Webinar Logistics -...
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10/20/2017 1 NC Department of Health and Human Services Division of Public Health 2017 Fall Child Health Updates Gerri L. Mattson, MD, FAAP, MSPH Pediatric Medical Consultant Tara Lucas, BSN, RN State Child Health Nurse Consultant October 19, 2017 Webinar Logistics • The sound for this webinar is provided in VoIP--you will use your computer speakers; be sure to turn up the volume; you will use the CHAT function to communicate with the presenters • The webinar will be archived and posted on the Child Health Provider resource page.
Transcript of Webinar Logistics -...
10/20/2017
1
NC Department of Health and Human
Services
Division of Public Health
2017 Fall Child Health Updates
Gerri L. Mattson, MD, FAAP, MSPH
Pediatric Medical Consultant
Tara Lucas, BSN, RN
State Child Health Nurse Consultant
October 19, 2017
Webinar Logistics
• The sound for this webinar is provided in VoIP--you will use your computer speakers; be sure to turn up the volume; you will use the CHAT function to communicate with the presenters
• The webinar will be archived and posted on the Child Health Provider resource page.
10/20/2017
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2017 Fall Child Health Updates
The Public Health Nursing and Professional
Development Unit (PHNPDU), North Carolina
Division of Public Health, is approved as a provider
of continuing nursing education, by the North
Carolina Nurses Association, an accredited
approver by the American Nurses Credentialing
Centers’ Commission on Accreditation.
Provided by Nurses, for Nurses
Disclosures
•Completion criteria: the learner must attend
100% of the webinar, complete the participant
evaluation which includes attestation by
signature on evaluation of their full attendance,
and correctly identify the clue word shared during
the presentation in order to receive 1.5 CNE
contact hours.
•The planners and presenters have no actual,
potential or perceived conflicts of interest to
disclose.
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Cherokee
Graham
Swain
ClayMacon
Jackson
Haywood
Madison
Buncombe
Henderson
McDowell
Rutherford
Polk
Burke
Cleveland
Watauga
Caldwell Alexander
Catawba
Lincoln
Gaston
Ashe
Wilkes
Alleghany
Surry
Yadkin
Iredell
Mecklenburg
Union
Stanly
Cabarrus
Rowan
Davie
Stokes
Forsyth
Davidson
Anson
Rockingham
Guilford
Randolph
Montgomery
Richmond
Caswell
Chatham
Orange
Person
Lee
Moore
Hoke
Scotland
Robeson
Cumberland
Harnett
Wake
Franklin
Warren
Johnston
Sampson
Bladen
Columbus
Brunswick
Pender
Duplin
Wayne
Wilson
Nash
Halifax
Northhampton
Edgecombe
Pitt
Greene
Lenoir
Jones
Onslow
Craven
Pamlico
BeaufortHyde
Martin
Bertie
Hertford
Gates
WashingtonTyrrell
Dare
Alam
ance Durham
Granville
Han
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Ch
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Child Health/Care Coordination for Children Consultation
& Technical Assistance- Effective April 1, 2017
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REGION 1
Linda Harrison
Cell: 828-342-4265
REGION 3
Melody McCune
Cell: 704-662-2108
REGION 2
Debra Patterson
Cell: (336) 239-9852
REGION 6
Stephanie Fisher
Cell: 252-571-2387
REGION 4
CARE COORDINATION FOR
CHILDREN
(CC4C) PROGRAM MANAGER
CC4C Program Only
Cheryl Lowe
Cell: 336-813-2068REGION 4
Child Health Program Only
Debra Patterson
Cell: (336) 239-9852
REGION 5
Brenda Sedberry
ov
Cell: 910-260-6641
REGION 7
Lynette Robinson
ov
Cell: 252-514-5905
REGION 8
STATE CHILD HEALTH
NURSE CONSULTANT
Child Health Program Only –
Sampson, Lenoir, and Jones
Counties
Tara Lucas
Cell: (919) 624-6652
BEST PRACTICE NURSE
CONSULTANT
Debby Moyer
v
Cell: 919-218-2945
REGION 8
CC4C Program Only – Sampson,
Lenoir, and Jones Counties; Child
Health and CC4C Program for all
other counties within Region 8;
Gail Lamb
Cell: 910-214-0210
Learner Outcomes
• Describe the critical components of an internal quality improvement and monitoring process
• Define the requirements needed to support ERRN practice
• Understand services provided by Child Care Health Consultants and recognize available child care provider forms
• Describe efforts to implement a plan of safe care for substance affected infants
• Describe examples of social determinants of health for children highlighted by the American Academy of Pediatrics
• Describe one new change in the clinical practice guidelines related to high blood pressure for children
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Learner Outcomes (cont.)
