1. family and parenting
2. children

1. Introduction
2. Practice Manager Network
3. Eligibility & Enrollment
4. Reimbursement, Claims Processing and Coding
5. Care Coordination & Socioeconomic Support Services
6. Mental Health Services
7. Case Management
8. Transportation
9. Training in Medical Spanish Interpretation
10. Automated Immunization Registry & Vaccines
11. Developmental Screening
12. Cross-Cultural Healthcare Learning Community
13. After-Hours Telephone Care
COLORADO CHILDREN’S HEALTHCARE ACCESS PROGRAM (CCHAP) Orientation Manual 2012 (rev JUNE 2012) A Medical Home for Every Child www.cchap.org 14. Family Voices Colorado
15. Medical Home Initiative
16. Quality Improvement
17. Cavity Free at Three
18. Accountable Care Collaborative
19. Meaningful Use and EHR Incentive
20. Key Contacts & Glossary of Terms
Chapter 1
Chapter 1 : COLORADO CHILDREN’S HEALTHCARE
ACCESS PROGRAM
A Non-Profit Organization
ORIENTATION MANUAL
INTRODUCTION
Thank you for participating in the Colorado Medical Homes for Children Program
(from Colorado Medicaid) in association with the Children’s Healthcare Access
Program - CCHAP. This Orientation Manual is being provided as an introduction to
the services CCHAP can provide to your practice. CCHAP is continually updating
and expanding the information contained in this manual, so we encourage you to
use the on-line version at www.cchap.org whenever possible.
Most of the contents of this manual are available online only to participating
practices. Therefore, you will need to log-in using the username and password we
have assigned to your practice:
USERNAME:
PASSWORD: everychild
Please share this log-in information with all of your providers and staff members, but
please do not share it with others outside of your practice. If your colleagues in
other practices would like this information, please refer them to CCHAP so we can
provide them with their own log-in and complete services. We will be measuring the
success of CCHAP for the organizations which fund us. In order to do this, we will
be monitoring how many practices are using the CCHAP website and how it is being
used. CCHAP’s goal is to continually improve the program and to strive toward
making all of the resources self-sustaining and enduring.
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Chapter 1
THE CCHAP QUICK REFERENCE LINK
Do you need to know the one telephone number to call for a Medicaid mental health
referral? Want to reach the CCHAP care coordinator? Need help in finding
resources for a special needs child? Use our CCHAP Quick Reference Link for your
desk top.
Recently, our Advisory Board of physicians and practice administrators suggested
an idea for a quick and easy way to access CCHAP affiliated resources for
frequently used contacts and services. We liked the idea and have developed a web
link that will quickly access a single page that contains contact information as well as
additional links to documents and web pages. The goal is to have a computer
desktop shortcut that, with just a click or two, will provide CCHAP affiliated providers
and staff with the information you need, when you need it.
We want this tool to be pertinent and efficient for you; so if you have ideas for
improvement, contact Kevin Heckman [email protected] or
720-777-6309 with your feedback and suggestions.
INSTRUCTIONS:
1. Click on this link http://www.cchap.org/qr/ to open the Quick Reference Link
web page (Note: you can also type this address into a web browser
manually).
2. In your browser window menu (upper left corner) click File>Send>Shortcut to
Desktop.
3. The Quick Reference Link is available from any computer with internet
access.
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Chapter 1
The CCHAP Team
Steven Poole, MD – Executive Director/Medical Director
720-777-6004 [email protected]
Kevin Heckman – Program Administrator
720-777-6309 [email protected]
Erlinda DeLuna – Manager of Care Coordination and Support Services
720-777-6336 [email protected]
Lorena Counts – Resource Coordinator
720-777-6334 [email protected]
Anita Rich, MSW – Director of Community Outreach
720-777-5495 [email protected]
Angie Goodger – Quality Improvement Coach
720-346-4903 [email protected]
Marcia Carteret – Director of Intercultural Communications
720-777-3124 [email protected]
Joy Carter – CCHAP Program Coordinator
720-777-1818 [email protected]
Jeff Poole – Information Technology
970-209-3166 [email protected]
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Chapter 1
PROGRAM DESCRIPTION
The Problems Addressed by CCHAP
•
In 2006, 140,000 Medicaid and Child Health Plan Plus (CHP+) eligible or
enrolled children in Colorado do not access to a regular source of
comprehensive health care: a medical home. The existing public clinics and
other safety net providers do not have the capacity to provide a medical home
to these children.
•
In 2006, only 20% of private pediatric or family practices accepted children on
Medicaid or CHP+
The Mission of CCHAP
•
To enable private pediatric and family practices (both urban and rural) to more
easily and cost-effectively provide health care for children covered by Medicaid
and CHP+.
•
To link community organizations and government agencies with private
practices to remove the barriers that previously discouraged private providers
from caring for Medicaid and CHP+ children.
The 14 Barriers Identified by Colorado Pediatricians
CCHAP is a non-profit organization, funded by seven Colorado foundations, that
works with over 30 community organizations and governmental agencies to remedy
the 14 barriers to provider participation in Medicaid and CHP+. These barriers were
identified in pre-planning provider surveys and focus groups, and refined during the
pilot phase.
The barriers include: (1) poor provider reimbursement from Medicaid and CHP+; (2)
poor family access to quality mental health services; (3) difficulties interacting with
the State regarding eligibility, authorizations, referrals, and claims; (4) unstable
Medicaid/CHP+ enrollment; (5) high levels of family need for social services; (6) high
levels of family need for care coordination ; (7) poor immunization rates; (8) high
demand for after-hours services; (9) families’ lack of reliable transportation; (10)
provider expressed need for help developing the knowledge and skills to provide
cross-cultural healthcare and for cultural competency training; (11) lack of trained
Spanish interpreters in practices; (12) the need for early recognition and
intervention for developmental problems in the highly at-risk population of children in
low-income families; (13) the need of primary care practices for assistance in
developing quality improvement projects in order to be certified as a Medicaid
medical home to qualify for higher reimbursement; and (14) for a support network for
the practice administrators who struggle to deal with the administrative and financial
challenges of providing a medical home for low income families.
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Chapter 1
CCHAP History
CCHAP’s pilot phase began in 7 Denver metro pediatric practices in 2006. The
CCHAP staff and the pilot practice administrators spent numerous hours working to
refine the program. CCHAP now works with over 200 pediatric and family practices
and has an Advisory Board made up of providers and practice mangers from all
around the state. We are continuously seeking advice and refining the support
services. Surveys each year show between 95% and 99% of the providers felt that
each of the supports offered were an important component and wished to continue
in the project, plus over 95% of administrators and providers encouraged other
practices to begin participating in CCHAP. Three evaluations of CCHAP and the
practices we support have shown that children covered by Medicaid and CHP+ in
these practices visited emergency departments after-hours half as often as children
without a medical home and the rate of hospital admissions decreased by 2/3.
Additionally, these Medicaid and CHP+ participants’ immunization rates were
equivalent to commercially insured children, and are better than the rates of other
Medicaid children. The cost savings have been acknowledged by the state Medicaid
system and as a result, CCHAP affiliated practices are receiving higher
reimbursement from Medicaid.
SUMMARY
The Colorado Children’s Healthcare Access Program is a nonprofit organization that
has grown from an awareness that private practice healthcare providers throughout
Colorado wanted to do their share in taking care of underserved children, but
numerous barriers prevented them from doing so. Although the barriers to private
practices serving these children were numerous, CCHAP and 96% of Colorado
private pediatric practices and over 80 family practices have shown that these
barriers can be overcome.
CCHAP currently works with over 200 primary care practices and 700 providers.
Thank you for doing your part to increase the number of children on Medicaid and
CHP+ who have a good medical home.
With the help of over 30 participating community organizations and agencies, we are
on track to make this program self-sustaining.
This manual is designed to help you understand and utilize the resources that are
available to you and your practice.
The lifelong success of this program depends on the feedback and advice from the
staff, administrators and providers in the participating practices.
--PLEASE DO NOT HESITATE TO CONTACT US--
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Chapter 1
CCHAP is possible only through a collaboration of many foundations, governmental
agencies and community organizations that all care deeply about the health and
well-being of all children and families in Colorado. We wish to thank these
organizations which are listed below. We are fortunate, also, that support is
continually growing; and, we apologize if we have missed anyone on this list.
CCHAP is funded by:
Caring for Colorado
Rose Community Foundation
The Colorado Health Foundation
The Colorado Trust
The Piton Foundation
Timothy and Bernadette Marquez Foundation
El Pomar Foundation
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Chapter 2
Chapter 2 : PRACTICE MANAGER NETWORK
CCHAP has an Advisory Board made up of practice managers and providers from
around Colorado. They have provided invaluable advice on a variety of issues and will
continue to provide guidance for CCHAP and recommendations for the over 200
practices with which CCHAP is affiliated. The members of the Advisory Board are listed
in a table below.
CCHAP also hosts bimonthly Practice Manager’s Meetings:
1. CCHAP provides our affiliated practices with updates and new developments
regarding all aspects of health care for children covered by Medicaid and
CHP+.
2. Practice managers discuss issues regarding health care for these children
and make recommendations that CCHAP can take to Medicaid or CHP+
leadership.
3. Practice managers make recommendations regarding ways CCHAP can
improve its support services to affiliated practices.
4. Practice managers provide advice regarding major decisions and the future
direction for CCHAP.
5. Practice Managers share ideas and provide advice and support for one
another.
We hope that, as Medicaid reform in Colorado gets going with Regional Care
Coordination Organizations (RCCOs) providing support services for practices, those
CCHAP-affiliated practices that are participating in the initial (pilot) phase will share their
experiences with the other practices at the Practice Manager’s Meetings.
Meetings are held every other month during the noon hour. You can attend in person
on the CHCO campus, or join in via webcast. Information regarding the upcoming
meetings is emailed to the practices as well as posted on the CCHAP website.
We highly encourage each practice to identify someone to attend, either the practice
manager or a provider. If there are issues you need help with, please contact Kevin
Heckman ([email protected]).
Other ways that CCHAP communicates and shares ideas with the CCHAP practice
managers and providers:
•
Monthly email newsletter – addresses issues related to healthcare for low
income and minority families. Please make sure the practice providers
and appropriate staff members receive copies and please make sure to
keep your practice contact email addresses current with us.
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Chapter 2
•
CCHAP Website (www.cchap.org) - Articles, links, newsletter archives,
meeting video recordings and related presentation documents, updated
orientation manual, and more. Please contact Joy Carter if you would like
an updated list of all of the practices and practice managers currently
participating with CCHAP.
Listed below are the members of the CCHAP Advisory Board. Feel free to contact any
of these individuals with ideas, issues, questions, concerns, etc.
Name
Organization / Practice
Email
Bruce MacHaffie
Pediatric Associates of Colorado Springs
[email protected]
Cecile Fraley
Pediatric Partners of the Southwest
[email protected]
Charyl LeBlanc
Arvada Pediatric Associates South
[email protected]
Chip Southern
Greenwood Pediatrics Southeast
[email protected]
Denise Hall
Advanced Pediatric Associates
[email protected]
Ellen Brooks
Pediatric Partners Glenwood
[email protected]
Gerri Morris
Children’s Medical Center
[email protected]
Jim Doody
Horizon Pediatrics Thornton
[email protected]
Karen Leamer
Rocky Mountain Youth Denver
[email protected]
Larry Mortenson
Fort Collins Youth Clinic South
[email protected]
Mac McMullen
Rocky Mountain Family Physicians
[email protected]
Mary Morin
Denver West Pediatrics
[email protected]
Patrice Whistler
Western Colorado Pediatric Associates
[email protected]
Tom Wiard
The Pediatric Associates Montrose
[email protected]
Wendy Foster
Office of Dr Marc Sindler
[email protected]
Kevin Heckman
CCHAP
[email protected]
Anita Rich
CCHAP
[email protected]
Steve Poole
MaryAnn Whiteside, Legal
Counsel
Erlinda DeLuna
CCHAP
[email protected]
CCHAP
[email protected]
CCHAP
[email protected]
Joy Carter
CCHAP
[email protected]
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 3
Chapter 3 : ELIGIBILITY AND ENROLLMENT FOR
MEDICAID AND CHILD HEALTH PLAN PLUS
CCHAP Resource Team
Erlinda DeLuna
[email protected]
720-777-6336 Direct Line
720-777-6363 Main Line
720-777-7338 Fax
Lorena Counts
[email protected]
720-777-6334 Direct Line
720-777-6363 Main Line
720-777-7338 Fax
BACKGROUND
Approximately 400,000 of Colorado’s children (roughly 1/3) are low income and/or uninsured.
Of this number, only 250,000 are actually enrolled in Medicaid or Child Health Plan Plus
(CHP+). Of the 150,000 uninsured children, about 100,000 are eligible for Medicaid or CHP+,
but are not enrolled. A recent newsletter from CHP+ states that only 43% of the eligible
children in Boulder and Arapahoe Counties are enrolled in CHP+. Many families in the metro
area are eligible for either Medicaid or CHP+, but their children are not enrolled.
Unfortunately, children on Medicaid or CHP+ may become dis-enrolled from the programs for a
variety of reasons. The process of re-enrollment (or re-determination) can be frustrating and
time-consuming, and is a frequent reason cited by practices who have not wanted to
participate with Medicaid or CHP+.
CCHAP helps with eligibility, enrollment and re-determination in the following ways:
1) This simplified overview and explanation of the processes;
2) Helpful contact numbers for who to call when there are problems;
3) Direct assistance for families who are having problems with the application process,
particularly with re-enrollment or re-determination;
4) Special training for office staff provided by CCHAP on how to handle problems with
these complications. Contact the CCHAP Resource Team to set up training.
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Chapter 3
ELIGIBILITY AND ENROLLMENT FOR MEDICAID & CHP+
Who is eligible?
Medicaid covers young children in families with a net income of zero to 133% of the Federal
Poverty Level (FPL), and also covers older children in families with income up to 100% of the
FPL. CHP+ covers children in families with incomes from the Medicaid level up to 250% of the
FPL. There are specific programs within Medicaid that have different income levels. The
decisions about eligibility are complicated and are made by the Colorado Benefits
Management System (CBMS) computer system. The CBMS system also determines eligibility
for other programs like TANF (financial assistance), food stamps, and CCAP child care
assistance.
We recommend you have at least one staff member trained in the processes involved in the
Medicaid and CHP+ application, enrollment and verification. Key resources and people who
can assist you and your practice are listed in this chapter. The CCHAP Resource Team (page
3-1) can answer any questions, help resolve problems, or supplement your training that was
provided by CHP+ and Medicaid.
Application Process for Medicaid and CHP+
The Colorado State Department of Health Care Policy and Financing (HCPF) oversees all of
the Medicaid programs and CHP+.
MAXIMUS is a private company contracted by the Colorado Department of Health Care Policy
and Finance (HCPF) to determine eligibility and to enroll patients for Medicaid and CHP+.
MAXIMUS processes one application form for both Medicaid and CHP+, so it is not necessary
to know for which program the child or family will qualify.
If a patient is uninsured and has not applied for assistance, please give the parent an
application and ask them to fill it out completely. An order form for application packets is
included in this chapter. There is no charge for forms for medical offices.
Families can send their applications to MAXIMUS, or apply through their county department of
social services. Our experience has shown that applications are processed through MAXIMUS
quicker, and tracking the application and problem resolution is simplified through MAXIMUS.
Please make sure your applicants write in “Colorado Access” on page 10 of the application
forms in case they are eligible for CHP+. (See the section on CHP+.)
The information on the application is entered into CBMS, which is the database system that
houses information for all healthcare programs (and also other entitlement programs like
financial assistance and food stamps) and determines program eligibility.
The enrollment process at MAXIMUS is as follows:
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1. Parent completes an application and mails it to MAXIMUS. The application should include
the documents requested to show proof of income and proof of citizenship or legal
immigration status and identity. A hand-out to help parents is included at the end of this
section in this chapter.
2. The application is received/date-stamped in the MAXIMUS mail-room. The application
information is entered into CBMS.
3. When the application is approved, a letter is sent to the family. The letter heading is from
the State of Colorado for both Medicaid eligible and CHP+ eligible participants. This letter
will give the family their technician’s contact information.
4. If the patient is CHP+ eligible, the application goes to an enrollment technician at
MAXIMUS. If they are Medicaid eligible, the application goes to the county where the
patient resides.
5. If the patient is approved for CHP+, a letter will be sent to the family. The family may also
receive a bill if they fall within the guidelines for a one-time yearly fee. The fee is $25.00 for
one child and $35.00 for more than one. The fee should be mailed to: CHP+ Enrollment
Fee, P.O. Box 17548, Denver, CO 80217. This fee is to be paid within 30 days or the
application will be denied.
6. If the application is denied, a letter is sent explaining the denial. If the family disagrees with
the decision they can appeal it.
7. If the application is incomplete, a letter is sent explaining what is missing and the parent
has 14 days to provide it (if the parent does not provide the information within 14 days, the
application is denied). If it is completed and returned within 14 days, it goes through the
eligibility process described above.
8. MAXIMUS will send separate requests for missing information. The first letter will request
income verification. Once the income verification is received, MAXIMUS will determine
which, if any, citizenship and identification documents are needed and hold it again for
those documents.
Encourage your families to make sure the application form is completed and all
necessary documents included to speed up the process. A document maybe held up twice if
MAXIMUS is waiting on supporting documentation. An information sheet and instructions for
your families about speeding the application process and the Affidavit to Establish Identity are
included in the next few pages.
According to HCPF policy, Medicaid applications are to be processed and an eligibility
determination made within 45 days of the application date. However, this may not always
happen, due to the number of applications a county receives. If a patient applied for Medicaid
through their county social services originally, they should contact that county (numbers at
listed at the end of this chapter). If the application was originally sent to MAXIMUS, questions
regarding the application should be directed to MAXIMUS/CHP+ at
1-800-359-1991. For additional help, contact the CCHAP Resource Team (page 3-1).
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Information to help a parent or guardian navigate and speed the application process:
1. Have or know the social security numbers of all your children you are applying for.
2. Parent’s/Guardian have a picture ID, or driver’s license.
3. Have an original birth certificate for your child/children that you are applying for.
Take this with you to the site where you get assistance with the application process.
4. Make copies of your last check stubs for the month that you are applying in as well as
the previous month. If you do not have all of these check stubs for the month, make a
copy of your most recent pay stub. If you are unemployed you will need a ledger copy of
you most recent taxes. If you do not get a pay stub, you can have your employer write
you a letter to show proof of your gross income.
5. Have an affidavit filled out and an identity/citizenship form to take with you to the site
where you get assistance with the application process. On the new application this is
done by filling out the “Affidavit to Establish Identity” at the bottom of pages 5-7.
6. Please include these copies with your application. You can also take the application
directly to your County Department of Social Services. Or take this application to the
accredited site for help with this application. At the accredited site, you may be able to
get a PE (presumptive eligibility) card which is a temporary card of coverage that same
day. The representative at this site will let you know if you qualify for this card. Or you
can mail your completed application to the address below, this could take up to 30-45
days for processing.
7. If you have any questions and need help with your application, you can call
1-800-359-1991, Monday – Friday 8 AM – 6 PM.
Please mail your application to:
CHP+/ MAXIMUS Medicaid
P.O. Box 929
Denver, CO. 80201
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AFFIDAVIT TO ESTABLISH IDENTIY
This form can be used by a parent or guardian to establish the identity of a child under the age
of 16. This form should only be used if none of the documents listed in Chart 5 of the
Documents Establishing US Citizenship and Identity document are available. It cannot be used
if an affidavit was used to establish the child’s citizenship, as described in Chart 4.
Instructions:
Complete the numbered blanks as follows:
1) Name of the parent or guardian.
2) Relationship of the individual to the child. The individual signing the affidavit must be a
parent or guardian.
3) Child’s full name.
4) Child’s full name.
5) Child’s date of birth.
6) Child’s place of birth.
7) Date of signature.
8) Name of the parent or guardian.
9) Signature of the parent or guardian.
AFFIDAVIT TO ESTABLISH IDENTITY
I, ______________________________(1), ______________________________(2) of
Name of Parent or Guardian
Relationship (Parent or Guardian)
______________________________ (3) state under the penalty of perjury that I have
Child’s Full Name
personal knowledge that ______________________________ (4) was born on
Child’s Full Name
____________________ (5) in ______________________________ (6).
Child’s Date of Birth
Child’s Place of Birth (city, state, country)
I affirm and declare that the facts stated in this Affidavit are true and correct.
Signed on ____________________(7) by ______________________________(8)
Date of Signature
Name of Parent or Guardian
______________________________(9)
Signature of Parent or Guardian
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Chapter 3
COLORADO MEDICAID
If the child has been placed into the Medicaid program, their case will be forwarded to the
County Department of Social Services in the county where they live. A list of the county
contact phone numbers is available on the EPSDT Toolkit website.
The term EPSDT refers to the benefits that children are entitled to under the Medicaid
program. These are listed on the EPSDT website. This website is loaded with helpful
information, forms, etc: http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1218622604254
What is an EPSDT Coordinator?
A Healthy Communities Outreach and Case Management Coordinator is a person that can
help the client navigate the Medicaid system as well as non Medicaid community systems.
See this link for a complete list of Healthy Community contacts:
http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobk
ey=id&blobtable=MungoBlobs&blobwhere=1251656456506&ssbinary=true
Eligible Needy Newborns
Eligible Needy Newborns is the Medicaid program which applies to children ages 0 to 1. If the
child’s mother is on Medicaid at the time the baby is born, the baby is automatically eligible. A
new application is not required; however, the birth does need to be reported to the County
Department of Social Services to have the baby added to the mother’s case. Anyone, including
the healthcare provider’s office, can report the birth to the County Department of Social
Services.
Add-a-Baby Form
Medicaid has made it possible for you to now report needy newborns directly to the
Department to be added to open Medicaid cases. Please remember that Needy Newborns are
those children born to mothers who were on an open Medicaid case at the time of the
delivery. This process cannot be used to add other children to a case or to open a closed
Medicaid case. Medicaid will add newborns to open cases, returning the state ID number to
the provider or reporting entity as well as the parent.
There are several options available to report a needy newborn. These are described on the
next page. You will see that most of the information is the same information you reported in the
past. FOR EMERGENT ADD-A-BABY REQUESTS: Note in large words when faxing or
emailing the Add a Baby to Shawna Moreno “EMERGENT REQUEST” and note the reason for
the urgency. Also we recommend you call or email Shawna Moreno to let her know you have
sent an urgent request. You may call her at 303-866-4456, and or email her at
[email protected]. Tracy Vallejo (303) 866-6103 can also assist with Emergent
Add-A-Baby’s.
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Add-A-Baby Requests
Medicaid and Child Health Plan Plus (CHP+) offer mandatory coverage for babies born to
Medicaid or CHP+ Prenatal-eligible mothers. These newborns are guaranteed eligibility
from birth through their first birthday. A Needy Newborn is a baby born to a mother who was
Medicaid eligible at the time of birth. The baby is automatically eligible for Medicaid through the
end of the month of the baby’s first birthday. A CHP+ Newborn is a baby born to a mother who
was CHP+ Prenatal Program. These babies are automatically eligible for CHP+ through the
end of the month of the baby’s first birthday. All other babies must be added through the
regular application process. HCPF gives providers a means to report the birth of a baby in
order to obtain a Medicaid ID number for billing.
Providers can submit the Add-A-Baby form in three different ways:
1) An online form is available at www.colorado.gov/hcpf > Clients & Applicants > Click
on Report the birth of a Medicaid or CHP+ baby online. Click here to go directly to the online
form. THIS IS THE BEST OPTION!
2) An email submission can be sent by completing the Add-A-Baby Form (Fill-in)
located at: www.colorado.gov/hcpf > Providers > Provider Services > Forms > Other Forms.
Email this form as an attachment to [email protected]. The email must be
encrypted for security purposes, please follow the instructions below:
How to encrypt the Add-A-Baby form:
a. In Microsoft Word, select the Tools option from the menu bar or
b. Select Options… from the drop down menu
c. Click on the Security tab and enter “hcpf” in the Password to open: field
located in the File encryption options for this document section
d. Click OK
e. NOTE: In the newer version of Word click the round “Office Button” in the
upper left corner and select “Prepare” > “Encrypt Document” > enter password
“hcpf”.
3) Submit the completed form by fax to HCPF at 303-866-2082, Attention: Shawna
Moreno or mail the completed form to Health Care Policy and Financing, 1570 Grant Street,
Denver CO, 80203, Attn: Shawna Moreno. The standardized Add-A-Baby Form (Print and
Fax/Mail) is available under “Other Forms” in the Provider Services Forms section and as
Attachment A of this bulletin. THIS IS THE LEAST DESIRABLE METHOD – FAXES ARE
NOW DISCOURAGED AS THEY MAY GET LOST!
Please note that HCPF will only accept the official form for Add-A-Baby requests.
We ask that providers do not alter the form in any way, since all of the information on the form
is needed to process the requests.
Please contact Shawna Moreno [email protected]. or Tracy Valdez
[email protected] or call 303-866-4456 if you have any questions.
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Chapter 3
Add-A-Baby Request Form 01.06.2011
Instructions: Please print legibly. If we are unable to read the information, it will be returned.
Fax this form to the Department of Health Care Policy and Financing, Attn: Shawna Moreno at 303-866-2082. Or
you can mail the form to: Health Care Policy and Financing, 1570 Grant Street, Denver CO 80203, Attn: Shawna
Moreno. Your request will be processed within 2-3 days.
NOTE: All forms missing the required information will be sent back to the requestor which will cause a delay in
this request. If you have any questions, please contact Shawna at 303-866-4456.
Please return form to:
Today’s Date:
Name:
Practice Name:
Phone:
Fax:
Information about Mother of Child: [REQUIRED INFORMATION]
Case Number:
State ID:
Social Security Number:
Date of Birth:
Last Name:
First Name:
Address:
Phone:
County of Residence:
Information about the Baby: [REQUIRED INFORMATION]
NOTE: Baby’s information must be the same as it appears on the birth certificate.
Name (first, middle, last):
Date of Birth:
Gender (circle one):
Male
Female
Gender (circle one):
Male
Female
Name (first, middle, last):
Date of Birth:
Child’s Doctor or HMO:
Report taken by:
Medicaid Tech and Date Reported to DHS office:
EPSDT Children’s Medicaid Navigator:
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Chapter 3
Duration of Eligibility
A Medicaid patient’s eligibility will undergo re-determination 1) annually, 2) if they move to
another county, or 3) anytime they submit an application for other services through the CBMS
system (for example, if they apply for food stamps or WIC).
Encourage your patients to pay close attention to the mail they receive from the State of
Colorado and bring the letters to you if they have difficulty understanding what they need to do.
We encourage you to call our resource coordinators if you have trouble understanding what is
being asked of the family. You may be surprised how difficult some of these written
communications are to understand.
Medicaid Accountable Care Collaborative (ACC)
The ACC is Colorado Medicaid’s new initiative to provide more cost effective and quality care.
During the initial phase of the ACC, there will be two main changes for patients and practices.
First, they will both be supported by Regional Care Collaborative Organizations (RCCO) who
can provide care coordination and other support. Second, patients will have to seek referrals
from their primary care medical provider (PCMP) for specialty care.
Health Care Policy and Financing will enroll patients in each of the seven (7) RCCO regions.
The Medicaid members will be assigned to the ACC and a particular ACC contracted PCMP.
Patients will be notified via a mailed letter (English version); (Spanish version). These patients
will be enrolled in the ACC and assigned to a primary care provider (if possible) and the RCCO
that covers the county where the patient lives. Patients will be notified thirty days before they
are enrolled in the ACC and given the option to opt out and choose another health plan (i.e.,
regular fee for service, Kaiser HMO, Denver Health HMO). Patients will also have the option to
select a different PCMP. The patient must call Health Colorado to make any changes! Nonparticipation in the ACC will not affect the patient’s Medicaid eligibility or Medicaid services.
DENVER COUNTY PASSIVE ENROLLMENT POLICY AND GUIDELINES
Passive Enrollment is a process whereby Medicaid recipients are systematically enrolled in a
Medicaid Health Plan if they do not respond to a letter from HealthColorado (Medicaid’s
enrollment service) that asks them for their Health Plan selection. So, patients who are under
the care of a private practice physician could get passively enrolled in the Denver Health
Medicaid Choice Plan which would require them to be seen only by a Denver Health provider,
with some exceptions (see below).
Private practices will be given an authorization (and receive payment) to see a patient that has
been enrolled in the Denver Health Medicaid Choice Plan, without hassle, within the 1st 90
days of enrollment under these conditions:
1.
2.
3.
4.
