The Informing & Care Coordination Handbook Handbook 2019.pdf · Periodic Children should receive...

The Informing & Care

Coordination Handbook

A Guide for Working with Families

Iowa Department of Public Health 1 EPSDT Informing and Care Coordination Handbook September 2019

TableofContents

CHAPTER1OVERVIEWOFIOWA’SEPSDTCAREFORKIDSPROGRAM 1.1

INTRODUCTION 1.1THEEPSDTBENEFIT 1.1EPSDTCAREFORKIDSINIOWA 1.3TITLEVAGENCYRESPONSIBILITYFOREPSDTCAREFORKIDS 1.2EPSDTCAREFORKIDSCOORDINATORS 1.3CLIENTRIGHTSUNDERMEDICAID 1.3MAINTAININGCONFIDENTIALITYFORTHECLIENT 1.4DOCUMENTINGANDMAINTAININGTHECLINICALANDFISCALINFORMATION 1.4

CHAPTER2INFORMING 2.1

WHYCLIENTSNEEDINFORMING 2.1WHATTOINFORMTHECLIENTABOUT 2.1HOWTHECLIENTQUALIFIESFORINFORMING 2.1CONTRACTAGENCYRESPONSIBILITYFORINFORMING 2.1SKILLSNEEDEDFORINFORMING 2.1THETHREESTEPSOFINFORMING 2.2THEINITIALINFORM 2.2

DOCUMENTINGTHEINITIALINFORM 2.3THEINFORMFOLLOW‐UP 2.3DOCUMENTINGTHEINFORMFOLLOW‐UP 2.4THEINFORMCOMPLETION 2.5DOCUMENTINGTHEINFORMCOMPLETION 2.6BILLINGFORINFORMINGSERVICES 2.6

CHAPTER3CARECOORDINATION 3.1

WHYFAMILIESNEEDCARECOORDINATION 3.1CARECOORDINATIONSERVICES 3.1SKILLSNEEDEDFORCARECOORDINATION 3.1CARECOORDINATIONFORCLIENTWITHSPECIALHEALTHCARENEEDS 3.4CARECOORDINATION:REMINDINGCLIENTWHENASCREENINGISDUE 3.3CARECOORDINATION:ASSISTINGTHECLIENTTOOVERCOMEACOMMUNICATIONBARRIER 3.3CARECOORDINATION:ASSISTINGTHECLIENTTOOVERCOMEATRANSPORTATIONBARRIER 3.3CARECOORDINATION:MAKINGAHOMEVISITFORAHIGHBLOODLEADORMEDICALLYNECESSARYCONDITION 3.4DOCUMENTINGCARECOORDINATIONSERVICES 3.5BILLINGCARECOORDINATIONSERVICES 3.6

CHAPTER4INTERPRETATIONFORINFORMINGANDCARECOORDINATION 4.7

CHAPTER5COMMUNITYLINKAGES 5.1

ASSISTINGCLIENTSTHROUGHCOMMUNITYLINKAGES 5.1PRIMARYANDSPECIALTYHEALTHCARERROVIDERS 5.2DENTALCAREPROVIDERS 5.2EDUCATIONALSERVICES 5.3HUMANSERVICEPOVIDERSANDOTHERRESOURCES 5.3

CHAPTER6PROTOCOLS 6.1


WHATAREAGENCYPROTOCOLS 6.1WRITINGPROTOCOLS 6.1INFORMATIONTOINCLUDEINPROTOCOLS 6.1INFORMINGPROTOCOLS 6.2CARECOORDINATIONPROTOCOLS 6.2

CHAPTER7FINANCIALMANAGEMENT 7.1

IMPORTANCEOFFINANCIALMANAGEMENT 7.1DETERMININGCOST 7.1TIMESTUDIES 7.1NON‐BILLABLEACTIVITIESFORINFORMINGANDCARECOORDINATION 7.3BILLINGIDPHFORINFORMINGSERVICES 7.4SEPARATINGINFORMINGANDCARECOORDINATIONFORACCURATEBILLING 7.4CARECOORDINATIONSERVICESALLOWABLEFORBILLING 7.4BILLINGIDPHFORCARECOORDINATION 7.6SUBMISSIONOFINFORMINGANDCARECOORDINATIONCLAIMSTOIDPH 7.6

CHAPTER8QUALITYASSURANCE 8.7

CHAPTER9APPENDICES

CHAPTER10AGENCYPROTOCOLS 10.1


Chapter1 OverviewofIowa’sEPSDTCareforKidsProgram

IntroductionTheEarlyandPeriodicScreening,Diagnosis,andTreatment(EPSDT)programprovidescomprehensivehealthcareforMedicaideligibleclients1undertheageof21.AccordingtothefederalCentersforMedicareandMedicaidServices(CMS)therearetwoimportantfeaturesoftheEPSDTprogram:(1)assuringtheavailabilityandaccessibilityofrequiredhealthcareresourcesand(2)helpingMedicaidclientsusetheseresources.ThepurposeofthishandbookistoguideTitleVChildandAdolescentHealthcontractagenciesinhelpingMedicaidclientseffectivelyusetheseresourcesthroughinformingandcarecoordinationservices.Thishandbookshouldbeusedinconjunctionwiththefollowingresources.

● Iowa’sTitleVAdministrativeManualforCommunityBasedPrograms.ThismanualprovidesguidanceforIowa’sTitleVMaternalandChild&AdolescentHealthprogramsandislocatedontheIowaDepartmentofPublicHealthwebsiteathttp://idph.iowa.gov/Portals/1/userfiles/88/2017%20FINALAdminMan_FULL.pdf

● TheMedicaidScreeningCenterProviderManual.ThismanualprovidesIowaMedicaid’sguidanceforScreeningCentersandislocatedontheDepartmentofHumanServiceswebsiteathttps://dhs.iowa.gov/sites/default/files/Scenter.pdf?031220191342

● Thesignifycommunity™ChildandAdolescentHealthUserManual.ThismanualprovidesguidelinesfordocumentationofEPSDTservicesandisavailableinthesignifycommunity™LibraryDocuments.

TheIowaEPSDTBenefit

TheEarlyandPeriodicScreening,DiagnosisandTreatment(EPSDT)programwasimplementedin1967bytheUnitedStatesCongress.Everystate’sMedicaidprogramacrossthenationhasanEPSDTprogram.Iowa’sEarlyandPeriodicScreening,DiagnosisandTreatmentprogramiscalledCareforKids.TheactivitiesoftheEPSDTCareforKidsprogramincludeinforming,carecoordination,screening,diagnosisandtreatment.ThefollowingsummarizestheprimaryactivitiesofEPSDT.

Early

Childrenshouldreceivequalityhealthcarebeginningatbirthandcontinuingthroughoutchildhoodandadolescenceincludingtheidentification,diagnosisandtreatmentofmedicalconditionsasearlyaspossible.

1 The term ‘client’ will be used throughout the EPSDT Informing and Care Coordination Handbook to include the child and young adults age 0-21 years eligible for Medicaid, and parents, foster parents, guardians or other family member’s responsible for the care of an eligible child 0-17 years of age. The term ‘client’ also includes 19-20 year olds enrolled in the Iowa Health and Wellness Plan, Title V or Medicaid.


Periodic Childrenshouldreceivewellchildcheck‐upsatregularintervalsthroughoutchildhoodaccordingtostandardssetbytheAmericanAcademyofPediatrics.Preventivehealthcarevisitsmaybeprovidedbetweenregularlyscheduledcheck‐upsbaseduponneed.

Screening Childrenshouldbescreenedforhealthanddevelopmentalproblems.Servicesshallincludehealthhistory,developmentalassessment,physicalexam,immunizations,labtests,healtheducation,dentalexam,andvisionandhearingscreenings.

Diagnosis Childrenshouldreceivefurtherevaluationofhealthordevelopmentalproblemsidentifiedduringcheck‐upsthatmayrequiretreatment.

Treatment Childrenshouldreceivetreatmentforhealthordevelopmentalproblemsidentifiedduringcheck‐ups.

Iowa’sEPSDTbenefitincludesthefollowingservices:

Informing

TheIowaDepartmentofHumanServices(DHS)providesthenamesofthenewlyeligibleclients,inadditiontodemographicinformation,totheIowaDepartmentofPublicHealth(IDPH).IDPHmakestheinformationavailabletotheTitleVcontractagencyservingtheareawheretheclientlives.

StaffattheTitleVChildandAdolescentHealthcontractagencycontactnewlyeligibleclientstoexplaintheEPSDTCareforKidsprogramandbenefits.Thediscussioncoversthebenefitsavailable,importanceofpreventivehealthcareservices,locationofservices,supportservicesavailabletohelptheclient,andlocalresources.

CareCoordination

AcarecoordinatorattheTitleVcontractagencycontactstheclienttodeterminewhetherassistanceisneededtofindamedicalanddentalhomeortoscheduleanappointmentforascreening.Thecarecoordinatorshallalsoassistwithtransportation,interpretation,developmentalconcerns,andotherresourcesasneeded.Thecarecoordinatorcontinuestofollow‐upwiththeneedsoftheclientuntilallneedsareaddressed.

Screening

TheIowaEPSDTCareforKidsPeriodicityScheduleincludesphysical,mentalhealth,dental,vision,andhearingscreenrecommendationsandintervalsforthosescreensforchildren.TheIowaPeriodicityScheduleisbasedontheAmericanAcademyof


Pediatrics’BrightFuturesRecommendations.Iowa’sPeriodicitySchedulecanbefoundatIowa'sEPSDTCareforKidsPeriodicitySchedule.

DiagnosisandTreatment

Theclient’sprimaryhealthcareproviderdiagnosesandprovidesneededtreatmentservices.Theclientmaybereferredtoanotherhealthcareproviderforspecialtycare.

Ifdiagnosisandtreatmentareindicated,thecarecoordinatoroffersassistanceinlocatingappropriateresources,schedulingappointments,andassistinginarrangingsupportservices.

TitleVContractAgencyResponsibilityforEPSDTCareforKids

InIowa,DHSadministerstheIowaMedicaidprogramandthereforeistheadministrativeagencyfortheEPSDTCareforKidsprogram.Throughaformalwrittenagreement,DHSengagestheIDPHtoprovideEPSDTCareforKidsinforming,carecoordination,andrelatedinterpretationservicesforeligibleclients.IDPHfulfillstheresponsibilitiesofthisagreementbycontractingwithlocalTitleVChildandAdolescentHealthcontractagenciestoworkwithclientsindesignatedserviceareas.

Contractagenciesareresponsibleforproviding:● InformingtonewlyMedicaidenrolledchildrenandadolescents0to21yearsofage.