•Describe process for submission of the FY 16-17
Child Health 351 Agreement Addenda End-of
Year Report
•Understand requirements to monitor the status
of meeting the FY 17-18 Child Health 351
Agreement Addenda deliverables
•Describe processes to complete the FY 18-19
Child Health 351 Agreement Addenda
Child Health Program Audit Tools
• Child Health Program Audit tools and instructions
were revised in July 2017 for the following visits:
− Well Child Care,
−Pediatric Primary Care, and
−Home Visit for Newborn Care and Assessment
• The Child Health Policy Audit Tool was also revised in
July 2017.
• The revised audit tools, instructions, and CH policy
audit tool include the most current revision date of
July 2017 at either the bottom left or right corner
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Children & Youth Branch Forms
https://www2.ncdhhs.gov/dph/wch/lhd/cyforms.htm
Home Visit for Newborn Care and Assessment
•DHHS 3944 Home Visit for Newborn Care and
Assessment Documentation form was revised in
July 2017.
−Revisions include questions related to:
• social determinants of health
• food insecurities
• critical congenital heart defects
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Home Visit for Newborn Care and Assessment Resources
http://childrenyouth.hvncaresources.sgizmo.com/s3/
Adolescent Well Child Care Flyer – Developed by Rowan Innovative Approaches Steering Committee
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New CHERRN Rostering Requirements
•NEW Requirement: Prior to December 31, 2017, each CHERRN will have completed an onsite clinical assessment by DPH nurse consultant every three years
• observation of a clinical visit
• medical record review
• policy and procedure review (related to ERRN practice)
•NEW Requirement: Beginning January 2018 annual rostering period•minimum number of visits: 50 visits/year
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New Re-Rostering Onsite Clinical Assessment (OCA)
• ALL ERRNS rostered for the period ending June 30, 2016 were required to submit an agency completed Clinical Performance Review form
• ALL ERRNS rostered for the period ending June 30, 2016 will need to have a DPH Onsite Clinical Assessment (OCA) completed prior to December 31, 2017
• Beginning January 1, 2018, the OCA will be completed every 3 years during the third year of the cycle
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Re-Rostering Transition Grid
Transition Grid (Continued)
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Re-Rostering Information
• Re-rostering information is sent to the Director of Nursing (DON)/Nurse Supervisor (NS) at each agency
• The DON/NS is responsible for sharing the information with the CHERRN for completion of the re-rostering documents which will be sent to the Public Health Nursing and Professional Development Unit
• Re-rostering confirmation will be sent to all DON/NS/CHERRNs that meet the re-rostering requirements after the deadline for submission of documentation
Continuing Education (CE) Process for ERRN Re-Rostering
• The only preapproved ERRN CE hours for re-rostering are the CHRMs held in April and September annually
• If ERRNs are not able to attend the CHRMs then they must submit the training agenda and objectives for other CE offerings to the RCHNC for approval prior to attending the training
• Once the training is approved the RCHNC will send an approval email to the ERRN
• ERRNs need to keep a copy of the training approval email and attach it to the re-rostering forms that are sent to Beth Murray
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Challenge Process for CHERRNs
• ERRNs who do not meet re-rostering requirements will need to meet challenge requirements to be re-rostered
• http://sph.unc.edu/nciph/nciph-chern-challenge/
• Challenge includes:
−Written exam
−Physical assessment check off
−Visit write-up
• Contact your RCHNC for assistance in
the challenge process
• ERRNS, who were not rostered in the last five years, must complete the CHTP to be re-rostered
State Child Care Nurse Consultant
Amy Petersen, RN, BSN
CCHC-C
919-707-5665
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Who Are Child Care Health Consultants?
• Child Care Health Consultants (CCHCs) are trained health professionals, generally RNs or Health Educators, with education and experience in both child and community health and early care and education
• CCHCs work with programs to assess, plan, implement, and evaluate strategies to achieve high quality, safe, healthy child care environments
−Promote use of appropriate provider forms to support health (e.g., asthma action plan, permission to administer medication)
−These forms are located at: http://ncchildcare.dhhs.state.nc.us/providers/pv_provideforms.asp
• Qualified CCHCs have completed the NC Child Care Health Consultant Training Course
What Do Child Care Health Consultants Do?
• Assess health and safety in child care centers and homes
• Develop strategies for inclusion of children with special
health care needs
• Support early educators in managing injuries and
infectious diseases
• Connect early educators and families to community health
resources
• Provide up-to-date information on regulations and best
practices
• Provide health and safety technical assistance and
training
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Additional Services Provided by CCHCs
Communicable Disease
• Help with health and communicable disease problem-
solving. Collaborate with Public Health Nurses and
Environmental Health when needed.
Records Review
• CCHCs review children’s records to ensure required
information is current. Assistance is provided if the
facility is out of compliance. This includes:
−out-of-date immunization records
−incomplete medical assessments
Child Care Health Consultants in NC
• 64 funded CCHCs in 45 counties
• 22 independent CCHCs
To find a CCHC in your county, refer to the website for the most up to date information.
www.healthychildcarenc.org/consultants
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Telephone Triage Protocols
Telephone Triage Protocols
•Disclaimer Notice of the Telephone Triage Protocols by Barton D. Schmitt:
−“Protocols are clinical guidelines that must be used in conjunction with critical thinking and clinical judgment. Therefore, these protocols are most suitable for use by physicians, nurse practitioners, or physician assistants.”