A Special Health Care Needs child
Acute care and follow-up visits
A child needing a well visit and/or immunizations
Visits for a child whose parents have previously contacted HealthColorado to have the
child moved to the Regular Medicaid plan within the 1st 90 days of enrollment
5. Pregnant Medicaid women who are under the care of a private practice family physician
for prenatal care
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Chapter 3
Denver Health has agreed to review and process all unpaid claims for Medicaid children that
have been seen in the private practice with an authorization. These claims should be sent to:
R.J. Aguilar
Director, HMO Contracting
[email protected]
720-956-2336
Beyond the 1st 90 day enrollment period, several options are available:
1. The parent or patient may contact Diane Stayton at [email protected] or 303866-2385 to request an exception to have the child or pregnant woman moved to
Regular Medicaid enrollment status.
2. Up to one year post-enrollment in the Denver Health Medicaid Choice Plan, the parent
may call HealthColorado and tell them:
• “I didn’t get the letter” or
• “I didn’t understand the letter”
HealthColorado will then switch them back to Regular Medicaid enrollment status.
HealthColorado Contact info:
http://www.healthcolorado.net/
303-839-2120
1-888-367-6557
If you are having trouble getting an authorization, please call or email the CCHAP Resource
Team (page 3-1) they will try to work with (DH) to get you an authorization.
Denver Health Prior Authorizations
Denver Health Authorization Line: 303-602-2140
Denver Health Medicaid Choice claims should be sent to:
P.O. Box 262249, Plano TX 75026
When you check eligibility and find one of your patients has been enrolled into Denver Health,
you will need to call the Denver Health Referral Center to attempt get a pre-authorization prior
to seeing the patient. If the child needs medications and is enrolled in Denver Health, call DH
Pharmacy (Ashley) at 303-602-2072 and she will determine if an authorization can be given to
the child for medications needed.
Please notify the CCHAP Resource Team (page 3-1) when you experience an issue related
to Denver Health and problems getting an authorization. We need specific names, dates, etc
for whom you spoke at Denver Health.
You may also provide us with a list of your Medicaid patients including Name, DOB, and
Medicaid State IDs on at least a monthly basis. This data will be communicated to Maximus
and will help prevent your patients from being pulled out of their Medical Home and enrolled in
Denver Health HMO. Contact kevin.heckman@childrenscolorado for more detail.
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Chapter 3
CHILD HEALTH PLAN PLUS (CHP+)
Children whose household income level falls between Medicaid eligibility and 250% of Federal
Poverty level (FPL) are eligible for the Child Health Plan Plus (CHP+) program. All family
members who are participating in CHP+ are required to be enrolled with an HMO provider after
the first 60 days. Children who are less than 60 days in the state provider network are
considered in the “pre-HMO period”, and will be assigned to Colorado Access to complete their
first 60 days of enrollment. If you experience any problems with the application or pre-HMOenrollment period billing, please contact MAXIMUS CHP+ Customer Service 1-800-359-1991.
Colorado Access CHP+
CHP+ requires that participating children be enrolled in an HMO after the 60 day pre-HMO
period. Colorado Access is a non-profit HMO provider for CHP+ that works with the Colorado
Children’s Healthcare Access Program (CCHAP) in the counties surrounding Denver. In the
Denver Metro counties, families can choose between Denver Health Authority, Kaiser and
Colorado Access. The only HMO working with private practices is Colorado Access. If an HMO
is not selected by the parent on the CHP+ application, their application may enter a “pended”
(held up) stage or be transferred to Denver Health.
Make sure your families choose Colorado Access as their HMO on Page 10 of the
enrollment application. If a parent comes to you with the letter that they have received from
the CHP+ program that is requesting them to choose an HMO, please help them with this
decision. An HMO Enrollment Form is included later in this chapter. This form needs to be
filled out for any patient who is still in the Colorado Access State Provider Network, and faxed
to CHP+ with a parents signature. This process will help ensure the patient and their family will
remain in your practice after the initial pre-HMO period ends.
Please refer to your Provider Manual from Colorado Access for further information. If you have
questions or problems concerning Colorado Access enrollment, call Colorado Access
Customer Service at 1-800-511-5010.*
CHP+ Newborns
The child’s birth should be reported to MAXIMUS at 1-800-359-1991, so it can be determined if
the child is eligible for Medicaid. The “Add a Member to CHP+” form in this chapter can be
used to add a newborn to CHP+. If the baby’s mother is a teenager on Colorado Access CHP+
she may call the Colorado Access Customer Service Line. The baby will be added more
quickly to CHP+, and Colorado Access will report the information to MAXIMUS for the mother.
Duration of eligibility
CHP+ patients are eligible for 12 months. If family finances decrease making them eligible for
Medicaid during the year, they should let their county technician or CHP+ customer service
know.
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Chapter 3
REQUEST TO ADD A MEMBER TO CHP+
Please complete one form for each member to be added to the household.
Please note: This is not a guarantee that this member will be added. CHP+ will still screen for
Medicaid eligibility and for all other eligibility requirements before adding him/her.
HOUSEHOLD INFORMATION (REQUIRED):
Head of Household’s Name:
Date of Birth:
Street Address:
City, State, and Zip Code:
Phone Number:
County:
PCP:
HMO:
MEMBER(S) TO BE ADDED:
Name (as it appears on the birth certificate):
Date of Birth:
Gender:
Social Security Number:
US Citizen (Y or N):
State ID (if available):
Does either parent of the child (or spouse if adding a pregnant adult) work more than 20 hours a
week for a Colorado State Government agency and have access to State health benefits?
YES
NO
Is this member currently covered by health insurance?
YES
NO
YES
NO
If yes, please provide the following information:
 Policyholder’s name
 Policy Number/Group Number
 Name of Insurance Company
 Policy Type
 Address and Phone of Insurance Company
Has this member had health insurance through an employer’s group policy in the last three months?
If yes, please provide the following information:
 When did insurance end?
 Amount family paid each month
 Amount employer paid each month
 Did insurance end because employment ended/the employer cancelled health insurance benefit?
What is the relationship of this member to all current members of the household?
THIS FORM IS BEING FAXED TO CHP+ FROM:
NAME:
DATE:
SITE:
PHONE:
Fax completed form to (303) 893-1780.
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Chapter 3
Helpful Contact Information
Please try the Customer Service numbers first, and use the direct contact numbers if those
lines are not helpful. If your issue or problem is still not resolved, please ask the Resource
Coordinator at CCHAP to assist - 720-777-6334.
MEDICAID
Customer Service
303-866-3513
Health Colorado – clients need to call this number
to choose a health plan
303-839-2120
1-888-367-6557
To check eligibility
www.chcpf.state.co.us
Fax Back 1-800-493-0920
1-800-237-0757 #1
Ann Clemens, HCPF
Medicaid Policy Specialist
303-866-6115
[email protected]
Outreach Coordinators
303-866-6010
Problems with eligibility – CBMS system
EPSDT – the Medicaid for children program
Newborn enrollment in Medicaid
Benefit questions
EPSDT website
http://www.colorado.gov/cs/Satellite/
HCPF/HCPF/1218622604254
CHILD HEALTH PLAN PLUS
Website for CHP+ clients
www.cchp.org
Website for Providers
www.chpplusproviders.com
MAXIMUS-CHP+ Customer Service
1-800-359-1991
Colorado Access Customer Service
1-800-551-5010
www.coaccess.com
303-751-9051
Colorado Access Provider Services
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Chapter 4
Chapter 4 : REIMBURSEMENT
BACKGROUND AND SUMMARY OF RESOURCE
In 2005, reimbursement from Medicaid and CHP+ to private practices covered less than 2/3
of the actual cost for providing care. At that time, only twenty percent of pediatric practices
accepted Medicaid or CHP+ patients. Eighty-five percent of Colorado pediatricians indicated
they would accept more of these children if reimbursement was closer to the actual cost of
providing care, and if the other supports provided by CCHAP were available.
In response, CCHAP has worked with HCPF and primary care practices to develop methods
to enhance reimbursement for providers:
1) Increased Medicaid reimbursement for CCHAP practices through the Colorado
Medical Home for Children Program.
2) Sharing more effective methods of billing and collecting from Medicaid.
In addition to the information in this chapter, the CCHAP email newsletter contains
tips on coding and billing from CCHAP practices. If have a tip that you would like to
share, please send it to: [email protected] or
[email protected]
3) The best list of contacts to help solve claims processing problems.
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Chapter 4
MAXIMIZING MEDICAID REIMBURSEMENT
CCHAP has worked very closely with Colorado Medicaid and with over 200 primary care
practices to determine ways of improving reimbursement for primary care practices for the
care they provide children on Medicaid. CCHAP has worked with Colorado Medicaid over
the past four years to develop a process that rewards primary care practices that are willing
to provide a good medical home for children covered by Medicaid. A recent study done by
the University of Denver, Daniels College of Business shows an average 28% profit margin is
obtainable by filling an open appointment slot with a Medicaid patient. So, if scheduling
capacity exists, seeing a Medicaid child will result in increased revenue for the practice.
This article describes how to maximize reimbursement from Medicaid in ways that Colorado
Medicaid approves and many practices regularly use. This chapter also provides a best list
of contacts to help solve claims processing problems and describes when and how to
effectively use the prior authorization process.
HIGHER REIMBURSEMENT
The higher reimbursement is available on Well Child Visit codes and Preventive Care and
Screening codes for practices that have obtained Certification as a Colorado Medical Home
for Children.
Higher Reimbursement for Well Child Visit Codes
Higher reimbursement from Colorado Medicaid is available for practices that are willing to
serve as a medical home for children on Medicaid and qualify by:
• Being an enrolled Medicaid provider with a Medicaid number
• Using Vaccines for Children
• Go through the two step process of Certification as a Colorado Medical Home for
Children:
o The practice completes and reviews a practice self-assessment survey, The
Medical Home Index (MHI). This survey can be scheduled with Family Voices
(they will contact you soon if they haven’t already)
o The practice chooses and begins a quality improvement project to make an
improvement in some aspect of being a medical home. CCHAP provides free
of charge a Quality Improvement Coach, Angie Goodger, who will contact your
practice after you complete the MHI. She can help you decide what you want to
do as a QI project and help you at every step of the way.
Practices willing to meet these expectations receive reimbursement that is higher for well
child codes than other practices receive. For practices willing to obtain Certification as a
Colorado Medical Home for Children receive the following additional reimbursement for the
following well child visit codes:
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Code
Service
Medicaid
Payment as
of 7/1/2011
Preventative Medicine Services
99381
New patient, under 1 year
99382
New patient, 1 - 4 years
99383
New patient, 5-11 years
99384
New patient, 12-17 years
99385
New patient, 18-39 years
99391
Established patient, < 1 year
99392
Established patient, 1-4 years
99393
Established patient, 5-11 years
99394
Established patient, 12-17 years
99395
Estab. patient, 18 up to19 years
99460/99461 Newborn Care
Additional
Medical
Home
Incentive
$77.10
$83.35
$82.03
$89.24
$89.24
$66.06
$73.99
$68.23
$74.80
$75.47
$55.21/70.00
$10
$10
$40
$40
$40
$10
$10
$40
$40
$40
$10
Total
$87.10
$93.35
$122.03
$129.24
$129.24
$76.06
$83.99
$108.23
$114.80
$115.47
$65.21/80.00
CCHAP can help your practice go through the process if you have not already
Higher Reimbursement for Screening and Prevention Codes
In addition, Colorado Medicaid pays primary care practices for: (1) developmental screening
at well child visits up to through the age of five years; (2) preventive dental counseling and
application of fluoride varnish to the teeth of children up to four years of age; (3)
administering the MCHAT screening questionnaire to identify children at risk for autism; and
(4) depression screening for adolescents from 12 to 18 years old.
Acute Care Visit Reimbursement
Colorado Medicaid pays roughly 85% of Medicare rates (RBRVS) for acute visit codes.
Under Federal Health Care reform, this reimbursement should go up to 100% Medicare
(RBRVS) in 2014. The State has tried to protect this reimbursement during three budget
reductions in the past two years. So, they are making an effort to be supportive.
CODING AND BILLING FOR WELL CHILD VISITS
WELL CHILD VISIT CODES
Once you are certified as a Colorado Medicaid Home for Children (above) you will
automatically receive the higher reimbursement shown on the table above, simply by coding
the age-appropriate visit code.
IMMUNIZATIONS:
Vaccine for Children is free to the practice to administer to children on Medicaid (details on
obtaining VFC are at: http://www.cdphe.state.co.us/dc/immunization/vfc.html
Colorado Medicaid will pay you for administering each injection:
90471 admin of initial injection $6.33 (most common code but others may be used)
90472 admin of each subsequent injection $6.33 (most common code; others may
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Chapter 4
be used)
You must bill for both the vaccine code ($0.00) and the administration code (at least $6.33)
for each vaccine administered.
New “immunization administration with counseling” codes were introduced in 2011.
These are billed to Medicaid using a different methodology as follows:
Code 90460 is set up in the system with 6 units allowed per date of service and a rate of
$6.33. Code 90461 is set up in the system with 15 units allowed per date of service and a
rate of $0.00. These unit updates were loaded in the system on 2/23/11, and the fiscal agent
reprocessed all claims submitted from 1/1/11 through 2/22/11 for codes 90460 and 90461 so
the unit updates would apply to all claims submitted before the updates were in place.
Providers SHOULD submit claims for multiple units using one detail claim for 90460 (with 1-6
units billed) and one claim line for 90461 (with 1-15 units billed) along with the appropriate
vaccine codes. I'll use MMR and DTaP as an example:
Line 1 -- 90460, 2 units (administration of 1st component of MMR & 1st component of DTaP)
Line 2 -- 90461, 4 units (administration of 2nd & 3rd components of MMR & 2nd & 3rd
components of DTaP) Line 3 -- 90707, 1 unit (MMR vaccine) Line 4 -- 90700, 1 unit (DTaP
vaccine)
Line 1 will pay at $6.33 times 2 units ($12.66). Line 2 will pay at $0.00 times 4 units (there is
no extra payment for administration of additional components of a combo vaccine.) Lines 3
and 4 will pay at $0.00 times 1 unit each (there is no extra payment for vaccines available
through VFC). So the total reimbursement for these services will be $12.66.
Providers SHOULD NOT bill multiple units on separate claim lines. Example:
Line 1 -- 90460, 1 unit
Line 2 -- 90460, 1 unit
Line 3 -- 90461, 1 unit
Line 4 -- 90461, 1 unit
Line 5 -- 90461, 1 unit
Line 6 -- 90461, 1 unit
In this example, lines 2 and 4-6 will deny for a "duplicate claim" edit.
We hope these examples will help clarify the billing information provided in the 2011
immunization provider bulletin. If providers did submit claims for multiple units on separate
lines (like the 2nd example above), the claims can't be reprocessed systematically because
the same "duplicate claim" edits will just set again. Providers can contact ACS at 303-5340146 for instructions on how to reverse the original claim and then resubmit with the multiple
units on one line.
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Note: Providers are not to bill CPT codes 90471-90474 for children aged 0-18 for whom
counseling was given. CPT Codes 90471-90474 must only be billed for adults (aged 19 and
over) or children aged 0-18 for whom no counseling was given.
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Chapter 4
DEVELOPMENTAL SCREENING: (Please also refer to Chapter 11 for more details)
If your practice administers a standardized developmental screening test accepted by
Colorado Medicaid. These are available here:
http://www.colorado.gov/cs/Satellite?c=Page&cid=1218622605039&pagename=HCPF%2FH
CPFLayout
The Colorado Medical Assistance Program covers developmental screening for children ages
0 – 4, using a standardized, validated developmental screening tool (e.g., PEDS, Ages and
Stages) at the child’s periodic visits. In the absence of established risk factors or parental or
provider concerns, the American Academy of Pediatrics (AAP) recommends developmental
screens at the 9th, 18th, and 30th month, and 3 and 4 year well-child visit.
Limitations:
Three (3) screens per year for children aged 0 – 24 months
Two (2) screens per year for children aged 25 – 59 months
Providers should report CPT code 96110, “Developmental testing; limited (e.g.,
Developmental Screening Test II, Early Language Milestone Screen), with
interpretation and report,” when providing developmental screens.
To report a positive screen:
Use a valid diagnosis code within category 315, “Specific Delays in
Development,” category 313, “Disturbance of Emotions Specific to Childhood and
Adolescence,” category 314, “Hyperkinetic Syndrome of Childhood,” for specific delays
in mental development.
Use a valid diagnosis code within category 783 (using 4th and 5th digits when
needed), “Symptoms Concerning Nutrition, Metabolism, and Development,” for
physiological delays.
To report a negative screen:
Use code V20.2, “Routine Infant or Child Health Check.”
Providers should report CPT code 96111, “Developmental testing; extended (includes
assessment of motor, language, social, adaptive, and/or cognitive functioning by
standardized developmental instrument) with interpretation and report,” when a limited
developmental screening suggests an abnormality in a particular area of development
and more extensive formal testing is needed to evaluate the concern.
The Medicaid reimbursement is $17.00 effective 8/1/2011.
The ABCD program through the Colorado Department of Health and Environment will help
your practice select a standardized developmental screening tool, train your staff, help you
build it into your office flow and coach providers and staff in how to use and interpret it, all for
free. The cost to purchase the materials for the most frequently used screening tool is
approximately $250. So, it pays for itself after using it on 7 children.
For free assistance in getting through the entire process, contact: Eileen Bennett (720-3331351 or [email protected] ). See Chapter 11 in the CCHAP Orientation Manual for more
information
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Chapter 4
AUTISM SCREENING
The Modified Checklist for Autism in Toddlers (M-CHAT™; Robins, Fein, & Barton, 1999) is
recommended as the screening tool. For more information:
http://www2.gsu.edu/~psydlr/Diana_L._Robins,_Ph.D..html
Bill using CPT code 96110 autism screening.
The Medicaid reimbursement is $17.00 effective 8/1/2011.
(requires documentation of the administration of the MCHAT in your chart)
The MCHAT is free and available for downloading at the above web site.
Colorado Medicaid covers autism screening for children aged 18- and 24-months, using a
standardized, validated depression screening tool (i.e., M-CHAT) at the child’s periodic visits.
Limitations:
Two (2) screens per year for children aged 18 – 24 months
Providers should report CPT code 96110, “Developmental testing; limited (i.e.,
Developmental Screening Test II, Early Language Milestone Screen), with
interpretation and report,” when providing autism screens.
• To report a positive screen:
Use a valid diagnosis code within category 299 (using 4th and 5th digits when
needed), “Pervasive Developmental Disorders.”
• To report a negative screen:
Use code V20.2, “Routine Infant or Child Health Check.”
ADOLESCENT DEPRESSION SCREENING
The recommended screening tool is the PHQ 9 Modified, although you can use other
standardized screening tools. To learn more:
http://www.teenscreen.org/images/stories/PDF/PHQ-9_SQ_Kitreadonly.pdf
The PHQ 9– Modified is free and downloadable at the above web site
The Colorado Medical Assistance Program covers depression screening for adolescents
aged 11 – 20, using a standardized, validated depression screening tool (i.e., PHQ-9,
Columbia Depression Scale, Beck Depression Inventory, Kutcher Adolescent Depression
Scale, etc.) at the child’s periodic visits.
Limitations:
• One (1) screen per year for adolescents aged 11 – 20 years
Post-Partum Depression Screening: providers may choose to screen adolescent
clients for post-partum depression as part of the client’s annual depression screen.
However, post-partum depression screening is a non-covered benefit for Medicaid
clients aged 21 and over.
Providers should report CPT code 99420, “Administration and interpretation of health
risk assessment instrument (e.g., health hazard appraisal),” when providing
depression screens.
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To report a positive screen, use diagnosis code V40.9
To report a negative screen, use diagnosis code V79.8
Medicaid
Use CPT Code 99420; reimbursement is $10.08 (effective 8/1/2011)
CHP+
Use CPT Code 99420
.
EDINBURGH POSTNATAL DEPRESSION SCALE (EPDS)
This post partum depression screening questionnaire is well accepted as the easiest, most
efficient and effective standardized questionnaire for use in primary care. All providers are
encouraged to use it, but you have to bill it on the mother using a 96110. You cannot bill it on
the infant. This is good news for family physicians; not good news for the pediatricians.
You can find more information at:
http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf
You can download the questionnaire and scoring instructions for free at:
http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf
PREVENTIVE DENTAL COUNSELLING AND TREATMENT: (Please refer to Chapter 17
for more details)
Colorado Medicaid would like to encourage primary care practices to provide preventive
dental care for children from zero to 4 years. They will pay for two things: (1) a combination
of oral examination and counseling on dental hygiene and (2) application of fluoride varnish.
They will pay primary care providers for these twice a year from zero to four years.
Oral evaluation and dental screening
D0145 Oral evaluation and counseling
D0999 Dental screening
Application of Fluoride Varnish
D1206 topical fluoride varnish
$28.41 (age 0 – 2)
$14.85 (age 3 – 4)
$14.96 (ages 0- 4)
Our estimate of the expense of providing this service is: materials between $6 and $7; staff
time between $2 and $3. Total between $8 and $10.
Please refer to Chapter 17 Cavity Free at Three in this manual for detailed information.
VISION AND HEARING
Vision and Hearing: Hearing and vision screening is an expected part of a well child checkup
and bundled with the well visit code. So, if you bill for this service as a separate line item
on the same claim as the well visit, you will not be reimbursed. If you do these at a sick visit,
however, you will get reimbursed for them in addition to the E&M code. Strange but true.
SPECIAL NOTES
Understand that Medicaid pays whichever is least, between your charge and the allowable.
Check to make sure you are billing at the maximum allowable, or higher, for each code used.
We suggest you consider adding codes 96110 and 99420 to your super bill.
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The Federal Government requires Lead Screening for children covered by Medicaid between
1 and 2 years of age, even though the incidence in Colorado is so low. Most daycare
facilities and Head Start require verification that this has been done.
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EXAMPLE FOR CODING AND BILLING FOR WELL CHILD VISITS
A 4 month old Medicaid Well Child Visit with immunizations:
Medicaid rate:
Average commercial rate:
99391 well visit
$76.06
$101.61
90700 DTaP injection admin.
$0.00
$22.47 (reimb. minus cost)
90471 Imm Administration (x1)
$6.33
$24.28
90648 Hib injection
$0.00
$9.23 (reimb. minus cost)
90713 IPV injection
$0.00
$12.31 (reimb. minus cost)
90669 PCV injection
$0.00
$17.38 (reimb. minus cost)
90472 Imm Administration (x3)
$18.99
$36.35
90680 Rotovirus
$0.00
$20.02 (reimb. minus cost)
90473 Imm Oral Admin (x1)
$6.33
$15.74
96110 Developmental screening
$17.00
$13.25
D1206 fluoride varnish
$14.96
$0.00
D0145 oral evaluation
$28.41
$0.00
Total
$168.08
$272.64
NOTE: Because commercial immunization costs and reimbursement rates fluctuate a
great deal and are dependent on the particular pharmaceutical company, purchasing
volume pricing, prompt pay discounts, cost of initial purchase outlay and holding stock
in inventory, variable commercial insurance reimbursement rates, etc.; this chart
shows the comparisons without the immunizations factored in:
Medicaid rate:
Average commercial rate:
99391 well visit
$76.06
$101.61
96110 Developmental screening
$17.00
$13.25
D1206 fluoride varnish
$14.96
$0.00
$28.41
$0.00
D0145 oral evaluation
Total
$136.43
$114.86
…and, even if you leave out the dental reimbursement, the comparison is very
competitive…
$93.06
$114.86
ACUTE VISITS:
For acute care visits, bill as you do for commercial plans
New patient visits
99201
99202
99203
99204
99205
Medicaid rate:
$30.95
$53.12
$79.70
$118.48
$148.77
Established patient visits
99211
99212
99213
99214
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
$17.02
$31.95
$51.32
$77.10
4-10
Average commercial rate:
----$89.42
$118.33
$176.66
$214.65
$25.98
$47.62
$75.29
$114.54
Chapter 4
99215
$104.09
$146.44
MAXIMIZING REIMBURSEMENT FOR CARE
PROVIDED TO MEDICAID CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE
NEEDS (CYSHCN)
Bill as you would for other children, with this one exception. Colorado Medicaid will pay for
creating Individual Care Plan on an annual basis for children with multiple chronic conditions.
An Individual Care Plan is a standardized summary of the child’s pertinent health record that
the family greatly appreciates having available in times of need. It can help improve care,
expedite treatments, reduce errors and medico-legal risk, and improve communication.
Examples of use:
• they see any of the child’s specialists
• they go to an emergency department or urgent care center
• they are traveling
• the child is admitted to a hospital
• paramedics are called to the school
• an insurance company requests a case summary to authorize claims payment or
referral,
• a school requests health information.
The 4-page Universal Care Plan can be filled out in a visit with the parents, with or without
the patient present. A copy of the Universal Care Plan can be downloaded from our website
http://www.cchap.org/information-library/tools-to-help-in-the-care-of-special-needs-children/.
The CPT code 99215 can be billed for the time it takes to complete the document.
Individual Healthcare Plan 99215 = $104.09 (Note this is the code for a level 5 visit)
First visits for a CYSHCN 99204 = $118.48
On the initial appointment, you can bill a comprehensive exam and with adequate
documentation, you can bill at the moderate complexity rate.
Annual Health Maintenance Visit
As you know, CYSHCN and their parents often miss out on anticipatory guidance and
standard health maintenance issues because the provider is working with the patients
multiple ongoing conditions. Be sure to schedule an annual health maintenance visit with the
patient to discuss developmentally age-appropriate guidance. Reimbursement from Medicaid
is equal to that of commercial insurances for developmental assessment of a patient that is 05 with CSHCN.
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
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Chapter 4
MEDICAID REIMBURSEMENT FOR TREATING BEHAVIORAL PROBLEMS
IN YOUR PRACTICE
You can be reimbursed by Medicaid for counseling Medicaid parents and/or children for
mental health issues or behavioral problems, but only if it is coded and billed correctly.
As you know, for billing there are two types of codes:
1. Diagnosis Codes (ICD-9 codes)- which are divided into
a. Physical (medical) health diagnoses
b. Mental health diagnoses
2. Visit or Procedures Codes – CPT codes- which are divided into:
a. Medical visit codes
-Preventative care visits/procedures
-E and M codes for illness care visits
b. Mental health visit codes
-Counseling codes
-Psychotherapy codes
The points to remember for Medicaid mental health billing by primary care providers are:
1. Use the appropriate ICD-9 mental health diagnosis code
2. Use only physical health (medical) CPT visit codes, not mental health visit codes (NO
counseling codes)
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© 2006 Colorado Children’s Healthcare Access Program
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Chapter 4
CPT Coding for Behavioral Problems
Your Medicaid contract is for a physical health (medical) provider, not a mental health
provider. If you code your visit with a mental health or counseling visit you will be denied
payment. You can bill medical E and M code (i.e. 99213, 99214, and 99215) using the length
of the visit or the supporting elements of the visit. You must document either the length of
time (and that greater than 50% of the time was spent in counseling or care coordination) or
the key elements that make the diagnoses. This process also works for the way you would
bill commercial health plans. Counseling for this purpose is defined not as psychotherapy but
as:
“a discussion with a patient and/or family concerning one or more of the
following areas: diagnostic results, impressions, and/or recommended
diagnostic studies, prognosis, risk and benefits of management (treatment)
options, instruction for management and/or follow-up, importance of
compliance with chosen management, risk factor reduction, patient and
family education”.
The time elements for the actual amount of time counseling are as follows:
99212 = 10 minutes minimum
99213 = 15 minutes minimum
99214 = 25 minutes minimum
99215 = 40 minutes minimum
99201 = 10 minutes minimum
99202 = 20 minutes minimum
99203 = 30 minutes minimum
99204 = 45 minutes minimum
99205 = 60 minutes minimum
ICD-9 Codes
You can use the appropriate mental health diagnosis on the bill. If you cannot find an
appropriate diagnosis (like depression, anxiety, ADHD, etc.) use symptom diagnosis codes or
consider: behavioral disturbance NOS.
Examples:
Case 1: A mother brings in her autistic 5 year old for advice regarding how to manage the
behavioral problems and discipline. You spend 20 minutes giving her the requested advice.
Billing: CPT code 99214 based on documentation of appropriate elements. If you are only
giving advice (no exam), billing should be coded based solely on time, which would be a
99213.
ICD-9 coding: Use the mental health condition as the primary diagnosis (behavioral
disturbances NOS) and autism (299.00) as the secondary diagnosis for Medicaid.
Case 2: An 8 year old child is in for a health maintenance visit. Towards the end of the visit
the mother says that the child’s school wants him evaluated for ADHD. You spend an extra
15 minutes addressing the ADHD.