● Dentalcarecoordinationforallchildrenandadolescents0to21yearsenrolledinMedicaidandTitleV.

● MedicalcarecoordinationtoMedicaidFee‐for‐Service(FFS)(notinMedicaidmanagedcare)andTitleVclients.MedicaidFFSclientsandTitleVclientsservedinthepasttwoyearswhoareinthesignifycommunity™AgencyHomereceivewellchildexamreminders.

● Interpretationservicespertainingtoinformingandcarecoordinationservices.

EachcontractagencyisrequiredtohaveprotocolstodirectitsactivitiesrelatedtotheEPSDTCareforKidsprogram.GeneralguidelinesforagencyprotocolsareincludedinChapter6ofthishandbook.SampleagencyprotocolsarelocatedinAppendix1.EPSDTCareforKidsCoordinators

EachIDPHTitleVChildandAdolescentHealthcontractagencyisrequiredtohaveadesignatedemployeetocoordinatetheEPSDTCareforKidsprogram.ThisemployeeiscalledtheEPSDTCareforKidsCoordinator.

ClientRights

ClientsenrolledinMedicaidareentitledtospecificrightsundertheMedicaidprogram.TitleVcontractagencystaffshouldbefamiliarwiththeserightstobeabletoappropriatelyinformclients.Primaryamongtheserightsaretherighttochooseaprovider,chooseaManagedCareOrganization(MCO),andtherighttoappealdecisionsmadebyMedicaidortheirMCO.


ChoiceofProvider

Federalrulesmandatethatclientshavethefreedomtochoosetheirhealthcareproviders.Tocomplywiththeserules,contractagencystaffmustbepreparedtodiscussEPSDTCareforKidsprovideroptionswitheachclient.ClientsenrolledinMedicaidhavetheabilitytochooseaproviderundertheirMedicaidstatus(Fee‐for‐Serviceormanagedcare).

Clientsmustbeinformedofthefinancialconsequencesofchoosinganon‐MedicaidprovidersinceMedicaidwillnotpayforservicesgivenbyanon‐Medicaidprovider.Aclient’schoiceofanon‐Medicaidprovidershouldnotbeconsideredarefusalofservices.

RighttoAppeal

AllMedicaideligibleclientshavetherighttoappeal.InformationonfilinganappealcanbefoundontheDHSwebsiteatwww.dhs.iowa.gov/appeals.ClientswhohavequestionsspecifictotheappealprocessmaycontacttheirDHSworkerortheAppealsSectionat515‐281‐3094.Althoughstaffwillbeabletoanswerquestions,theywillnotprovidelegaladvice.

Commonreasonsforappealsincludethefollowing:● Benefitsarebeingterminatedandtheclientbelievesthereasonforthetermination

isincorrect

● Priorauthorizationisdeniedforaservice

● Non‐paymentbyMedicaidissenttoacreditor

ClientswishingtoappealmayalsowishtocontactanattorneyorIowaLegalAidat1‐800‐532‐1275.InPolkCounty,clientsmaycall515‐243‐1193.

MaintainingConfidentialityfortheClient

AllIDPHTitleVChildandAdolescentHealthcontractagenciescarryoutthefunctionsoftheEPSDTCareforKidsprogram,andtherebybecomeanarmofMedicaid.ContractagenciesmustmeetthestandardsofconfidentialityofMedicaidandfollowHealthInsurancePortabilityandAccountabilityAct(HIPAA)requirements.AgenciescancommunicatewithlocalDHSofficesregardingclientinformationwithoutareleaseofinformation.AdditionalconfidentialityguidelinesarefoundinlocalcontractagencyHIPAApoliciesandtheIDPHHIPAAstatementonlineathttps://idph.iowa.gov/hipaa‐statement.SpecificconfidentialityguidelinesrelatedtotheEPSDTCareforKidsprogramincludethoselistedbelow.

● Whenacontractagencysendscorrespondencetoclients,theterm‘Medicaid’maynotbeusedontheoutsideofenvelopes,postcards,orinelectronictransmissions


thatcouldbeseenbythoseotherthantheintendedrecipient.AgenciesmayusetheEPSDTCareforKidslogo‐excludingtheword‘Medicaid’.

Whenleavingmessagesonvoicemailthatspecificallyidentifytowhomyouareleavingthemessage,thecontractagencynameand‘CareforKids’maybeleftinthemessageinadditiontoidentifyingthecallerandthenameoftheclient.Forexample,‘ThisisSylviafromCareforKids.Iamcallingtotalktotheparentof[client'sname]abouthishealthinsurancebenefits.SorryImissedyou.Pleasecallmeat...’Ifthevoicemaildoesnotgiveenoughinformationtoidentifywhosephonehasbeencontacted,themessageshouldbelessspecific,andthenameoftheclientshouldnotbementioned.DocumentingServices

TheIDPHweb‐basedsignifycommunity™istheofficialrecordforallEPSDTCareforKidsinformingandcarecoordinationservices.Signifycommunity™isusedbyIDPHTitleVChildandAdolescentHealthcontractagenciestomonitorclientdemographicinformation,needs,andservices.Allservicesprovidedbycontractagenciesmustbeenteredintosignifycommunity™withthecompleteinstructionsforthatdataentrylocatedinthesignifycommunity™ChildandAdolescentHealthUserManualandfoundintheLibraryDocuments.

FiscalManagement

EachcontractagencyestablishespoliciesrelatedtothefiscalmanagementoftheEPSDTCareforKidsprogram.AgenciescompleteaCostAnalysistoestablishtheirlocalagencycostsforprovidingeachservice.ContractagencystaffmemberskeepacontinuoustimestudythatisusedtohelpdeterminethestaffcostsforprovidingtheEPSDTCareforKidsservices.SeeChapter7FinancialManagement.MaintainingClientRecords

ThecontractbetweenIDPHandthecontractagencyaddressestheretentionofbothmedicalrecordsandalsofiscalandotherprogramdocuments.ThefollowinglanguageisapartoftheGeneralConditionsofthecontract:

● Medicalrecords:‘TheContractorshallretainallmedicalrecordsforaperiodofsix(6)yearsfromthedaythecontractorsubmitsitsfinalexpenditurereport;orinthecaseofaminorpatientorclient,foraperiodofoneyearafterthepatientorclientattainstheageofmajority,whicheverislater.’

● Financialandotherprogramrecords:‘Thecontractorshallretainallaccountingandfinancialrecords,programmaticrecords,supportingdocuments,statisticalrecordsandotherrecordsreasonablyconsideredaspertinenttothecontractforaperiodoffive(5)yearsfromthedaytheContractorsubmitsitsfinalexpenditurereport.Ifanylitigation,claim,negotiation,auditorotheractioninvolvingtherecordshasbeenstartedbeforetheexpirationofthefive(5)yearperiod,therecordsmustberetaineduntilcompletionoftheactionandresolutionofallissues


whicharisefromit,oruntiltheendoftheregularfive(5)yearperiod,whicheverislater.Clientrecordswhicharenon‐medicalmustberetainedforaperiodoffive(5)years.’

Medicaidmayauditrecordsforaperiodoffiveyearsafteraclaimissubmitted,orifanauditisinprocess,fiveyearsafterthecompletionoftheaudit.Contractagenciesmustkeepallfilesforfiveyearsafterthecompletionoftheaudit,eveniftheoriginalretentionexpirationisbeforethatdate.SignatureLog

ContractagenciesarealsorequiredtomaintainasignaturelogofallstaffprovidingChildandAdolescentHealthservicesthatincludetheirfirstname,lastname,credentials,fullsignature,andinitials.Thislogisimportantforreferenceintheeventofanaudit,asitisthelinktorequiredsignaturesforstaffprovidingservicesthatareenteredintosignifycommunity™.RecordReviews

Withproperidentification,authorizedrepresentativesofIDPH,DHS,CentersforMedicareandMedicaidServices(CMS),and/ortheOfficeofInspectorGeneral(OIG)havetherighttoreviewtheclinicalandfiscalrecordsofacontractagencytodeterminewhether:

● ThecontractagencyhasfurnishedtheservicestoMedicaidrecipients.

● Documentationoftheservicesupportstheclaim.

● DocumentationfollowstheDHSIowaAdministrationCode441‐79.3requirementsfordocumentationofservices.Theserulescanbefoundathttps://www.legis.iowa.gov/docs/iac/rule/03‐28‐2018.441.79.3.pdf.

ServiceNoteReviews

BothIDPHstaffandcontractagencystaffparticipateinbi‐annualServiceNoteReviewswhichincludeareviewofdocumentationofinformingandcarecoordinationservicesinsignifycommunity™.ThepurposeoftheServiceNoteReviewsistoevaluatewrittendocumentationtoidentifyeducationalopportunities,neededservicedeliveryadjustments,andneedforcorrectionofinadequateorincompletedocumentation.SeeChapter8QualityAssurance.FordetailedguidelinesforServiceNoteReview,seetheProjectManagementPortalathttp://idph.iowa.gov/family‐health/mchportal.


Chapter2 Informing

Thischapterprovidesstep‐by‐stepinstructionsfortheinformingprocess.NewlyMedicaidenrolledclients,ages0to21years,receiveinformationaboutthehealthcareservicescoveredundertheEPSDTCareforKidsprogramthroughaprocesscalled‘informing’.Thisisafederallyrequiredservice.IowaDHScontractswithIDPHtohavethelocalcontractagenciesprovidethisservice.

Notethatclientsages19‐20maybeeligibleforMedicaidthroughtheIowaHealthandWellnessPlan(IHAWP).Becausetheseclientsareunderage21,theyreceivethesameEPSDTbenefits.Thosewhoarenewlyeligiblealsoreceivetheinformingservicesothattheycanlearnabouttheirbenefits.HowtheClientQualifiesforInforming

WhenaclientmeetsMedicaideligibilityrequirementsandbecomesnewlyenrolledintheMedicaidprogram,theclientqualifiesforinformingservices.Contractagenciesprovidetheinformingserviceforeachnewlyeligiblechildinthefamily.However,billingisforthefamilyunitratherthanforeachindividualclient.

Informingbundlesarecreatedinsignifycommunity™fornewlyeligibleMedicaidclients.Thesebundlesidentifytheclientswhoarenewlyeligiblethatneedaninformingservice.ContractagenciesprovidetheInformingservicefortheclientsthathaveaninformingbundleinsignifycommunity™.IfneedingtochecktheMedicaideligibilitystatusofaclient,contacttheIowaMedicaidEnterprise(IME)EligibilityVerificationSystem(ELVS)at800‐338‐7752(or515‐323‐9639inDesMoines).ClienteligibilitycanalsobeverifiedusingtheIMEELVSWebPortal.Accesstothisportalcanbeobtainedathttps://ime‐ediss5010.noridian.com/iowaxchange5010/LogonDisplay.do.ContractAgencyResponsibilityforInforming

IDPHcontractswithTitleVChildandAdolescentHealthcontractagenciestoprovideservicestoclientsintheirservicearea.Agenciesareresponsibleforinformingclientsunderage21whoarenewlyeligibleforMedicaidorIHAWPcoverage.Theinitialinformandfollowupphonecallsmustbeginwithin30daysofthebeginningofthemonth.