−“Nurses should receive special training before using these protocols (see How to Use and Quality Assurance Checklist in User’s Guide).”
−“Non-licensed and non-health professionals (eg, Secretaries) should not use these protocols.”
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Telephone Triage Protocol
• Many of the telephone triage protocols are appropriate to serve as standing orders for Nurses; however, not all of the telephone triage protocols are appropriate for nurses per the NC Board of Nursing
• Telephone triage protocols should not be used unless the protocols have been reviewed, amended as necessary, and approved by a supervising physician or medical director responsible for overseeing the use of the protocols used.
• Adopting the entire book by reference is not appropriate for agencies
• The agency’s Medical Director may pull out the telephone triage protocols specific to nursing to sign off as standing orders for nurses.
• For telephone triage protocols that require medical decision making, nurses will need to obtain a standing order
− This guidance would apply if a standing order could be derived for nurses to implement by providing specific parameters.
Guidance provided by PHNPDU and the NC Board of Nursing
Documentation Clarification for Dental Caries related to the role of the CHERRN
• Dental Caries is considered a medical diagnosis that only a dentist or higher level medical provider can make.
• A nurse or dental hygienist may document any descriptors such as “holes in teeth or evidence of dental decay, black spots, broken tooth”.
• Describe the findings and refer for further evaluation
• CHERRNs may use an appropriate Nursing Diagnosis
• Appropriate Z-Codes related to risk for dental caries−Z91.841 – risk for dental caries, low
−Z91.842 – risk for dental caries, moderate
−Z91.843 – risk for dental caries, high
Guidance provided by PHNPDU
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Use of Appropriate ICD-10 Codes related to the Role of the CHERRN
CHERRNs should use ICD-10 code ranges from Z00-Z99; Z77-Z99; or Z87 when reporting a disease or condition that the parent or guardian or client reports without a documented diagnosis from a higher level provider (either in the client’s medical record at the agency or by obtaining past medical records).
• Z00-Z99 Factors influencing health status and contact with health services
• Z77-Z99 Persons with potential health hazards related to family and personal history and certain conditions influencing health status
• Z87- Personal history of other diseases and conditions
Guidance provided by PHNPDU
Use of Appropriate ICD-10 Codes related to the role of the CHERRN
• CHERRNs must document clearly in the client’s medical record which advance practice practitioner or physician previously made the medical diagnosis for the client.
−For Example: If a CHERRN documents a medical diagnosis for a condition that was previously diagnosed by a provider when reviewing past medical records, then the CHERRN must document:
• The provider’s name and the clinic or agency where the medical records were obtained.
• This will ensure to a reviewer that the CHERRN did not exceed scope of practice by making a medical diagnosis.
Refer to the memo provided by Phyllis Rocco on September 25, 2015 related to “Questions regarding selection of ICD9/10 Codes”
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Use of Appropriate ICD-10 Codes related to the role of the CHERRN
•CHERRNs can also use the appropriate diagnosis
code if the client or parent/guardian presents to
clinic with the client’s current prescribed
medications.
−The CHERRN can review the current medications and
note that the client was prescribed specific
medications from the name of the previous provider
and practice.
−The CHERRN will update the client’s medication list in
the chart based on the review of the client’s current
medications.
Use of Appropriate ICD-10 Codes related to the role of the CHERRN
•If a client or parent/guardian present to
the clinic with no medications and no past
medical records to reflect that a previous
advance practice provider or physician
treated a client, the CHERRN will need to
document an appropriate personal history
Z-code.
Guidance obtained by PHNPDU
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Use of Appropriate ICD-10 Codes related to the role of the CHERRN
• Additional options for the CHERRN:
− Document the client visit and do not bill the visit until the client’s past medical records can be obtained. Once the past medical records are obtained, the CHERRN can utilize the previous diagnosis code and note the name of the provider and practice where the client was diagnosed with that particular condition.
−Contact the previous provider office and speak with the Nurse Manager to review previous diagnoses located in the client record. The CHERRN would document the diagnosis code and state that the diagnosis was confirmed with the name of the office/practice that the client received treatment for that particular diagnosis and state the name of the provider that diagnosed the client.
Guidance obtained by PHNPDU
Use of Appropriate ICD-10 Codes related to the Role of the CHERRN
• Local Health Department CH Clinical staff could search the agency’s top 10 most frequently used diagnosis codes encountered by CHERRNs and providers
• CHERRNs can meet with the agency’s provider to assist with developing a help guide/cheat sheet of appropriate Z-codes for the CHERRNs to utilize
• A review of the Z code section is a good place to start for the CHERRNs since it is the ICD-10 equivalent to the V code section for the previous ICD-9 codes
Guidance provided by PHNPDU
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Clarification regarding Well Child Visit Z-codes related to the role of the CHERRN
•Z00.121 – Encounter for routine child health examination with abnormal findings
−This code is to be used when abnormal findings are present for the date of service the client is seen.