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
4-13
Chapter 4
Billing: CPT codes: There are two options: (1) bill as a 99215 if you include all elements in the
note. (2) bill both (a) 99393 for the health maintenance and (b) 99213 for the ADHD
evaluation. A representative from Medicaid has told us they will pay in this instance. For
commercial payors, you need to include the -25 modifier, but with Medicaid you do not.
ICD-9 codes: (1) V20.2 preventative care and (2) 314.0 for ADHD
Case 3: If a child comes in with an ear infection, but the conversation deviates to problems at
school and other behavior issues and the visit ends up taking 41 minutes, you would bill CPT
99213 (for the Otis media), and the prolonged physician service code 99354 for the additional
31 plus minutes spent talking about the behavioral problems. You need to document the
basics of what was discussed. The ICD-9 codes would be 382.00 and the behavioral codes.
This requires only one encounter and more than doubles reimbursement.
NOTE: 2011 CODING CHANGES
Several important coding changes will take effect starting in 2011. Some of these changes
include the following:
New Guidelines for Time
Definition of Time: Instructions have changed to include 1) clarification that when
counseling and/or coordination of care dominates the encounter, time will (not may)
be considered the key or controlling factor in the selection of a particular level of E/M,
and 2) when the actual time spent in the encounter is between 2 typical times, the
code with the typical time closest to the actual time is reported.
CPT Updates to Vaccine Codes
Updates occur twice a year in January and July due to emerging vaccines that are
released midyear or after the cutoff date for CPT code submissions for that year.
Updates can be found on the AMA Web site:
www.ama-assn.org/ama/pub/category/10902.html
New pediatric immunization administration codes for 2011:
Deleted
• 90465
• 90466
• 90467
• 90468
Replaced with
• 90460 Immunization administration through 18 years of age via any route of
administration, with counseling by physician or other qualified health care
professional; first vaccine/toxoid component
• +90461 each additional vaccine/toxoid component (List separately in addition to
code for primary procedure.)
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
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Chapter 4
Coding Guidelines for Commonly Administered Vaccines
Vaccine
HPV
Influenza
Meningococcal
Pneumococcal
Td
DTaP or Tdap
MMR
MMRV
DTaP-Hib-IPV (Pentacel)
DTaP-HepB-IPV (Pediarix)
Components
1
1
1
1
2
3
3
4
5
5
IA Codes Reported
90460
90460
90460
90460
90460 and 90461
90460, 90461, 90461
90460, 90461, 90461
90460, 90461 x3
90460, 90461 x4
90460, 90461 x4
Please see this AAP Presentation for more detailed information on the 2011 coding
changes.
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
4-15
Chapter 4
MEDICAID PRIOR AUTHORIZATIONS
FFS Prior Authorization Requirements
Under FFS reimbursement, the Colorado Medical Assistance Program prior authorizes:
• Expensive services such as transplantation, long term care, most DME, Orthodontia,
hearing aids, PDN and OT and PT
• Procedures where inappropriate utilization has been reported in medical literature.
• Procedures that may be performed both for medical reasons and for cosmetic
reasons.
FFS prior authorization approval assures the provider that the service is medically necessary
and a Colorado Medical Assistance Program benefit.
• Approval of the Prior Authorization Request (PAR) does not guarantee Colorado
Medical Assistance Program payment.
• PAR approval does not serve as a timely filing waiver.
• PAR approval does not override benefit eligibility requirements or benefit delivery
requirements.
PAR Forms:
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542696550
Pharmacy PAR Form:
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542571132
Pharmacy Preferred Drug List:
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1197969485609
Please refer to the General Provider Information Manual and other related billing guides on
the HCPF website for additional details regarding PARs:
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542320888
TOP 10 REASONS A PAR WILL DENY
1. Duplicate
2. Missing or Invalid Provider (billing or requesting) number
3. Incomplete questionnaire
4. Dates of service
5. Over three months (timely)
6. No number of requested units
7. Invalid DOB or Client ID
8. Invalid code
9. Information provided does not meet the guidelines of medical necessity
10. Not a benefit
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
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Chapter 4
Please be aware that with some PARs, a letter of medical necessity is required.
Writing the Letter of Medical Necessity
1.
2.
3.
4.
5.
6.
7.
8.
9.
Name of child, names of parents (parents and child may have different names)
Date of birth of child
Insurance plan name (there may be more than one plan)
Relevant diagnoses (codes are helpful only if they are accurate!)
Item/service requested
Why item/service is medically necessary (refer to the plans’ definition)
What positive/negative impacts the item/service will result on (include financial)
Scope and duration of treatment
Supplemental documents (letters from other providers, research articles, product
information, PAR, results from the well child exam, etc.)
10. Funding streams NOT able to help
11. Terms to use
a. medically necessary
b. clinically based
c. promoting independence
d. preventing secondary disability
e. cost-effective
f. safety
12. Terms to avoid
a. custodial
b. rehabilitate
c. developmental delay/disability
d. speech delay (without a diagnoses such as aphasia)
PARs should be submitted to:
Prior Authorization Request
PO Box 30
Denver CO 80201-0030
For assistance with PARs and Letters of Medical Necessity:
303-534-0279
1-800-237-7647
PAR Hotline for Medical Home Providers:
DME Line: (303) 866-5571
Find out what was approved, what was denied and research questions the providers
or the parents may have about why something was denied.
All Other PARS: 1-866-956-9409
Find out if a PAR is in process or already denied or approved. Also provides help with
the denial reasons. This line should be limited to providers only. Parents can call the
other line for DME.
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
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Chapter 4
CONTACTS
CCHAP has worked with the Colorado Department of Health Care Policy and Financing
(HCPF) to identify the right people to help with the specific problems with Medicaid and
CHP+. Their names and contact information are listed below:
MEDICAID:
Medicaid Provider Services:
(800) 237-0757
http://www.colorado.gov/hcpf
•
•
•
•
Claims and prior authorization submission
Claims and status inquiries
Claims verification
Provider Demographic Updates
Medicaid Customer Service: (303) 866-3513 or 1-800-221-3943
Medicaid Pharmacy Questions: (800) 365-4944
Denver Health Prior Authorizations: (see Chapter 3 for detailed information)
Child Health Plan Plus (CHP+):
CHP+ Customer Service: (800) 359-1991
Fax (303) 893-1780
www.cchp.org
Customer Service Manager: Rebecca Schreiber (303) 866-3877
[email protected]
CHP+ Colorado Access:
www.coaccess.com
Provider Service: 303-751-9005 x7987
Customer Service (800) 511-5010
[email protected]
Claims:
PO Box 17470
Denver, CO 80217-0470
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
4-18
Chapter 5
Chapter 5 : Care Coordination and Socioeconomic Support
Services
BACKGROUND AND SUMMARY OF SERVICE
At the end of the CCHAP pilot program, we surveyed the providers regarding their
satisfaction with each of the components that CCHAP offered. We also asked for
their opinions regarding how important each component was to them. The only
component that was determined to be more important than increased
reimbursement was the assistance of the socioeconomic support services.
CCHAP Resource Team
Erlinda DeLuna
[email protected]
720-777-6336 Direct Line
720-777-6363 Main Line
720-777-7338 Fax
Lorena Counts
[email protected]
720-777-6334 Direct Line
720-777-6363 Main Line
720-777-7338 Fax
The CCHAP Resource Team:
• Is available Monday through Friday, 9 AM to 5 PM.
• Can provide consultation to healthcare providers (physicians, nurse
practitioners, physician assistants or nurses) by telephone or email
regarding Medicaid or CHP+ patients in the practice.
• Can provide direct intervention for Medicaid, CHP+ and uninsured patients
and families by phone or by appointment.
• Can work with patients by appointment at CCHAP, when arranged
between the care coordinator and the practice.
• Will provide training to staff members who are interested in learning how
to better help Medicaid and CHP+ patients and families.
• Will train staff to help families apply or reapply for Medicaid/ CHP+.
• Will maintain records of how they helped a patient or family. Copies of
these records will be made available for inclusion into the practice medical
record when appropriate and approved by the provider.
• Can assist with socioeconomic support services and resource
coordination to providers and practices.
• Can help identify individual needs and assist with referring families to the
appropriate community resources.
• Assists with providing support and education to practices and the families
they care for.
Updated 7/31/2012
5-1
© 2006 Colorado Children’s Healthcare Access Program
Chapter 5
The CCHAP Resource Team is available by email, phone (see page 5-1), or you
can fax them the Referral Form included in this chapter. They will contact the family
as soon as possible. You may give their number directly to the patients.
CCHAP Resource Team
Erlinda DeLuna
Erlinda DeLuna has 10 years of experience as a clinical case manager and 6 years
acting as the Social Worker and Manager of Care Coordination Support Services
with CCHAP in supporting Private Pediatric Practice providers in the State of
Colorado. Her work with disadvantaged families and low income families is a special
skill, and her greatest source of personal satisfaction. In this role, she has developed
a thorough knowledge of the health care and psychological needs of low income
families, and knowledge of the many resources and services needed by and
available to these families. She has a Bachelor’s Degree in Psychology and has
completed her Master’s Degree in Counseling at Regis University. She is fluent in
Spanish.
Lorena Counts
She has over fifteen years of experience assisting Medicaid and CHP+ with eligibility
as well as helping uninsured patients find available community resources. She
previously worked with Colorado Access, Child Health Plan Plus and Clinica
Campesina. She also speaks fluent Spanish.
When to Call the CCHAP Resource Team
Most private practice healthcare providers do not have access to socioeconomic
support services, so they may not be sure when to ask for help. The Manager of
Care Coordination and Support Services and the Resource Coordinator work to help
practices by helping patients and families find and utilize the appropriate resources
for their needs: financial aid, food, problems with Medicaid and CHP+ eligibility,
housing, day care, legal advice, job training and placement, getting appropriate
mental health referrals, transportation to visits, substance abuse or family violence,
etc.
Other common issues for which the resource team can be of help include:
•
•
•
•
•
When the designated enrollment person in your practice is having trouble
with a particularly difficult Medicaid / CHP+ enrollment problem.
When there are financial problems in the family.
When a parent needs emotional support beyond what the healthcare
provider and staff can provide.
When a CHP+ or uninsured family has missed, or failed to call for,
appointments
When there are problems obtaining home health assistance.
Updated 7/31/2012
5-2
© 2006 Colorado Children’s Healthcare Access Program
Chapter 5
•
•
•
•
When a family needs assistance with paying for prescription medications.
When a family needs classes, such as nutrition education, parenting, or
childbirth education.
When a patient or family member is struggling with substance abuse,
addiction or distressing habits.
When a family needs help in getting through the specialty referral process
or following through with referrals or appointments.
Potential questions to ask a parent in order to discover where they need help:
•
•
•
•
•
•
“How are things going at home for you?”
“Today, with the current economy, many families are having financial
difficulties. How are finances at home for your family?”
“Do you feel you have enough supportive family or friends around who are
able to help you if needed, and to provide you with emotional support?”
“Tell me a little about where you are living. Are things OK there?”
“What kinds of services or help do you think you need for your family that
you don’t have now?”
“Are there things in your life that you wish you could change?”
The CCHAP Resource Team will train your office staff to efficiently handle many of
these issues, and are available when additional assistance is needed.
RESOURCE LIST
A list of common needs and the appropriate community resources are available at
the end of this chapter as well as on our web site at http://www.cchap.org/practiceresources/. Please feel free to copy it for office staff and providers. There maybe
times when you will be able to find the resource for the families quicker than calling
the CCHAP resource team.
HEALTHY COMMUNITIES (formerly EPSDT) OUTREACH
COORDINATORS
Medicaid Healthy Communities Outreach Coordinators are also available to assist
your Medicaid families with resources and administrative case management issues
such as missed appointments. These outreach workers are available to evaluate
families that no-show two or more times and assist families with getting to
appointments. Please refer to the chapters on Enrollment and Eligibility and Case
Management for more information and contact information.
A referral form for the Healthy Communities Outreach Coordinators for Missed
Appointments and E.D. utilization follows in this chapter. It can be faxed to your
county coordinator.
Updated 7/31/2012
5-3
© 2006 Colorado Children’s Healthcare Access Program
Chapter 5
CCHAP Care Coordination and Socioeconomic Support Services Contact Form
Provider Name: __________________________________________
Phone #: ________________________
CCHAP Phone #: (720) 777-6336 / 720-777-6334
Fax #: (720) 777-7338
Mother’s Information:
First Name: _____________________Last Name: _______________________________
Mother’s DOB:
/
/
State ID#: ____________________
Complete Address: _______________________________________________________
________________________________________________________________________
County: ________________
Phone #: _________________________________
Nature of Concern: __________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Names of children:
First Name
Last Name
DOB
State ID#
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Resource Coordinator Use Only:
Action Taken: ____________________________________________________________
________________________________________________________________________
________________________________________________________________________
Outcome of Action: _______________________________________________________
________________________________________________________________________
________________________________________________________________________
Person Working Referral:
Erlinda DeLuna
Lorena Counts
Date Received: __________Date Completed: ____________Date Logged: _________
Updated 7/31/2012
5-4
© 2006 Colorado Children’s Healthcare Access Program
Chapter 5
CCHAP
Missed Appointment & E.D. Utilization
Referral Sheet
This form is utilized for excessive missed appointments and E.D. use.
Please fill out form as completely as possible. Thank you!
Clinic/Provider Information
Provider Name:_______________________________________________________________________________________
Phone Number:_____________________________
Fax:____________________________________________________
Reason for Referral:____________________________________________________________________________________
Comments: ___________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Guardian Information
Name:________________________________________________________________________________________________
Address:______________________________________________________________________________________________
County: ______________________________________ Zip Code: _______________________________________________
Childs Information
Name:_________________________________________________________________________________________________
Date of Birth: _______________________ Medicaid Number:________________________ DHH:____________________
Outreach Coordinator Report
Date Worked: __________________________________________________________________________________________
Action Taken:__________________________________________________________________________________________
Outcome of Action:______________________________________________________________________________________
Date Worked:__________________________________________________________________________________________
Action Taken:__________________________________________________________________________________________
Outcome of Action: _____________________________________________________________________________________
Date Worked:__________________________________________________________________________________________
Action Taken:__________________________________________________________________________________________
Outcome of Action:______________________________________________________________________________________
Outreach Coordinator:
Location:1
Phone Number:
Date Received:
Date Completed:
Updated 7/31/2012
5-5
© 2006 Colorado Children’s Healthcare Access Program
Fax Number:
Chapter 5
HEALTHY COMMUNITIES OUTREACH COORDINATORS
See Tri-County for Adams, Arapahoe, Douglas and Elbert Counties
Office/ Contractor
Counties Covered
Contact Numbers By County
Boulder County Public Health
Boulder
(303) 441-1100/ (303) 678-6125 (Fax)
Broomfield Health & Human Services
Broomfield
Clear Creek
(720) 887 2230/ (720) 887-2224 (Fax)
(303) 567-3144/ (303) 567-3132 (Fax)
Denver Health & Hospitals
Denver
(720) 956 2151/ (720) 956-2159 (Fax)
Four Counties
Dolores
Eagle
Gilpin
Montezuma
(866)978 5567/ (970) 677-2948 (Fax)
(866)978 5567/ 1-866-978-5567 (Fax)
(866)978 5567
(866)978 5567/ (970) 565-0647 (Fax)
Peak Vista Community Health Centers
El Paso
(719) 630 6463/ (719) 386-0511 (Fax)
Garfield County Nursing Services
Garfield
Pitkin
(970) 625 5200/ 970-625-4804 (Fax)
(970) 625 5200/ 970-920-5419 (Fax)
Healthy Community Program Jefferson
Jefferson County Department of Health
Kit Carson Health and Human Services Kit Carson
Lincoln
Cheyenne
(303) 239-7091 (303) 239-7140 (Fax)
Larimer County Department of Health
Larimer
(970) 498 6755/ (970) 498-6772 (Fax)
Mesa County Health Department
Mesa
Gunnison
Hinsdale
Ouray
San Miguel
Delta
(970) 248 6930/ 970-254-4118 (Fax)
(970) 248 6930/ 970-641-8346 (Fax)
(970) 248 6930/ 970-641-8346 (Fax)
(970) 248 6930/ 970-325-7314 (Fax)
(970) 248 6930/ 970-728-9276 (Fax)
(970) 874 2165/ 970-874-2175 (Fax)
Montrose Health & Human Services
Montrose
(970) 252 5000/ (970) 252-5073 (Fax)
Northwest Colorado
Visiting Nurses Association
Routt
Moffat
Grand
Rio Blanco
Jackson
(970) 879 1632/ (970) 870-1326 (Fax)
(970) 879 1632/ (970) 824-2548 (Fax)
(970) 879 1632/ (970) 725-3330 (Fax)
(970) 879 1632/ (970) 878-0321(Fax)
(970) 879 1632/ (970) 723-8447 (Fax)
Otero County Health Department
Otero
Bent
Huerfano
Las Animas
Crowley
(719) 383 3040/ 719-383-3060 (Fax)
(719) 456 0517 x112/719-546-0518(Fax)
(719) 738 2650/ 719-738-2653 (Fax)
(719) 738 2650/ 719-846-4472 (Fax)
(719) 267 4750
Updated 7/31/2012
(719) 346 7158/ (719) 346-8066 (Fax)
(719) 346 7158/ (719) 743-2482 (Fax)
(719) 346 7158/ (719) 767-8747 (Fax)
5-6
Chapter 5
Office/ Contractor
Counties Covered
Contact Numbers By County
Park
Summit
(303) 838 7653/ (303) 816-5971 (Fax)
(303) 838 7653/ (970) 668-4115 (Fax)
Prowers County Nursing Service
Prowers
Baca
Kiowa
(719) 336 8721 x21/(719) 336-9763 (Fax)
(719) 336 8721 x21/ (719) 336-9763 (Fax)
(303) 783 7121/ (719) 336-9763 (Fax)
Pueblo County Department of Social
Services
Rio Grande County Nursing Service
Pueblo
(719) ) 564-3758/ 719-557-3880 (Fax)
Alamosa
Mineral
Saguache
Rio Grande
Chaffee
Lake
Conejos
Costilla
(719) 587 3099/ (719) 589-1103 (Fax)
(719) 657 2296/ (719) 658-2764 (Fax)
(719) 657 2296/ (719) 754-2392 (Fax)
(719) 657-2296/ (719) 657-2286 (Fax)
(719) 672 3332/ (719) 539-7197 (Fax)
(719) 672 3332/ (719) 486-4164 (Fax)
(719) 672 3332/ (719) 274-4309 (Fax)
(719) 672 3332/ (719) 672-3856 (Fax)
San Juan Basin Health Department
La Plata
Archuleta
(970) 247-5702/ (970) 247-9126 (Fax)
(970) 264-2409/ (970) 264-4640 (Fax)
Teller County Public Health Dept
Teller
(719) 687-6416/ (719) 687-6501 (Fax)
Tri County Department Of Health
Adams
Arapahoe
Douglas
Elbert
All:
(303) 873-4404/ (303) 745-6146 (Fax)
Upper Arkansas Area Council of Gov
Custer
Fremont
(719) 275 8350/ (719) 783-2377 (Fax)
(719) 275 8350/ (719) 275-2907 (Fax)
Weld County Health Dept
Weld
Logan
Yuma
Washington
Morgan
Phillips
Sedgwick
(970) 304-6420 / (970) 304-6416 (Fax)
(970) 526-2991/ (970) 522-1412 (Fax)
(970) 526-2991 (call for fax info)
(970) 526-2991/ (970) 945-6562
(970) 526-2991/ (970) 867-0878 (Fax)
(970) 526-2991/ (970) 854-4559 (Fax)
(970) 526-2991/ (970) 332-4978 (Fax)
Park County Public Health Department
Updated 7/31/2012
5-7
Chapter 5
Resources for Families
GENERAL RESOURCES
FOOD ASSISTANCE
Colorado Department of Human Services
http://www.cdhs.state.co.us/
303.866.5700
Mile High United Way
*Child and elderly care
*After-school programs
*Emergency shelter
*Counseling
Food Distribution Program
303.866.5106
888.467.0418
The Emergency Food Assistance Program
303.866.5700 (ask for your local TEFAP agency)
TEFAP is a federal program that helps
supplement the diets of low-income needy
persons by providing them with emergency
food and nutrition assistance
*Rent assistance
* Job training
* Utility assistance
*Substance abuse
303.433.8383 or simply call 2-1-1
http://www.unitedwaydenver.org/
CSFP (Commodity Supplemental Food Program)
Program created to provide an opportunity for
low-income persons to receive specified
nutritional foods that will provide them a more
adequate diet and help them achieve good
health
Big Brother/Big Sister of Colorado
www.biglittlecolorado.org
Denver
2420 W 26th Ave, Ste 450-D
Denver, CO 80211
303.433.6002
Conejos County
719.274.4307
Costilla County
719.672.3332
Pikes Peak Region
111 S Tejon St, Ste 302
Colorado Springs, CO 80903
719.633.2443
Denver County
303.375.8081
Pueblo County
719.583.6318
Mesa County
970.241.3651
Rio Grande County
719.852.5778
Weld County
970.356.2199
Colorado CSFP Office
303.866.2652 or toll-free 888.467.0418
SHAREColorado
www.sharecolorado.com
800-933-7427
The goal of SHARE is to help families save
about 50% on their groceries, while
encouraging the building of relationships with
their neighbors in the community. There are no
qualifications...if you eat, you qualify.
WIC (Women, Infants and Children)
http://www.cdphe.state.co.us/ps/wic/
For WIC enrollment, please call The Colorado WIC
Program at 303.692.2400
WIC participants are given monthly checks for
foods that contain selected nutrients. These
foods are intended to supplement a person’s
diet to make it more nutritious.
Updated 7/31/2012
5-8
Chapter 5
El Paso County
719. 667.3700
EMPLOYMENT ASSISTANCE
Colorado Employment First
303.866.2929
Federally mandated program designed to
ensure that all able-bodied food stamp
participants are engaged in activities that will
improve their employability.
Fremont County
719.275.7408
Gilpin County
303.582.6003
Colorado Workforce Centers
Provide a variety of free services to assist
employers and job seekers alike. These
include: job listings, computer & internet
access, career counseling & training for job
seekers; pre-screening & referral services, tax
credits
Jefferson County
303.271.4700
Kit Carson County
719.346.5331
Lake County
719.486.2428
Adams County
303.363.9380
303.453.8600
Larimer County
970.667.4261
Alamosa County
719.589.5118
Lincoln County
719.775.2387
Arapahoe County
303.340.7575
Mineral County
719.852.5171
Boulder County
303.301.2900
Moffat County
970.824.3246
Broomfield County
303.464.5855
Montezuma County
970.565.3759
Cheyenne County
719.346.5331
Pueblo County
719.562.3720
Clear Creek County
303.567.3135
Rio Blanco County
970.878.4211
Costillo County
719.589.5118
Rio Grande County
719.852.5171
Conejos County
719.589.5118
Saguache County
719.852.5171
Custer County
719.275.7408
Teller County
719.667.3700
Delta County
970.874.5781
Weld County
970.353.3800
970.498.6600
Denver County
720.865.5619
720.865.0100
720.865.0060
720.944.1615
Dolores County
970.565.3759
Douglas County
303.340.7575
Updated 7/31/2012
5-9
Chapter 5
Project Wise (Mental Heath and Empowerment)
303.765.5879
www.denverprojectwise.org
The mission of Project WISE is the
empowerment of women with low incomes
through offering opportunities to meet
personal, family and economic goals, and
attain a positive involvement with their
community.
COUNSELING AND ASSESSMENT
Asian Pacific Development Center
www.apdc.org
303.365.2959-Aurora office
303.393.0304-Denver office
719.459.3947-Colorado Springs office
nonprofit organization serving the needs of the
growing population of Asian American and
Pacific Islander residents throughout Colorado.
Services include mental health services, victim
assistance, health care assistance, ESL classes,
and interpretation services
Savio House
303.922.5576
Savio offers comprehensive services that
strengthen families and prevent child abuse,
neglect and youth delinquency
Catholic Charities
www.ccdenver.org
303.742.0828 x642
Provides mental health treatment for
individuals, families and children.
Signal (Substance Abuse)
720.944.1366
Signal provides substance abuse treatment
through network area providers. An on-site
substance abuse professional is located at
Denver Human Services providing
assessments, brief counseling, education, and
prevention services.
Colorado Access to Recovery (Substance Abuse
Treatment)
303.839.9422
FACES (Family Advocacy, Care, Education, Support)
www.facesonline.org
720.570.9333
FACES provides home based, intensive
individual, family and child (0-12 years of age)
counseling and intervention services
CHILD CARE
Qualistar
www.qualistar.org
877.338.2273
Bright Beginnings
www.brightbeginningsco.org/
303.433.6200
The Haven
303.761.7626 x281
The Haven offers a therapeutic community for
pregnant and post-partum women and their
children up to 18 years of age.
Family Resource Centers
http://www.familyresourcecenters.info/
303.388.1001
Home Base Treatment and Contracting Services
303.465.2033
Project P.A.V.E.(Promoting Alternatives to Violence
through Education)
http://www.projectpave.org/
303.322.2382
Because violence is a learned behavior, it can
be unlearned. Project PAVE’s counseling
program helps children and youth (birth - 24
years) who have been touched by relationship
violence
Project Safeguard (Domestic Violence)
303.863.7233
http://psafeguard.qwestoffice.net
Specially trained legal advocates assist women
and their children when seeking protection
from violence and stalking through the courts
Updated 7/31/2012
5-10
Chapter 5
SPECIAL NEEDS CARE
HOUSING ASSISTANCE &
COUNSELING
Family Voices
www.familyvoicesco.org
877.731.6017
Provides help looking for a health care
provider, help to pay for a health or related
service provider, programs a child or adult
with special needs might be eligible for, or
connections to other families or family
advocates
Colorado Department of Local Affairs- Division of
Housing
303.866.2033
Offers information and applications for Section
8 housing for low-income families
Parent to Parent of Colorado
http://www.p2p-co.org/
877.472.7201
A non-profit organization committed providing
emotional and information support, resources
and by matching parents seeking support with
a support parent.
Colorado Housing Assistance Corporation
http://coloradohousingassistance.org
303.572.9445
CHAC is a private nonprofit agency that offers
loan programs and supportive financial
counseling to help Colorado families buy
homes.
Denver Options
http://www.denveroptions.org
303.636.5600
provides a wide choice of services and
resources for people with developmental
delays and disabilities
For Foreclosure Prevention Assistance call
303.572.9445 ext 23
Colorado Housing & Finance Authority
800.877.2432
303.297.7305 (TDD)
Provides resources for low-income renters and
home owners
Early Childhood Connections
http://www.earlychildhoodconnections.org
888.777.4041
Early Intervention supports and services
for infants, toddlers and their families
PEAK Parent
http://www.peakparent.org/
719.531.9400
PEAK helps parents and educators to see new
possibilities for children, expands their
knowledge of special education issues, and
offers new strategies for success
Easter Seals
http://co.easterseals.com
303.233.1666 (voice)
303.232.5685 (tty)
Provides resources, job-training and
employment, adult day programs, and general
support for people with special needs
Updated 7/31/2012
5-11
Chapter 5
ENERGY ASSISTANCE PROGRAMS
Prowers
•
Prowers County DSS
719.336.7486
State-Wide programs
LEAP (low income energy assistance program)
http://www.cdhs.state.co.us/leap/
303.866.5700
LEAP is a federally funded program
administered by the Colorado Department of
Human Services and is designed to assist with
winter heating costs. Runs from Nov. 1-April
30. all other times call 866.432.8435
Pueblo
•
Weld
•
Energy $aving Partners Program
866.432.8435 (this toll-free # will redirect people to
nearest county service agency)
Offers free energy-efficiency services for
income-qualified households.
.
Planned Parenthood of the Rocky Mountains
www.pprm.org
303.321.7526
Locations throughout Colorado.