Thecontractagencyisresponsiblefordevelopinginformingprotocolsandmakingsurethatthecontractagency’spracticesareconsistentwiththerequiredcomponentsoftheinformingprocess.

ThecontractagencymaychoosetoinformthefamiliesoffostercarechildrenorthoseinMedicaid’sMedicallyNeedywithSpenddownProgram.However,thecountyDHSofficeshaveprimaryresponsibilityforinformingtheseclients.SomeclientshaveneverbeeneligibleforMedicaid.SomemayhavereceivedMedicaidbenefitsinthepast.Anyclientwhobecomeseligibleagain,afterbeingoffMedicaidforthe


previous90daysormoreisconsideredtobenewlyeligible.Theywillreceiveaninformingbundleinsignifycommunity™andshouldreceivetheinformingservice.SkillsNeededforInforming

Eachcontractagencyisrequiredtodesignateoneormoreemployeestocarryoutinformingservices.Staffingisdependentupontheclientloadforyouragency’sservicearea.InordertobeeffectivewheninformingclientsabouttheEPSDTCareforKidsprogram,certainskillsarenecessary.Contractagencystaffneedto:

● Communicateclearlywhenwritingandspeakingtoclients.● RelatetoclientstoencourageinvolvementinEPSDTservices.● Assessclientneedsandrefertoappropriateproviders.● Tailorinformingservicestoaddressclientchoices,preferences,andspecialneeds

suchaslanguagebarriers,lowliteracylevels,andhearingorsightimpairment.● UnderstandtheEPSDTCareforKidsprogram,includingcomponentsofIowa’s

EPSDTCareforKidsPeriodicitySchedule.● UnderstandChildhoodImmunizationSchedulesforbirththrough18yearoldhere

fromtheCentersforDiseaseControlandPrevention’s(CDC)AdvisoryCommitteeonImmunizationPractices(ACIP).

● Understandandexplainchildandadolescentgrowthanddevelopment.● Establishandmaintainlinkageswithlocalprovidersandcommunityresources.

ThreestepsofInforming

Therearethreepotentialstepstoprovidingtheinformingservice.Theseare:

1. Initialinform

2. Informfollow‐up(s)

3. Informcompletion

TheInitialInform

ThefirstcontactmadewithaclientwhoisnewlyeligibleforMedicaidiscalledthe‘initialinform’.ContractagencieshavetheresponsibilityforprovidingtheinitialinformfornewlyMedicaideligiblechildren.AgenciesmusthaveprotocolsconsistentwithIDPHguidelinesforprovidingtheinitialinform.Theinitialinformisamailingofaletterorpacketofinformation(mustincludeEPSDTbrochure)tofamiliesofallnewlyMedicaidenrolledclients.ThismailingservestointroduceEPSDTtothefamilybybrieflydescribingtheEPSDTCareforKidsprogram.Itmayincludeinformationaboutservicesandothercommunityresourcesinthearea.It


canidentifyaspecificagencycontactperson(carecoordinator).Agenciesshallindicateintheletterthattheywillfollow‐upwithaphonecallorface‐to‐facevisit.TheEPSDTCareforKidsbrochureistobeincludedwiththeinitialinformletter.AsofJanuary1,2019,IowaPrisonIndustriesopenedanewwebsitefortheorderingthisDHSform.Startbyregisteringforanaccountathttps://dhsforms.iaprisonind.com.TheEPSDTbrochurewillbesentinblackandwhiteatnocosttothecontractagency.Noticethatthereisanemptyboxforplacingastickerwithyouragency’slocalcontactinformationonboththeEnglishandSpanishsidesofthisbrochure.Iftheagencychooses,theymayprinttheEPSDTbrochureincolorattheirowncost.ThebrochureisfoundontheMCAHProjectManagementPortalathttp://idph.iowa.gov/family‐health/mchportal.AsampleinitialinformletterisincludedinAppendix2ofthishandbook.DocumentingtheInitialInform

Staffmustdocumenteachinitialinforminsignifycommunity™foreachnewlyeligibleclientinthefamily.Thesignifycommunity™ChildandAdolescentHealthUserManual‐DocumentLibraryprovidesspecificguidelinesforenteringthisinformation.Documentationoftheinitialinformmustincludethefollowing:

1.Countyofservice2.Locationofservice3.Statementthataninformingletterorpacketwassent4.Firstandlastnameoftheserviceproviderandtheircredentials

Thisinformationmaybemassupdatedinsignifycommunity™.

Timelydocumentationisrequired.Staffmustdocumenttheinitialinforminsignifycommunity™foreachnewlyMedicaideligibleclientinthefamilybythe15thofthefollowingmonth.

TheInformFollow‐up

Theinformingprocessisnotconsidered‘complete’untilverbalcontactismadewiththeclientonthephoneorinperson–toexplaintheEPSDTprogramanditsbenefits.‘Informfollow‐ups’areattemptstoreachtheclientthatdonotresultinverbaldialoguetoexplaintheEPSDTservices.Theseareattemptstoreachthefamilywherethefamilyisnotreached.ThecontractagencymusthaveprotocolsthatadheretoIDPHguidelinesforprovidinginformfollow‐ups.Theremustbeattemptstoreachclientsbyphoneorface‐to‐face(homevisitorclinicvisit).Forfamiliesthataredifficulttoreach,atleasttwoinformfollow‐upphoneattemptsmustbemadeatdifferenttimesoftheday‐duringthemonththatthe


informingbundlesarepopulatedinsignifycommunity™i.e.oneattemptinthemorningandoneattemptintheeveningorweekend.Contractagenciesarerequiredtomakeinformingattemptsoutsidethetraditionalbusinesshourspertheircontract.Atextmaybesubstitutedforonefollow‐upphonecall.Thetextistobeusedtoeitherencouragethefamilytocontacttheagencyortoaccepttheagency’scall.Noprotectedhealthinformationistobeincludedintexts,includingstatingthatthechildisenrolledinMedicaidorTitleXIX.Appropriateuseofinformfollow‐uptextingwouldbesimilarto:‘ThisisMandywithCareforKids(ornameofAgency),Iamtryingtoreachyoutodiscussimportantinformationaboutyourchild’shealthinsurance.Pleasecallmebackat(phonenumber)’or‘Iwillbeattemptingtocallyoufromthisnumber’.AlltextsmustcomplywithHIPAA,IDPH,andlocalagencypoliciesandprocedures.Textsmustbesentfromanagencydevice.Nopersonaldevicesmaybeused.Ifnophonenumberisfoundinsignifycommunity™foraclient,contractagencystaffshouldattempttolocateaphonenumberthroughotherdatabases,systems,andresources.Ifthefamilycannotbereachedbyphoneinthesetwoattempts,afollow‐upwrittencommunicationmustthenbesent,reinforcingcomponentsoftheEPSDTprogramandencouragingitsuse.Afollow‐uppostcardmaybemailedinsteadofaletter.Postcardsmaynotcontainprotectedhealthinformation,includingstatingthechildisenrolledinMedicaidorTitleXIX.AllpostcardsmustcomplywithHIPAA,IDPH,andlocalagencypoliciesandprocedures.Ifnophonenumbercanbelocated,afollow‐uplettermustbesentwithaformandpostagepaidenvelopeenclosed,requestingaphonecalloracurrentphonenumberbereturnedtotheagency.DocumentingtheInformFollow‐up

Staffmustdocumenteachinformfollow‐upattemptinsignifycommunity™foreachnewlyeligibleclientinthefamily.Thesignifycommunity™ChildandAdolescentHealthUserManual–DocumentLibraryprovidesspecificguidelinesforenteringthisinformation.Documentationoftheinformfollow‐upsmustincludethefollowing:

1.Countyofservice2.Locationofservice3.Specifictimeofdaytheattempttocontactthefamilywasmade.Enterthisin

‘Timeinfield’.Anactualtimeisnecessary.Whentwofollow‐upsareprovided,besuretheseareatdifferenttimesofday(a.m.andp.m.).

4.Descriptionoftheattempttoreachthefamilyandtheresultofthisattempt(noanswer,busysignal,phonedisconnected,etc.)includinganymessageleftandthecontentofthatmessage.


5.Whenafollow‐upletterisnoted,thisoccursonlyafterexperiencingatleasttwofailedphoneattempts.6.Firstandlastnameoftheserviceproviderandtheircredentials.

Informfollow‐upsarerequiredwithin30daysoftheinitialinform.Ifrepeatedattemptstoreachthefamilyareunsuccessful,thecontractagencymayelecttoreleaseownershipoftheclientperagencyprotocols.Donotmarkunsuccessful,leaveclientopenincaseoffuturecontact.Theclientwillautomaticallybemarkedunsuccessfulinsignifycommunity™after12months.TheInformCompletion

Thegoaloftheinformingprocessistosuccessfullycontacttheclientbyphoneorface‐to‐facetoverballyexplaintheEPSDTservicesforwhichtheclientisnoweligible.Thisisreferredtoasthe‘informcompletion’.InformcompletionisonlyachievedwhenthedescriptionofservicesavailableundertheEPSDTCareforKidsprogramisgivendirectlytotheclientinpersonoronthetelephone.

Informcompletionmaynotbeaccomplishedviatext,voicemessage,receivingaletterorformfromthefamily.Ifafamilyisreached,butforsomereasontheagencyserviceproviderisunabletoexplainEPSDTtothefamily(e.g.hangup,badtimingforthefamily),thespecificcircumstancesofthesituationshouldbeexplainedwithinaninformfollow‐upservice.However,thisdoesnotmeetthecriteriaforaninformcompletion.

WhenservingclientsnewlyeligibleforMedicaid,itisexpectedthatinformingservicesarecompletedpriortoproviding(andbilling)carecoordinationservices.Anyverbalorface‐to‐facecontactwiththeclientwithin12monthsoftheinitialinformprovidesopportunitytocompletetheinformingprocess.Becauseofthis,itisadvisedthattheinformcompletionbeleftopeninsignifycommunity™(notmarked‘unsuccessful’).