•Z00.129 – Encounter for routine child health examination without abnormal findings
−If a client has a history of a disease or illness but no abnormal findings are present during the visit, then the appropriate code to use would be Z00.129 along with an appropriate personal history of Z-code if pertinent.
Clarification regarding Well Child Visit Z-codes related to the role of the CHERRN
• Example: A 4 year old child presents for a well child visit with mom. The family recently moved here from California and reports the client has a history of asthma. During the visit, the mom reports client’s last asthma attack occurred 2 years ago. Mom reports the client has an albuterol inhaler to use as needed and that the inhaler was prescribed by a previous provider from California. The client’s mom did not bring previous past medical records to the visit so a release of information was signed by mom for the agency to obtain a copy of the past medical records. The mom did not bring the client’s current medications to the appointment and the provider office in California was closed for the day.
• The CHERRN completed the physical exam and no abnormal findings were assessed. The CHERRN developed an appropriate plan of care to refer the client to establish a medical home to ensure follow-up for the client’s history of asthma so that an asthma action plan could be completed and a prescription for refills for the albuterol inhaler could be obtained.
• The CHERRN would bill Z00.129 (encounter for routine child health examination without abnormal findings) and an appropriate Z-code (Z87.09 -for personal history of other diseases of the respiratory system).
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Best Practice Recommendation for CH Visits
Advise clients or parents/guardians to bring
current medications to all client well or sick
visit appointments.
Guidance provided by PHNPDU
Updates: Plan of Safe Care, Social Determinants of Health, and High Blood Pressure in Children
Gerri L. Mattson, MD, FAAP, MSPH
Pediatric Medical Consultant
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125 190 201 258290
399483
572
764
874
1148
1252
104.4
154.4157.5
197.1
221.8
314.7
394.9
475.1
637.9
734.6
949.2
1036.2
0
250
500
750
1000
1250
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014* 2015**
New
born
Hospitaliations
Newborn Hospitalizations Rate per 100,000 Live Births
Rate of Hospitalizations Associated with Drug Withdrawal in
Newborns
North Carolina Residents, 2004-2015
39
2004 to 2015
893% increase
Source: N.C. State Center for Health Statistics, Hospital Discharge Dataset, 2004-2015 and Birth Certificate records, 2004-2015Analysis by Injury Epidemiology and Surveillance Unit
*2014 data structure changed to include up to 95 diagnosis codes. It is unclear the overall impact of this change.**2015 ICD 9 CM coding system transitioned to ICD10 CM. Impact unclear.
Impact of Federal Legislation on Substance Exposed Infants in States
Comprehensive Addiction and
Recovery Act of 2016
Child Abuse Prevention and Treatment Act Amendment
Title 1 §106(b)(2)(B)(ii)
(2016)
State Policies and Processes
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The CAPTA legislation can be found at:
https://www.acf.hhs.gov/sites/default/files/cb/capta2016.pdf
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North Carolina Plan of Safe Care Interagency Collaborative (POSCIC)To create a state-specific policy agenda and action plan to address and implement
the provisions of CAPTA amended by CARA. And to strengthen the collaboration across systems to address the complex needs of infants affected by substance use
and their families.
• Division of Mental Health, Developmental Disabilities and Substance Abuse Services
• Division of Public Health
• Division of Social Services
• Division of Medical Assistance
• Community Care of North Carolina
• North Carolina Hospital Association
• North Carolina Obstetrics and Gynecological Society
• North Carolina Commission on Indian Affairs
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North Carolina’s Response to CAPTA
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Health Provider Involved in the
Delivery or Care of Infant
1. Identifies infant as “substance affected” based on DHHS definitions*
2. Makes notification to county child welfare agency.
County Child Welfare Agency
1. Completes CPS Structured Intake Form (DSS-1402) with caller
2. Develops Plan of Safe Care/CC4C Referral using ONLY the information that is obtained during the intake process
3. Refers ALL infants and families to CC4C PRIOR to any screening decision being made
4. Collects and reports required data
5. Uses “Substance Affected Infant” Policy to screen, report and provide services for screened in cases
Care Coordination for Children (CC4C)
1. Participation is voluntary
2. Services based on needs identified in Plan of Safe Care embedded on revised CC4C referral form
3. Progress is monitored based on monitoring tools already in place
*Affected by substance use, affected
by withdrawal symptoms or affected
by Fetal Alcohol Spectrum Disorder
(FASD)
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Revised CC4C Referral Form
Revised CC4C Referral Form
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Resources
• For questions email: [email protected]
• CAPTA/CARA Quarterly Conference Calls
Toll-Free Number (877) 594-8353
Participant Pass Code 48729103
• November 21 12:30-1:30PM
• December 14 4-5PM
• Perinatal Quality Collaborative of NC (PQCNC): https://www.pqcnc.org/
• FASD in NC: http://www.fasdinnc.org/
• Archived July 2017 webinar, entitled, Substance Exposed Infants, CAPTA and Hospitals found at: https://whb.adobeconnect.com/_a1138253972/pq9wxqaexbot/?launcher=false&fcsContent=true&pbMode=normal
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Updates from the AAP: Children in Immigrant Families
• Children in immigrant families are children who are foreign-born or are born in the US and live with at least 1 parent who was born outside of the US
• One in every 4 children in the US (about one in every 5 children in NC) live in an immigrant family and 9 out of 10 of these children are US citizens
• Children in immigrant families are more likely to live with two parents and have parents who work but nearly 2x as likely to be uninsured and more likely to live below the federal poverty level than children in nonimmigrant families
Sources: AAP NCE Plenary slides by Dr. Linton, AAP Policy Statement: Providing Care for
Immigrant, Migrant and Border Children, Pediatrics 2013 and Immigrant Health Toolkit,
and 2015 Kids Count Data
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Who Are Children in Immigrant Families?