Comprehensive reproductive healthcare for
women and men, as well as assistance in
pregnancy planning and prevention
County-specific programs
Almost Home
303.659.6199
IMMIGRATION ASSISTANCE
Rocky Mountain Immigration Advocacy Network
www.rmian.org
303.433.2812
non-profit organization that serves low-income
men, women, and children in immigration
proceedings. RMIAN promotes knowledge of
legal rights and provides effective
representation to ensure due process
Archuleta
•
Housing Solutions for the Southwest
970.259.1086
Boulder
•
Emergency Family Assistance Association
303-442-3042
Clear Creek
•
Clear Creek County DHS
303-679-2368
El Paso
•
Energy Resource Center
719.591.0772
•
Colorado Springs Utilities
719.448.4800
La Plata
•
Community Emergency Assistance
Coalition
970-259-1255
Montezuma
•
Housing Solutions for the Southwest
970-259-1086 x 22
Montrose
•
MADA
970-249-4774
Updated 7/31/2012
Longs Peak Energy Conservation
Weatherization Program
http://fcgov.com/conservation/res-reach.php
800-200-9006
FAMILY PLANNING ASSISTANCE
Energy Outreach Colorado
http://www.energyoutreach.org
303.935.7386
Adams
•
Catholic Charities – Pueblo
719.544.4233
5-12
Chapter 6
Chapter 6 : MENTAL HEALTH SERVICES
BACKGROUND AND SUMMARY OF RESOURCES
This chapter describes options for mental health care for children on Medicaid, children on
Colorado Health Plan Plus (CHP+)
Children on Medicaid
In the State of Colorado, mental health care for children on Medicaid is coordinated by the
Behavioral Health Organizations (BHO’s). The BHO’s are the HMO’s of mental health, and
have contracted with The Colorado Department of Health Care Policy and Financing (HCPF,
which oversees Medicaid and CHP+ in Colorado) to arrange for, and reimburse, necessary
mental health services for Medicaid eligible individuals. In the Metro area the BHO’s have
agreed to serve as the initial contact point for referrals from CCHAP practices to help identify
the best mental health provider for your patient. In the western part of the state the BHO has
asked that providers work with their local Mental Health Center (MHC) just as they would
have with the main BHO office. Both the BHOs may refer the child to county mental health
centers or private mental health providers.
The four Medicaid BHOs along the Front Range and the Rural BHO/MHC mental health
providers they work with have assured CCHAP they will:
•
•
•
•
•
•
•
Accept all referrals from CCHAP-affiliated practices without requiring a diagnosis for
triage and assessment
Have the child evaluated as quickly as possible
Make outbound calls to follow up on referrals
For practices with large numbers of Medicaid and CHP+ children, we have arranged
for mental health providers to set up regular hours to see patients/families in the
pediatric office.
Send reports to the PCP and promote the exchange of information between mental
health professional and the PCP.
Provide educational sessions in your office on mental health topics of your choice.
Each local Mental Heath Center provides mental health resources for uninsured
children.
When the BHO/MHC personnel understand that you are working with CCHAP, they will meet
all of these objectives. They will recognize our project either by the name “A Medical Home
for Every Child,” or by the name CCHAP. So please state that you are connected with the
“CCHAP – the Medical Home for Every Child” program” when you call to refer a
patient.
If you are interested in having a mental health provider set up regular office hours in
your practice office to see patients on Medicaid, please contact Steve Poole at 720-7776004 or [email protected].
Updated 7/31/2012
6-1
Chapter 6
Representatives from the area BHO/MHCs have indicated they would like to visit your office
to explain how they can be of service to you and your patients. To schedule an appointment
with a BHO please call one of the BHOMHC managers listed below:
Access Behavioral Care – Reyna Garcia, Executive Director, CHP+ Customer
[email protected]
Service, Colorado Access, 720-744-5302
Behavioral Healthcare Inc. – 303-617-2702
Foothills Behavioral Health Partners – Michelle (Chelle) Denman, FBH Partners
Provider Network, 719-538-1463, [email protected].
Northeast Behavioral Health Partnership - Karen Thompson, Executive
Director, 970-347-2372, [email protected]
Colorado Health Networks - Arnold Salazar, Director, 800-804-5008
[email protected]
The Center for Mental Health - Jon Gordon, CEO, 970-252-3210 (for Delta,
Gunnison, Hinsdale, Montrose, Ouray, San Miguel counties)
[email protected]
Southwest Community Mental Health Center - Pam Wise-Romero, Executive Vice
President of Integrated Care, 970-403-0181, [email protected] (for Archuleta,
Dolores, La Plata, Montezuma, San Juan counties)
Colorado West Regional Mental Health Center - Sharon Raggio, CEO, 970-4522241 (for Eagle, Garfield, Grand, Jackson, Mesa, Moffat, Pitkin, Rio Blanco)
When there is a problem
You may also contact these BHO representatives if you are experiencing any kind of
difficulties obtaining mental health consultation or treatment for your Medicaid patients. They
will be happy to assist you.
Updated 7/31/2012
6-2
Chapter 6
Patient Referral for Behavioral Health Services
The county where the patient lives is the key to choosing the right agency. If a child is in foster care please note that the
child’s county for referral is in the county of the foster care case worker.
Patients have a choice to be seen by the Community Mental Health Center (CMHC) that serves the county where they live
or by a provider within the Behavioral Health Organization Network. Once you know the child’s county (see above regarding
children in foster care), please follow the following steps:
•
•
•
•
Ask the family or guardian whether they want their child to be seen at the CMHC or by a provider that is not affiliated
with the CMHC. In general the CMHCs provide a wider array of services, including psychiatric, but all Behavioral Health
Organizations (BHOs) should a Provider Network available for child/youth referrals
If the family/guardian prefers to see a CMHC provider please see Table 2 for the CMHC affiliated with the child’s county
and the phone numbers for that CMHC for the family to contact for an appointment and the fax number for sending the
referral.
If the family/guardian prefers to see a non-CMHC provider, please see Table 2 for the BHO for the county and Table 1
for the phone numbers for the family to contact for non-CMHC Network Providers.
If there are questions regarding a referral please contact the BHO affiliated with the child’s county (Table 1).
Table 1: BEHAVIORAL HEALTH ORGANIZATIONS
BEHAVIORAL HEALTH ORGANIZATIONS
PHONE NUMBERS
FAX NUMBERS
Access Behavioral Care (ABC)
http://www.coaccess.com/access-behavioral-care-provider-information
For appt: 303.751.9030 or 1.800.984.9133
For emergency: 1.877.560.4250 (Metro Crisis Line)
Fax #: 877.232-5976
Behavioral Health Inc (BHI)
http://www.bhicares.org/providers.htm
For appt: 720.490.4400
For emergency: 720.490.4400
Fax #: 720.490.4395
Colorado Health Partnerships (CHP)
http://www.coloradohealthpartnerships.com/providers.htm
For appt: 1.800.804.5008
For emergency: 1.800.804.5008
Fax #: 719-538-1439
Foothills Behavioral Health Partners (FBHP)
http://www.fbhpartners.com/providers.htm
For appt: 303.432.5950
For emergency: 1.866.245.1959
Fax #: 303.432.5970
Northeast Behavioral Health Partnership (NBHP)
http://www.nbhpartnership.com/providers.htm
For appt: 1.888.296.5827
970.347.2374
For emergency: 1.888.296.5827
Fax #: 719-538-1439
Updated 7/31/2012
6-3
Chapter 6
Table 2: MENTAL HEALTH CENTERS BY COUNTY
COUNTY
BEHAVIORAL HEALTH
ORGANIZATION
COMMUNITY MENTAL
HEALTH CENTER
PHONE NUMBERS
FAX NUMBERS
Adams
Behavioral Health Inc (BHI)
Community Reach Center (not
Aurora)
Aurora MHC (Aurora)
Community Reach Center
Fax #: 303.426.9384
Aurora MHC
Fax #: 303.617.2397
Alamosa
Colorado Health
Partnerships (CHP)
San Luis Valley
Comprehensive CMHC
Community Reach Center
For appt: 303.853.3500
For emergency: 303.853.3500
Aurora MHC
For appt: 303.617.2300
For emergency: 303.617.2300
For appt: Alamosa Center 719.589.3671
For emergency: 719.589.3671
Arapahoe
Behavioral Health Inc (BHI)
Arapahoe Douglas Mental
Health Network
For appt: 303.730.8858
For emergency: 303.730.3303
Fax#: 303.797.9348
Archuleta
Colorado Health
Partnerships (CHP)
Southwest Colorado MHC
Fax #: 970.264.2108
Baca
Colorado Health
Partnerships (CHP)
Southeast Mental Health
Services
Bent
Colorado Health
Partnerships (CHP)
Southeast Mental Health
Services
Boulder
Foothills Behavioral Health
Partners (FBHP)
Mental Health Partners
For appt: Pagosa Springs Counseling
970.264.2104
For emergency: Day: 970.264.2104
After Hrs: 970.247.5245
For appt:
719.384.5446 (La Junta)
719.336.7501 (Lamar)
For emergency:
1.800.511.5446 (La Junta)
1.800.603.7501 (Lamar)
For appt:
719.384.5446 (La Junta)
719.336.7501 (Lamar)
For emergency:
1.800.511.5446 (La Junta)
1.800.603.7501 (Lamar)
For appt: 720.406.3606
For emergency: 303.413.6388
Broomfield
Foothills Behavioral Health
Partners (FBHP)
Mental Health Partners
For appt: 720.406.3606
For emergency: 303.413.6388
Fax #: 303.413.6263
Updated 7/31/2012
6-4
Fax #: 719.589.9136
Fax #:
719.384.5672 (La Junta)
719.336.7453 (Lamar)
Fax #:
719.384.5672 (La Junta)
719.336.7453 (Lamar)
Fax #: 303.413.6263
Chapter 6
Chaffee
Colorado Health
Partnerships (CHP)
West Central MHC
For appt: 719.539.6502
For emergency: 719.539.6502
Fax #: 719.539.3988
Cheyenne
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
Fax #: 719.346.0292
Clear Creek
Foothills Behavioral Health
Partners (FBHP)
Jefferson Center for Mental
Health
For appt: 719.346.8183
970.522.4549
For emergency: 719.346.8183 or 970.332.3133
For appt: 303.425.0300
For emergency: 303.432.5525
Conejos
Colorado Health
Partnerships (CHP)
San Luis Valley
Comprehensive CMHC
Fax #:
719.274.5414 (La Jara)
719.376.2047 (Antonito)
Costilla
Colorado Health
Partnerships (CHP)
San Luis Valley
Comprehensive CMHC
For appt:
La Jara Center: 719.274.5154
Antonito Center: 719.376.2511
For emergency:
719.274.5154 (La Jara)
719.376.2511 (Antonito)
For appt: San Luis Center 719.672.0331
For emergency: 719.672.0331
Crowley
Colorado Health
Partnerships (CHP)
Southeast Mental Health
Services
Fax #:
719.384.5672 (La Junta)
719.336.7453 (Lamar)
Custer
Colorado Health
Partnerships (CHP)
West Central MHC
For appt:
719.384.5446 (La Junta)
719.336.7501 (Lamar)
For emergency:
1.800.511.5446 (La Junta)
1.800.603.7501 (Lamar)
For appt: Westcliffe Office 719.275.2351
For emergency: 719.275.2351
Delta
Colorado Health
Partnerships (CHP)
Midwestern Colorado MHC
For appt: Delta Outpatient 970.874.8981
For emergency: 970.252.6220
Fax #: 970.874.4169
Denver
Access Behavioral Care
(ABC)
Mental Health Center of
Denver (MHCD)
For appt: 303.504.1250
For emergency: 303.436.4100 (Mobile Crisis)
Fax #: 303.321.2633
Douglas
Behavioral Health Inc (BHI)
Arapahoe Douglas Mental
Health Network
For appt: 303.730.8858
For emergency: 303.730.3303
Fax#: 303.797.9348
Dolores
Colorado Health
Partnerships (CHP)
Southwest Colorado MHC
For appt: 970.259.2162
For emergency: 970.247.5245
Fax #: 970.247.5255
Updated 7/31/2012
6-5
Fax #: 303.432.5530
Fax #: 719.672.0336
Fax #: 719.269.9386
Chapter 6
Eagle
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
For appt:
Eagle Office: 970.328.6969
Vail Office: 970.476.0930
For emergency:
970.328.6969 (Eagle)
970.476.0930 (Vail)
For appt: 303.646.4519 or 970.522.4549
For emergency: 303.646.4519
Fax #:
970.328.6329 (Eagle)
970.476.0535 (Vail)
Elbert
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
El Paso
Colorado Health
Partnerships (CHP)
AspenPointe
For appt: 719.572.6100
For emergency: 719.635.7000
Fax #: 719.572.6399
Fremont
Colorado Health
Partnerships (CHP)
West Central MHC
For appt: Canon City Office 719.275.2351
For emergency: 719.275.2351
Fax #: 719.269.9386
Garfield
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
Fax #:
970.928.8852 (Garfield)
970.625.9707 (Rifle)
Gilpin
Foothills Behavioral Health
Partners (FBHP)
Jefferson Center for Mental
Health
For appt:
Garfield Outpatient: 970.945.2583
Rifle Office: 970.625.3582
For emergency:
970.945.2583 (Garfield)
970.945.2583 (Rifle)
For appt: 303.425.0300
For emergency: 303.432.5525
Grand
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
For appt: Granby Outpatient 970.887.2179
For emergency: 970.887.2179
Fax #: 970.887.9311
Gunnison
Colorado Health
Partnerships (CHP)
Midwestern Colorado MHC
For appt: Gunnison Outpatient 970.641.0229
For emergency: 970.252.6220
Fax #: 970.641.2949
Hinsdale
Colorado Health
Partnerships (CHP)
Midwestern Colorado MHC
For appt: 970.252.3200
For emergency: 970.252.6220
Fax #: 970.252.3208
Huerfano
Colorado Health
Partnerships (CHP)
Spanish Peaks MHC
For appt: Walsenburg Office 719.738.2386
For emergency: 719.738.2386
Fax #: 719.738.2021
Jackson
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
For appt: Walden Outpatient Clinic 970.723.0055
For emergency: 970.723.4242
Fax #: 970.723.4732
Updated 7/31/2012
6-6
Fax #: 303.646.4451
Fax #: 303.432.5530
Chapter 6
Jefferson
Foothills Behavioral Health
Partners (FBHP)
Jefferson Center for Mental
Health
For appt: 303.425.0300
For emergency: 303.432.5525
Fax #: 303.432.5530
Kiowa
Colorado Health
Partnerships (CHP)
Southeast Mental Health
Services
Fax #:
719.384.5672 (La Junta)
719.336.7453 (Lamar)
Kit Carson
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
For appt:
719.384.5446 (La Junta)
719.336.7501 (Lamar)
For emergency:
1.800.511.5446 (La Junta)
1.800.603.7501 (Lamar)
For appt: 719.346.8183 or 970.522.4549
For emergency: 719.346.8183 or 970.332.3133
Lake
Colorado Health
Partnerships (CHP)
West Central MHC
For appt: 719.539.6502
For emergency: 719.539.6502
Fax #: 719.539.3988
La Plata
Colorado Health
Partnerships (CHP)
Southwest Colorado MHC
Fax #: 970.247.5255
Larimer
Northeast Behavioral
Health Partners (NBHP)
Larimer Center for Mental
Health
For appt: Durango Counseling Center
970.259.2162
For emergency: 970.247.5245
For appt: 970.494.4200 or 970.494.9761
For emergency: 970.494.4200
Las Animas
Colorado Health
Partnerships (CHP)
Spanish Peaks MHC
For appt: Trinidad Office 719.846.4416
For emergency: 719.846.4416
Fax #:719.846.6408
Lincoln
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
For appt: 719.775.2313 or 970.522.4549
For emergency: 719.775.2313
Fax #: 719.775.2315
Logan
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
For appt: 970.522.4392 or 970.522.4549
For emergency: 970.522.4392
Fax #: 970.522.2217
Mesa
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
Fax #: 970.683.7272
Mineral
Colorado Health
Partnerships (CHP)
San Luis Valley
Comprehensive CMHC
For appt: Grand Junction Child & Family
970.241.6023
For emergency: 970.241.6023
For appt: 719.589.3671
For emergency: 719.589.3671
Moffat
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
For appt: Craig Outpatient Clinic: 970.824.6541
For emergency: 970.824.9411
Fax #: 970.824.0313
Updated 7/31/2012
6-7
Fax #: 719.346.0292
Fax #: 970.484.4559
Fax #: 719.589.9136
Chapter 6
Montezuma
Colorado Health
Partnerships (CHP)
Southwest Colorado MHC
Montrose
Colorado Health
Partnerships (CHP)
Midwestern Colorado MHC
Morgan
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
Otero
Northeast Behavioral
Health Partners (NBHP)
Southeast Mental Health
Services
For appt: La Junta Office 719.384.5446
For emergency: 1.800.511.5446
Fax #: 719.384.5672
Ouray
Colorado Health
Partnerships (CHP)
Midwestern Colorado MHC
For appt: 970.252.3200
For emergency: 970.252.6220
Fax #: 970.252.3208
Park
Colorado Health
Partnerships (CHP)
AspenPointe
For appt: 1.800.285.1204
For emergency: 719.635.7000
Fax #: 303.838.5867
Phillips
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
For appt: 970.854.2114 or 970.522.4549
For emergency: 970.854.2114
Fax #: 970.854.4584
Pitkin
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
For appt: Aspen Outpatient Clinic: 970.920.5555
For emergency: 970.920.5555
Fax #: 970.920.5557
Pueblo
Colorado Health
Partnerships (CHP)
Spanish Peaks MHC
For appt: Pueblo Office 719.545.2746
For emergency: 719.545.2746
Prowers
Colorado Health
Partnerships (CHP)
Southeast Mental Health
Services
For appt: Lamar Office 719.336.7501
For emergency: 1.800.603.7501
Fax #:
719.545.4100 (Admin)
719.584.0110 (Outpatient)
Fax #: 719.336.7453
Rio Blanco
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
Rio Grande
Colorado Health
Partnerships (CHP)
San Luis Valley
Comprehensive CMHC
For appt: Meeker Outpatient Clinic:
970.878.5112
For emergency: 970.878.5023
For appt: Monte Vista Center 719.852.5186
For emergency: 719.852.5186
Updated 7/31/2012
6-8
For appt: Cortez Counseling Center:
970.565.7946
For emergency: 970.565.7946
For appt:
Montrose Outpatient: 970.249.9694
Nucla Outpatient: 970.327.4449
Northside Child Health Center: 970.240.6438
Olathe School & Community Health Center:
970.323.6141
For appt: 970.867.4924 or 970.522.4549
For emergency: 970.867.4924
Fax #: 970.565.9005
Fax #:
970.249.2955 (Montrose)
970.327.4676 (Nucla)
970.240.9296 (Northside)
970.323.6117 (Olathe)
Fax #: 970.867.2695
Fax #: 970.878.4315
Fax #: 719.852.3043
Chapter 6
Routt
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
For appt: Steamboat Springs Outpatient Clinic
970.879.2141
For emergency: 970.870.1244
For appt: Center Office 719.754.3927
For emergency: 719.754.3927
Fax #: 970.879.7912
Sagauche
Colorado Health
Partnerships (CHP)
San Luis Valley
Comprehensive CMHC
San Juan
Colorado Health
Partnerships (CHP)
Southwest Colorado MHC
For appt: 970.259.2162
For emergency: 970.247.5245
Fax #: 970.247.5255
San Miguel
Colorado Health
Partnerships (CHP)
Midwestern Colorado MHC
Fax #:
970.327.4676 (Norwood)
970.369.1261 (Telluride)
Sedgwick
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
For appt:
Norwood Outpatient 970.327.4449
Telluride Outpatient: 970.728.6303
For emergency: 970.252.6220
For appt: 970.474.3769 or 970.522.4549
For emergency: 970.474.3769
Summit
Colorado Health
Partnerships (CHP)
Colorado West Regional MHC
Fax #: 970.668.0632
Teller
Colorado Health
Partnerships (CHP)
AspenPointe
For appt: Frisco/Summit County Services
970.668.3478
For emergency:
Call 911 and ask for the On-Call Counselor
For appt: 719.572.6100 or 1.800.285.1204
For emergency: 719.635.7000
Washington
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
For appt: 970.345.2254 or 970.522.4549
For emergency: 970.345.2254
Fax #: 970.345.2744
Weld
Northeast Behavioral
Health Partners (NBHP)
North Range Behavioral
Health
Fax #:
970.353.3906 (Greeley)
303.857.2724 (Lupton)
Yuma
Northeast Behavioral
Health Partners (NBHP)
Centennial MHC
For appt: Greeley Office 970.347.2120
Fort Lupton Office: 303.857.2723
For emergency: 970.347.2120 (Greeley)
303.857.2723 (Lupton)
For appt:
Wray Office 970.332.3133 or 970.522.4549
For emergency: 970.332.3133
Yuma Office 970.848.5412 or 970.522.4549
For emergency: 970.848.5412
Updated 7/31/2012
6-9
Fax #: 719.754.3415
Fax #: 970.474.2099
Fax #: 719.686.0738 (Woodland Park)
719.689.2426 (Cripple Creek)
Fax #:
970.332.3134 (Wray)
970.848.2414 (Yuma)
Chapter 6
Child Psychiatry Telephone Consultation
For Children on Medicaid
The Behavioral Health Organizations and the Mental Health Centers in the greater metro
area have very generously made available telephone consultation by child psychiatrists for
CCHAP-affiliated providers regarding children who do not have a mental health provider.
The child psychiatrist will answer questions about children on Medicaid who have
complicated mental health issues or complicated medication regimens. You can ask for their
help by phone or email. Please understand that their return phone call or email may take
hours or a couple of days, since they have wide-ranging responsibilities.
These child psychiatrists are also willing to come visit your practice to get to know you and
even to discuss cases. We are very grateful for this very generous support for your Medicaid
children. You can determine which child psychiatrist to call based on the county in which the
child received their Medicaid card.
Telephone consultation from a child psychiatrist for Medicaid children cared for in a
CCHAP-affiliated practice is now available:
For all counties – Yvette Buxton, MD – 303-504-1500 or [email protected]
Children on CHP+
For children whose physical health care is paid for by CHP+, their mental health care is
managed and coordinated by their physical health plan. So, for example, in Denver County,
Colorado Access is the CHP+ physical (medical) health plan and therefore Colorado Access
also serves as the BHO (mental health HMO) for children on CHP+
Who to call when your patient on CHP+ needs a mental health referral
CHP+ Carrier
BHO
Phone
When Colorado Access is the
HMO for CHP+ physical
Access Behavioral Care
health
1-888-214-1101
When patient is still on the
CHP+ State Managed Care
Network
1-800-414-6198
Also Colorado Access
MESA, MONTROSE, DELTA,
Rocky Mountain Health Plans Service 1-800-346-4643
LA PLATA
Children with Autism are treated in a slightly different way. Autism is considered to be a
medical condition rather than a mental health condition. So, visits to the primary care
provider for autism and any related medical condition are billed and paid for as a medical
condition. When behavioral problems are identified in a child with Autism, the reason for the
referral to mental health should not be Autism, but instead use a mental health diagnosis for
the referral.
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Chapter 6
UNINSURED PATIENTS
Most local mental health centers will accept uninsured children, but if they don’t, here are
some other resources
BHO
Phone
CENTUS
(303) 639-5240
Each Mental Health Center
will see uninsured patients
Call the appropriate center
from the list above
Jewish Family Services
(303) 597-7777
Services Provided by CENTUS for Kids
CENTUS for Kids is a philanthropically-supported network of mental health professionals
willing to accept uninsured or commercially insured children and parents. They cannot accept
Medicaid or CHP+ at this time. They have eleven treatment sites throughout the metro area.
Families that are not insured are asked to pay on a sliding scale.
Services Provided:
o Ages served: 3 years through adolescence
o School problems, family issues, parenting issues, behavioral problems, parentchild interaction problems, psychological testing, depression, anxiety
o Family Therapy
o Marital Counseling
o Support for families of severely mentally ill patients
o Child advocacy
o Gay-Lesbian-Bisexual-Transgender issues
CENTUS for Kids Exclusions:
CENTUS for Kids is not the most appropriate resource if there are severe or complex multiple
needs or if the patient is in need of a drug treatment program. They are not able to serve
those who do not speak English, and do not provide inpatient care.
Referrals to Jewish Family Service (JFS)
Jewish Family Service’s mission is to restore well being to the vulnerable throughout the
greater Denver community by delivering services based on Jewish values. Jewish Family
Service, a community agency that serves individuals and families regardless of faith or
Updated 7/31/2012
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Chapter 6
economic status, is a hub of resources for the elderly, refugees, disabled, hungry, and
emotionally distressed; and, operates in a collaborative manner with other community
agencies.
Counseling Center
JFS counseling center located in Denver, (303) 597-7777. The Counseling Center accepts
Medicaid, commercial insurance and uninsured children and will bill for services accordingly.
JFS operates on a sliding scale for uninsured patients and will work with families to determine
payment options.
KidSuccess
If your child attends one of the following schools, KidSuccess is an option for referral:
1. Ashley Elementary
2. Cory Elementary
3. Emily Griffith High School
4. Florida Pitt Waller ECE- 8
5. Hamilton Middle School
6. Merrill Middle School
7. Steele Elementary
8. Teller Elementary
9. Thomas Jefferson High School
10. Whittier
In order to make a referral to KidSuccess, please fill out the referral form located at the end of
this chapter. Please be sure to check the box indicating the child is KidSuccess and fill out as
much of the form as possible and fax to JFS. JFS will process the referral and report back to
you the status of the referral within a few days. If you have not heard from them within two
weeks post-referral, we recommend you call them for follow-up. The KidSuccess program
accepts Medicaid. There are no fees for families associated with the KidSuccess program.
The fees for the program and service are paid by the school.
Children and families that do not attend the above mentioned schools may still use JFS
through their counseling center. The referral process is identical to the process listed above,
except you would not check the KidSuccess box.
The Counseling Center accepts Medicaid, commercial insurance and uninsured children and
will bill for services accordingly. JFS operates on a sliding scale for uninsured patients and
will work with families to determine payment options.
Referrals from JFS
Jewish Family Service, in partnership with CCHAP, will periodically refer families to primary
care providers when a child is identified as not having a medical home. This family may have
Medicaid or commercial insurance, and needs a PCP. Referrals will be faxed to your practice
using the above-referenced form. We ask that you please consider taking these children as it
creates an equitable working relationship with JFS and supports the community and
children’s health in general. Whether or not you are able to accept a child as a new patient,
Updated 7/31/2012
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Chapter 6
please respond to JFS with the outcome of their referral to you. It is important that JFS knows
whether or not they need to continue searching for a PCP.
SUMMARY OF BEHAVORIAL HEALTH SERVICES
PROVIDED BY PROGRAM
For Medicaid Patients
Outpatient Services:
•
•
•
•
•
•
Individual (limited to 35 sessions unless EPSDT evaluation determines it is medically
necessary), family and group psychotherapy
Mental health evaluation
Psychiatric evaluation and medication management
Psychological/ neuropsychological testing
Crisis management
Case management
Intensive Outpatient Services:
•
•
•
Day Treatment / Partial Hospitalization (educational and therapeutic day program for
mental health issues only)
Home-Based Services (intensive therapeutic services for children and families
provided in the home and community)
Acute (Sub-acute) Treatment Unit (24-hour, facility-based service in lieu of
hospitalization)
Inpatient Services:
•
Limited to 45 days unless EPSDT evaluation determines it is medically necessary
Medicaid Exclusions:
All services provided for Medicaid members through their BHO, beyond the initial evaluation,
must target interventions for a specific mental health disorder. Services for those with primary
developmental disabilities, learning disabilities or substance abuse issues are not covered.
However, if these conditions occur in addition to a mental health disorder, services may be
provided in coordination with the appropriate alternative system provider.
For CHP+ Patients
Outpatient Services:
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Chapter 6
o
o
o
o
o
o
Individual, family and group psychotherapy
Mental health evaluation
Substance abuse evaluation and treatment
Psychiatric evaluation and medication management
Neuropsychological testing (does not cover psychological testing)
Crisis management
CHP+ Exclusions:
CHP+ benefits are more limited than Medicaid benefits and are more consistent with those of
other private insurance companies. There are limits on the number of sessions for outpatient
services and days for more intensive outpatient and inpatient services. CHP+ does not
provide for case management, psychological testing or residential services. The
representative at Colorado Access can assist you in determining the services needed and if
there are benefit limits that apply.
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Chapter 6
Tools for Providers
1. Quarterly Continuing Education for All Providers on Child Health Mental Health
Topics
The State BHO/MHCs will develop a speaker's bureau in which selected child psychiatrists
who will provide in-service training on topics that are interesting to the pediatric providers
(e.g., use of psychotropics, mood stabilizers and other medications in kids; psychiatric
evaluation skills and tools; and training on specific psychiatric diagnoses). The BHO/MHCs
will share financial and operational responsibility for making this happen.
2. Clinical Consultation for Difficult Cases
There are two possible options: 1) some of the quarterly mental health conferences will focus
on difficult cases brought forth by the providers, or 2) you may have a child psychiatrist come
to your office and discuss difficult cases with the providers. This also can be arranged by the
BHO/MHC.