TheInformCompletionConversation

Therearemanypossibletopicsfortheinformcompletiondiscussion,dependingontheknowledgelevelandneedsoftheclients.Thesetopicsinclude:

● Thebenefitsofpreventivemedicalanddentalcare.● TheservicesavailableunderEPSDTCareforKidsincludingcarecoordination

andthevariousscreeningservices.● ThecomponentsoftheEPSDTscreenaccordingtoIowaEPSDTCareforKids

PeriodicityScheduleandImmunizationSchedule● FreedomofchoiceoftheirhealthcareprovidersunderMedicaid.● FreedomofchoiceofmanagedcareorganizationunderMedicaid.● Theimportanceoftheclientestablishingamedicalhomeanddentalhome,and

theprocessforselectingahealthcareprovider.● Informationonwherescreeningservicesareavailableandhowtoobtainthem.


● InformationonthesupportservicesavailableunderEPSDT,suchastransportationandinterpretationservices.

● Informationaboutotherresourcesinthecommunity.

Assurethatacurrent,fullycompletedIntakeAssessmentispostedinsignifycommunity™.Thesignifycommunity™ChildandAdolescentHealthUserManual‐DocumentLibraryprovidesspecificguidelinesforenteringthisinformation.

Atinformcompletion,emphasizethatcarecoordinationservicesareavailablethroughtheEPSDTCareforKidsprogramtolinktheclientwiththehealthcaresystem.Forthisdiscussion,befamiliarwiththeguidelinesforcarecoordinationinChapter3ofthishandbook.

Afterdescribingcarecoordinationservices,askwhethertheclientneedstheassistanceofacarecoordinator.Ininstanceswheretheclientdoesnotwantassistance,providetheclientwithagencycontactinformation,includingthenameofthecarecoordinator,incasetheneedsoftheclientchange.Iftheclientrequestsnofurthercontact,indicatethisinformationinthedemographicnotes.Contractagenciesmayusetheconfidentialityflagtohighlightthatnofurthercontactisdesired.Thereisalsoadeathnotificationfeaturethatcanbeused.Seethesignifycommunity™ChildandAdolescentHealthUserManualintheLibraryDocumentsfordetailedinstructions.

DocumentingtheInformCompletion

Staffmustdocumenteachinformcompletioninsignifycommunity™foreachnewlyeligibleclientinthefamily.Thesignifycommunity™ChildandAdolescentHealthUserManual–LibraryDocuments,providesspecificguidelinesforenteringthisinformation.Documentationoftheinformcompletionmustincludethefollowing:

1.Countyofservice2.Locationofservice3.Contactedperson4.ExplanationoffullbenefitsandservicesavailableundertheEPSDTCareforKids

program5.Medicalappointmentsummary(nameofprovider;pastorupcoming

appointments)6.Dentalappointmentsummary(nameofprovider;pastorupcoming

appointments)7.Immunizationstatus8.Client/familyfeedback9.Referrals,outcomes,&planforfollow‐up10.Intakeassessmentaddressed11.Firstandlastnameoftheserviceproviderandtheircredentials

Youragency’sMCAHcontractspecifiesthetimelinerequirementsfordocumentingservicesinsignifycommunity™.Itstates,‘Allchild&adolescenthealthandoralhealth


servicesprovideddirectlybytheContractororthroughsubcontractorsmustbedocumentedatthetimeofserviceandavailabletoIDPHbythe15thofthemonthfollowingthemonthofservice.Allchild&adolescenthealthandoralhealthservicesmustberecordedregardlessofpayersource.’

BillingforInformingServices

Eachmonth,IDPHgeneratesareportofeachcontractagency’snumberofinitialinformsforpaymentbyIDPHasFee‐for‐Service.Thepaymentcoverstheentireinformingserviceprovidedtotheclient,includingtheinitialinform,informfollow‐ups,andinformcompletion.Paymentismadeforinformingtheentirefamily,notperclient.

Theclaimforinformingalsocoversanyassistanceprovidedduringtheinformcompletiondiscussionwiththeclient.Donotbillordocumentacarecoordinationserviceforanyportionoftheinformcompletioncontact.

signifycommunity™servicesarepulledforIDPHFee‐for‐Servicebillingimmediatelyafterthe15thofthemonthfollowingthemonthofservice.Anyservicesenteredintosignifycommunity™afterthe15thofthemonthfollowingthemonthofservicewillnotappearinyouragency’sIDPHFFSbilling.


Chapter3 CareCoordination

OnceclientshavebeeninformedabouttheEPSDTCareforKidsprogram,theymayneedfurtherassistance.Someclientschoosetoobtainserviceswithoutanyhelp.Otherclientsmayrequestassistanceinobtainingmedicalanddentalscreeningsandotherservices.

BenefitsofCareCoordinationServices

TheEPSDTCareforKidsprogramencouragesclientstohavemedicalanddentalhomesforcontinuityofcare.Theprogramassuresthatoverallhealthisimprovedthroughperiodicexams,earlydiagnosis,andappropriatetreatment.

Carecoordinationserviceshelpclientsto:● Becomeindependenthealthconsumers● Develophealthybeliefs,attitudes,andbehaviors● Makeinformedhealthcarechoices● Establishandmaintainmedicalhomesanddentalhomes● Improvetheirhealthandphysicalwell‐being

Specificcarecoordinationactivitieswilldependontheneedsandpreferencesoftheclient.Thefollowinglistcontainssomeofthepossibleactivities:

● Remindingclientsthatperiodicwell‐childscreeningsanddentalexamsaredue● Assistingwithschedulingappointments(outsideofthecontractagency)● Assistingtheclienttopreparealistofquestionsorconcernspriortothemedicalor

dentalvisit● Followinguptomakesuretheclientreceivedthecareintendedattheappointment● Followinguptoreschedulemissedappointments● Assistingclientswhenreferralforfurthercareisneeded● ArrangingsupportservicessuchastransportationtoMedicaidprovidersor

interpreterservices● Monitoringmedicalanddentalcareplans● Linkingclientstootherhealth‐relatedcommunityservices

SkillsNeededforCareCoordination

Eachcontractagencyisrequiredtodesignateoneormoreemployeestoprovidecarecoordinationservices.Aneffectivecarecoordinatorwillpossessspecificskillsincludingtheabilityto:

● Communicateclearlywhenwritingandspeakingtoclients● RelatetoclientstoencourageinvolvementinEPSDTservices● Understandhowtouseaclient‐centered,strength‐basedapproach


● Assessclientneedsandrefertoappropriateproviders● Tailorcarecoordinationservicestomeetspecialneedsoftheclient,suchas

languagebarriers,lowliteracylevels,andhearingorsightimpairment● Understandtheimpactoftheclient’sculturally‐relatedhealthbeliefs● UnderstandtheEPSDTCareforKidsprogramincludingcomponentsofIowa’s

EPSDTCareforKidsPeriodicitySchedule● UnderstandtheImmunizationSchedulefromtheCentersforDiseaseControland

Prevention(CDC)AdvisoryCommitteeonImmunizationPractices(ACIP)● Understandandexplainchildandadolescentgrowthanddevelopmenttoclients● Establishandmaintainlinkageswithlocalprovidersandcommunityresourceson

behalfoftheclient

AsamplejobdescriptionforacarecoordinatorislocatedinAppendix3ofthishandbook.

TitleVContractAgencyResponsibilityforCareCoordination

Carecoordinationistheprocessoflinkingtheclienttothehealthcaresystem.OralhealthcarecoordinationisprovidedtoallclientsregardlessofMedicaideligibility.Inaddition,Fee‐for‐ServiceandTitleVclientsreceivemedicalcarecoordinationfromTitleVChildandAdolescentHealthcontractagencies.ClientsenrolledinaMedicaidMCOmaybereferredtotheirMCOforcarecoordinationservices.ChildrenwithSpecialHealthCareNeedsmaybereferredtoChildHealthSpecialtyClinicsforspecializedcarecoordination.

Billablecarecoordinationservicesmustincludephoneorface‐to‐facedialoguewithMedicaidFee‐for‐ServiceclientstoassistthemwithMedicaidrelatedservicessuchasmedical,dental,mentalhealth,transportation,interpretation,ChildHealthSpecialtyClinics,AEA,orsubstanceabuseprograms.AslongasMedicaidrelatedservices/programsareaddressed,linkagetonon‐Medicaidresources(suchaschildcare,WIC,parentingprograms,socialservices,legalservices,food,clothing,housing,andshelterservices)mayalsobeincludedinthebillabletimespentwiththeclient.

MedicalcarecoordinationprovidedtoMCOenrolledclientsisnotabillableservice.ThisactivityistheresponsibilityoftheMCOsbasedupontheircontractwithIowaDHS.

AcontractagencymusthaveitsownprotocolsthatareconsistentwithIDPHguidelinesforprovidingcarecoordination.

ExamplesofCareCoordination

AssistingtheClienttoOvercomeaCommunicationBarrier

Sometimesaclienthasdifficultygettinghealthcarebecauseofacommunicationproblemsuchasalanguagebarrier,hearingimpairment,orhealthliteracyobstacle.Carecoordinatorscanhelptheclientovercomethebarrier.


Thereareavarietyofstrategiestoassistaclientwithacommunicationproblem.Thecontractagency’scarecoordinationprotocolswillguideusingaparticularstrategy,suchasspeakingwiththeclientonthephoneoratthecontractagencyinthepreferredlanguageorcommunicationmethod.Inmanyinstances,carecoordinatorshelptheclientbyarrangingforinterpreterservices.

Asacarecoordinator,determinewhethercontractagencymaterialsareatanappropriatereadinglevelandculturallyappropriatefortheclientsintheservicearea.Carecoordinator’sinsightsareimportanttoguidethecontractagencyinmakingappropriatechangestoprotocolsandmaterials.

AssistingtheClienttoOvercomeaTransportationBarrier

ContractagenciesmayassistclientstoarrangetransportationtoMedicaidhealthproviders(medical,dental,andmentalhealth).

ContractagenciesmaybotharrangeandbillMedicaidforin‐town(local)transportationservicesforMedicaidFee‐for‐Serviceclients.ContractagenciesmayreferMedicaidFee‐for‐ServiceclientstoIowaMedicaid’stransportationbroker(Access2Care)fortransportationservices.ContactAccess2Careat1‐866‐572‐7662.

Contractagenciesmayalsoarrangein‐towntransportationforTitleVclients.TheseserviceswouldbecoveredbyTitleVgrantfunds.

Transportationformedical,dentalandmentalhealthappointmentsforMCOenrolledclientsmaybereferredtotheMCO’stransportationbroker.