Slide borrowed from Dr. Linton NCE session on children in
immigrant families
Increased Concerns About Toxic Stress
• Impact of trauma for immigrant children who have been in detention centers and then released
•Additional trauma for children in immigrant families
−Threatened family deportation with fear and uncertainty leading to negative psychological impact, limited enrichment experiences, and decreased perceived access to care
−Actual deportation with dissolution of parent/child relationship, mental health and academic problems, sleeping and eating disruptions, and family economic instability
Slide content from Dr. Linton 2017 NCE Plenary and Linton, et al
Pediatrics, 2017, and the Migration Policy Institute
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Importance of Cultural Humility and Cultural Safety
•Cultural humility: Openness and respect for
differences and an awareness of our own cultural
issues
•Cultural safety: Recognition of power differences
and inequalities in health and the clinical
encounter that result from social, historical,
economic, and political circumstances
Slide adapted from slide by Dr Andrea Green at NCE
Sources: Tervalon and Murray-Garcia, Journal of Health Care for the
Poor and Underserved, 1998; Papps and Ramsden, International
Journey of Quality in Health Care, 1996. Image used by permission
from Dr. Andrea Green and high school students in Vermont.
Use in Conversations with Immigrant Families
• Welcome the family to your space
• Create a safe space
−Sit down
−Speak slowly, calmly
−Look at the family
• Set the stage
−“I would like to ask you a lot of personal questions that relate to
your health and your family’s access to public benefits.”
−DESCRIBE CONCEPT OF CONFIDENTIALITY
• “Tell me about your journey”
Slide borrowed from Dr. Julie Linton presentation at 2017 NCE
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Great Resource: AAP Immigrant Health Toolkit
• Includes several sections including but not limited to:
−Key facts
−Clinical care
−Immigration status and related concerns
−Access to health care and public benefits
−Mental and emotional health
Access at: https://www.aap.org/en-us/about-the-
aap/Committees-Councils-Sections/Council-on-Community-
Pediatrics/Pages/Immigrant-Child-Health-Toolkit.aspx
Health Literacy: Another Social Determinant of Health
• The ability to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions
• Grade 8 reading level or below results in better comprehension regardless of reading level and analogies
• Ask how or what way would family or youth like to receive information (oral or written down)
• When teens visit they may have developed incorrect or misunderstood opinions about diagnosis or treatment
• Need to practice cultural safety when interacting with parents and families to help them feel safe enough to ask difficult questions that impact health literacy
Slide content borrowed from Dr. Andrea Green 2017 NCE presentation on health literacy and
from https://www.cdc.gov/healthliteracy/index.html
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Housing Instability (NOT Just Homelessness) is a Social Determinant of Health
Slide borrowed from 2017 AAP Presentation by Children’s Health Watch by Dr. Megan
Sandel
NEW: Housing Stability Vital Sign
Since [current month] of last year:
• Was there a time when you were not able to pay the mortgage or rent on time?
Answer is Yes or No and positive screen if answer is yes
• How many places have you lived?
Answer is # of places lived, positive screen if answer if 3 or more
• At any time did you stay in a shelter or didn’t have a steady place to sleep at night (including now)?