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Chapter 6
JFS Referral Coordination
Contact Form
Person making referral: ________________________Phone #____-____-______
Referred to:___________________________
KidSuccess____yes____no
Phone #: ________________________
Name of Person being Referred:
First Name:______________________Last Name:_____________________________
DOB: _____ /_____ /______
Type of Insurance___________________________
Insurance #__________________________Group #____________________________
-----------------------------------------------------------------------------------------------------------Parent’s Information:
First Name: _____________________Last Name: ______________________________
Phone Number:_____-_____-________
Address: _______________________Apt_______City________________ZIP________
County of Residence: ________________
-----------------------------------------------------------------------------------------------------------Reason for Referral:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
________________________________
-----------------------------------------------------------------------------------------------------------Outcome/Action Taken:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
__________________________________________________________________________________
______________________________________________________________
Date Received: / / Date Completed: / / Date of Follow-Up: / /
Person Working Referral: _______________________Phone #____-____-_______
JFS Counseling:
Updated 7/31/2012
Phone: (303) 597-7777 Fax: (303) 309-6715
3201 South Tamarac Drive, Denver, 80231
6-16
Chapter 7
Chapter 7 : CASE MANAGEMENT
The private practice providers who were surveyed during the CCHAP planning
phase identified a need for case management. Based on this survey it was
determined that there are three common and very important issues that case
management needs to address. They are:
•
•
•
Children who were frequently in the emergency department
Children whose asthma was not well controlled
Children who miss appointments regularly
CCHAP Resource Team
Erlinda DeLuna
[email protected]
720-777-6336 Direct Line
720-777-6363 Main Line
720-777-7338 Fax
Lorena Counts
[email protected]
720-777-6334 Direct Line
720-777-6363 Main Line
720-777-7338 Fax
Definitions- Case management and resource coordination are often used
interchangeably. However, at CCHAP, these terms mean the following:
Case management - health education, telephone follow-up, ongoing clinical
advice and coordination of clinical referrals and specialty visits to directly improve
clinical health outcomes, (for example; the kind of things a nurse would help
with).
Resource coordination- helping patients and families find and utilize the
appropriate resources to meet the patients/family’s non-clinical needs. This
means working to find financial assistance, Medicaid eligibility, food, housing,
day care, help with domestic violence, legal advice, job training and placement
transportation to visits, getting appropriate mental health referrals, etc. (See
Chapter 5.)
Updated 7/31/2012
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 7
Case management for high ED utilization
CHP+ patients enrolled in Colorado Access – Contact the nurse care
coordinator at Colorado Access at 720-744-5534 if you are concerned about
extremely high ED utilization. You can also contact the CCHAP Resource Team
(page 7-1).
Medicaid patients – Contact the Healthy Communities Outreach Worker in the
patient’s county of residence. You can also contact the CCHAP Resource
Team (page 7-1).
Client Over-Utilization Program (COUP) – The COUP is a lock in policy for
providers who want to lock in Medicaid clients who over utilize ED. The families
will qualify under the 4th bullet option below. Providers should send in their lock
in requests to Ethel Smith at HCPF ([email protected] ). HCPF will send
the family a warning letter and then lock them into the referring physician the next
month for at least 12 months.
Those clients whose use of Medicaid benefits without medical necessity
exceeds any one of the following during a quarter shall be subject to
placement in the program:
o
o
o
o
use of 16 or more prescriptions,
use of three or more pharmacies,
use of three or more drugs in the same therapeutic category,
i.e., oxycodone, oxycontin, hydrocodone; or
by referral, review or other analysis that indicates possible
over utilization.
Once enrolled in COUP, the client is locked-in to one physician and one
pharmacy for an initial period of twelve consecutive months. As a lock-in
provider, the physician would be wholly responsible for all of the client's
care and prescribing needs and the client would not be able to be seen by
any other physician or facility.
You can also contact the CCHAP Resource Team (page 7-1) if you are
interested in using this program and they will forward you the request form
template.
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 7
Asthma case management
The Pediatric Pulmonary Division at Children’s Hospital Colorado offers an
asthma case management program for children whose asthma is poorly
controlled, as well as education and support for families, and follow up care with
the appropriately health care provider. They require an initial appointment to
begin the education process. At the initial visit, the asthma specialists will
develop an asthma care plan and coordinate care with your practice providers.
The nurse case manager provides asthma education and follow-up by phone to
assist with decisions at home regarding care. To refer a child/family for an
appointment, you can have the family call 720-777-6181, or if you are concerned
about compliance, your office can call this number and they will contact the
family. After that initial visit, the asthma case management nurse will follow the
patient and keep in touch with your office.
Missed appointments by Medicaid families
Case Management is provided by HCPF (state Medicaid) for all Medicaid eligible
patients and families through the Healthy Communities Outreach Coordinators.
They are available to evaluate and intervene with Medicaid families where a child
has missed 2 or more appointments (no shows).
A list of Healthy Communities Outreach Coordinators in the counties surrounding
Denver is included in the Eligibility and Enrollment chapter or on this link:
http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheader=application%2
Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251656456506&ssbinary
=true
You may also call 303-866-6167.
You will find it very helpful to develop a close working rapport with the lead
Outreach Coordinator in the county or counties from where most of your
Medicaid patients reside. They are available to meet with your staff to explain
their services at your request. You can also contact the CCHAP Resource
Team (page 7-1) to help facilitate such a meeting at your request.
Missed appointments by CHP+ families
For CHP+ children who have excessive missed appointments contact the
appropriate Healthy Communities Outreach Coordinator. If you need additional help,
you can also contact the CCHAP Resource Team (page 7-1). They will help
evaluate and assist the family.
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 8
Chapter 8 : TRANSPORTATION
BACKGROUND AND SUMMARY OF RESOURCE
During the planning phase for CCHAP, private practice physicians surveyed indicated their
Medicaid and CHP+ patients often have difficulty with transportation to office visits. To
eliminate this barrier to access, there are several options available to CCHAP practices to
assist their patients’ families in getting their children to their healthcare visits. This process
differs for rural and front range practices: 1) Medicaid arranged; 2) RTD and 3) Taxi
vouchers.
Please note: Transportation is not a covered benefit for CHP+ patients. Medicaid does
provide and pay for transportation for foster children.
Medicaid Arranged Transportation
Most Medicaid clients are eligible for transportation services to routine (scheduled
appointments) and urgent (client needs to get to the doctor within less than 72 hours)
medical appointments. Urgent appointments will be verified with the physician’s office.
Non-Emergent Medical Transportation (NEMT) is transportation to and/or from Medicaid
medical appointments or services and is only available when a client has no other means of
transportation. All transportation requests must be prior approved if Medicaid is to pay for
the transportation. The types of transportation available include:
· Mobility vehicles
· Wheelchair vans
· Ambulance
· Taxi
· Stretcher van
· Private vehicle
· Train
· Plane
· Reimbursement may be provided for
gas, bus tokens and bus passes
Is anything else covered under NEMT?
· Meals and lodging may be covered under NEMT. Approval for meals and lodging will
only be considered if the trip cannot be completed in one day.
· Medicaid may also pay for transportation, meals and lodging for an escort for at-risk
adults or children. A stay at Ronald McDonald House can also be covered. Ronald
McDonald House staff can help with approval of this benefit in cases of an
emergency admission. Otherwise all meals and lodging must be pre authorized.
Transportation to a medical appointment:
Front Range Counties
IMPORTANT! Effective January 1, 2012 First Transit will replace Logisticare as the NEMT
provider for Colorado Medicaid. For Denver Metro area counties Adams, Arapahoe,
Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer and Weld (the county where your
patient lives) call First Transit (Toll Free Reservation Line) 1-855-264-6368. If
arrangements have been made through First Transit, a confirmation number will be given.
Please write this number down in case transportation is canceled or the appointment is
changed and First Transit needs to cancel the pickup.
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Chapter 8
Outside of the Metro area
Call the county Human Services office, county NEMT Coordinator in which the patient lives
and they will assist with your client’s transportation needs. See table at the end of the
chapter for a list of contacts within all counties. Patients are advised to call at least 3 days
before scheduled appointments.
For urgent and scheduled medical appointments (<72 hours) transportation dollars are
available to pay the patient, neighbor, relative or friend for transportation in their private
vehicle. Information to the Transportation Coordinator in the patient’s county of residence
must include the name of the driver, a copy of the driver’s license and proof of insurance.
The County must be sure that the individual is legally allowed to drive in the state of
Colorado. Having the ability to pay a private individual or another individual party for their
gas expenses should help patients make their appointments. This payment MUST be
authorized before the patient is transported. The County Coordinator will call the practice
to confirm the appointment.
How will the patient know they will get a ride?
If arrangements are made through the county, the county Coordinator will
provide the patient with the name of the transportation company and the time the patient
will be picked up to confirm transportation arrangements.
For transportation to clinics that only schedule same day appointments, be sure that the
transportation provider or county Coordinator knows that this is the clinic’s rule. The
transportation provider will call to verify that this is the rule and the appointment date and
time.
What information will First Transit, or the county need, when called?
Name
Medicaid ID number
Home address
Phone number
Doctor’s name, phone number, address, time of the appointment.
Can the patient go anywhere they wish?
No, patients can only go to and from Medicaid medical appointments. If there is no doctor
close to your home or if you are seeing a specialist, First Transit or the county will contact
the doctor to fill out a form stating the patient must be seen by that doctor.
What is not covered under NEMT?
· Transportation anywhere other than a Medicaid medical appointment or service with a
Medicaid provider.
Transportation to pick up prescriptions:
The patient must to preapproved by the county Coordinator before a stop to fill a
prescription occurs. It may be worth having the patient ask if this is available if there
is no prescription service at the practice site.
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Chapter 8
Patient’s family should be given the phone number for First Transit and/or their County
Transportation Coordinator and be expected to make their own transportation
arrangements under most circumstances. However, your office staff may call First Transit
or the county Coordinator for the parent if they need assistance.
For questions or issues, contact First Transit at 1-855-638-8178.
For more information call: Medicaid Customer Service:
Within Denver metro area – 303-866-3513
Outside Denver metro area – 1-800-221-3943
If you have questions about Medicaid Medical Transportation call 303-866-5622.
Updated 7/31/2012
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Chapter 8
Other Transportation Resources
RTD (Metro Denver)
Access-a-Ride (Not paid by Medicaid)
Access-a-Ride provides transportation to passengers with disabilities who are unable to
use RTD's regular lift-equipped fixed route bus service and who qualify for certification
under the eligibility guidelines established by the Americans with Disabilities Act (ADA) of
1990. The Access-a-Ride program is open to persons with disabilities under the following
conditions:
• An individual requires a lift-equipped bus and the bus they need does not have a lift.
• An individual is unable to independently get to and from a bus stop or cannot get on
and off the bus.
• An individual is unable to understand how to complete bus trips.
Qualification for Access-a-Ride service:
The certification process requires a functional evaluation and a physician's statement for
verification. There is no certification fee.
If you qualify for Access-a-Ride, you will receive a photo ID card that must be shown to the
driver each time you board. You will also receive a User's Guide explaining how the
program works, including information on making and confirming reservations, types of
service, escorts, trip cancellations and more.
Service Area:
You can use Access-a-Ride to travel within Arapahoe, Adams, Denver, Boulder,
Broomfield, Douglas and Jefferson counties as long as the same trip could have been
made on the regular RTD fixed-route bus system. Your trip must have a starting and ending
point within 3/4 mile of an RTD non-commuter fixed route bus service as well as Call-nRide service areas and you must travel on the same days and during the same hours as
the fixed route bus service operates.
Reservation Service: Access-a-Ride reservations can be made up to three (3) days in
advance. Make your request as early as possible, since Access-a-Ride trips are scheduled
on a space-available, shared-ride basis.
Subscription Service: Recurring trips, same days and times, at least three times per
week, you may request Access-a-Ride subscription service. This allows you to take regular
trips without making and confirming reservations each time. Please note that subscription
service is very popular and there may be a waiting list.
Door-to-Door Service: Access-a-Ride offers curb-to-curb service with driver assistance at
the vehicle or curb. Special door-to-door assistance may be available upon request.
See http://www.rtd-denver.com/accessARide.shtml or call the access-a-Ride office at
(303) 299-2960 for more information.
Updated 7/31/2012
8-4
Chapter 8
Taxi Accounts
For CHP+ and uninsured patients or when Medicaid cannot provide service for Medicaid
patients, CCHAP will pay for taxi service. Records must be kept by the practice by utilizing
the “Taxi Ride Log” at the end of this Chapter so we can track usage and reconcile invoices
from the cab companies.
The companies we are currently contracted with are:
1. Metro Taxi, Inc. (303) 333-3333
Account: 8601 (Medical Home for Every Child Number)
Covers Metro Denver and some areas of Castle Rock
2. Yellow Cab (303) 777-7777
Account: 1737
Covers Metro Denver, Boulder, Longmont, Loveland, Greeley, Fort Collins
and north to the Wyoming border. South from Metro Denver to Castle Rock
3. Yellow Cab, Colorado Springs (719) 634-5000
Account: (call CCHAP 720-777-6363)
Covers Colorado Springs/El Paso County
4. Moffat and Routt County Only
All Around Taxi (Craig, CO)
Account: “CCHAP”
970-824-1177
5. Lake County
Cloud City Cab Company
Account: “CCHAP”
719-207-8833
6. Pueblo City Cab Company
Serving Pueblo, CO
Account: “CCHAP Pueblo”
719-543-2525
Please keep these account numbers secure, so they are not misused. Do not give
the patient the account number.
•
Please tell the Taxi dispatcher “No Stops’’ and “No tip unless provided by rider”.
•
IMPORTANT!
Please complete the taxi ride log sheet in this chapter and fax (720-777-7338)
or email scan ([email protected] ) to: ATTN: CCHAP.
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
8-5
Chapter 8
County
Adams, Arapahoe, Boulder, Broomfield,
Denver, Douglas, Jefferson, Larimer,
Weld
Alamosa, Conejos, Costilla,
Mineral, Rio Grande, Saguache
Logan, Morgan, Phillips,
Sedgwick, Washington, Yuma
Delta
Montrose
Archuleta
Baca
Bent
Chaffee
Cheyenne
Clear Creek
Crowley
Custer
Dolores
Eagle
Elbert
El Paso
Fremont
Garfield
Gilpin
Grand
Gunnison, Hinsdale
Huerfano
Jackson
Kiowa
Kit Carson
Lake
La Plata
Las Animas
Lincoln
Mesa
Moffat
Montezuma
Otero
Ouray
Park
Pitkin
Prowers
Pueblo
Updated 7/31/2012
Transportation
Company
Contact information
First Transit (eff. 1/1/2012)
1-855-264-6368
San Luis Valley
Transportation
County Express
719-589-5734
All Points Transit
970-874-7334
970-249-0128
970-264-2182
719-523-4131 x100
719-456-2620 x108
719-539-6627 x8908
719-767-5629
303-679-2368
719-267-3546 x248
719-783-2371
970-677-2250
970-328-8845
303-621-3206
719-444-5600
719-275-2318
970-625-5282 x221
303-582-5444
970-825-3331
970-641-3244 x1
719-738-2810
970-723-4750
719-438-5541
719-346-8732
719-426-4156
970-382-6186
719-846-2276 x7109
719-743-2404 x142
970-256-2498
970-824-8282
970-564-4138
719-383-3125
970-626-2299
719-836-4143
970-328-8845
719-336-7486 x146
719-583-6924
1-866-734-6666
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
8-6
Chapter 8
Rio Blanco
Routt
San Juan
San Miguel
Summit
Teller
Updated 7/31/2012
Social Services
Social Services
Social Services
Social Services
Social Services
Social Services
970-878-9640 x1230
970-870-5260
970-387-5326
970-369-5446
970-668-9174
719-686-5500
8-7
Chapter 8
TAXI RIDE LOG
Practice Name _____________________________________________
Please complete each time the CCHAP account is used. At the end
of each month fax or email to: ATTN CCHAP
(fax 720-777-7338) or email to: [email protected]
Date
Taxi Company
Reason for Office
Visit
Updated 7/31/2012
© 2006 Colorado Children’s Healthcare Access Program
Practice staff member
ordering or authorizing ride
8-8
Please state the reason that First Transit
or other transportation was not available.
Please note if patient is MCD, CHP+ or
Uninsured
Chapter 9
Chapter 9 : SPANISH INTERPRETATION TRAINING
Improving Health Outcomes for Spanish Speaking Families
BACKGROUND AND SUMMARY OF RESOURCE
Nearly 50 million Americans (18.7 percent of U.S. residents) speak a language other
than English in their homes; 22.3 million (8.4 percent) have limited English
proficiency. Research shows that the language barriers impede access to
healthcare, compromise the quality of care, and increase the risk of adverse health
outcomes for patients with Limited English Proficiency (LEP). When a parent is LEP,
the family is less likely to adhere to medication or treatment plans and more likely to
miss appointments and to defer necessary medical care. Patients are also less
likely to have a medical home, receive preventive care, and are more likely to
experience medication complications. Language barriers can lead to inefficient care
because clinicians are unable to elicit LEP patients’ symptoms and, thus, use more
diagnostic resources or invasive procedures. Children with asthma whose families
have LEP are less likely than others to return for follow-up appointments, have
higher rates of hospitalization and drug complications, have more expensive care,
have an increased risk of complications such as intubations, and have lower levels
of patient/parent satisfaction. LEP increases the risk for medical errors and
malpractice suits.
Many studies document that trained professional interpreters and bilingual
providers improve health outcomes, thus reducing the number of tests and
hospitalizations and improving parent and provider satisfaction.
Ad hoc interpreters--including family members, friends and untrained members of
the support staff--are commonly used as interpreters in busy office practices. Ad hoc
interpreters are unlikely to have the training and knowledge needed to be effective,
including medical terminology, confidentiality, and duel proficiency in English and
their primary language. Untrained interpreters are considerably more likely than
trained interpreters to commit an interpretation error that can have adverse
clinical consequences. Ad hoc interpreters may also have beliefs that conflict with
those of the patient or the healthcare provider. Their presence may inhibit
discussions regarding sensitive issues such as domestic violence, substance abuse,
psychiatric illness, and sexually transmitted diseases.
It is especially risky to have children interpret since they are unlikely to have a full
command of two languages. Children frequently make errors of clinical
consequence, and they are particularly likely to avoid sensitive issues. Children
should never be interpreters. In some cultures, the child is expected to “take care
of” the parent who does not speak English. Reassure the child that this decision has
no bearing on their abilities to provide the service, but that the Federal Guidelines
require a trained professional to translate.
Updated 7/31/2012
9-1
Chapter 9
The Office for Civil Rights 2003 guidelines seem to allow smaller health care
facilities (i.e., practices) to opt out of providing language services which can be too
costly. But, private practices are expected to have at least one of the following for
languages often spoken in their patient population: bilingual staff, staff interpreters,
volunteer interpreters, contract interpreters, or telephonic interpretation.
Spanish Interpretation Training for Medical Practices
Training for staff or providers who already speak some Spanish
CCHAP offers a convenient, time-efficient, cost-efficient medical Spanish
interpretation training program for pediatric office staff and providers. It is provided
as a telephone conference during the lunch hour. The instructor, Maria Soto, is a
certified Spanish Interpreter and trainer with International Language Services.
Training in medical Spanish interpretation includes:
• Medical (pediatric) terminology
• The subtle differences in the two languages in word selection and grammar.
• Culturally appropriate communication skills
• Professionalism and etiquette of interpretation
• Confidentiality
Who: This program is for providers or practice staff members who are bilingual.
How: The sessions will be conducted via telephone, using handout materials and
the Internet, and will also include role-playing. An assessment of each individual’s
skill level will be done during a 5-10 minute phone call prior to the first session.
When: These sessions can be arranged during the workday or after-hours.
Registration: To register for these classes, please send an email to Maria Soto at
[email protected] with the following information:
1. Name of student
2. Job title
3. Pediatric practice name
4. Work phone number
5. Home phone number
6. Is your first language English or Spanish?
7. How long have you been speaking Spanish, if it is not your first language?
8. What time you prefer?
9. What is your goal in enrolling in this class?
Price: $20 per session. After registering, please send a check for $120, payable to
International Language Services, 12572 West Brandt Place, Littleton CO 80127.
A certificate of completion will be given after completion of all 6 sessions.
Updated 7/31/2012
9-2
Chapter 9
Course for providers who do not speak Spanish
www.bilingualmed.com
Ingléspañol/SpanishEnglish is a business dedicated to address cultural gaps and
language barriers, helping health professionals and the legal community to create a
dynamic relationship with their customers that are conductive to produce improved
outcomes and economic advantages. Ingléspañol/SpanishEnglish offers the
following services:
•
•
•
•
•
Customized classes in “Medical Spanish” helping clinics and health
organizations to increase the staff’s ability to understand and interact with
Spanish speaking patients.
Online “Medical Spanish” These are two separate practical basic courses,
one for Medical health Providers and one for Dental Health Providers. Learn
Fast with Innovative, Interactive, online Lessons & vocabulary Tools; these
courses complement the language immersion classes in Cuernavava, and
Puebla, México or Costa Rica, and the customized Medical and Dental
Spanish classes here in the U.S.A.
Translation to Spanish of manuals, brochures, articles, and written
presentation. Creation of PowerPoint presentations.
Culturally sensitive advice, translations and interpretations for child adoption
agencies, workers compensation cases and medico-legal consultants
Assistance in coping with cultural differences in accessing medical care,
reducing barriers to locating and using services.
Contact: Abe Grinberg MD (303-437-1105)
[email protected] my web-site www.bilingualmed.com
Updated 7/31/2012
9-3
Chapter 10 : IMMUNIZATION REGISTRY AND VACCINES
BACKGROUND AND SUMMARY OF RESOURCE
By two years of age, nearly a over half of children on Medicaid or CHP+ in the U.S.
have seen more than one healthcare provider / facility. Accurately assessing
immunization needs is difficult when records are scattered and the available
immunization history is incomplete. In addition to missed opportunities for
immunization, one in five U.S. children receives at least one unnecessary dose of
vaccine by two years of age.
CCHAP’s initial survey of providers indicated that tracking immunizations for children
in low income households is a challenge because they tend to be transient, and the
children have often received immunizations from several different clinics. They also
indicated that records are often not kept by these families.
Keeping track of shot records has never been easier! By participating in the
Colorado Immunization Information System (CIIS), healthcare professionals, parents
and individuals can rest assured that their immunization records are safe and
complete.
Colorado Immunization Information System
Operated by the Colorado Immunization Program at the Colorado Department of
Public Health and Environment, CIIS enables any immunization provider in Colorado
to electronically track immunizations a person has received, thereby maintaining an
ongoing and complete record to ensure that the person receives all recommended
shots in a timely manner.
An immunization information system is an important tool to increase and sustain
high immunization coverage rates by consolidating immunization records from
multiple providers, allowing providers to generate recall notices for individuals who
are not up-to-date, minimizing over-immunization, and identifying missed
opportunities for immunization. CIIS meets the guidelines for immunization
information system functionality developed by the Centers for Disease Control and
Prevention.
Benefits of CIIS
The Colorado Immunization Information System (CIIS) provides the following
benefits to providers:
•
Consolidates all immunizations into one easily accessible yet secure record
for each individual
•
Provides decision support by displaying the vaccines recommended under
current guidelines based on the individual’s age and immunizations already
received
•
Provides an accurate, official copy of a child’s immunization history for
personal, school, child care or camp entry requirements
Updated 7/31/2012
10-1
•
Enables providers to easily screen for immunizations at each visit
•
Enables providers to notify parents if a child has missed an immunization
•
Facilitates the introduction of new vaccines or changes in the recommended
vaccine schedule
•
Identifies an individual’s previously reported contraindications and allergies
•
Web-enabled database for data entry and access
•
Interoperability with electronic health records and billing software
•
Enables providers to generate recall notices for individuals who have missed
an immunization
•
Allows state and local public health officials to make assessments of
populations that are un- or under-immunized in order to implement
geographically targeted interventions
Why should your practice participate in CIIS?
To provide quality patient care
•
CIIS displays recommended immunizations at each visit based on current
ACIP standards
•
CIIS allows for capture of immunizations based on a catch-up schedule as
well as immunizations recommended for travel
•
CIIS highlights previously reported reactions and contraindications
•
CIIS provides a way to identify and recall individuals who are overdue for
immunizations
•
CIIS can immediately identify patients for vaccine manufacturer recalls
To save time
•
Retrieve immunizations entered by other offices for your new patients
•
Print official immunization forms for school, child care and camp entry
requirements without pulling charts
•
Track vaccine usage and manage inventory
•
Record all data required by the National Childhood Vaccine Injury Act
•
Complete required benchmarking reports if enrolled in the Vaccines for
Children program through the Colorado Department of Public Health and
Environment
Updated 7/31/2012
10-2
To ensure more complete immunization records
•
CIIS combines the immunization record from multiple providers into a single
record for each individual
•
Immunization information supplied by individuals can be easily added to the
record in CIIS
To save money and reduce wastage
•
Some malpractice insurers offer discounts on premiums to providers
participating in CIIS
•
Minimize over-immunization and the costs associated with delivering an
unnecessary vaccine
•
Identify missed billing opportunities by comparing billing records with CIIS
records
If your practice does not already use the CIIS immunization registry, please go to the
following website for more information about the many advantages and to sign up:
http://www.cdphe.state.co.us/dc/immunization/ciis/index.html
If you have questions or there are problems with the CIIS, please contact:
For practices that do not use CIIS, contact:
CIIS Help Line: 303-692-2437 or 888-611-9918 #1
Or visit their public website: www.coloradoiis.com
For practices already on CIIS who have questions:
CIIS Help Line: 303-692-2437 or 888-611-9918 #1
Or Web site: https://CIIS.state.CO.US/CIISV4net
Mailing Address:
Colorado Immunization Information System
Colorado Dept of Public Health and Environment
DCEED-IMM-A3
4300 Cherry Creek Drive South
Denver, Colorado 80246-1530
Updated 7/31/2012
10-3
Chapter 10
Vaccines for Children
Medicaid provides free vaccines for your Medicaid patients. If your practice is new to
the program, the Department of Public Health will come to your office for an
orientation to make sure you understand their requirements, as well as explain how
to order vaccines and inspect your vaccine storage. Although you are required to
use the free VFC vaccines for Medicaid patients, and keep them separate from
those vaccines you purchase for your other patients, it is easy to do because each
vial is clearly labeled VFC. The Department of Public Health will require a once-ayear report; which can easily be retrieved from the CIIS system.
The CCHAP pilot practices report that the Vaccines for Children Program is very
easy to work with and is worthwhile. Practices report their reimbursement rate for
immunizations visits is higher than commercial insurance when the cost of the
vaccines is included.
Further information about the Colorado Dept of Public Health and Environment
Vaccines for Children program is available at:
http://www.cdphe.state.co.us/dc/Immunization/vfc.html
Please contact Debra Zambrano RN, at 1-866-530-1813 x22 or Nicole Ortiz at 303692-2334 if you have additional questions or need additional information.
Billing for administration of vaccine for Medicaid children
Even though the vaccine is provided free to the practice, you must bill Medicaid for
the vaccine and the administration of each injection. The administration code will be
reimbursed at $6.33 per injection (see the chapter on enhanced reimbursement).
VFC Program FAQs
http://www.cdphe.state.co.us/dc/Immunization/vfc/FAQs09.pdf
Colorado Immunization Manual
This is a comprehensive guide book for the VFC program and includes valuable
information on ordering, storage, immunization schedules, vaccines available
through this program, etc. Download the .pdf document at:
http://www.cdphe.state.co.us/dc/Immunization/immunmanual/immunmanual.ht
ml
Updated 7/31/2012
10-4
Chapter 10
IMMUNIZATION MATERIALS ORDER FORM (Fax to 303-866-3235)
ITEM
QTY (#)
ITEM
Certificates:
CO Revised Statutes: School Entry Immunization [#26] (White) limit 2
Certificate of Immunization [#1] (Gray)
CO Revised Statutes: Meningococcal Disease [#27] (White) limit 2
Certificate of Immunization for Electronic Records [#2] (Eggshell)
Flowchart of School Immunization Law [#28] (White) limit 2
Certificate of Immunization for College Students [#3] (White)
Clarification of Immunization Requirements 08-09 [#29] (White) limit 2
QTY (#)
Record Cards, etc.:
Immunization Administration Record Sheet for Child or Teen [#4]
(Blue)
Immunization Administration Record Sheet for Adult [#5] (Green)
Expanded Immunization Administration Record Sheet for Adult
[#6] (Yellow)
Immunization Administration Record Card for Child or Teen [#7]
(White)
Expanded Immunization Administration Record Card for Adult
[#8] (White)
Personal Immunization Record Card for Children [#9] (Yellow)
Personal Immunization Record Card for Adults [#10] (Purple, Wallet
Size)
Minimum # of Doses Child Care thru Preschool, 08-09 [#36] (White)
Minimum # of Doses Kindergarten thru Grade 12, 08-09 [#37] (White)
Plastic Protection Sleeve for Children’s Personal Record Cards #9
ONLY [#11] (Clear)
Cards: In your Notice of Privacy Practice, state that cards will be sent!