Whendocumentingcarecoordinationfortransportationneeds,recordthefollowing:

1.Timeinandtimeout2.Countyofservice3.Locationofservice4.Contactedperson5.TypeofMedicaidservicetheclientisgoingto/from6.Tripdate7.Transportationtype8.Firstandlastnameoftheserviceproviderandtheircredentials

CareCoordinationforChildrenwithSpecialHealthCareNeeds

ChildHealthSpecialtyClinics(CHSC)isIowa’sTitleVprogramforclientswithspecialhealthcareneeds.TheCHSCstatewideprogramincludesRegionalCentersthatprovideservicestochildrenwithspecialhealthcareneedsandacentraladministrativecenterattheUniversityofIowa.

RegionalCHSCstaffareskilledincoordinatingcaresothatlocalresourcesareusedinthemosteffectiveandconvenientmannerpossible.CHSCparentconsultantsassurethatservicesareclient‐centered,sothatclientscanconsideroptionstomakeinformeddecisionsabouttheircare.


HomeVisitforaHighBloodLeadorMedicallyNecessaryCondition

Mostcarecoordinationactivitieswillinvolvetalkingtoclientsonthetelephoneoratthecontractagency’sofficeorclinicsetting.However,acontractagencymustbepreparedtoprovidehomevisitstoclientswhenindicated.

Twoinstanceswhencarecoordinationmightbeprovidedduringahomevisittotheclientareoutlinedbelow.

1. Eachclientwithabloodleadlevelequaltoorabove15microgramsperdecilitermustreceiveaskillednursingvisit.AnRNcarecoordinatormayfollowuponthishighbloodleadlevelbymakingahomevisitto:● Assesstheclient’sknowledgeofleadpoisoningandinstructtheclientregarding

nutrition,housekeeping,andotherrelevantissues● Assisttheclientinmakingandkeepingfollow‐upappointments● Remindthefamilytonotifytheclient’sleadprogramcasemanagerifthefamily

moves● Remindthefamilytoinformtheclient’scurrentandfuturehealthcareproviders

oftheelevatedleadlevelandanysubsequentteststhatmaydemonstratealowerbloodleadlevel

2. Ahomevisitmayalsobeindicatedforaclientthatrequiresamedicallynecessarycarecoordinationforahealthrelatedcondition.Suchnecessitymayincludeclientsthatlackphoneserviceorareotherwisehard‐to‐reach.Thepurposeofthishomevisitmaybeto:● Provideinformationaboutavailablemedicalanddentalcareservices● Coordinateaccesstocare● Assisttheclientinmakinghealthcareappointments(otherthanthoseatthe

contractagency)● Makereferrals● Coordinateaccesstoneededsupportservices

DocumentingCareCoordinationServices

Allcarecoordinationservicesmustbedocumentedinsignifycommunity™.Thesignifycommunity™ChildandAdolescentHealthUserManual–LibraryDocuments,providesspecificguidelinesforenteringthisinformation.Selecttheappropriatetypeofcarecoordinationfromthedropdownlist.Documentationofthecarecoordinationservicemustincludethefollowing:

1.Timeinandtimeout2.Countyofservice3.Locationofserviced4.Contactedperson5.Concerns&issues


6.Staffresponse7.Ifcoordinatingmedical/dentalcare: ‐Medicalappointmentsummary(nameofprovider;pastorupcomingappointments)‐Dentalappointmentsummary(nameofprovider;pastorupcomingappointments)‐Assessimmunizations8.Referrals,outcomes,&planforfollow‐up9.Client/familyfeedback10.Intakeassessmentaddressed11.Firstandlastnameoftheserviceproviderandtheircredentials.

Fortargetedfollowupcarecoordinationnotesthatdonotinvolvecoordinatingmedical/dentalcare,thedateoflastwellnessexam,nameofprovider,andassessmentofimmunizationstatusisnotrequired.Indicateinthenoteifitisafollow‐upcarecoordinationservice.Addressanyadditionalfamilyneeds.Ifcarecoordinationisprovidedformultipleclientsinthefamily,documentthecarecoordinationinthesignifycommunity™recordofeachclientserved.

Youragency’sMCAHContractspecifiesthetimelinerequirementsfordocumentingservicesinsignifycommunity™.Itstates,‘Allchild&adolescenthealthandoralhealthservicesprovideddirectlybytheContractororthroughsubcontractorsmustbedocumentedatthetimeofserviceandavailabletoIDPHbythe15thofthemonthfollowingthemonthofservice.Allchild&adolescenthealthandoralhealthservicesmustberecordedregardlessofpayersource.’

BillingforCareCoordinationServices

Eachmonth,IDPHgeneratesareportofthenumberofbillablecarecoordinationminutes.Paymentismadeperclient(notperfamily).Servicesarepaidbasedupona15‐minuteunit.

Signifycommunity™servicesarepulledforIDPHFee‐for‐Servicebillingimmediatelyafterthe15thofthemonthfollowingthemonthofservice.Anyservicesenteredintosignifycommunity™afterthe15thofthemonthfollowingthemonthofservicewillnotappearinyouragency’sIDPHFFSbilling.Non‐BillableCareCoordination

Non‐billablecarecoordinationincludes:● Attemptstoreachaclientforcarecoordinationservicesthatarenotsuccessful.● Activitiesthatareapartofthematernalhealthpostpartumvisit.Anycare

coordinationforthenewbabyispartofthispostpartumvisitbilledunderthematernalhealthprogram.

● Makingappointmentsforservicesprovidedwithinthecontractagency● Reportinglabresultstotheclientormedicalhomeforlabteststhatareconducted

withincontractagency.Theseactivitiesareconsideredpartofthelabdirectcareservice.


● Referralormakingappointmentsonthesamedateasdirectcarethatisrelatedtothedirectcare.Thisisconsideredpartofthedirectcareservice.

● MedicalcarecoordinationforMedicaidMCOclients

Typically,carecoordinationisnotbillablewhenprovidedonthesamedayasadirectcareserviceprovidedwithincontractagency.However,thefollowingexceptionstothispolicyapply:

● Carecoordinationtoarrangetransportationservicesmayoccuronthesamedayasadirectcareservice.

● Interpretationforacarecoordinationservicemaybebilledonthesamedayasthecarecoordinationservice.

● Medicalcarecoordinationmaybebilledifadentaldirectcareserviceisprovidedbyotherstaff(RDH)onthesameday(ifnomedicaldirectcarewasprovidedonthatdate).

● Dentalcarecoordinationmaybebilledifamedicaldirectcareserviceisprovidedbyotherstaffonthesameday(ifnodentaldirectcarewasprovidedonthatdate).

TitleVContractAgencyResponsibilityforWellChildExamReminders

ProvidingwellchildexamremindersbasedontheEPSDTCareforKidsPeriodicityScheduleisalsotheresponsibilityofcontractagencies.ContractagenciesarerequiredtoremindMedicaidFee‐for‐ServiceandTitleVclientsservedinthelasttwoyearswhoareinyoursignifycommunity™AgencyHome.Thesearethenon‐MCOenrolledclientsrecentlyservedbyyouragency.Areportthatincludesthesepopulationscomesfromsignifycommunity™tothecontractagencyatthefirstofthemonth.Thisidentifiesclientstoberemindedofupcomingwellchildexams.Thesepopulationsincludethefollowingclients:

● NewlyeligibleFee‐for‐ServiceMedicaidclients● EligibleMedicaidenrolledFee‐for‐Serviceclients● Noteligible‐TitleVclients● Unknown‐TitleVeligibleclientsenteredintothesystembyyouragency

Wellchildexamremindersmaybeprovidedtwoways:

● Phoneconversationwithclientorface‐to‐faceverbalremindersforwellchildexams.FortheMedicaidFee‐for‐Servicepopulation,thesearebillablecarecoordinationservices.Besuretomark‘TitleXIXFee‐for‐Service’astheprimarypayersourcewhendocumentinginsignifycommunity™.ThiswillidentifytheserviceaspayablebyIDPHasFee‐for‐Service.

● Mailingaletterorpostcard,sendingatextmessage,orleavingavoicemailmessage.Althoughthesemethodscanbeusedtoremindaclientofanupcomingwellchildexam,theydonotconstituteabillablecarecoordinationservice.Seethesignifycommunity™UserManualforguidanceondocumentingthisservice.Theseareenteredasa‘Task’–‘Send/GiveEducationalMaterials’.

Chapter4 InterpretationforInformingandCareCoordination


ProvidingInterpretationforInformingandCareCoordinationServices

InterpretationisbillabletoIDPHFee‐for‐Servicewhenprovidedforinformingandbillablecarecoordinationservices.Interpretationmaybeprovidedandbilledforface‐to‐faceoralinterpretation(CodeT1013)orphoneinterpretationprovidedthroughaninterpreterphoneservice(CodeT1013UC).

● RememberthatbillablecarecoordinationforMedicaidclientsincludesalldentalcarecoordinationforanyMedicaidenrolledclient,butformedicalcarecoordination,billableservicesapplytoonlytheMedicaidFee‐for‐Servicepopulation.MedicalcarecoordinationforMCOenrolledclientsistheresponsibilityoftheMCO.

● Rememberthatface‐to‐faceinterpretationisonlybillablewhenprovidedbyindividualswhoareemployedorcontractedbytheMCAHagencyforthesolepurposeofprovidinginterpretation.Theseservicesareprovidedbyinterpretersthatprovideonlyinterpreterservices.Billingcannotoccurwhentheinterpretationisprovidedbyabilingualserviceproviderwhoservesotherrolesanddoesotherworkwithinyouragency.

EnteringServicesinsignifycommunity™

Whenenteringinterpretationservicesintosignifycommunity™forinformingandcarecoordination,documentBOTHtheinformingserviceorcarecoordinationserviceandALSOaseparateinterpretationservice.Whenenteringtheinterpretationserviceintosignifycommunity™:

● Under'HealthServices',selectT1013fororalinterpretationorT1013UCfortelephonicinterpretation(e.g.LanguageLine).Timeinandtimeoutisrequired.T1013isbilledbasedupona15‐minuteunit,andT1013UCisbilledbaseduponaone‐minuteunit.

● IMPORTANT!Select'TitleXIX‐Interpretation‐PE,Inf,CC'asthePayerSource.ThiswillidentifythattheinterpretationserviceistobepaidbyIDPHasFee‐for‐Service.

● Placeanoteinthe‘Comment’fieldoftheinformingorcarecoordinationservicestatingthatinterpretationwasprovidedfortheservice.