Answer is Yes or No and positive screening if answer is yes
Slide borrowed from 2017 AAP Presentation by Children’s Health Watch by Dr. Megan
Sandel
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New Clinical Practice Guideline: Screening and Management of High Blood Pressure in Children
• 30 Key Action Statements with some old and some new things
• As a screen, only measure blood pressure (BP) at routine well visits
• Pre-hypertension (HTN) is no longer used: now category is called elevated blood pressure
• New easier BP tables with heights for healthy children that do not include 99th percentile (just to 95th percentile)
• Stage 1 and 2 HTN now based off 95th percentile
• Teens now have set cut offs for threshold BPs to decide if elevated, Stage 1 or 2
Content from presentation at 2017 NCE based on Flynn et al, Pediatrics 2017
Child Health 351 Agreement Addenda
Updates
Tara Lucas, BSN, RN
State Child Health Nurse Consultant
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Clue Word
updates
FY 16-17 CH 351 AA End of Year Report
https://www.surveygizmo.com/s3/3321316/CH351AAFY1617
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FY 16-17 CH 351 AA End of Year Report
•FY 16 -17 - agencies are required to report on
deliverables at mid-year and end of year
•Deadline for submitting the FY 16-17 CH 351 AA
End of Year report is October 31, 2017
•Agencies will receive a confirmation email once
the End of Year Report has been submitted
•RCHNCs will review the End of Year reports and
follow-up with the agencies regarding any
questions or concerns
FY 16-17 CH 351 AA End of Year Report – Optional Worksheet
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CSDW Report Instructions for the CH AA Data Dashboard
Increasing Accountability for Agreement Addenda Deliverables
•Agencies who did not meet the FY 15-16 CH 351
AA deliverables and pulled down the funds, are
designated as a high risk sub-recipient of Title V
funds
•Failure to meet 351 AA deliverables for two years
may result in reduction in funds
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Recommendations for Internal Monitoring of the AA Deliverables
• Designation of a team who is responsible for tracking expenditures in relationship to deliverables
− Team meetings are recommended to be held at a minimum quarterly
• Designation of a person responsible for each activity whom will be accountable for coordination of all deliverables in an activity
• Designation of a person to serve as the lead for the CH 351 AA who will be listed as the LHD program contact for children’s clinical services
− The lead is usually the CH Program Supervisor or DON
Internal Monitoring of FY 17-18 CH 351 AA
• Due to the recent 2.2 million dollar Maternal Child Health Block Grant Reduction, local health departments will be responsible for documenting how their Child Health Programs were impacted by this reduction in the FY 17-18 CH 351 AA Mid-Year Report
• Local Health Departments will be responsible for documenting which deliverables the agencies will not be able to provide as a result of the MCH Block Grant reduction
• Local Health Departments are still responsible for providing or assuring child health clinical services regardless of the MCH Block Grant reduction
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Revisions to the CH 351 AA
• Anytime changes are needed to realign deliverables and/or budget, contact your regional child health nurse consultant for assistance.
• Changes in deliverables and/or budget could result in a formal agreement addenda revision through the DPH Contracts Office.
• Any revisions to the FY 17-18 Child Health 351 AA must be submitted to Tara Lucas, SCHNC, no later than February 1, 2018 for review/approval in order for revisions to be processed through DPH Contracts Office no later than March 1, 2018.
Branch Objectives for Agreement Addenda Transformation
• Improve child health outcomes
• Implement the use of evidence-based or evidence-
informed strategies
• Implement data-driven and community decision
making
• Increase accountability by reporting performance
outcomes and utilization of funds
• Streamline and standardize practices and measures
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Process of Transformation
• Internal Workgroup – Process to respond to new requirements from HRSA, the DHHS, and DPH
• Expanded to include local health directors.
• Pre-populated templates for some of the more prevalent activities
• Focus on developing an infrastructure
• Drawing funds down by “time sheet” can be a house of cards, if you find at the end of the year that you have drawn down all your 351 funds, but have not delivered the service you will be out of compliance
Best Recommendation
Draw funds down as services are provided. This is especially important if:
1. You have “other deliverables” in your scope of work
2. You have a history of not being able to provide all the direct medical services that you quoted on your 351
Drawing down funds without completing all the deliverables in your scope of work could result in reduced funding in subsequent years.
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Activity Templates
• The Branch has engaged content experts to: −Revise sample activity templates based on the
most common activities in past years −Review activity proposals submitted by local
health departments and assist in the development of approved templates which will be posted on the FY 18-19 CH 351 AA Training website
−Monitor the status and completion of deliverables and provide expert guidance as needed
Standardized Intervention Criteria
• Must be evidence-based or evidence-informed
• Must have measurable outcomes
• County-level and/or state-level data must indicate a need for the service
• Agencies may choose from the available templates or develop new activities for approval
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FY 18-19 CH 351 AA
•What changes have occurred with
preparation for the FY 18-19 CH 351 AA?
•How will this impact local health
departments?
Transition to Non-Negotiable AA
•The CH 351 AA has been a Negotiable AA
•For FY 18-19, the CH 351 AA is transitioning to a Non-Negotiable AA
•Preparation for the completion and submission of the FY 18-19 CH 351 AA will begin in the Fall & Winter of 2017.