Brochures, etc.:
Folding Reminder (English) [#41] (Purple)
Attention: College-bound Students [#18] (Yellow)
Folding Reminder (Spanish) [#42] (Yellow)
Charts:
Reminder (English) [#43] (Pink)
Summary of ACIP/AAP/AAFP Pediatric Immunization
Recommendations [#21] (Green)
Reminder (Spanish) [#44] (Peach)
Summary of ACIP/ACOG/AAFP Adult Immunization
Recommendations [#22] (White)
Colorado Immunization Information System (CIIS):
HIPAA Information:
Frequently Asked Questions Eng/Sp [#45]
HIPAA Frequently Asked Questions [#23] (White)
Notification Poster Eng/Sp [#46]
HIPAA & the School Immunization Laws: Authorizations Not
Needed [#24] (Purple)
Non-participation Form Eng/Sp [#47]
School/Childcare Resources:
CIIS Brochure [#48]
Rules of the CO Board of Health [#25] (White) limit 2
SHIPPING INFORMATION
PLEASE PRINT CLEARLY!
Name:
Attention:
P.O. Box:
Street
Address:
We need your P.O. Box in case we ship your order via USPS.
City:
Zip Code:
Phone:
Date:
We need your street address in case we ship your order via UPS.
PLEASE ALLOW UP TO THREE (3) WEEKS FOR DELIVERY!
Updated 7/31/2012
10-5
Chapter 10
TO SUBMIT ORDERS (choose one method below):

(Fax to 303-866-3235)
Mail to: Integrated Document Solutions, ATTN: Immunization Orders, 2 Jetway Ct., Pueblo, CO 81001.
 Fax to .................................................................... (303) 866-3235
If you have Microsoft Word on your computer, save Order Form in Word found on website listed above as a file on your
computer, complete the form, and…
 Send as an attachment to ................................... [email protected]
ORDER FORM ITEM DETAILS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
18.
21.
22.
23.
24.
25.
26.
27.
28.
Certificate of Immunization – gray card, required for schools & childcare providers, updated 04/07
Certificate of Immunization for Electronic Records – tan sheet, alternative certificate to be used w/customized software
Certificate of Immunization for College Students – white sheet, lists requirements for college students, p. 2 has
meningococcal info
Immunization Administration Record Sheet: for Child or Teen – blue sheet for providers (for patient’s file), w/section for
exemptions, approved certificate
Immunization Administration Record Sheet for Adult – green sheet for healthcare providers (for patient’s file), w/basic adult
vaccines
Expanded Immunization Administration Record Sheet for Adult – yellow sheet for healthcare providers (for patient’s file),
includes travel vaccines
Immunization Administration Record Card for Child or Teen – white, card-stock for healthcare providers; smaller size (folded
to size 7.5x5)
Expanded Immunization Administration Record Card for Adults – White, card-stock for healthcare providers; smaller size
(folded to size 7.5x5)
Personal Immunization Record for Children – yellow tri-fold card for healthcare providers (to give to parents)
Personal Immunization Record for Adults – purple tri-fold card for healthcare providers (to give to patients)
Plastic Protection Sleeve – clear sleeve, fits yellow & purple tri-fold cards above
Attention: College-bound Students – yellow flyer about requirements for college students
Summary of ACIP/AAP/AAFP Pediatric Immunization Recommendations – 11x17” for 2008
Summary of ACIP/ACOG/AAFP Adult Immunization Recommendations – 8½”x11” for 2008
HIPAA Frequently Asked Questions – white sheet for healthcare providers, about immunization records
HIPAA & the School Immunization Laws: Authorizations Not Needed – purple sheet for healthcare providers, schools, &
childcare providers
Rules of the CO Board of Health – white sheet, about the infant immunization program & school immunization rules
CO Revised Statutes: School Entry Immunization – white sheet, CO law
CO Revised Statutes: Meningococcal Information for College Students – white sheet, CO law, about providing
meningococcal disease information to postsecondary students
Flowchart of School Immunization Law – white sheet, step-by-step explanation for record keepers
29. Clarification of Immunization Requirements 2008-09 – white sheet, for record keepers
Minimum # of Doses Child Care thru Preschool, 2008-09 - for schools and childcare providers
Minimum # of Doses Kindergarten thru Grade 12, 2008-09 - for schools and childcare providers
Folding Reminder (English) – purple card for healthcare providers (to send to parents noting what shots are due)
Folding Reminder (Spanish) – yellow card for healthcare providers (to send to parents noting what shots are due)
Reminder (English) – pink postcard for healthcare providers (to send to parents noting that shots may be due), w/opt out
Reminder (Spanish) – peach postcard for healthcare providers (to send to parents noting that shots may be due), w/opt out
Frequently Asked Questions Eng/Sp – FAQ’s about CIIS for distribution by providers to parents. Eng on one side Spanish
on other side
46. Notification Poster Eng/Sp – Poster in English & Spanish to be posted in provider office for notification of using CIIS
47. NonParticipation Form Eng/Sp – Form to be completed to Opt out of CIIS. Eng on one side Spanish on other side
48. CIIS Brochure – brochure containing additional information about the Colorado Immunization Information System
36.
37.
41.
42.
43.
44.
45.








Quantity is the individual # of sheets, cards, forms, brochures, etc. you wish to receive (not # of packs, groups, stacks, etc.).
There is no charge for any of the materials.
All materials (except for the plastic protection sleeves) can be downloaded from the website.
Materials are only in English unless noted.
Vaccine Information Statements are available on-line www.cdc.gov/vaccines or www.immunize.org
International Certificates of Vaccination are also available on-line (www.gpo.gov).
For materials related solely to the VFC Program, please call Houston at (303) 692-2795.
Healthcare providers do not need to get a patient's/guardian's authorization before immunization information can be released
to schools or childcare providers. However, the disclosure must be noted in the file.
WEBSITE: http://www.cdphe.state.co.us/dc/immunization/
...................................................................................... QUESTIONS: (303) 692-2650
Updated 7/31/2012
10-6
Chapter 11
Chapter 11 : DEVELOPMENTAL SCREENING AND
ADOLESCENT DEPRESSION SCREENING
Screening tools are available in Colorado to help primary care providers improve the
identification of children with developmental delay by using a highly effective standardized
screening test. Practices that provide standardized developmental screening at preventive
care visits for Medicaid children can bill for this service and will be reimbursed the going
Medicaid rate for this screening. Please see Chapter 4 for more billing details.
Using only clinical impressions rather than formal screenings leads to under-detection and
decreases the likelihood of a child receiving early intervention services. National studies
show that only 30% of children with disabilities are detected before school entrance.”
(AAPCOP Policy Statement, July 2006). Based on Colorado’s current population,
potentially 40,000 infants and toddlers in our state have disabilities, but only 6,000 children
from birth to three in Colorado were referred for early intervention services last year (Part C,
Colorado Department of Human Services, 2006). This raises the concern that a significant
number of children are not being identified and are missing the opportunity for early
intervention services during these crucial first few years of life.
In order to promote early identification of developmental concerns, the use of a
standardized screening tool that meets a threshold of 70% sensitivity and specificity is now
recommended at well child visits for children birth to six years of age (AAPCOP Policy
Statement, July 2006). The perceived barriers to screening in practices include: time, staff
and inadequate reimbursement. The Colorado Assuring Better Child Health and
Development (ABCD) Project began three years ago in order to address these barriers. The
pilot program included several primary care sites in Arapahoe, Douglas and Denver
counties.
Goals of the ABCD Project
•
•
•
•
•
The mission of the ABCD project is to promote early identification and referral
through the use of a standardized screening tool.
ABCD provides free technical assistance to practices who wish to implement a
standardized developmental screening tool into well child checks.
ABCD will help practices make a decision about which tool to use and train staff to
use the tool.
ABCD helps providers understand the referral process for children at risk for
developmental delay.
ABCD aims to assist practices in building relationships with local community
resources.
While there are several valid and standardized developmental screening tools available, the
Ages & Stages Questionnaire (ASQ) was selected by all of the practices participating in
the Colorado pilot based on its diagnostic elements and practical application. Participating
primary care offices identified several advantages of using the tool and integrating
developmental screening into their practice.
Updated 7/31/2012
11-1
Chapter 11
Providers’ Perspectives: Advantages to Using a Standardized Developmental
Screening Tool





Time efficient – The ASQ utilizes a questionnaire completed by the parent in the waiting
room or an exam room
Supports anticipatory guidance - Serves as a talking guide with parents, identifying a
child’s strengths as well as things the child is not doing yet.
Practical – Scoring takes 1-2 minutes and can be done by paraprofessionals.
Cost-efficient – The tool is affordable and the parent questionnaires may be photocopied
for on-going use; practices can bill for reimbursement
Valid and reliable – helps to accurately identify when further diagnostic assessment is
recommended
To share the pilot sites’ successful strategies for integrating standardized developmental
screening into practice, the ABCD Project will train your office staff. If you have questions
about developmental screening for your practice, would like more information about the
ABCD Project or wish to schedule staff training please contact the ABCD Coordinator,
Eileen Bennett 720-333-1351 or [email protected]).
The ABCD Project is a collaborative effort between the Colorado Department of Public
Health and Environment, the Colorado Department of Human Services Part C Program, the
Colorado Department of Health Care Policy and Finance, the Arapahoe County Early
Childhood Council, and CCHAP. Additional support for the project has been provided by the
Colorado Health Foundation, the Kaiser Foundation, the Temple Hoyne Buell Foundation,
and St. Mary’s Land and Mine Foundation.
Clarification – Although the ABCD program recommends the ASQ, several other
standardized developmental screening tests are acceptable to state Medicaid and qualify for
the Developmental Screening reimbursement. Please reference the Birth-5 Developmental
Screening and Assessment Instruments link on the HCPF website at:
http://www.colorado.gov/cs/Satellite?c=Page&cid=1218622605039&pagename=HCPF%2F
HCPFLayout.
Please note that the HCPF website lists the Denver II as an acceptable screening tool. This
means actually administering the Denver II, not just having a few questions from the Denver
II incorporated into the visit.
Medicaid Policy
Effective for dates of service on or after August 1, 2011, Medicaid has issued the following
policy for developmental and depression screens, and set the following rates for CPT codes
96110 and 99420. The Colorado Medical Assistance Program will reimburse developmental
screening code, 96110, at $17.00 and depression screening code, 99420, at $10.08.
Developmental Screening
The Colorado Medical Assistance Program covers developmental screening for children
ages 0 – 4, using a standardized, validated developmental screening tool (e.g., PEDS, Ages
and Stages) at the child’s periodic visits. In the absence of established risk factors or
parental or provider concerns, the American Academy of Pediatrics (AAP) recommends
developmental screens at the 9th, 18th, and 30th month, and 3 and 4 year well-child visit.
Limitations:
Updated 7/31/2012
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Chapter 11
Three (3) screens per year for children aged 0 – 24 months
Two (2) screens per year for children aged 25 – 59 months
Providers should report CPT code 96110, “Developmental testing; limited (e.g.,
Developmental Screening Test II, Early Language Milestone Screen), with
interpretation and report,” when providing developmental screens.
To report a positive screen:
Use a valid diagnosis code within category 315, “Specific Delays in
Development,” category 313, “Disturbance of Emotions Specific to Childhood and
Adolescence,” category 314, “Hyperkinetic Syndrome of Childhood,” for specific
delays in mental development.
Use a valid diagnosis code within category 783 (using 4th and 5th digits when
needed), “Symptoms Concerning Nutrition, Metabolism, and Development,” for
physiological delays.
To report a negative screen:
Use code V20.2, “Routine Infant or Child Health Check.”
Providers should report CPT code 96111, “Developmental testing; extended
(includes assessment of motor, language, social, adaptive, and/or cognitive
functioning by standardized developmental instrument) with interpretation and
report,” when a limited developmental screening suggests an abnormality in a
particular area of development and more extensive formal testing is needed to
evaluate the concern.
Screening for Adolescent Depression
Colorado has one of the highest rates of teen depression and teen suicide in the country.
Mental health screening is recommended the American Academy of Pediatrics, the
American Academy of Family physicians, the National Association of Pediatric Nurse
Practitioners, the U.S. Preventive Services Task Force and the Institute of Medicine on all of
our teenage patients each year. It is a required component of routine care for new plans
under the 2010 health reform legislation.
The Patient Health Questionnaire Modified for Teens (PHQ-9 Modified) is a well-accepted
questionnaire, used by many providers and health plans across the country. It can be used
with patients between the ages of 11 and 20 and takes less than five minutes for them to
complete. The PHQ-9 Modified can be administered and scored by a nurse, medical
technician, physician assistant, physician or other office staff. Teens are more likely to
truthfully answer questions about depression on a questionnaire than when asked the same
question by a provider.
The PHQ-9 Modified was developed by the Division of Child and Adolescent Psychiatry at
Columbia and is available for free. You can download the questionnaire and a guide for
implementation in your practice at teenscreen.org. There is a guide for implementing
depression screening in your practice (http://www.teenscreen.org/library/implementationmaterials-fact-sheets#PC). It also has a guide for when to refer and how to get
reimbursed (http://www.teenscreen.org/library/implementation-materials-factsheets#PC). There are training tools for office staff also at
(http://www.teenscreen.org/library/implementation-materials-fact-sheets#PC)
Updated 7/31/2012
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Chapter 11
How to bill:
The Colorado Medical Assistance Program covers depression screening for adolescents
aged 11 – 20, using a standardized, validated depression screening tool (i.e., PHQ-9,
Columbia Depression Scale, Beck Depression Inventory, Kutcher Adolescent Depression
Scale, etc.) at the child’s periodic visits.
Limitations:
• One (1) screen per year for adolescents aged 11 – 20 years
Post-Partum Depression Screening: providers may choose to screen
adolescent clients for post-partum depression as part of the client’s annual
depression screen. However, post-partum depression screening is a non-covered
benefit for Medicaid clients aged 21 and over.
Providers should report CPT code 99420, “Administration and interpretation of health
risk assessment instrument (e.g., health hazard appraisal),” when providing
depression screens.
To report a positive screen, use diagnosis code V40.9
To report a negative screen, use diagnosis code V79.8
Medicaid
Use CPT Code 99420; current reimbursement is $10.08 (effective 8/1/2011)
CHP+
Use CPT Code 99420; current reimbursement is $9.07 (effective 8/1/2011)
Where to refer a teen at risk for suicide
Medicaid clients only:
Resources for contacting BHOs are available online at BHO Resources.
Access Behavioral Care 800-984-9133 (toll free)
Behavioral Healthcare, Inc. 877-349-7379 (toll free)
Colorado Health Networks 800-804-5008 (toll free)
Foothills Behavioral Health Partners 866-245-1959 (toll free)
Northeast Behavioral Health Partnership 888-296-5827 (toll free)
Clients or providers may call the customer service number and request a mental
health assessment appointment, or may select a provider from the BHO’s Provider
Directory. Initial appointments should be offered within seven business days of the
request. If a client has Medicare in addition to Medicaid, the BHO can assist the client
to find a provider who takes both kinds of insurance. If a client has commercial or
other insurance in addition to Medicaid, the client should first access mental health
services under the primary insurance policy, as Medicaid is always the payer of last
resort. It is also important to get a signed release of information from the client so that
PCPs and BHO providers may share important treatment information.
CHP+ clients:
CHP+ members do not need a referral from their primary care provider for mental
health services. CHP+ members receiving care through their HMO must receive care
by a mental health provider who is part of that HMO provider network for the care to
be covered. Members should call their HMO directly for an appointment.
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Chapter 11
If a client has a mental health or substance abuse crisis, and cannot reach their BHO or
Community Mental Health Center, they can call:
Metro Crisis Line at 888-885-1222.
If you are afraid that someone is at risk for suicide, call:
Colorado Lifeline 800-273-TALK 800-273-8255 - a 24 hour crisis line for
depression/suicide.
Uninsured or Under-insured Teens at Risk for Suicide
When a teen at risk for suicide has no insurance or has inadequate mental health coverage,
contact Second Wind Fund (SWF). The mission of Second Wind Fund of Metro Denver is to
decrease the incidence of teen suicide by removing financial and social barriers to treatment
for at-risk youth. Learn more by visiting http://www.swfmd.org/aboutfund.html or calling 303988-2645
After you make the referral, SWF will:
1. After ensuring that the student is a suicide risk, lacks financial means to pay for therapy,
and is not on Medicaid, SWF assigns the student a referral number. If the student is on
Medicaid, he or she is first referred to the county mental health association.
2. The counselor initiates a referral with parental permission. After given a SWF referral
number, the school counselor writes the referral number on a program referral form, signs
the form, and gives it to the student and/or parents.
3. The referred student is given the referral form and a list of private therapists who have
agreed to see SWF clients.
4. All therapists in the SWF program are private therapists who are licensed, maintain
malpractice insurance, have experience with teens at-risk for suicide, and have agreed to
see SWF clients at a drastically reduced hourly rate.
5. SWF will pay for a student to visit a program therapist up to 20 times. (Eight visits are
automatically approved at the time of the initial referral. More visits require additional
information.)
To contact someone in your area to make a referral of a teen at risk of suicide:
SWF Metro Denver (Adams, Arapahoe, Broomfield, Denver, Jefferson, Park Counties) – call
303-988-2645
SWF Four Corners Colorado -- Lillian Ramey -- [email protected] (covers
La Plata and Montezuma Counties)
SWF Boulder County -- Faye Peterson and Kathy Valentine – [email protected]
and [email protected] (covers Boulder County) 720.212.7527
SWF Uncompahgre Plateau -- Kimberly Hamilton – [email protected]
(covers Montrose, Ouray, and San Miguel Counties)
SWF Weld County – Keith and Shannon Wawrzyniak -- [email protected]
(covers Weld County)
SWF Eagle River Valley – Carrieann Angrisani, [email protected] (covers Eagle
County)
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Chapter 11
SWF El Paso and Teller Counties – Constance Gelvin, [email protected] (covers El Paso
and Teller Counties)
SWF Douglas County -- Lynn Pender, [email protected] (covers Douglas
County) 303-895-0434
SWF Northeastern Colorado -- Maranda Miller and Jackie Reynolds, [email protected] and [email protected] (covers Sedgwick, Phillips, Yuma,
Morgan, Lincoln, Washington, Logan, and Kit Carson Counties)
Autism Screening
Colorado Medicaid covers autism screening for children aged 18- and 24-months, using a
standardized, validated depression screening tool (i.e., M-CHAT) at the child’s periodic
visits.
Limitations:
Two (2) screens per year for children aged 18 – 24 months
Providers should report CPT code 96110, “Developmental testing; limited (i.e.,
Developmental Screening Test II, Early Language Milestone Screen), with
interpretation and report,” when providing autism screens.
• To report a positive screen:
Use a valid diagnosis code within category 299 (using 4th and 5th digits when
needed), “Pervasive Developmental Disorders.”
• To report a negative screen:
Use code V20.2, “Routine Infant or Child Health Check.”
Screening Tools:
The Colorado Medical Assistance Program does not require the use of a specific
developmental screening tool, but providers must use a validated, standardized
developmental screening tool.
The Colorado Medical Assistance Program recommends the use of PHQ-9
depression screening tool, but other validated, standardized depression screening
tools are also acceptable.
Referrals to Care:
If a behavioral health need is identified, the primary care clinician must offer to either:
Provide the necessary services; or
Refer the patient to a specialist.
Primary care providers who choose to refer a client to a specialist must assist with
the referral process.
For more information on which Behavioral Health Organization (BHO) to refer
pediatric clients, visit the BHO section of the Department’s Web site at
colorado.gov/hcpf.
For additional information, please refer to the Developmental/Depression Screening
Policy Statement by visiting the Boards & Committees section of the Department’s
Web site and choose the Benefits Collaborative option. Please contact Sheeba
Ibidunni at [email protected] or 303-866-3510 with any questions.
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Chapter 12
Chapter 12 : CROSS-CULTURAL HEALTH CARE
LEARNING COMMUNITY
BACKGROUND AND SUMMARY OF RESOURCE
During our 18-month CCHAP pilot program, surveys identified the need for practices
to learn ways to help with the special needs and challenges of families from diverse
cultural backgrounds. We received a generous grant from the Colorado Trust to
develop a learning community among all Colorado pediatric practices to enable the
providers, administrators, and staff to learn and share knowledge and skills
regarding cross-cultural communications in healthcare settings.
Why should we learn more about cross-cultural care?
The Demographics
• Racial and ethnic minorities make up 1/3 of the Colorado population and are
the most rapidly growing group.
• 1/3 of Colorado children are born into poverty or near poverty (less than
200% of the Federal Poverty Level).
• Over one-third of Colorado children and 1/3 of children in the seven Metro
Denver counties are Hispanic, African-American, Native-American, or AsianAmerican.
• 99.4% of Colorado’s pediatricians are white, non-Hispanic.
• 40% of all Colorado newborns are born into poverty, the majority of who are
born into cultures other than their provider’s.
Improve Parent and Patient Satisfaction
The methods described in our Learning Community can be used with all families
in your practice from any socioeconomic level or culture to improve patient and
parent satisfaction.
Improve Your HEDIS (Health Effectiveness Data and Information Set)
Outcomes
• Better compliance with treatment
• Higher immunization rates
• Lower ED utilization rates
Reduce Practice Liability
• Fewer medical errors
• Better compliance
• Higher parent/patient satisfaction rates
Federal Guidelines
Guidelines are now just recommendations, but it is anticipated that they eventually
become regulations for practices. See guidelines on our web site www.cchap.org
Updated 7/31/2012
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 12
Earn ERS Points to Reduce COPIC Malpractice Premiums
Certain of our activities allow the provider to earn malpractice premium discounts:
• CCHAP quarterly seminar on cross-cultural healthcare. Watch for
announcements in our emailed newsletter.
• The AAFP on-line course in cross-cultural healthcare described below.
Project Summary
Our cross-cultural care learning community involves the following components:
eNewsletters – A monthly newsletter presenting cross-cultural communications
topics related to healthcare settings is emailed to your practice manager and
providers monthly. The material is succinct and reader friendly with links for further
learning opportunities and suggestions. www.cchap.org
One Hour Lunch In-Services – Our Director of Intercultural Communications,
Marcia Carteret, is bringing a series of one hour lunch in-services to participating
CCHAP pediatric practices to help providers and their staffs learn more about
successful communications between healthcare professionals and patients of
different cultural backgrounds. The changing demographics of our state continue to
have a heavy impact on healthcare professionals. Training around how culture
impacts health beliefs and behaviors is critical in achieving better patient satisfaction
and compliance. Contact Marcia Carteret @ 720-777-3124 or
[email protected]. Family practices interested in this training can
make arrangements with Marcia directly, as well.
Learning Community Web site - www.dimensionsofculture.com On this web site
you will find a collection of learning materials designed to help your providers and
staff enhance their knowledge and the skills needed to provide relevant familycentered, culturally-competent communication and patient care. The web site
includes newsletters that cover in greater depth much of the material presented in
Marcia’s trainings. There is also a Provider’s Guide with detailed information about
working in cross-cultural situations. Lists of relevant reading recommendations for
self-study are included. Contact Marcia Carteret @ 720-777-3124 or
[email protected].
Cross Cultural Care Workshops – Periodically workshops are offered to all
pediatric practice providers and staff on key elements of cross-cultural care. For
health care providers, the health care malpractice insurance carrier for Colorado
(COPIC) has agreed to give premium discounts to providers who take this workshop.
Watch the CCHAP newsletter for details. Contact Marcia @ 720-777-3124 or
[email protected]
On-line Course – A 3-hour on-line course on culturally competent health care, by
the American Academy of Family Practice, is available to all CCHAP providers.
Continuing medical education credits and credit toward discounts on COPIC medical
malpractice premiums are awarded for completion of the course. See the web site
at:
https://cccm.thinkculturalhealth.org/Registration_Login/GUI_Registration.asp?mode
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Chapter 12
Multilingual/Multicultural Quality Patient Education Materials
Immunization Action Coalition is a source of childhood, adolescent, and adult
immunization information and hepatitis B educational materials in over 30
languages. http://www.immunize.org/
Consumer Health Information in Many Languages contains links to resources with
materials in many languages and a glossary by language.
http://nnlm.gov/outreach/consumer/multi.html
The 24 Languages Project by Spencer S. Eccles Health Sciences Library, in
partnership with the Utah Department of Health provides electronic access to over
200 health education brochures in 24 different languages. Good information on
common illnesses and immunization information.
http://library.med.utah.edu/24languages/
www.dimensionsofculture.com
The website built for CCHAP practices supporting the in-practice trainings by Marcia
Carteret.
7/31/2012
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Chapter 13
Chapter 13 : AFTER-HOURS TELEPHONE TRIAGE AND
ADVICE
BACKGROUND AND SUMMARY OF RESOURCE
Children covered by Medicaid and CHP+ who do not have a medical home are
taken to the emergency department after office hours twice as often as
commercially insured children. When you look at the costs for Medicaid patients,
it is clear that reducing unnecessary visits to the emergency department or
urgent clinic is a major means of reducing the total cost of their care. Studies
show that Medicaid families can be successfully helped to change this behavior
by providing them with a medical home and after-hours telephone care.
To be certified as a Medicaid Medical Home for Colorado Children and receive
the higher reimbursement, your practice is required to provide telephone triage
and advice 24 hours a day.
During CCHAP’s pilot phase, after-hours telephone care was provided by The
Children’s Hospital After Hours Telephone Care Program (AHTCP) and the
practices. The Children’s Hospital ED, Urgent Care Centers and AHTCP have all
begun to educate and encourage families on how to access care by telephone
instead of going to emergency departments.
Once Medicaid and CHP+ families have been in a private practice for 12 to 18
months, they utilize after-hours telephone care at about the same rate as
commercially-insured families. You can anticipate an average of 1-2 calls per
night per thousand patients in the practice.
After-Hours Telephone Care
After-hours calls may be handled by the providers (or clinical staff) in the practice
or by a telephone triage and advice call center staffed by nurse, mid-level
providers or physicians. Over a 24-hour period, most practices offer a
combination.
The Children’s Hospital After-Hours Telephone Care Program (AHTCP) is the
clinical call center used most often, but there are other options in Colorado.
Medicaid also provides a no cost Nurse Advice Line that is available to your
Medicaid patients for after-hours coverage. A practice can add this information
to their after-hours phone message and meet the minimum requirements of 24x7
accessibility for Medical Home Certification.
Medicaid Nurse Advisor Line 1-800-283-3221.
Updated 7/31/2012
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Chapter 13
Second Level Triage
Most Colorado pediatric practices assign some or all of their after-hours
telephone care to The Children’s Hospital After-Hours Telephone Care Program
(AHTCP). Dr. Bart Schmitt and Dr. Steve Poole developed this program, and this
system is an excellent resource that provides great advice. However, an AHTCP
nurse using the protocols cannot provide telephone triage that is as effective as a
primary care provider can. If the AHTC nurse using the AHTCP protocols feels
that the child needs to be seen, the practice can opt to have the call forwarded to
the on-call provider. The practice provider on call may then find an alternative
way to manage the child to avoid an after hours visit. ATCH nurses manage 7578% of calls without an after-hours visit. Physicians manage 85-90% without an
after-hours visit. We hope in the future that Medicaid will provide incentive
payments to practices willing to do second level triage.
Additional Methods for Preventing Inappropriate Visits to the
Emergency Department
Many Medicaid and CHP+ families often have not had much experience with a
primary practice with 24-hour telephone availability. They need frequent
reminders to call the practice rather than go to the ED. The literature shows that
the single best way to reinforce that behavior is for practice staff and providers to:
Pleasantly remind parents at every visit that the
practice provides 24-hour telephone coverage.
Encourage them to call during office hours if they
can, but if problems arise after hours, call prior to
taking the child in.
CCHAP suggests you develop a scripted statement that staff and physicians in
your practice will use to encourage families to call rather than just go in. Make
that statement a part of every visit. One option is to say:
“Don’t forget we are available whenever your child is
ill. We prefer you call during office hours, but if a
serious concern arises after office hours, please call
rather than go to the emergency department.”
The next best method is to give them something to take home that reminds them
of this practice policy and includes the practice phone number. This physical
reminder has to be very difficult to lose – such as a refrigerator magnet.