Chapter5 CommunityLinkages

Assistingclientstocommunitylinkagesisanimportantcomponentoftheroleofcarecoordinators.Thisresponsibilityincludeseffortstoidentifycommunitylevelresources,linkclientswithservices,identifygapsandbarriersinservice,andpromotethedevelopmentofcommunitycapacity.Carecoordinatorsneedaworkingknowledgeofresourcesandwheretofindadditionalinformationinordertoassistclients.Strongrelationshipswithcommunitypartnershelpfacilitatelinkagesforclients.Thedevelopmentofformalandinformalconnectionsamongcommunityprovidersandorganizationsisessentialtocoordinatetheplanninganddeliveryofeffectiveservices.Manyregions,counties,ortownshaveregularmeetingsforsocialserviceandhealthcareproviders.Thesemeetingspromotenetworkingandinformationsharingtoensurethatlocalservicesandresourcesarenotduplicated.Attendanceatthesemeetingscanbeverybeneficialtothecontractagencyandtheclientsserved.Establishinglinkagesisessentialandcanbestbeaccomplishedthroughregular,personalcontacttoprovideinformationaboutcontractagencyservicesandtosharemutualconcerns.Therearemanywaystoestablishrelationshipswithcommunitypartners.Linkagesareestablishedandmaintainedthrough:

● Verbalcommunication● Personalcontact● Lettersofintroduction● Peernetworks● Involvementincommunitytaskforces,advisorycommittees,andboards● Trainingprograms● Agencytours● Systematicfollow‐up● Subcontractsandagreements

Itisimportantforcontractagenciestoestablishwrittensubcontractsandagreementswithlocalentitiestoestablishclearexpectationsofbothparties.Importantelementstoincludeinasubcontractinclude:

● Alistoftheworkandservicestobeperformedbythesubcontractor● Programpoliciesandrequirements● ProvisionforIDPHandanyofitsdulyauthorizedrepresentativestohaveaccess,for

thepurposeofauditandexamination,toanydocuments,papers,andrecordsofthesubcontractorpertinenttothesubcontract

● Theamountofthesubcontract


● Alineitembudgetofspecificcoststobereimbursedunderthesubcontractorotherbasisfordeterminingtheamountcostsofthesubcontractasappropriate

● AstatementthatallprovisionsoftheIDPHTitleVChild&AdolescentHealthContractareincludedinthesubcontract,includingauditrequirements

● Timeperiodofperformance● Anyadditionalsubcontractconditions

HealthyFamiliesLine

IDPHhasacontractwithIowaStateUniversityExtensiontoprovideafreephonelineservice.TheHealthyFamiliesLineat1‐800‐369‐2229providesinformationandreferralforcallers,includingfamilieswhosechildrenreceiveEPSDTCareforKidsservices.TheHealthyFamiliesLinecallcenterprovidesresourceinformationonMaternalHealth,Child&AdolescentHealth,andFamilyPlanningservices.StaffattheHealthyFamiliesLineareabletopatchcallsdirectlytothecaller’sMCAHcontractagencyforassistance.PrimaryHealthCareProviders

FacilitatingmedicalanddentalhomesforclientsisanimportantfunctionoftheChild&AdolescentHealthprogram.Thefollowingareimportantlinkagesthatcanserveasmedicalanddentalhomesandsourcesforfurtherdiagnosisandtreatment.

● Primarycarepractitioners(doctor’sanddentist’sofficesandotherpractitionerssuchasnursepractitioners)

● FederallyQualifiedHealthCenters(FQHC),whichofferfreeandlow‐cost(slidingfeescale)healthcareclinics

ChildHealthSpecialtyClinics

ChildHealthSpecialtyClinics(CHSC)serveIowachildrenandyouthfrombirththroughage21yearswith,oratriskof,achronichealthconditionordisabilitythatincludespsychosocial,physical,andhealth‐relatededucationalorbehavioralneeds.TheCHSCstatewideprogramincludesanadministrativecenterattheUniversityofIowaand14regionalcentersthatprovideservicestochildrenwithspecialhealthcareneeds.OralHealthProviders

OralhealthservicesarerequiredcomponentsoftheEPSDTCareforKidsprogram.TheAmericanAssociationofPediatricDentistry(AAPD)recommendsthatinfantsseeadentistby12monthsofage.Accesstodentalproviderscanbeverydifficultinmanyareasofthestateduetoashortageofprovidersandalackofproviderswillingtoseeyoungchildrenand/orMedicaidclients.Yourcontractagency’sI‐SmilecoordinatorhelpstoidentifydentistswhocanseeMedicaidandTitleVclients.Clientswithspecialhealthcareneedsoftenexperienceadditionalaccessbarrierstodentalservices.Tolinkwithadentistwhoiswillingtotreatlow‐incomeclientsage0‐21whoaredisabled,contacttheCenterforDisabilitiesandDevelopmentattheUniversityofIowa(319‐356‐1513).


EducationalProgramResources

Thefollowingentitiesprovideeducationalservicesandsupportforclients:

● EarlyACCESS(PartC–EarlyIntervention):Thisisacollaborationofpublichealth,humanservices,ChildHealthSpecialtyClinics,andeducationthatsupportclientsbirthtoage3whohavedevelopmentaldelaysorahighprobabilityofdelay.

● EarlyHeadStart:Thisisacomprehensivechilddevelopmentprogramforclientsbirthtoagethree.

● HeadStart:Thisisacomprehensivechilddevelopmentprogramincludingclassroomandhome‐basedpreschoolforclientsage3to5years.

● AreaEducationAgency(AEA):AEAsprovideeducationalsupportincludingspeechtherapy,occupationaltherapy,andphysicaltherapyforclientsbirthtoage22years.

● LocalEducationAgency(LEA):Localschooldistrictsprovideeducationalservicesforclientsage3to21years.

OtherProgramsandResources

Therearemanyhumanserviceprovidersandotherprogramsavailabletohelpmeettheneedsofclients.Thispartiallistingprovidesbriefdescriptionsofsomeofthemostimportantcommunityresourcesavailable.

● ChildCareResourceandReferral(CCR&R):CCR&Rprovidesinformationandreferralstoappropriateshort‐term,drop‐in,orlong‐termchildcareservices.IowahasasystemoffiveCCR&Rs,eachcoveringmultiplecounties.

● ChildhoodLeadPoisoningPreventionProgram(CLPPP):TheChildhoodLeadPoisoningPreventionProgramprovidesaccesstobloodleadtesting,casemanagementservices,andeducationregardingchildhoodleadpoisoning.SeeAppendix4foralistoflinkstomapsofstatewideresources.

● Parentingprograms:Theseprogramsprovideparenteducation,counseling,and/orsupportservicesforfamilies,especiallythoseatrisk.

● LocalDepartmentofHumanServicesIncomeMaintenanceWorkers:Iowa’sIncomeMaintenanceWorkersreviewanddetermineinitialandcontinuingfinancialeligibilityforcategoricalpublicassistanceprograms.Forofficelocations,seehttps://dhs.iowa.gov/dhs_office_locator.

● LocalDepartmentofHumanServicesChildAbuseUnit:Thisunitprovidesinvestigationandinterventionforclientswhomaybevictimsofphysical,emotional,orsexualabuse.

● Teenpregnancypreventionandsupportservices:Theseprogramsprovideeducationandcounselingservicestohelppreventteenpregnanciesandprovidesupporttoteenmomsanddads.

● FamilyPlanningprograms:FamilyPlanningprogramsprovidepre‐conceptioncounselingandbirthcontrolservices.


● Substanceabusepreventionandtreatmentservices:Theseprogramsprovidepreventionand/ortreatmentservicesforalcoholorotherdrugdependency.

● Interpreterandtranslationservices:Interpretersprovideassistancewithverbalcommunication,includingforthosewhoarehearingimpaired.Translationservicesareusedtotranslateprintmaterials.

● Legalaid:Legalaidprovideslegalservicesforfamiliesthatmeetincomeguidelines.

● SpecialSupplementalNutritionProgramforWomen,Infants,andChildren(WIC):WICprogramsprovidefoodandnutritioncounselingservicesforpregnantwomen,infants,andchildrenunderage5whomeetincomeguidelines.

● FoodAssistanceprograms:Foodassistanceprovideresourcesforpurchaseoffoodforfamilieswhomeetincomeguidelines.

● FamilyInvestmentProgram(FIP):TheFIPprogramprovidesfinancialandfamilysupportforfamilieswhomeetincomeguidelines.

● SupplementalSecurityIncome(SSI):SSIprovidesfinancialsupportforchildrenwhohaveadisabilityandmeetincomeguidelines.

● Housingprograms:Housingprogramsprovidelow‐incomehousingresourcesandenergyassistance.

● Shelters:Localsheltersmayservethehomelesspopulationorwomenwithchildrenwhoarevictimsofphysical,emotional,orsexualabuse.

● Transportationbrokers:TransportationbrokersareavailableunderIowaMedicaid(Access2Care)andalsoundereachoftheMedicaidmanagedcareorganizations.Theyassistclientstoaccessmedical,dental,and/ormentalhealthservices.TitleVChild&AdolescentHealthagenciesmayalsoprovideandbilllocaltransportationtomedical,dental,and/ormentalhealthservicesfortheMedicaidFee‐for‐Servicepopulation.


Chapter6 Protocols

Protocolsclarifylocalcontractagencypoliciesandprovideexplanationtostaffabouthowserviceswillbedelivered.Protocolshelpthecontractagencyprovidethebestservicepossibleby:

● Standardizingactivitiesamongdifferentstaffmembers● Standardizingactivitiesamongsubcontractors● Assistinginnewstafforientation● Assuringcontinuityandqualityofcare● Providingdirectionforuniformdocumentationofservices

Whenwritingprotocols,IDPHTitleVcontractorsidentifyhowtheirlocalstaffwillimplementEPSDTCareforKidsactivities,consistentwithcontractrequirementsandstatewideprogramguidelines.Protocolsreflecttheuniqueneeds,practices,andsystemsofthelocalservicearea.Protocolsaremaintainedonfilewithinthecontractagency,andacopyisgiventoeachsubcontractor.Subcontractorsfollowthecontractagencyprotocolstomaintainconsistencyandcontinuity.Onceprotocolsarewritten,theapprovalandresponsibilityforimplementationofthecontractagency’sprotocolslieswiththeExecutiveDirectorand/orProjectDirector.Protocolsmustberevisedandupdatedannually.WritingProtocols

Informationtoincludewhenwritingprotocolsshouldincludewhy,what,who,where,when,andhowservicesareprovided.Protocolsshouldcontaininformationsuchas:

● Purposestatementincludingwhytheserviceisimportantandtheexpectedoutcomeforclients

● Descriptionoftheserviceorprocedure● Namesorjobdescriptionsforpersonsauthorizedandtrainedtoperformthe

activity● Locationoftheservicedelivery● Timelineforaccomplishingtheactivity● Methodsforcontactinghard‐to‐reachclients● Proceduresforassuringfollow‐upactivities● Transitionofclientswhomoveoutoftheservicearea● Guidancefordocumentingservices● Billingprocedures● Administrativeactivities


● ReferencetootherpoliciesandsourcesofauthoritysuchasEPSDTCareforKidsHandbook,TitleVMCAHcontract,andIowa'sTitleVAdministrativeManualforCommunityBasedPrograms

● Anannualreview/revisiondate● Signatureanddatelineforthecontractagency’sExecutiveDirectorand/orProject

Director● Signaturelineanddatelineforthesubcontractor(ifapplicable)

InformingProtocols

Ataminimum,thecontractagency’sinformingprotocolsmustincludethefollowingfortheinitialinform,informfollow‐ups,andinformcompletion:

● Whatstaffmemberswillbeassignedtospecificcomponentsoftheservice?