•RCHNCs will contact local health departments to schedule an onsite visit to provide technical assistance in completing the additional documents of the AA
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Transition to Non-Negotiable AA
•Local Health Departments will need to begin reviewing local data to determine if the agencies plan to provide or assure direct services
•Local Health Departments will also review local and state data to determine what evidence-based activities the agencies may wish to implement
•RCHNCs will contact Local Health Departments to schedule an onsite visit to provide technical assistance with completing the additional documents for the AA
Transition to Non-Negotiable AA
•RCHNCs will schedule the onsite visit between
the months of November – January
•DPH Contracts office will provide agencies with
the original FY 18-19 CH 351 AA in February
•Local Health Departments will be required to
submit the FY 18-19 CH 351 AA to DPH
Contracts by April 15, 2018
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Transition to Non-Negotiable AA
• The RCHNCs will assist the Local Health Departments with completing and approving all additional documents for the AA prior to the FY 18-19 CH 351 AA being released to the agencies in February
• Once the Local Health Departments receive the FY 18-19 CH 351 AA, Local Health Departments will complete the required sections of the Original CH 351 AA
• Local Health Departments will print the pre-approved additional AA documents and attach to the AA
Transition to Non-Negotiable AA
•By completing the additional AA documents prior
to the release of the Original AA, the process for
completing and submitting the CH 351 AA will be
greatly expedited
•This will also expedite the review and approval
process for the CH 351 AA by the State Child
Health Nurse Consultant
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Transition to Non-Negotiable AA
• Once approved, funds will be released to the health department through the WIRM to support this activity
• Once approved, the health department will need to follow-up with the RCHNC to discuss the need for any changes to the AA because changes may require a formal revision through DPH contracts
Non-Medicaid Health Care Services
• Provide child health direct services−CH preventative & E/M visits−Adolescent RH preventative & E/M visits−Medical nutrition therapy services−Behavioral health visits−Dental services
• Assure provision of child health services−Transfer of 351 funds −No transfer of 351 funds
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Assurance of Child Health Services
If 351 funds are transferred between the health department and another provider:
• The MOU/MOA, contract, CCNC Community Care Plan must specify the services to be provided, DMA rate for services provided, and for services such as dental or vision, the projected cost per patient
• The contracting provider will invoice the LHD for services provided for the previous month; (the agency cannot transfer funds upfront)
• The LHD reimburses the contracting providers at the DMA rate for services provided to Non-Medicaid, non-insured clients
Refer to the Guidance for LHD Assurance of Child Health Services Document
Assurance of Child Health Services
If 351 funds are transferred between the health department and another provider: (continued)
• The contracting provider must follow the current Health Check Program Guide Requirements
• The LHD will need to request a copy of the internal chart review from the contracting provider or will need to complete an internal chart review
− If any findings are identified, the LHD is responsible for developing a corrective action plan (CAP) to resolve the findings. If CAP findings are present, billing adjustments are required to be made to the Children and Youth (C&Y) Branch and follow-up is required to close the CAP
• The C&Y Branch will need to review and approve the MOA or contract prior to the LHD signing with the contracting provider
Refer to the Guidance for LHD Assurance of Child Health Services Document
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Assurance of Child Health Services
• If 351 funds are transferred between the health department and another provider: (continued)
• The agency will assure eligibility assessment, referral, and delivery of the contracted services outlined in the CH 351 Agreement Addenda in the dollar amount that meet DMA and CMS quality and billing requirements.
• The agency will be required to report both mid-year and end-of-year clinical data in an electronic survey distributed by the Child Health Program in order to demonstrate meeting the negotiated deliverables.
Refer to the Guidance for LHD Assurance of Child Health Services Document
Assurance of Child Health Services
If 351 funds are NOT transferred between the health department and another provider :
• The LHD will assure CH services with contracting provider
• The contracting provider must follow the current Health Check Program Guide
• The C&Y Branch will need to review and approve the MOA prior to the LHD signing with the contracting provider
Refer to the Guidance for LHD Assurance of Child Health Services Document
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If Providing Direct Services…..
•You will not need to consult your Community Advisory Council
•Complete Direct Services Worksheet
•Complete the Activity Budget Worksheet and label as “Direct Services”
If Assuring Direct Services…..
• You will not need to consult your Community Advisory Council
• Provide evidence of assurance of child health services by attaching a copy to the CH 351 AA:
−MOA/MOU with local health care provider(s)
−Contract with a local provider
−Community plan
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If Providing Other Services…..
New Update: Community Advisory Council input is not required for additional evidence-based activities for FY 18-19
• Review county and state data
• Establish priorities for the community
• Propose EB interventions that correspond to priority needs, supported by data
Additional Requirements…..
• At least one CH staff to attend both the Spring & Fall CYB regional meetings whether the agency provides or assures CH services
• Written policies and procedures, including delivering services in a culturally/linguistically appropriate manner
• Use of customer service survey two times per year with results sent to your RCHNC for review
• Copy of the written agreement with LEA(s) for FY 18-19
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Reporting Requirements
• Provide mid-year status report on all interventions in Attachment A worksheets, no later than January 31, 2019, through a report format to be distributed by the Child Health Program
• Provide end-of-year outcome data and final report on interventions in Attachment A worksheets no later than July 31, 2019, in a report format to be distributed by the Child Health Program
Child Health Program Monitoring
• Clinical chart review every three years, unless “high risk”, then annually
• Annual internal chart review required, quarterly is strongly recommended
• RCHNCs are available to provide additional consultation and technical assistance.