Updated 7/31/2012
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Chapter 14
Chapter 14 : FAMILY VOICES COLORADO
FAMILY VOICES COLORADO
FAX: 303-733-3344
Phone: 1-877-731-6017
E-mail: [email protected]
Family Voices Colorado (FVC) assists providers in identifying appropriate
services and resources for children with chronic illness or special needs and for
their families:
•
•
•
•
•
•
•
Case management
Care coordination
Specialized services, resources, medical equipment, therapies
Parent/patient education about chronic illness / special needs
Parent/patient support services
Help in finding funding for uncovered services
Patient and Family Advocacy
Examples:
• You are seeing a new patient (new to Colorado) who is an infant with 22q
Deletion Syndrome, congenital heart disease, cleft palate and an oxygen
requirement of undetermined etiology. Parents want to link up with all of
the support services and a parent group like they had where they used to
live.
• A child with multiple developmental delays also has behavioral problems.
The parents are not sure they are getting all the help their child is entitled
to and they want a parent support group and they are asking for
counseling.
• A parent with a disabled child wants your help in applying for some sort of
waiver that you aren’t familiar with.
Hours of operation:
Monday thru Friday from 8 AM to 4 PM
Voicemail available 24/7
Contact Family Voices Colorado (FVC) for clinical referral needs. FVC
provides follow-up with the provider office and with the family.
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Chapter 14
If FVC can answer your questions immediately, you can pass the information to
the family while they are in the office, or FVC can contact the family and give the
information to them directly.
If the information is not immediately available, FVC will research your question or
case and provide the information to you and the family as soon as possible in
whatever manner you and the family wish (via phone, fax, or email).
If you feel the family needs more assistance or follow- up, share the family’s
contact information with FVC or provide the family with the FVC number for them
to contact FVCdirectly.
When contacting FVC, please provide be ready to provide the following
information:
1. Your provider office and PCP name
2. Name of Child
3. Date of Birth
4. Medical Condition / Primary Disability
5. Type of insurance
6. Resource or service requested
7. Who should we contact with information?
8. Family Contact Information
9. How is it best to provide information back to you: phone, fax, email or
voicemail
A Fax Referral Info Form is provided on the following page.
Updated 7/31/2012
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Chapter 14
FAMILY VOICES COLORADO
FAX INFO SHEET
FAX: 303-733-3344
Phone: 1-877-731-6017
E-mail: [email protected]
Name of Child_________________________________________
Date of Birth________________
Medical Condition/Primary Disability_______________________
______________________________________________________
Resource or service requested______________________________
______________________________________________________
Who should we contact with information? ___________________
______________________________________________________
Family contact information________________________________
______________________________________________________
Practice Name:_________________________________________
Provider Name and Contact Information: ____________________
______________________________________________________
Other Information: ______________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
Date Faxed:_____________
Updated 7/31/2012
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Chapter 15
Chapter 15: MEDICAL HOME INITIATIVE
AND MEDICAL HOME INDEX
The American Academy of Pediatrics and the American Academy of Family
Practice have promoted the concept of a medical home for many years now. A
recent combined statement by the two academies reaffirmed their support of the
concept. The Academies believe that all children should have a medical home
where care is accessible, family-centered, continuous, comprehensive,
coordinated, compassionate, and culturally effective.
Accessible
• Care is provided in the child’s community
• All insurance, including Medicaid, is accepted and changes are accommodated
Family-Centered
• Recognition that the family is the principal caregiver, the center of strength
and support for children
• Unbiased and complete information is shared on an ongoing basis
Continuous
• Same primary pediatric health care professionals are available from infancy
through adolescence
• Assistance with transitions (to school, home, adult services) is provided
Comprehensive
• Health care is available 24 hours a day, 7 days a week
• Preventive, primary, and tertiary care needs are addressed
Coordinated
• Families are linked to support, educational, and community-based services
• Information is centralized
Compassionate
• Concern for well-being of child and family is expressed and demonstrated
Culturally Effective
• Family’s cultural background is recognized, valued, and respected
A medical home is not a building, house, or hospital, but rather an approach to
providing health care services in a high-quality and cost-effective manner.
Children and their families who have a medical home receive the care that they
need from a pediatric health care professional whom they trust. The pediatric
health care professionals and parents act as partners in a medical home to
identify and access all the medical and non-medical services needed to help
children and their families achieve their maximum potential.
Colorado State Medical Home Standards
Senate Bill 07-130 (Concerning Medical Homes for Children) directs The
Colorado Department of Health Care Policy and Financing (HCPF), which
administers Medicaid and CHP+ and the state Department of Public Health and
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Chapter 15
Environment (CDPHE) to develop systems and standards to maximize the
number of Medicaid and CHP+ children who have a medical home. The systems
and standards developed shall include, but need not be limited to, ways to
ensure that a medical home shall offer family-centered, compassionate, culturally
effective care and sensitive, respectful communication to a child and his or her
family. And, the care should be continuous, accessible, comprehensive, and
coordinated. This law says that medical homes should at least ensure:
(a) health maintenance and preventative care;
(b) anticipatory guidance and health education;
(c) acute and chronic illness care;
(d) coordination of medications, specialists, and therapies;
(e) provider participation in hospital care; and
(f) twenty-four-hour telephone care.
This definition was derived in large part from the AAP’s definition. Several
members of the Colorado Chapter of the AAP helped craft this bill. CCHAP
works closely with HCPF and CDPHE to determine what supports a practice
needs in order to provide a medical home for Medicaid and CHP+ children.
Colorado Senate Bill 07-211 (Concerning Improvements To Health Care For
Children) does many things. Included among its objectives is for the state to
increase the number of children receiving Medicaid and CHP+ coverage and to
document the quality of the care they receive. The state has to report back to the
legislature on a variety of improvements in the state Medicaid and CHP+
systems. An important element that state Medicaid and CHP+ must report on to
the legislature is the quality of health care these children are receiving. The law
directed the state to develop “standards” that represent quality health care for
children and then monitor and report to the legislature how well those quality
standards are being met. These standards must include medical home
standards.
Medical Home Standards
Standards of care that Medicaid and CHP+ children should receive from a
medical home in Colorado were developed under the leadership of HCPF and
CDPHE, with considerable input from the Colorado Chapter of The American
Academy of Pediatrics, CCHAP, the Colorado Academy of Family Practice,
parent groups and many community-based organizations. Many of you
participated in a survey to help develop the standards.
The Medical Home standards for Medicaid and CHP+ children in Colorado are
the result of the laws described above and the one year planning process. They
drew heavily from the AAP’s work on Medical Home Initiative. As mentioned
above, many pediatricians and practice managers contributed to the
development. Here is what Colorado would like Medicaid and CHP+ children
and their parents to experience when being cared for in a medical home:
Updated 7/31/2012
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Chapter 15
1. 24 –hour, 7 day access to a provider or telephone nurse triage service.
2. Family has a personal provider or team of providers.
3. Appointments are based on the child’s condition (acute, chronic, and well)
and provider can accommodate same day scheduling when appropriate.
4. Information is made available about insurance, community resources,
non-medical services, and transition to adult providers.
5. Providers communicate in a way that is family centered and encourages
the family to be a partner in health care decision making.
6. Provider and office staff are culturally competent.
7. The Medical Home takes the primary responsibility for care coordination.
8. Age appropriate preventive care and screening are provided through
structured templates and anticipatory guidance, counseling, and referrals
as appropriate.
9. A Medical Home adopts and implements evidence-based diagnosis and
treatment guidelines.
10. A Medical Home’s medical records are up to date and comprehensive.
11. A Medical Home has a continuous quality improvement plan that
references Medical Home standards and elements.
Medical Home Index (MHI) is a validated self-assessment and classification tool
designed to translate the broad indicators defining the medical home (accessible,
family-centered, continuous, comprehensive, coordinated, compassionate, and
culturally effective) into observable, tangible behaviors and processes of care
within any office setting. It is a way of measuring and quantifying the "medical
homeness" of a primary care practice. The MHI is based on the premise that
"medical home" is an evolutionary process rather than a fully realized status for
most practice settings. The MHI is a nationally validated tool that measures a
practice's progress in this process. There are two forms of the MHI: one for the
practice providers and staff to fill out and another for families to fill out.
What can the MHI do for your practice?
 You can identify your practice’s strengths.
 You can identify what aspects of a medical home you would like to
build on or improve.
 It gives you a clear starting point.
 It allows you to measure your progress.
 It promotes the conversation among all providers and staff about
what you want the practice to be.
 It is a great way for a practice to begin a quality improvement
process, because it creates buy-in among all staff.
 It will improve care.
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 It will help you improve patient- and parent-satisfaction.
 Health plans are going to be requiring something like this within a
few years. Get a head start on it now.
You can learn more about the MHI by visiting the National Center of Medical
Home Initiatives website www.medicalhomeinfo.org.
The National Center for Medical Home Implementation supports medical home
implementation in order to ensure that all children and youth, including those
with special health care needs, have the services and support necessary for full
community inclusion.
You will receive assistance with understanding the results of the Index, decisions
on what your practice would like to do to enhance any element of the medical
home you provide, strategies for making the changes you want to make and
evaluation of the effectiveness of the changes, all at no cost to your practice.
Enhanced Reimbursement:
The Colorado Medicaid Program has been directed by the state legislature to
encourage primary care practices to provide a “quality medical home” for
Medicaid children. The Colorado Medicaid Program needs to document that
quality and wants to reward your practice for your commitment to providing a
quality medical home. So, your practice will receive the higher reimbursement for
preventive care as a reward for providing a quality medical home, completing the
Medical Home Index (MHI) documenting that quality, and committing to working
on improving that quality.
The following process was developed to help your practice accomplish this.
Process:
1. After your orientation, your practice will be contacted by the Medical Home
Navigator (MHN). S/he will schedule a group meeting to complete the
Medical Home Index (MHI). You will be provided with a questionnaire for
all practice providers and staff to complete. The MHI forms are then
collected by the MHN.
2. The MHN conducts the family portion of the MHI in the provider office over
the course of a day by sitting in the waiting room and asking parents to
take a moment to fill out the survey.
3. The MHN will compile the results of the questionnaires and create a
Medical Home Report. A quality improvement (QI) coach will be available
at no cost to your practice to help create a Quality Improvement process
focused on an improvement of the practice’s choice.
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4. You can use the results of the MHI report to see where your practice falls
along a continuum of “Medical Homeness.” No practice is ever a perfect
medical home. All practices are continually evolving.
The higher reimbursement your practice will receive for preventive care is a
reward for your practice’s commitment to providing a quality Medical Home for
the Medicaid children in your practice.
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Chapter 16 : QUALITY IMPROVEMENT
CCHAP works closely with HCPF, Family Voices of Colorado, and HealthTeam Works to
offer technical assistance to practices in order to help them develop continuous QI
programming. Assistance will be available to practices wishing to improve efficiency, and
improve their “medical home-ness.” Your practice chooses what to work on and what kind of
assistance, if any, you want.
Medicaid asks practices pursuing Medical Home Certification to complete The Medical Home
Index (MHI), a quick practice self-assessment, on an annual basis. As you work through the
MHI, you will likely think of things to change or adjust. QI involves working together as a team
to discover logical and efficient ways to improve outcomes, effectiveness, return on
investment (ROI), communication, and performance in your chosen topic area(s).
Once the MHI is completed, your practice manger will be contacted by the CCHAP Quality
Improvement Coach within a few weeks. At that time, the practice manager will be asked to
set up a time to work with the Quality Improvement Coach in order to review your Medical
Home Index results, receive guidance as to how to interpret those results, and identify
possible QI projects. HCPF requests that your practice select some element of “medical
home-ness” to improve.
The CCHAP Quality Improvement Coach – at no cost to your practice – is
available to help you (1) decide what QI project your practice would like to work
on, (2) develop strategies for making the changes you want to make, and (3)
measure the effectiveness of the resultant changes.
Your practice may have already implemented Quality Improvement (QI) projects. Perhaps
you didn’t even think of them as “Quality Improvement” because the new or “tweaked”
process seemed logical, necessary, and efficient.
QI is in fact logical, necessary, and efficient!
•
•
Your CCHAP Quality Improvement Coach will train your team to use a logical,
systematic approach to QI called the Plan Do Study Act (PDSA) Cycle of
Improvement.
Is QI Required? YES! Physicians must develop a QI project for:
o
o
o
•
Recertification for both AAP & AAFP
Medical Home Certification
Some Commercial Insurance Plans
Best practices yield optimal levels of efficiency, effectiveness, and overall
performance. QI also has the potential to decrease costs and increase reimbursement,
as well as increase patient, family, and staff satisfaction.
Are you ready to get started with your QI project? Call or email Angie Goodger at
720-346-4903 or [email protected].
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Sample QI projects
1. CAVITY FREE AT THREE
A goal will be set regarding the number / percent of children who are screened and receive the
varnish application. Progress will be measured through billing reports by comparing well child
visits to oral screens and varnish application. QI Plans to include Action Steps should goals
not be reached.
2. INDIVIDUAL CARE PLAN FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
Goals will be set (typically written as % of patients with a documented care plan). The QI
Coach will work with practice teams to determine appropriate measurements of progress (e.g.
chart audits, logs, etc). QI Plans to include Action Steps should goals not be reached.
3. DEVELOPMENTAL SCREENING
A goal will be set regarding the number / percent of children who are screened. Progress will
be measured through billing reports by comparing well child visits to developmental screens
(96110). QI Plans to include Action Steps should goals not be reached.
4. SCREENING FOR ADOLESCENT DEPRESSION
A goal will be set regarding the number / percent of teens who are screened. The QI Coach
will work with practice teams to determine appropriate measurements of progress (e.g. chart
audits, logs, etc). QI Plans to include Action Steps should goals not be reached.
5. ASTHMA REGISTRY AND CARE PLAN:
Goals will be set (typically written as % of patients with a documented asthma care plan, % of
patients evaluated in the past 12 months, etc). QI Coach will work with practice teams to
determine appropriate measurements of progress (e.g. EMR report, chart audits, logs, etc). QI
Plans to include Action Steps should goals not be reached.
6. OBESITY PREVENTION AND REDUCTION
Goals will be set (e.g. create and maintain a registry, reduce the number of children in the
practice with high BMI by %, % of children with documented action plan, etc.). QI Coach will
work with practice teams to determine appropriate measurements of progress (e.g. EMR
report, chart audits, logs, etc). QI Plans to include Action Steps should goals not be reached.
7. FAMILY SURVEY
Goals will be set (typically written as a % of patients who indicate satisfied or extremely
satisfied on each question). Results reviewed according to an established timeline. QI Plans
to include Action Steps should goals not be reached.
As a reminder, practice teams may also choose a QI that is not a CCHAP QI Plug N’ Play (e.g. MOC
QI projects, NCQA projects that are geared toward children, issues of interest to the providers, etc).
The only requirements are that the project:
• is family-centered
• looks to improve outcomes of the
Angie Goodger, MPH, MHA
children you serve
Quality Improvement Coach
• meets a Colorado Medical Home
Colorado Children's Healthcare Access
Standard
Program
• is measurable
If you have any questions about these or
other possible QI projects, please contact
your CCHAP QI Coach directly.
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720-346-4903 Cell
720-285-1919 Fax
[email protected]
www.cchap.org
Chapter 16
WHAT IS QI AND WHERE DO I START?
The ability to develop, test, and implement change is essential for any individual, group, or
organization that wants to continuously improve. Our goal is to assist you in gaining
knowledge and experience with the basic principles and tools of QI so that your team can be
successful!
QI is a DATA-based, TEAM approach designed to improve quality by seeking out areas of
improvement and proficiency.
When working on a QI project, always keep the following questions in mind:
•
•
•
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?
PLAN DO STUDY ACT (PDSA) CYCLE OF IMPROVEMENT
When we talk about QI, the discussion is really about enhancing the value or excellence of
something (e.g. a process or a procedure) through a systematic approach.
PDSA, developed by W. Edwards Deming as the “Total QM Movement,” is a widely accepted
model of improvement for the implementation of a QI project. It is a simple and effective way
to evaluate and improve current or future processes by planning what you want to do,
implementing the plan, studying the results, and then acting on your findings in order to
produce better outcomes. In many cases, you will implement and study many small,
incremental steps of improvement – each step increasing in complexity – until continuous
“optimal performance is reached.”
Why PDSA?
•
•
•
•
•
Promotes a clear vision
Team learns by testing change on a
small scale
Short study time keeps the process
moving
Decreases data collection & overload
Works well with small numbers
PLAN
ACT
Model for
Improvement
DO
STUDY
Many practices choose to pilot their
projects. This allows them to “test” the test
and make any modifications necessary
before full scale implementation. You may
need to start the cycle over again if you feel
that the results were unsatisfactory. This is completely acceptable and expected. The
point of PDSA is to try new approaches until you find something that improves your
outcomes.
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When it comes to QI, your motto can be:
Adapt!
ADOPT!
ABANDON!
The following sections outline the steps of PDSA, as well as suggest questions to ask and
observations to look for during the cycle.
PLAN – Getting Started
Let’s face it, sometimes things get started pretty fast: do yourself a favor and take a
moment to step back and do a little planning! This will help your team create a clear
vision, and gain full understanding of the goal and individual roles during the process.
When planning, remember to:
•
Identify and involve all stakeholders
o
•
Always remember that a TEAM approach is vital to your success. A team approach will
foster ownership, develop new skill sets, empower staff that enjoy process
improvement, and lighten your load!
State the goal of cycle
When developing your goals and objectives, make sure that your goals are SMART
Goals. A SMART Goal is Specific, Measurable, Achievable, Realistic and Timely.
Make predictions (What will happen? Why?)
o
•
•
Develop a plan to test the change
o
o
o
o
o
o
•
When (date span)?
Where?
What change is being tested?
What is the objective of the test?
Who is included in the test?
Who does the work, and on who/what will the test be conducted?
Determine how will you collect data and report observations?
o
It is EXTREMELY important to retain good PDSA cycle details (notes) for other teams
and for future QI implementations.
DO
Now set your plan in motion! Remember to:
•
•
•
•
Start small & complete quickly
Test on a small scale (test your test)
Collect data for analysis (chart audits, EMR, surveys, etc.)
Begin analysis
o
o
o
Observe
Begin to analyze findings
Document expected and unexpected outcomes
Testing on a small scale should help you gain additional support within your organization.
QI experts point out that this type of testing helps foster staff confidence that the change
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will result in improvement. Additionally, you may begin to notice a reduction in resistance
to future implementations, and an increase in staff satisfaction!
STUDY
Once you’ve planned and implemented your QI project, it’s extremely important that you
MAKE time to study your outcomes. When you commit to making time for evaluation, you
will ensure that the plan is working as intended, and if not your team will have the
opportunity to regroup and try again.
During the STUDY phase you should:
•
•
•
Review your data
Complete the analysis
Ask:
o
o
o
•
Did my prediction hold?
What was learned?
What assumptions need revision?
Review problems, successes & surprises
ACT
“People don’t plan to fail. Instead, they fail to plan.”
Once you’ve studied the project, you will be prepared to decide whether to adapt, adopt or
abandon your intervention.
Creating an action plan will improve project efficiency by saving time, energy and
resources. An action plan will also ensure that you haven’t overlooked any details, and will
inject accountability into the project.
During the action phase you will determine the following:
•
•
How can we expand and/or sustain these improvements?
What is our Action Plan?
o
•
What will be done if you don’t meet your stated goal?
What is the next cycle?
o
o
Refine the change based on what you learned.
Establish a new plan for the next PDSA and begin again.
Your action plan defines specific strategies and detailed steps necessary to meet your
goals and objectives. When developing your action plan, you will probably consider a
number of changes. Your plan should also include: what change(s) will occur, who will
carry out change(s), and when will the change(s) occur. Also consider what resources will
be needed, and how the plan will be communicated. Always be sure that your plan is
complete, clear, and current.
This Action Plan brings you through the PDSA cycle again. First, you will implement the
plan. Then you will need to study the outcomes. Remember, each change should be
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restudied at intervals to ensure that the same results and efficiencies you previously
gained are being maintained and not lost or changed.
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QUALITY IMPROVEMENT MEASUREMENT
A vital piece of QI is measurement of progress. In order to measure progress, you need to
first clearly define what you want to change, as well as your desired outcome. Next, you need
to find your baseline. Once you’ve implemented your project, you will periodically measure
your progress against this baseline in order to determine whether or not your specific change
has actually led to an improvement.
When defining your measurements, keep the following in mind:
•
•
•
•
•
Keep it simple: gather just enough data to learn what you want to learn.
Don’t rely only on hunches.
Look at data that you are currently using to see if that data meets your needs.
How can data be collected most easily? And can this new data be gathered
concurrently with existing data queries?
What data is easily available from other sources?
It is important to ensure data validity. During your planning, be sure to consider:
•
•
•
Who will collect the data?
How will the data be collected and how often?
Are results consistent with reality?
At its core, QI is a data driven, team approach to see if changes in care practices (or process)
make a difference in outcomes.
Experts agree that there are certain Keys to QI Success
 Commit to the Process.
 Assess current performance (MHI) &
choose focus area.
 Start small & keep it simple!
 ID all stakeholders & invite them to join
your team.
 Don’t get lost in the data; Instead use it
to show progress!
 Embed QI philosophy into
organizational goals & priorities
(including Job Descriptions).
 Educate staff & seek their support
through empowerment & involvement.
 Consider appointing a team
leader to manage “day to day” QI
activities.
 Gain buy-in from leadership: QI
is most successful when adopted
by leadership & the entire
organization.
 Develop & implement a plan of
action that is precise,
understandable, and practical.
(PDSA)
 Review. Measure. Evaluate.
“All changes do not lead to improvement; but all improvement requires change.”
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RESOURCES
CCHAP Quality Improvement resources now available! Watch our Quality Improvement
video. The purpose of the session, lead by our Quality Improvement Coach Angie Goodger,
is to introduce the basic concepts of Quality Improvement (QI), increase your QI confidence,
and provide a roadmap for how to get QI started in your practice. You can also download
related QI handouts.
See: www.cchap.org/pmmeeting and view the materials from our March 11, 2010 Practice
Manager’s meeting.
Remember: A QI Coach is available – for FREE – to CCHAP affiliated practices wishing
to improve their Medical Home. Call or email today!
Angie Goodger, MPH, MHA
Quality Improvement Coach
720-346-4903 Cell
720-285-1919 Fax
[email protected]
If you would like to go deeper into QI, we recommend that you visit the following websites:
HealthTeam Works
 TRIA / RIA
 IPIP (practice improvement process)
Colorado Academy of Family Physicians (CAFP)
 Self-paced NCQA Recognition tools & resources
Physician Health Partners
 Colorado Pediatric Partners
NCQA Recognition
National Initiative for Children's Healthcare Quality (NICHQ)
American Academy of Family Physicians
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QI PLUG ‘N PLAYS
The following Quality Improvement projects have been outlined following the PDSA
Cycle of Improvement.
All projects are available to CCHAP affiliated practices pursuing Medical Home
Certification – at no cost – and are completely customizable.
Cavity Free by Three
Cultural Competence (Dimensions of Culture)
Depression Screening (Teen)
Developmental Screening
Family Feedback (survey/focus group)
Postpartum Depression
Don’t see what you are looking for? Let’s create a new QI project together!
Contact your Quality Improvement Coach TODAY to get started!
Angie Goodger, MPH, MHA
Quality Improvement Coach
720-346-4903 Cell
720-285-1919 Fax
[email protected]
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EXAMPLE QI PLANNING SHEET
Practice Name: _____________________________ QI Project Begin Date: ____/____/____
QI PROJECT:
GOAL
Personnel Involved:
COLORADO MEDICAL HOME STANDARD
INDICATOR(S)
MEASUREMENTS OF PROGRESS
DATA COLLECTION
1. Who will pull/create reports? What report format will be used?
2. Where will you collect the information from (i.e. billing, chart audit, etc.)?
3. How will you identify eligible patients? Will all children be eligible?
4. What will report include and who should receive the reports?
5. How often will data be evaluated and by whom?
6. What report format will be most useful?
7. What is your baseline?
ACTION PLAN
/
/
Action plan initiated on:
1.
Is your process (flow) working? Is the plan moving you toward goal
achievement?
a. What did you find out? (Record observations, good AND bad.)
2.
Study: Look at the results of implementing the project. Look at data collected.
a. After 2 months evaluate whether or not the desired percentage is being
reached. If not, develop a plan to improve the percentage. Continue to monitor.
b. If goal is being reach, monitor for at least 6 months to be sure that percentage
is maintained.
3.
Consider next steps if goal percentage is maintained.
4.
Decide what actions should/could be taken to improve outcomes. AND, what
could you do to take this project up a notch?
5.
Repeat process as needed: What other reports/ data might be useful? (ROI,
number of Medicaid children treated, time spent completing process, process
changes, capacity changes, etc.)
6.
Consider next Action steps:
a. Contact CCHAP Quality Improvement Coach to discuss next steps.
/
/
b. NEW Action plan initiated on:
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SOURCES
American Academy of Family Physicians 2009. “Quality Improvement Achieving Excellence
In Healthcare.” Teaching and Self Assessment Tool. Retrieved November 13, 2009 from
www.aafp.org/online/en/home/practicemgt/quality/qitools/quality/qimusc.html6kCenter for
Medical Home Improvement 2009. CMHI Teamwork: The Cornerstone for Medical Home
Improvement (CMHI 2009) Retrieved October 26, 2009 from
http://www.medicalhomeimprovement.org/pdf/QI-Teamwork_PDSA.pdf
Center for Medical Home Improvement 2009. The Medical Home Index – Short Version
(CMHI 2006). Retrieved October 26, 2009 from http://www.medicalhomeimprovement.org
Healthy Communities 2010: Regional Seminar for Local Public Health Planners, Power Point
Presentation given in September & November of 2000.
Institute for Healthcare Improvement (n.d.) Improvement: “Improvement Methods”. Retrieved
November 19, 2009 from
http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/
Iowa Foundation for Medical Care (n.d.). “Quality Improvement Basics: A Guide to
Understanding and Implementing Quality Improvement in Health Care Settings”. Retrieved
November 3, 2009 from
http://www.internetifmc.com/provider/documents/quality_improvement_basics.pdf
National Initiative for Children’s Healthcare Quality (NICHQ) (n.d.) “Model for Quality
Improvement” power point presentation. Retrieved October 2009 from
http://www.nichq.org/pdf/Model%20for%20Quality%20Improvement.pdf
National Initiative for Children’s Healthcare Quality (NICHQ) “What is Quality?” NICHQ.
Retrieved October 26, 2009 from http://www.nichq.org/what_is_quality.html
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Chapter 17 : CAVITY FREE AT THREE
Cavity Free at Three is a three-year, statewide effort to prevent oral
disease in young children. The effort aims to engage dentists,
physicians, nurses, dental hygienists, public health practitioners and
early childhood educators in the prevention and early detection of oral
disease in pregnant women, infants and toddlers.
Our goal is simple: We want all children in our state to be cavity free by the time they
reach age three. Dental disease is the number one chronic disease of children in
America, yet, it is a 100% preventable disease.
• Dental caries is the most common chronic childhood disease – 5 times as common
as asthma; 7 times as common as hay fever.
• 80% of the disease is in 20% of the population. It is largely a disease of poverty.
• Dental disease affects children's ability to eat properly, grow, attend school and
learn.
In Colorado:
• 18% of 2-4 year olds have dental caries; 16% have untreated decay.
• 45.7% of kindergarteners have dental caries; 26.9% have untreated decay.
• 57.2% of third graders have dental caries; 26.1% have untreated decay.
• By age 17, 78% of children have had at least one cavity; 7% have lost a permanent
tooth to dental decay.
• The state of Colorado has designated Oral Health as a Colorado Priority “Winnable”
Battle.
Cavity Free at Three strives to make dental disease in children rare instead of
inevitable. To do so the project will:
• Educate health professionals about the consequences of early childhood caries and
their role in helping to prevent this disease.
• Facilitate the implementation of an infant oral care model throughout Colorado with a
special emphasis on underserved populations.
Implementing Cavity Free at Three within your health clinic, dental clinic or public
health program is simple! Adding simple steps to the care you provide pregnant women
and young children can prevent a lifetime of poor oral health outcomes for generations
of Colorado's children. The role of preventing oral disease in children lies with ALL
health professionals - not just the dental community.
Dental Caries is 100% Preventable. As a health professional, you can play an important
role in reducing dental disease in our children! Oral health is integral to overall health for
all ages, but especially for our children oral health needs to start early.
Remember: Prevention begins before birth. Critical prevention strategies include:
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•
•
•
The combined approach has shown to be effective in preventing disease. Taken
separately, none of the interventions will result in decreased dental disease.
o Oral screen
o Caries risk assessment
o Self management goal setting
o Fluoride varnish
It is important for everyone to have a dental home as well as a medical home.
o Children need their first dental visit by age one.