● Whatmethodsofdirectcontactwillbeused(phonecalls,texting,email,homevisits,clinicvisits)?

● Whattimeofdaywillservicesbeavailable?● Didyouincludeaminimumoftwophoneattemptstoreachaclient(a.m.andp.m.)?

● Whatinformationisneededtocompletetheinformingprocess?

● Whatistheinformingmessagebyage?

● Whatarethekeypointstobecoveredineachcall?

● Whatisdoneifthecontractagencyisunabletocontacttheclient(follow‐upletter,homevisit)?

● Whataretheprovisionsforensuringconfidentiality?

● Howdoyouhandlearefusalofaninformcompletionservice?

● Whendoesdocumentationtakeplace?

● Whataretheproceduresfordocumentationconsistentwithprogramguidelinestoassurethatitsupportstheservicesbilled?

● Whataretheagency’scriteriafordischargefromAgencyHomeinsignifycommunity™?

Itisrecommendedthatasamplemessageforcontactsorcallsbeincludedintheprotocolthatliststhepurposeofthecall,pointstobecovered,‘redflag’wordstoavoid,andstatementsthathavebeenfoundtoimprovecommunicationwithclients.CareCoordinationProtocols

Ataminimum,thecontractagency’scarecoordinationprotocolsmustinclude:● Whatstaffmemberswillprovidetheservice?● Whatmethodsofcontactareutilized(letters,phonecalls,texting,email,home

visits)?


● Whattimeofdaywillservicesbeavailable?● Whatareexamplesofkeycarecoordinationmessages?● Howdoyouhandleacarecoordinationrefusal?● Whenarehomevisitsindicated?● Whataretheprovisionsformakinghomevisits?Whatarethesafetyproceduresto

befollowedduringahomevisit?● Whendoesdocumentationtakeplace?● Whataretheproceduresfordocumentationconsistentwithprogramguidelinesto

assurethatitsupportstheservicesbilled?

● Whatisdoneifthecontractagencyisunabletocontacttheclient?

● Whataretheagency’scriteriaforreleasefromAgencyHomeinsignifycommunity™?

Itisrecommendedthatsamplecarecoordinationmessagesbeincludedthatlistthepurposeofthecontact,pointstocover(suchasservicestoexpectatthenextwell‐childvisitandimportanceofpreventivecare),‘redflag’wordstoavoid,open‐endedquestionsforfamilies,andstatementsthathavebeenfoundtoimprovethecommunicationwithclients.ReferralProtocols

Developmentofreferralprotocolsarealsoencouraged.Theseshouldaddress:● Whatstaffwillprovidetheservice?● Howwilltheclient’sneedsbeaddressed?Howwilltheclient’sneedsbematched

withavailableservices?Howwilltheclientbeconnectedtotheservice?● Howwillfollow‐upaftertheservicebescheduled?● Whataretheavailablecommunity‐basedreferralsystems?● Whatmethodsofcontactwillbeused(withclient,provider,orotherprograms)?● Howisthereferralservicetobedocumented?


Chapter7 FinancialManagement

ImportanceofFinancialManagement

Providingqualityinformingandcarecoordinationservicesrequiresthatadequatefundsareavailabletocarryoutallprogramactivities.AlthoughMedicaidistheprimarypayerfortheseservices(throughanagreementbetweenIowaMedicaidandtheIowaDepartmentofPublicHealth(IDPH)),eachcontractagencyisencouragedtoexploreadditionalsourcesoffundingthatmaybeneeded.Ultimately,avarietyoffundingsourcesmaybeusedinabraidedfinancialstructurethatallowsthecontractagencytobestservetheneedsofallclients,regardlessofpayersource.DeterminingCostsofServices

EachprogramstaffmemberplaysaroleinthefinancialmanagementoftheEPSDTCareforKidsprogram.Forfront‐linestaffprovidinginformingandcarecoordinationservices,thisrolestartswithanunderstandingofthecostsofprovidingtheservices.EachcontractagencycompletesaMaternalandChild&AdolescentHealth(MCAH)CostAnalysis.Thecostanalysistakesintoaccountallcostsrequiredtoprovideservicesthroughouttheserviceareaandincludesthecostofagencysubcontractors.Thecostofaserviceincludesstafftime,stafftraining,travel,supplies,telephone,fax,computers,printers,equipment,andothercoststoruntheeverydayoperationsoftheorganization.Whencontractagenciessubmitclaimstopayers,theybilltheircostofprovidingservices‐asdeterminedbytheCostAnalysis.MedicaidreimbursementratesaresetbytheIowaMedicaidEnterprise.TitleVChild&AdolescentHealthcontractagenciesbilltheircostforeachserviceasdeterminedbytheMCAHCostAnalysis.Medicaid,MCOs,IDPH,andotherpayersreimbursethecontractagencytheircostuptoamaximumrateestablishedfortheservicebilled.Iftheagencycostislessthanthemaximumreimbursementrateforaservice,theyarepaidtheircost.Iftheagencycostexceedsthemaximumreimbursementrateforaservice,theyarepaidthemaximumrate.Child&AdolescentHealthcontractagenciesmaynotprofitfromservicesprovidedunderMedicaidorTitleV.Agenciesmustbilltheiractualcostforprovidingtheservices,regardlessofthemaximumreimbursementsetbyMedicaid,MCOs,IDPH,orotherpayers.TimeStudyRequirement

ThefederalCenterforMedicareandMedicaidServices(CMS)requiresthatcontinuoustimestudiesbecompletedbyallstaffprovidinginformingandcarecoordinationundertheEPSDTCareforKidsprogram.Timestudiesprovidedataonactualtimespentincostcenteractivities.Itisan‘afterthefact’reportandmayvaryfromthetimethatstaffareactually‘scheduled’toworkinvariousactivities.Thetimestudiesmustbekeptonfileineachcontractagencyforatleastfiveyears.


Thetimespentworkingasafront‐linestaffmemberfortheEPSDTCareforKidsprogramisaprimarycostoftheprogramforacontractagency.Itisveryimportanttoconsistentlydocumentstafftimeonthecontractagency’stimestudyformtobesurethatallassociatedcostsarecaptured.Timestudiesprovideinformationaboutthecostofstaffneededtoprovideservices.Timestudieshelpacontractagencyto:

● Determineactualcostofservices● Provideaccountabilityforservicesprovided● Determinestaffingneeds

TimeStudyTool

Thetimestudytoolisdesignedtoassistcontractagenciesinthedevelopmentorimprovementoflocaltimestudies.TheTimeStudyGuidanceandTimeStudyWorkbookarelocatedwiththeCostAnalysisresourcesontheMCAHProjectManagementPortalathttp://idph.iowa.gov/family‐health/mchportal.NotethatthecategoriesintheTimeStudyformalignwiththoseinthe‘AllocateStaff’pageoftheCostAnalysisWorkbook.ThistoolmaybeusedasitappearsintheTimeStudyWorkbookoritmaybealteredtomeetacontractagency’sneeds.Ifacontractagencydeterminestheneedtomodifythetemplate,pleasecontactIDPHat1‐800‐383‐3826.UseofTimeStudiesforProgramMonitoring

Timestudiesarealsovaluabletoolsformonitoringprogramefficiencyandstudyingwaystoimproveservicedeliveryandstaffingpatterns.Timestudieshelpadministratorstoidentifywhatportionofacontractagency’sresourcesareusedtoprovideprogramservices.Areviewofthetimestudycanhelpadministratorsanswerthefollowingquestionsandmakeadjustmentsasnecessary.

● Doesthestaffingpatternprovideaqualityclient‐centeredservicetotheclient?● Areallrequiredactivitiesbeingcompletedasspecifiedinthecontractagency’s

protocols‐frominitialcontactwiththeclientthroughdocumentationandbilling?● Howmanypeoplearedoingthesameactivityandwheniseachinvolved?● Istheactivitybeingcompletedinanefficientmanner?● Arequalified,appropriatelytrainedstaffdoingtheactivity?● Isthecontractagencyprovidingadequatetimeforprovidingtheservice?● Isthecontractagencyusingtheappropriatestafftomeettheneedsofthe

populationserved(e.g.interpreters,etc.)?● Dobilledservicesalignwithtimespent(numberofunitsbilledasrelatedtothe

timespent)?


Non‐BillableActivities

Someoftheactivitiesrequiredforeffectiveinformingandcarecoordinationservicesarenotbillable.Allnon‐billableactivitiesshouldbeincludedinthetimestudyinadditiontothebillableactivities–sothatyouragencycandeterminethefullcostofinformingandcarecoordination.ThefollowingtablewillhelpwithunderstandingEPSDTCareforKidsinformingandcarecoordinationactivitiesthatarenotbillable.

Activity Description

Maintainingfiscalrecords

● CompletingclaimsformsandpreparingsubmissiontotheMedicaidorMCOfiscalagent

● Reviewingdenialsoforiginalbillingsandresubmittingthecorrectedclaims

● Maintainingfiscalrecordsbasedongenerallyacceptedauditingprocedures

MaintainingsuppliesManagingthepaper,brochures,postageandothersuppliesrequired

Maintainclinicalrecords

Dataentryintosignifycommunity™

(Notethatdocumentingcarecoordinationbytheserviceprovideronthesamedaythatthecarecoordinationisprovidedcanbeincludedinbillableunits.)