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Funding Guidelines
Requirements for pass-through entities: The Division provides federal funding reporting supplements to the Local Health Departments receiving federally funded Agreement Addenda
Definition of a Supplement: A supplement discloses the required elements of a single federal award. Supplements address elements of funding sources only. State funding elements will not be included in the Supplement. Agreement Addenda funded by more than one federal award will receive a disclosure Supplement for each federal award.
Funding Guidelines
• Activity 351 CH funds specified in the Scope of Work and Deliverables may not support services and activities that have not been approved by the C&Y Branch
• Funds used to support services in Attachment A and/or B worksheets may not be used to support services or activities supported by other Agreement Addenda
• Funds may not be used to supplement Medicaid services. Receipt of Medicaid reimbursement for services rendered is considered “payment in full”
• Activity 351 CH funds may be used to support attendance at C&Y Branch supported CH regional meetings for programmatic updates
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Activity Worksheets
• Activity worksheets have been developed for your use and will be posted on the FY 18-19 CH 351 AA training website
• The Scope of Work (SMART objectives) and Measures have been developed for each activity and will be consistent across the state
• Agencies who wish to develop an Activity other than the ones posted will need to work with their RCHNC to make sure that the proposed Activity, Scope of Work and Measures are consistent with required evidence-based practices
Activity Worksheets & Local Accountability
• The Scope of Work defined in each Activity is a high level description of the work to be completed
• The agency is responsible for development of an internal detailed action plan and accountabilities to achieve the negotiated deliverables−The plan will include how the deliverable and
measures will be achieved and how the agency will assure documentation of the measures and track expenditures as defined in the Activity Budget Worksheet
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Directions for Budgetary Estimates for Attachment A and/or B Worksheets
• Complete an activity budget worksheet for each activity.−All services listed on the Direct Services worksheet can be
listed on one activity budget worksheet and labeled as “Direct Services”
• For Interpreter Services you may count the following:
−Interpreter services provided in CH clinic, immunization clinic, Home Visits for Newborn Assessment and Care, and if you are using Reproductive Health services for teens as a deliverable in your 351 AA
• You must be able to demonstrate how this data is collected, i.e., time studies by program type.
• If using in RH for teens, you may need an additional category on your time study to capture adolescents in FP Program
Directions for Budgetary Estimates for Attachment A and/or B Worksheets
• Anytime changes are needed to realign deliverables and/or budget, contact your regional child health nurse consultant for assistance
• Changes in deliverables and/or budget could result in a formal agreement addenda revision through DPH Contracts Office
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Budget Calculations
• Indirect or administrative costs for interventions may not exceed 10% of the total budget for the activity
• Funds may be used to support staff time (FTE) to manage/coordinate projects, i.e. the Reach Out and Read Coordinator needs a few hours per month to support data collection and inventory.
• Funds may be used to support staff time (FTE) for services, instruction, follow-up at a clinic visit. Medicaid or Title V fund reimbursement at the Medicaid rate is considered payment in full for the service. However, remember the “house of cards” warning.
Budget Calculations
• You must show how you calculated FTE on the budget worksheets
• Purchased educational materials must be evidenced based and from a reliable source, i.e. AAP, CDC, Bright Futures
• Supplies or equipment must include the unit cost and relate to the number of clients served
• A cost per participant should be calculated for interventions such as Reach Out and Read, ESMM classes, asthma care
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Budget Calculations
• Funds may not be used for incentives, unless the incentive marks a milestone, i.e. if there is six ESMM classes in a series and the client participates in all six, an incentive may be used.
−Incentives to return for follow-up or to complete a questionnaire are not allowed.
• Funds may be used for education and training for tuition and travel at the state rate.
Other Attachment B Activities
Sample Activity Templates to be posted on the FY 18-19 CH 351 AA training website:
• Air Quality/Asthma Management
• Asthma Coalition
• Bicycle Safety & Helmet Distribution
• Car Seat Safety
• Child Fatality Prevention Team
• Innovative Approaches
• Mother-Baby Breastfeeding Friendly Health Care Clinics
• Obesity Prevention
• Reach Out and Read
• Real Talk
• School Nurse FTE
• School Nurse Supervisor Position
• Triple P
• Whole School Whole Community Whole Child
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School Health Activity Templates
• If based on your data review, your agency wishes to use 351 Funds to support school nurse FTE:
Contact your regional school health nurse consultant (RSHNC) for assistance in completing the Attachment B Worksheet
The RSHNC will notify the State Child Health Nurse Consultant that the activity worksheet is ready for approval
School Health Activity Templates
• Each School Health Activity has an inclusion of a percentage of FTE sentence that is listed under Scope of Work. The School Nurse FTE must be calculated and included on both the activity worksheet and the activity budget worksheet
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Additional Activity Templates
• If based on your data review, your agency wishes to
develop a strategy for which an Attachment B Activity
Worksheet has not been completed:
1. Contact your RCHNC for assistance with linking you
with the appropriate content experts and
development of the draft worksheet
2. The draft worksheet will be reviewed and approved
by the State Child Health Nurse Consultant
Questions