Physicians and dentists, working together, are critical in preventing the most
common disease of childhood.
Cavity Free at Three Physician Training
The Cavity Free at Three Physician Training Program is a collaborative statewide effort
directed towards prevention of oral disease in young children. This program is now
administered through the Colorado Area Health Education Center (AHEC) within the
University of Colorado at Denver School of Medicine.
Cavity Free at Three provides training and technical assistance to dental and medical
providers in the community interested in performing oral health assessments,
counseling to primary caregivers as well as risk assessment skills. The comprehensive
oral health training provided by the Cavity-Free at Three Program consists of a four
hour lecture component and a practical hands-on session. This program offers training
opportunities for primary care providers to perform oral health assessments and apply
fluoride varnish so they may be reimbursed according to the new Medicaid guidelines
as of July 1, 2011. One- hour training is also available to do a program review and to
provide any hands on training members of your staff may need. Cavity Free at Three is
free, very available and can occur in your office. The training through Cavity Free at
Three will include all skills needed by medical assistants and providers. It also provides
tips on effectively and efficiently incorporating this model into office practice, as well as
lessons learned by pediatric and family practices utilizing this oral health model.
In addition to the training opportunities through the Cavity Free at Three Program,
providers can access training online through the Smiles for Life curriculum at
http://www.smilesforlifeoralhealth.org.
For more information about the Cavity Free at Three program and how to implement
oral health assessments and counseling in your office, please contact Karen Savoie at
the AHEC office at 303-724-4750 or [email protected]
Prevention of cavities by primary care providers for children on Medicaid
Children whose care is covered by Medicaid have 2-3 times as many cavities as other
children. Reduction in the number of cavities can be accomplished by preventive
counseling (especially regarding the child’s specific high risk factors) and by application
of fluoride varnish. We know that prevention of dental disease in children starts before
birth, and counseling of a pregnant woman is very influential in the dental health of her
child. Colorado Medicaid would like primary care providers to assess cavity risk, do a
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good oral exam, provide anticipatory guidance on cavity prevention and apply fluoride
varnish. Colorado Medicaid is reimbursing generously for this.
Billing and Reimbursement
Effective July 1, 2009, trained medical personnel may administer fluoride varnish for
moderate to high caries risk Medicaid and CHP+ children, ages 0 through 4 (until the
day before their fifth birthday), in conjunction with an oral evaluation and counseling with
a primary caregiver after performing a risk assessment. Risk assessment forms may be
found on the Care to Kids tab of the Cavity Free at Three website and documentation
should be part of the client’s medical record. The fluoride varnish can be applied by a
medical assistant. Printable educational materials are available in a variety of languages
on the Educating Parents tab of the Cavity Free at Three website.
You need to do the following at a well child visit:
1. complete oral exam and assessment of risk factors (like nighttime bottle)
2. anticipatory guidance about preventing cavities
3. apply fluoride varnish
Then you can bill for (1) the well child visit (and you will get the enhanced
reimbursement for being a CCHAP-affiliated medical home), (2) the comprehensive oral
exam and anticipatory guidance and (3) applying the fluoride varnish. Here is how
Colorado Medicaid and CHP+ instruct providers on the billing for dental care.
Medicaid
Trained medical personnel (see qualifications below) may administer fluoride varnish to
Medicaid children ages 0 through 4 (until the day before their fifth birthday) with
moderate to high caries risk. A fluoride varnish may be administered only after a risk
assessment is completed, and must be administered together with an oral evaluation
with counseling by a primary caregiver. Risk assessment forms may be found either at
http://www.cavityfreeatthree.org/care-kids or at www.colorado.gov/hcpf (select
Providers/Provider Services/Forms). Documentation of risk must be part of the client’s
medical record.
Medical personnel who may bill directly for these services include MDs, DOs, and nurse
practitioners. Trained medical personnel employed through qualified physician offices or
clinics may provide these services and bill using the physician’s or nurse practitioner’s
Medicaid provider number. In order to provide this benefit and receive reimbursement,
the medical provider must have participated in on-site training from the “Cavity Free at
Three” team or have completed Module 2 (child oral health) and Module 6 (fluoride
varnish) at the Smiles for Life curriculum at http://www.smilesforlifeoralhealth.org online
courses. Medical personnel who complete the training must save the documentation for
this training in the event of an audit.
Billing procedures
For children ages birth-2 (until the day before their third birthday):
Private practices:
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D1206 (topical fluoride varnish) and D0145 (oral evaluation for a patient under
three years of age and counseling with primary caregiver) must be billed on a
Colorado1500 paper claim form or electronically as an 837P (Professional)
transaction in conjunction with a well-child visit.
Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs):
D1206 and D0145 must be itemized on the claim with a well-child visit, but
reimbursement will be at the current encounter rate. The diagnosis V72.2 (dental
examination) should be used as a secondary diagnosis. Billing is on the UB-04
paper claim form or electronically as an 837I (Institutional) transaction.
For children ages 3 and 4 (from their third birthday until the day before their fifth birthday):
Private practices: D1206 and D0999 (dental screening) must be billed on a
Colorado 1500 paper claim form or electronically as an 837P transaction in
conjunction with a well-child visit.
FQHCs and RHCs: D1206 and D0999 must be itemized on the claim with a wellchild visit but reimbursement will be at the current encounter rate. The diagnosis
V72.2 (dental examination) should be used as a secondary diagnosis. Billing is
on the UB-04 paper claim form or electronically as an 837I transaction.
Medicaid will reimburse for a maximum of three fluoride varnish administrations
per year for each eligible and high risk child, and CHP+ will reimburse for a
maximum of two per year for CHP+ clients. Additionally, State Managed Care
Network CHP+ clients must be treated by a CHP+ participating primary care provider.
Dental and medical providers are encouraged to communicate with one another to
avoid duplication and nonpayment of services.
Children should receive 3 fluoride varnish applications per year, through 4 years
of age. CCHAP recommends that providers educate and encourage families to
receive any remaining fluoride varnish applications at their child’s dental home.
The Medicaid provider fee schedule is updated regularly.
NOTE: Effective for dates of service on or after July 1, 2011, Medicaid will no longer
reimburse claims for oral hygiene instruction (D1330). However, providers will be able to
bill for dental screening instead, using code D0999. This change applies to children ages
3 and 4. Reimbursement rates will be per the July 1, 2011 Medicaid fee schedule. Also,
effective for dates of service on or after July 1, 2011, fluoride application (D1206) is
limited to a maximum of three applications per patient per state fiscal year (July 1 – June
30).
HCPF has created a Preventive Care in Oral Health Tool Kit for primary care providers.
Primary care physicians can consult the following website for a list of Medicaid enrolled
dental providers: www.insurekidsnow.gov or www.colorado.gov.
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Chapter 17
Reimbursement Rates:
Procedure
Topical fluoride varnish
(risk assessment must be
included)
Oral evaluation for children
ages <3 years & counseling
with primary caregiver
Unspecified diagnostic
procedure
Procedure
Code
Criteria
D1206
CO Medicaid
Reimbursement
(as of 7/1/11)
$14.96
D0145
$28.41
Children ages 0-4
who are mod-high
caries risk
Children ages 0-2
D0999
$14.85
Children ages 3-4
Please contact Marcy Bonnett at [email protected] or at 303-866-3604 with
any questions.
CHP+
The following services are covered by the CHP+ State Managed Care Network when
provided by your assigned in-network PCP:
• Fluoride varnish services provided in your PCP’s office.
• Up to 2 fluoride varnish treatments in a calendar year for children ages 0 - 4.
• A risk assessment prior to varnish.
Fluoride varnish may also be provided by an in-network dentist. When provided by a
dentist these services are covered by Delta Dental under the routine dental benefit.
Regarding reimbursement, CHP+ will follow Medicaid and eliminate D1330 (oral
Instructions) as a reimbursable service effective on and after July 1, 2011. Like
Medicaid, CHP+ will open up a new code D0999 for Unspecified Diagnostic Procedures.
There will be an announcement in the CHP+ Provider Bulletin around this change. This
effects very few CHP+ members e.g., those living in Teller, El Paso and Sedgwick
County (counties not served by a CHP+ HMO) who use their PCP for their FV benefit
instead of the usual Delta Dental CHP+ providers.
To Order Oral Health Kits
Lonnie L. Schwindt, Bayaud Enterprises
Phone 303-830-6885 x212
Fax 303-830-6653
[email protected]
http://bayaudenterprises.org
Updated 7/31/2012
As of June 1, 2012
Cavity Free at Three Kits = $6.25* each.
Fluoride Varnish ONLY = $1.00* per application
* always contact Bayaud Enterprises for the most up-todate pricing
17-5
Chapter 18
Chapter 18 : ACCOUNTABLE CARE COLLABORATIVE
COLORADO MEDICAID ACCOUNTABLE CARE COLLABORATIVE (ACC)
What is it?
The ACC is Colorado Medicaid’s new initiative to provide better health care for fewer dollars;
provide Medicaid clients with medical homes that offer client-centered care; and provide a
blueprint for improving care coordination, efficiency, quality and patient satisfaction. The
Colorado Department of Health Care Policy and Financing (HCPF, which administers
Medicaid in Colorado) has divided the state up into 7 regions and selected a Regional Care
Collaborative Organization (RCCO) for each of these regions (see the listing of the counties
in each region on the link below). The RCCOs are responsible for providing carecoordination among providers and other community and government services. CCHAP will
offer to assist practices with care coordination and in meeting Colorado’s expectations for
providers who wish to provide a medical home for children and/or adults on Medicaid.
Another feature of the ACC is that a Statewide Data & Analytics Contractor (Treo Solutions,
Inc.) has been selected to provide practices and RCCOs with much better data on their
Medicaid patients to help providers improve outcomes.
The ACC initial phase began in mid 2011. Practices that have expressed an interest and
have been selected to participate in the initial phase of the ACC will be required to sign a
contract with HCPF as well as a contract with the RCCO for that region. The initial phase will
only take place in small focus communities that each RCCO has selected. Only a few
CCHAP-affiliated practices are participating. As these practices gain experience with the
ACC, we will share what they have learned and help all CCHAP-affiliated practices prepare
for the expansion phase that begins in July, 2012, at which time all practices will be given
the opportunity to participate in the ACC. CCHAP will provide frequent updates regarding
Colorado Medicaid reform (The ACC). The ACC is a dynamic new program and we will
continue to update you on new policies and changes as we learn about them.
Here is what you need to know:
Patient Attribution and “the letter”:
HCPF (Colorado Medicaid) is in the process of enrolling patients in each of the seven (7)
RCCO regions. The Accountable Care Collaborative Process is considered a passive
enrollment process for patients. Passive enrollment is the process where patients are
enrolled into a plan if they do not respond and choose a plan for themselves. When a client
is passively enrolled into the ACC, the state’s database system (MMIS) enters an enrollment
for them effective the first of the following month typically about 45 days). The information is
sent electronically to HealthColorado, who then sends out a packet of information. The
packet gives the client information about the plans available to them, and gives them 30
days to opt-out of the ACC before it becomes effective. The Accountable Care Collaborative
(Each RCCO), Rocky Mountain Health Plan, Denver Health Medicaid Choice, the Primary
Care Physician Plan, and Fee for Service (or Regular Medicaid) are all considered plans.
This packet includes a letter that assigns the Medicaid member to the ACC and a particular
ACC contracted PCMP (please see below under “More information” for a link to the letter
templates). These patients will be enrolled in the ACC and assigned to their medical home
(if possible) and the RCCO that covers the county where the patient lives. Patients will also
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Chapter 18
have the option to select a different PCMP (medical home). If your patient has inadvertently
been assigned to another practice, the patient must call Health Colorado at 303-8392120 to make any changes! Non-participation in the ACC will not affect the patient’s
Medicaid eligibility or Medicaid services.
If a client calls HealthColorado to remove themselves from the plan within the first 30 days,
the enrollment is voided out of the system and never becomes effective for the client. If the
client does not respond to the letter, the client is then enrolled into the ACC. Once the
enrollment has become effective, the client can still disenroll from the plan for the next 90
days by calling HealthColorado to disenroll. If the client calls, the change in enrollment is
effective the first of the month after the change is requested. After the first 90 days, the
client can only change plans once a year during their open enrollment. Open
enrollment is the two months before the month of birth. If a client calls during their open
enrollment to change plans, the effective date of the change is the first day of their month of
birth.
Clients may call to change doctors within the plan at any time. If a client calls to change
doctors, the effective date of the change is the first of the month after the request is made.
Your practice staff needs to be knowledgeable about the letter that will be mailed to patients
so that they can help explain the importance of this letter and counsel your patients and
families appropriately, should they desire to make any changes. Here are some possible
strategies:
Proactively educate your patients about this letter using one or more of these methods:
• In person when the patient is in the office
• A posted notice in the office where patients can see it
• When parents of children on Medicaid call the office
• A handout
• Encourage your patients to call your office if they need help with the letter.
Explain the Health Colorado letter to the patient: (Remember, not all of your patients will
receive this letter!)
•
•
•
•
•
•
“You may get enrolled in a new Medicaid health plan. This plan does not affect
your eligibility for Medicaid, nor does it affect the services that you can receive.””
“If so, you may get a letter in the mail that looks like this (show them the
template)”
“If you receive this letter, make sure that our office or one of our physicians is
listed as the Primary Care Medical Provider in the letter” - “If we are, you do not
need to do anything else”
“If no assigned provider is listed or if another practice/physician is listed in the
letter as the PCMP, make sure you call 303-839-2120 immediately to have that
changed to our practice/physician”. Help the patient make the phone call if
possible.
Explain to the patients that “If you do not wish to participate in this plan, call 303839-2120 immediately. Participation in this plan or not participating in this plan in
no way effects your Medicaid benefits.”
IMPORTANT: If your practice will not be participating in the initial phase of the
ACC, and your patients receive a letter assigning them to the ACC, you should
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Chapter 18
advise your patient to call and opt out of the ACC and back into regular fee for
service Medicaid so they can continue as your patient.
Reimbursement:
Providers will continue to be paid fee for service under the initial phase of this program.
CCHAP affiliated practices will also continue to receive the Medical Homes for Children
enhanced reimbursement for well child care. CCHAP affiliated practices that participate in
this initial phase and who take care of adult patients will also receive $4.00 per member per
month (PMPM) for their adult Medicaid patients in addition to the enhanced reimbursement
for children.
Beginning in July 2012, all participating providers will receive $3.00 PMPM with a $1.00
PMPM incentive withhold. The Medical Homes for Children enhanced reimbursement will no
longer apply for ACC contracted providers.
Note: If you provide services to an ACC patient that has not been assigned to your practice,
you will still be paid fee for service but will not be eligible for the PMPM until the patient
changes their provider selection.
To participate:
Providers interested in participating in the program may contact the RCCO in their area.
CCHAP has been reaching out to RCCOs with the offer to do whatever we can to help make
the ACC successful.
More information:
For more information and document links, please see this web page:
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1233759745246
RCCO Table of Counties and Contacts (next page):
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 18
COUNTY
Region 1
Archuleta, Delta, Dolores, Eagle, Garfield, Grand,
Gunnison, Hinsdale, Jackson, La Plata, Larimer,
Mesa, Moffat, Montezuma, Montrose, Ouray, Pitkin,
Rio Blanco, Routt, San Juan, San Miguel, Summit
Region 2
Cheyenne, Kit Carson, Lincoln, Logan, Morgan,
Phillips,
Sedgwick, Washington, Weld, Yuma
Region 3
Adams, Arapahoe, Douglas
Region 4
Alamosa, Baca, Bent, Chaffee, Conejos, Costilla,
Crowley, Custer, Fremont, Huerfano, Kiowa, Lake,
Las Animas, Mineral, Otero, Prowers, Pueblo, Rio
Grande, Saguache
Region 5
Denver
Region 6
Boulder, Broomfield, Clear Creek, Gilpin, Jefferson
Region 7
El Paso, Elbert, Park, Teller
RCCO
Rocky Mountain Health Plans
Contact: Lesley Reeder
Email: [email protected]
Office Phone: 303-967-2018
Mobile Phone: 303-710-6384
Medical Director: Kevin Fitzgerald, M.D.
Phone: 970-248-5123
Email: [email protected]
Website: http://acc.rmhp.org/providers_support.aspx
Colorado Access
Contact: David Rastatter
Email: [email protected]
Office Phone: 970-350-4665
Mobile Phone: 970-397-5375
Medical Director: Mark Wallace, M.D.
Phone: 970-350-4674
Email: [email protected]
Website: http://www.coaccess-rcco.com/provider-northeast
Colorado Access
Contact: Molly Markert
Email: [email protected]
Mobile Phone: 720-775-5453
Office Phone: 720-744-5415
Medical Director: Deb Parsons, M.D.
Email: [email protected]
Office Phone: 720-744-5411
Mobile Phone: 303-204-8833
Website: http://www.coaccess-rcco.com/provider-east-metro
Integrated Community Health Partners
Contact: Michelle Denman
Email: [email protected]
Office Phone: 719-538-1463
Medical Director: Ricardo Velazquez, M.D.
Phone: 719-587-1016
Website: http://ichpcolorado.com/index.htm
Colorado Access
Contact: Julie Holtz
Email: [email protected]
Office Phone: 720-744-5100
Medical Director: Genie Pritchett, M.D.
Email: [email protected]
Phone: 720-744-5408
Website: http://www.coaccess-rcco.com/provider-denver
Colorado Community Health Alliance
Contact: Josie Dostie
Email: [email protected]
Office Phone: 303-489-0630
Medical Director: Pat Sankovitz
Email: [email protected]
Website: http://www.phpmcs.com/Home.aspx
Community Care of Central Colorado
Contact: Brandi Haws
Email: [email protected]
Office Phone: 719-314-2527
Medical Director: Michael Welch, D.O.
Phone: 1-866-938-5091
Website: http://www.mycommunitycare.org/
Updated 7/31/2012
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 19
Chapter 19 : MEANINGFUL USE AND EHR INCENTIVE
Meaningful Use and Electronic Health Record (EHR) Incentive
The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for the
"meaningful use" of certified electronic health records (EHR) technology to achieve health
and efficiency goals. By putting into action and meaningfully using an EHR system,
providers will reap benefits beyond financial incentives - such as reduction in errors,
availability of records and data, reminders and alerts, clinical decision support, and eprescribing/refill automation.
The EHR Incentive Program was created as a result of the Health Information Technology
for Economic and Clinical Health (HITECH) Act of 2009, allowing eligible health care
professionals to qualify for Medicare and Medicaid incentive payments of up to $63,750 over
six years.
Requirements for meaningful use incentive payments will be implemented over a multi-year
period, phasing in additional requirements that will raise the bar for performance on
information technology and quality objectives in later years.
The final Centers for Medicare and Medicaid Services (CMS) rule specifies initial criteria that
eligible professionals (EPs) and eligible hospitals, including critical access hospitals (CAHs),
must meet. The rule also includes the formula for the calculation of the incentive payment
amounts; a schedule for payment adjustments under Medicare for covered professional
services and inpatient hospital services provided by EPs, eligible hospitals and CAHs that
fail to demonstrate meaningful use of certified EHR technology by 2015; and other program
participation requirements.
What is "Meaningful Use"?
The American Recovery and Reinvestment Act of 2009 specifies three main components of
Meaningful Use:
1. The use of a certified EHR in a meaningful manner, such as e-prescribing.
2. The use of certified EHR technology for electronic exchange of health information to
improve quality of health care.
3. The use of certified EHR technology to submit clinical quality and other measures.
Simply put, "meaningful use" means providers need to show they're using certified EHR
technology in ways that can be measured significantly in quality and in quantity.
CMS EHR Meaningful Use Criteria Summary
The criteria for meaningful use will be staged in three steps over the course of the next five
years.
• Stage 1 (2011 and 2012) sets the baseline for electronic data capture and
information sharing.
• Stage 2 (expected to be implemented in 2013) and Stage 3 (expected to be
implemented in 2015) will continue to expand on this baseline and be developed
through future rule making.
How do I Meet Meaningful Use Requirements?
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Chapter 19
To qualify for incentive payments, meaningful use requirements must be met in the following
ways:
•
Medicare EHR Incentive Program—Eligible professionals, eligible hospitals, and
critical access hospitals (CAHs) must successfully demonstrate meaningful use of
certified electronic health record technology every year they participate in the
program.
•
Medicaid EHR Incentive Program—Eligible professionals and eligible hospitals
may qualify for incentive payments if they adopt, implement, upgrade or demonstrate
meaningful use in their first year of participation. They must successfully
demonstrate meaningful use for subsequent participation years.
•
Adopted: Acquired and installed certified EHR technology. (For example, can show
evidence of installation.)
•
Implemented: Began using certified EHR technology. (For example, provide staff
training or data entry of patient demographic information into EHR.)
•
Upgraded: Expanded existing technology to meet certification requirements. (For
example, upgrade to certified EHR technology or add new functionality to meet the
definition of certified EHR technology.)
Do You Have a Plan to Get Your EHR Stimulus Funds? The Colorado Regional
Extension Center Can Help!
CO-REC, an initiative of CORHIO, assists primary care providers in adopting, implementing
and becoming meaningful users of electronic health record (EHR) systems to qualify for
federal stimulus funds.
Through federal American Recovery and Reinvestment Act (ARRA) funding, CO-REC
services are designed to help more than 2,200 eligible primary care providers qualify for
Medicaid and Medicare incentive payments now through 2012. The REC program has
coverage throughout Colorado and has created a model of community-based support by
partnering with six key health-related organizations from Colorado. While the primary goal of
CO-REC is to serve health care providers in Colorado, the ultimate goal is to improve the
quality of health care for all Coloradans.
CO-REC services, including hands-on, in-practice consultations, are free to eligible primary
care providers. For non-eligible providers, CO-REC is making available educational
resources and information via the Web and through various seminars and events throughout
the state.
Meaningful Use in Colorado:
• Colorado primary care providers have already started receiving Medicare incentive
payments (started in late May 2011)
• Eligible primary care providers can receive no-cost services from the CO-REC
program to get help implementing an EHR and achieving 'meaningful use'
Are You Eligible for Medicare or Medicaid EHR Incentives?
> Find out with this easy-to-use flow chart! (PDF)
Registration for the Medicare EHR Incentive Program
Visit the CMS website now to register online. Providers should register for the EHR Incentive
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 19
Program as soon as possible. You can register before you have a certified EHR. Register
even if you do not have an enrollment record in PECOS.
Additional Links and Perspectives:
• Being a Meaningful User of Electronic Health Records, HHS Web site with numerous
resources
• Meaningful use glossary (PDF) from the American Medical Association (AMA)
• Meaningful use attestation calculator - an online tool provided by CMS that allows
providers to test whether or not they would successfully demonstrate meaningful use
for the EHR Incentive Programs
• Tip Sheet: MEDICARE Electronic Health Record Incentive Payments (PDF) provided
by CMS
• Tip Sheet: MEDICAID Electronic Health Record Incentive Payments (PDF) provided
by CMS
• Medicare EHR Incentive Programs, PQRI & E-Prescribing Comparison (PDF)
provided by CMS
• "What Physicians Need to Do" from American Medical News (AMA), July 19, 2010
• "The "Meaningful Use" Regulation for Electronic Health Records," The New England
Journal of Medicine, July 13, 2010
CORHIO Meaningful Use Resources:
• Meaninful Use Workshop Presentation (PDF) a detailed overview of the EHR
Incentive Programs provided by CO-REC.
• CORHIO (Colorado Regional Extension Center)
http://www.corhio.org/co-rec.aspx
• Centers for Medicare and Medicaid EHR Incentive Program Site (CMS)
http://www.cms.gov/EHRIncentivePrograms/
• Certified Health IT Product List (CHPL)
http://onc-chpl.force.com/ehrcert
• Colorado EHR Incentive Program Site (HCPF)
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1251581838726
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© 2006 Colorado Children’s Healthcare Access Program
Chapter 20
Chapter 20 : DIRECTORY OF CONTACT INFORMATION
AND GLOSSARY OF TERMS
CCHAP coordinates services and resources to enable your practice to care for
Medicaid and CHP+ children. Following is a directory of the contact information
referred to throughout this manual, alphabetically.
Organization or Service
Contact Information
CHP+:
Access Behavioral Care
CHP+ Billing Questions
CHP+ Claims Manual
CHP+ Customer Service
CHP+ Provider Services
Manual
CHP+ State Managed Care
Network Eligibility Line
(Maximus)
CHP+ State Managed Care
Network Customer Service
CHP+ State Managed Care
Website
Colorado Access Customer
Service
Colorado Access Provider
Representative
Colorado Access Website
http://www.coaccess.com/access-behavioral-care-providerinformation
1-888-214-1101
http://www.coaccess.com/sites/default/files/chp_claims_manual.pdf
1-800-359-1991
http://www.coaccess.com/sites/default/files/chp_provider_services_
manual.pdf
1-800-359-1991
303-751-9051
1-800-414-6198
http://www.chpplusproviders.com/
800-511-5010
www.coaccess.com
800-511-5010
[email protected]
http://www.coaccess.com/our-providers
MEDICAID:
Health Colorado (Maximus)
303-839-2120 / 888-367-6557 http://www.healthcolorado.net/
Medicaid Billing Manuals
Medicaid Customer Service
Medicaid Eligibility – CBMS
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542320888
303-866-3513
Medicaid FAQ’s
Medicaid Forms
Medicaid Pharmacy Questions
Medicaid Prior Authorizations
Medicaid Provider Bulletins
Medicaid/ACS Provider
Services
Medicaid Technical Questions
Medicaid Website
www.colorado.gov/benefits
[email protected]
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542696399
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1201542696550
800-365-4944
1-800-237-0757
http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1246972411343
1-800-237-0757
or 1-800-237-0044
1-888-538-4275
http://www.colorado.gov/hcpf
OTHER RESOURCES:
Provider Resource Helpline
SSI Appointments
877-731-6017 [email protected]
1-800-772-1213
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Chapter 20
GLOSSARY OF TERMS AND ACRONYMS
ACS - is a private company contracted by the Colorado Department of Health Care Policy and
Finance (HCPF) to determine eligibility and enroll patients for Medicaid and CHP+. HCPF oversees
Medicaid and CHP+.
ASO – Administrative Services Organization – a term used to described organizations that contract
with HCPF to handle credentialing, claims processing, payment to providers, case management and
other administrator functions on behalf of HCPF with practices.
BHO – Behavioral Health Organizations – contract with HCPF to serve as a managed care
organization for mental health services for Medicaid recipients. They contract with, and pay, mental
health centers and private mental health providers for care and help practices find the best provider
for their patient.
CBMS - Colorado Benefits Management System - The computer system that makes decisions about
eligibility about Medicaid and CHP+ and for other programs like TANF (financial assistance), food
stamps, and assistance with child care.
CHP+ - Child Health Plan Plus - The state entitlement program that covers children who are not
eligible for Medicaid, but whose family is below 200% of the Federal Poverty Level.
EPSDT - The Early and Periodic Screening, Diagnostic, and Treatment service is Medicaid's
comprehensive and preventive child health program for children under the age of 21. The benefits
include any medically necessary health care service, assuring the availability and accessibility of
required health care resources and helping Medicaid recipients and their parents or guardians
effectively use these resources.
FPG (formerly FPL, Federal Poverty Level) - the new term is Federal Poverty Guidelines, used to
determine eligibility for many federally supported programs. http://aspe.hhs.gov/poverty/index.shtml
HCPF - Colorado Department of Health Care Policy and Finance – the department in the Colorado
State Government that oversees all of the Medicaid and CHP+ programs.
LEP – limited English proficiency – having limited ability to understand or speak English - ; 22.3
million (8.4 percent) have limited English proficiency. Research clearly shows that language barriers
impede access to healthcare, compromise quality of care, and increase the risk of adverse health
outcomes among patients with limited English proficiency.
SCHIP - The State Children’s Health Insurance Program - is a national program in the United States
designed for families who earn too much money to qualify for Medicaid, yet cannot afford to buy
private insurance. In Colorado it is called the CHP+ program (see above).
TANF - Temporary Assistance for Needy Families - commonly known as welfare, provides monthly
cash assistance program for poor families with children under age 18. It used to be Aid to Families
with Dependent Children (AFDC). It is a block Federal grant program to help States move recipients
into work and turn welfare into a program of temporary assistance. The four purposes of TANF are:
• assisting needy families so that children can be cared for in their own homes
• reducing the dependency of needy parents by promoting job preparation, work and marriage
• preventing out-of-wedlock pregnancies
• encouraging the formation and maintenance of two-parent families
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© 2006 Colorado Children’s Healthcare Access Program