach and Case Manager to work with local Medicaid providers. This process may include: (1) identifying providers in a local county or adjacent client -accessible counties, who will deliver medical screening, diagnostic and treatment services, dental, orthodontia, vision, hearing, or other services to the EPSDT-eligible client; (2) explaining to the providers the nature and intent of the EPSDT Program, including the PCP referral requirement; (3) referring interested providers to the coordinator of the Primary Care Physician Program at HCPF for assistance in acquiring more information concerning the role of the primary care physician; (4) acting as a resource to providers who need assistance with EPSDT administrative case management services. L. Screening: An EPSDT medical service provided to EPSDT-eligible clients by a Medicaid primary care physician, by a provider qualified to furnish medical screening services upon referral from the primary care physician or managed care system, or by other qualified providers in areas without available primary care physicians. The EPSDT medical screening includes (a partial EPSDT screen is any screen less than all of the 5 required components: - Comprehensive health and developmental history with physical and mental health components - Comprehensive unclothed physical examination - Appropriate immunizations according to age and health history - Laboratory tests, including blood lead levels - Health education, including anticipatory guidance M. Subcontract: A written agreement between Health and local health agencies and/or other local agencies which shall serve as a basis for EPSDT administrative outreach and case management activities at the local level. N. Training and Technical Assistance: Work performed under the direction of the Department of Public Health and Environment to assist Medicaid providers in developing and providing enhanced prenatal services. II. EPSDT ADMINISTRATIVE OUTREACH/CASE MANAGE MNT The EPSDT Outreach and Case Manager offers and provides, when requested and/or necessary: A. Provides outreach and/or administrative case management activities for the EPSDT- eligible client upon written or verbal request by the client or upon referral from Medicaid providers or other agencies. The administrative activities may include, but not be limited to, the. following types of responsibilities: 1. Initiate t phone, mail or face-to-face tacts to explain the EPSDT Program and the &...ainistrative case management rola, assist in the identification of health care needs, assist in requests for referrals for preventive health services; assist in clarification and/or answering questions, including, where applicable, questions/information regarding managed care. 2. Provide mailings, as indicated, that include provider listings, descriptions of basic EPSDT services, screening schedules, brochures and case management information (hours of operation and business cards.) Work with the local social service agencies, outreach sites, and other agencies where individual families apply for Medicaid to assure that such materials are available. 3. Maintain and update a list of the names, addresses and telephone numbers of Medicaid -enrolled providers from whom EPSDT medical, dental, hearing, and vision care may be obtained. 4. Facilitate provider interface by promoting the linkage of the EPSDT-eligible client with the primary care physician or HMO and through EPSDT advocacy efforts in the provider community, and through other activities as defined in Section 1 - I of this exhibit. 5. Coordinate with nurse supervisor and initiate and/or participate in interagency coordination with public health and other human resources agencies as appropriate upon consultation with the Nurse Supervisor. 6. Upon consultation with the nurse supervisor make home visits to difficult -to - reach EPSDT-eligible clients or coordinate for this service with other community agencies that also provide home visitation services. 7. Facilitate, upon request of client or provider, referrals for Medicaid covered services 8. As resources are available, and in consultation with the State office, provide assistance with the inform process, including assistance with provider selection, at selected local county social service departments B. In selected counties, EPSDT administrative case management staff will provide assistance with the managed care inform process in local social service agencies and presumptive eligibility sites. C. The EPSDT Outreach and Administrative Case Manager will utilize data provided by HCPF and local social service agencies which provide information for the provision of EPSDT administrative outreach and case management activities and will notify the State EPSDT Office in writing of any discrepancy, inaccuracy or unavailability of information received from the State or local Social Service agency which impede the provision of EPSDT administrative outreach and case management activities. III. EPSDT PROGRAM SUPPORT SERVICES A. The EPSDT Outreach and Case Manager offers and provides, when requested and/or necessary: 1. Assistance with scheduling appointments for EPSDT Program screening services 2. Assistance with scheduling appointments for follow-up diagnostic and treatment services, including medical, dental, vision, and hearing care services. - 3. Information to the EPSDT-eligible client concerning the availability of transportation assistance which is offered through the local county department of social services. 4. Referral assistance to the local county department of social services for the EPSDT-eligible client requiring transportation.-a-ssistance. B. The EPSDT Out =h and Case Manager provides additional support services of 1. Maintaining the lists of the names, addresses and telephone numbers o agencies or human resource groups who have expressed a willingness to furnis uncovered services at little or no expense to the EPSDT-eligible client and/o family. 2. Referring clients in all categories of the WIC target population to the loca. WIC Program available within each county. 3. Initiating and promoting of collaborative activities with WIC, Head Start the Health Care Program for Children With Special.Needs (HCP), Child Find, Famil; Healthline, Family Resource Centers, Bright Beginnings and other child healt related social agencies which are available within each local county to promot the availability and utilization of the services. C. The EPSDT Case Manager facilitates the referral of EPSDT-eligible client needin uncovered health or social services not covered under Medicaid to providers o agencies willing to furnish uncovered treatment at little or no cost. IV. EPSDT PROGRAM DOCUMENTATION REQUIREMENTS A. The EPSDT Case Manager assures that documentation of the outreach and cas- management activities occurs and that the documentation includes the following 1. Written materials utilized by the EPSDT outreach and case manager t• - facilitate the administrative services provided for the EPSDT-eligible client: (brochures, reminder cards, etc.) 2. Written or computerized documentation of all administrative EPSDT outreacl and case management activities which occurred. 3. Documentation should include efforts made to provide EPSDT outreach and case management services in a timely manner following client request for assistance - B. The case manager shall assure that written and/or computerized family records of summaries are available to State or Federal reviewers upon written request anc shall submit to the State monthly, on a form provided by the State, a summary o: EPSDT activities (Exhibit C). V. PLANNING, EVALUATION, MONITORING A. Site reviews by Colorado Department of Health EPSDT staff will be arranged on e mutually agreed upon basis with local EPSDT Staff. Site reviews will include: 1. Review of EPSDT outreach and case management activities, including writter materials, designed to assure that EPSDT clients receive requested assistance it a timely manner. 2. Review of EPSDT Procedure Manual for accuracy and content of requirec materials. 3. Review of written/computerized documentation for completeness and accuracy. 4. Review of agency written protocols/ guidelines for outreach and case management, including at -risk client definitions. 5. Review of agency written protocols for nurse supervision. 6. Training/updates for case managers as needed. 7. Discussion of EPSDT case manager needs, concerns and requests. 8. Input from the nurse supervisor on EPSDT issues, needs, etc. H:\EXHB9798. rd