Managingthecomputerizedlist/reports

Downloadingdataandprintinglabelsandlists/reportsforstafftouseintheirwork

Reception

ActivitiesbycentralservicestafftoconnectclientstotheEPSDTCareforKidsinformingandcarecoordinationstaffwhichmayincludeansweringthephone,takingmessages,andmakingappointmentswiththecarecoordinator

Stafftravelforotherthanvisitstoclient

Traveltoclinicsites,meetings,andconferences

Developingcommunitylinkages

Activitiestodevelopandmaintainformalandinformallinkagesbetweencommunityagencies,providers,andorganizationstocommunicate,coordinate,andplaneffectivedeliveryofservices

EPSDTCareforKidsadministrativemeetings

Activitieswithsubcontractorsandotherstafftoplan,communicate,andcoordinatetheactivitiesoftheprogram

ContinuingeducationActivitiesforstaffskilldevelopmentandeducationtokeepcurrentonpolicyandbestpractice

Administrativeactivities ActivitiesrelatedtothemanagementoftheEPSDTCareforKidsprogram,includingsupervisingtheworkofothers

Developingeducationalmaterialsforclients

Activitiestocreateandmaintainbrochures,letters,postersandothereducationalmaterialsforclients


Developmentofeducationalmaterialsforprovidersandothercommunityresources

Activitiestocreateandmaintainbrochures,posters,andothereducationalmaterialsforproviders,communityagencies,andorganizations

GeneralofficeworkActivitiesrequiredofstafftomaintaincommunicationandrequirementsoftheorganizationsuchascompletingreportsofactivities,filingtravelexpenses,etc.

Vacation,sick,holidaytime Timegivenforvacation,holiday,andsickdaysbasedonthepoliciesoftheorganization

BillableInformingServices

Informingservicesarebilledaftertheinitialinformingletter/packetismailed.Billingiscompletedforthefamilyunit(ratherthanperclient)accordingtotheIDPHTitleVcontractagency’sCostAnalysis.Thebillingforaninformingserviceincludesallactivitiespertainingtotheinitialinform,informfollow‐up,andinformcompletion.Theinformingserviceisnotconsidered‘complete’untilverbalcontactismadewiththeclient(eitherface‐to‐faceorbyphone)toexplaintheEPSDTbenefits.

Often,inthecourseofcompletinganinformingservice,theconversationmaymovetolinkingtheclienttoservices.Becausetheseactivitiesareapartoftheinformingcontact,theyareconsideredpartoftheinformcompletion.Theycannotbebilledseparatelyascarecoordination.However,subsequentcontactswiththeclienttolinkthemtoservicesmaybebilledascarecoordination.BillableCareCoordinationServicesCertaintypesofcarecoordinationcanbebilledtoIDPHasFee‐for‐Service.KeepinmindthattheMCOshaveresponsibilityformedicalcarecoordinationfortheMCOMedicaidenrolledclients.ThefollowingtypesofcarecoordinationservicesarebillabletoIDPHFee‐for‐Service:

● AlldentalcarecoordinationforanyMedicaidenrolledclient● MedicalcarecoordinationfortheMedicaidFee‐for‐Servicepopulation.This

includesmedicalcarecoordinationprovidedduringthepresumptiveeligibilityperiod.

Allcarecoordinationservicesrequiretimeinandtimeoutinsignifycommunity™.Billablecarecoordinationservicesarebilledforthetotaltimespentworkingwithaclientforeachdateofservice.Timemaynotbecarriedovertoadditionalservicedates.Selectingthecorrectpayersourceinsignifycommunity™iskeytoaccuratebilling.Foranybillablecarecoordinationserviceprovidedduringthepresumptiveeligibilityperiod,select‘TitleXIX‐PE‐CC’insignifycommunity™.ForotherbillablecarecoordinationforMedicaidclients,select‘TitleXIX–Fee‐for‐Service’asthepayersource.


DentalcarecoordinationclaimsaresubmittedtoIDPHforservicesprovidedforanyMedicaidenrolledclient.MedicalcarecoordinationclaimsaresubmittedtoIDPHonlyfornon‐MCOclients.CarecoordinationforTitleVclientsisnotbillableasFee‐for‐ServicetoIDPH.ForcarecoordinationforTitleVclients,thepayersourceselectedistobe‘TitleV/Uninsured’.TheseservicesarecoveredbyTitleVgrantfunds.Thefollowingtableoutlinesbillableactivitieswhenprovidingabillablecarecoordinationservice.

Activity Definition

Clientcontact

Timespentopeningtheclient’srecordandlocatingneededinformationtocontacttheclient

Telephone,clinic,text,email,orhomevisitwiththeclientforassessmentofneedandprovisionofcarecoordinationservices

Identificationofneededresourcesandreferral

Activitiesrelatedtoidentifyingappropriateresourcesandmakingreferralsfortheclientbasedupontheirneeds

Schedulingappointments,transportation,orsupportservices

Activitiestosetupappointments(outsideofthecontractagency),makingarrangementsfortransportationtohealthservices,arranginginterpreterservices,andlinkingwithothersupportservices

Documentation

Whendocumentationinsignifycommunity™isdonebythecarecoordinatorprovidingtheserviceonthesamedaytheservicewasprovided,thetimedocumentingthecarecoordinationserviceincludingneedsandsolutionsisbillablecarecoordination.

Thisisallowabletimeonlywhentheserviceproviderentersthedocumentationintosignifycommunity™onthedateofservice.Anytimefordataentrybyapersonotherthantheserviceproviderisnotincludedinbillablecarecoordinationtime.Anydataentryonadatethatdiffersfromthedateofservicedeliveryisnotbillablecarecoordinationtime.

BillableCareCoordinationHomeVisits

HomevisitsforthepurposeofprovidingcarecoordinationservicesarealsobilledtoIDPHFee‐for‐ServiceforMedicaidenrolledclients.RememberthatclaimsfordentalcarecoordinationcanbesubmittedtoIDPHforservicesprovidedforanyMedicaidenrolledclient.MedicalcarecoordinationhomevisitclaimsaresubmittedtoIDPHforonlyfornon‐MCOclients.HomevisitcarecoordinationforTitleVclientsisnotbillableasFee‐for‐ServicetoIDPH.ForTitleVclients,thepayersourceselectedistobe‘TitleV/Uninsured’.TheseservicesarecoveredbyTitleVgrantfunds.Notethatthemaximumreimbursementisgreaterforcarecoordinationforahomevisitduetotheadditionalcostincurredfortravelbytheserviceprovider.Donotincludetime


orcostsfortraveltoandfromthehomevisitforcarecoordination,asthisisalreadyincludedinthehigherreimbursementrate.SubmittingClaimstoIDPHforInforming,CareCoordination,andRelatedInterpretationServices

TheIowaDHScontractswiththeIDPHtoprovidefinancialmanagementthatincludespayingcontractagenciesforinforming,carecoordination,andrelatedinterpretationservices.TheseservicesarebilledtoIDPHasFee‐for‐Service.IDPHreimbursestheactualcostoftheservices,basedonthecontractagency’sCostAnalysis,uptoanestablishedmaximumrate.TimelyDataEntry

Eachcontractagencymustassurethatalldataentryiscompletedinthesignifycommunity™systeminatimelybasis.Allservicesmustbeenteredintothesystembythe15thofthemonthfollowingthemonthofservice.IDPHFee‐for‐Servicebillingpullsthedataimmediatelyafterthe15thofthemonthfollowingthemonthofservice.Anyservicesenteredintosignifycommunity™afterthe15thofthemonthfollowingthemonthofservicewillnotappearinyouragency’sIDPHFee‐for‐Servicebilling.SubmittingtheMonthlyInformingandCareCoordinationClaim

TheContractorshallcompleteandsubmitamonthlyclaimforservicesprovidedinthegrantsitelocatedinIowaGrantsaccordingtotimelinesestablishedinyourMCAHcontract.

● ForprogrammaticMCAHlineitemclaimsbilledtoIDPH(e.g.grantfunds),expendituresandsupportingdocumentationmustbesubmittedmonthlywiththeclaim.

● ForFee‐for‐Service(FFS)claimsbilledtoIDPH(e.g.claimsforinformingandcarecoordinationservices),expendituresandsupportingdocumentationmustbesubmittedmonthlywiththeclaim.Claimsarerequiredtomeetauditrequirements.Errorsidentifiedbythequalityassuranceprocesswillbesharedwiththecontractagencyforcorrectionpriortopayment.

o DocumentationforCAHFee‐for‐Serviceactivitiesmustbeenteredinsignifycommunity™bythe15thofthemonthfollowingthemonthofservice.IDPHwillautomaticallypullthesignifycommunity™documentationfortheseclaims.Claimsforservicesenteredafterthisdatewillnotbepaid.

o DocumentationforallFee‐for‐Serviceactivitiesmustbeenteredintosignifycommunity™accordingtoIDPHrequirements.

Questions?

QuestionsregardingbillingforinformingandcarecoordinationservicescanbesubmittedtoKellyHaaseatkelly.haase@idph.iowa.govor(515)418‐7505.


Chapter8 QualityAssurance

QualityAssurance(QA)Reportsinsignifycommunity™

Contractagenciesareencouragedtoregularlyaccesssignifycommunity™reportsforqualityreviewofservicesenteredintothesystemtoassureaccuratedataentryanddocumentation.Thesereportsarefoundinthesignifycommunity™Dashboardunder‘MyGroupReports’and‘ContractingAgencies’.

Signifycommunity™ServiceNoteReview

Signifycommunity™ServiceNoteReviewsareconductedtwiceeachyear.Thisinvolvesareviewofdocumentationinthesignifycommunity™systemforpresumptiveeligibility(PE),informing,carecoordination(includinghomevisitforcarecoordination),andrelatedinterpretationservices.ConductingServiceNoteReviewisaqualityimprovementactivity.Thepurposeistoevaluatewrittendocumentationtoidentifyeducationalopportunities,neededservicedeliveryadjustments,andneedforcorrectionofinadequateorincompletedocumentation.Abi‐annualreviewofupto10recordsofeachtypeofserviceisconductedbyaninterdisciplinaryteamoflocalcontractagencystaff,inadditiontoBureauofFamilyHealthandBureauofOralandHealthDeliverySystemstaff.Reviewersmusthaveknowledgeoftheprogramrequirementsandservicesandhaveaccesstothesignifycommunity™database.ProjectDirectorsorProgramCoordinatorsserveastheprimarycontactforthereviewsatthelocallevel.ServiceNoteReviewProcess

TheIowaDepartmentofPublicHealthpreparestherandomsamplesofservicesforreviewandsendsthemasasignifycommunity™ClientDataWorkbooktotheagencyviasecureemail.IDPHprovidestheServiceNoteReviewtoolsnecessaryforagenciestoconductthesereviews.ToolsandresourcesmaybefoundontheMCAHProjectManagementPortalathttp://idph.iowa.gov/family‐health/mchportal.

Agencyandstateteamsconductthereviewsofthesameservicesusingthesametools.ResponsesareenteredintoServiceNoteReviewSummaryformswhicharedevelopedforeachtypeofservicereviewed.Uponcompletion,localcontractagenciesuploadtheircompletedSummaryFormsintotheServiceNoteReviewsectionofIowaGrants.gov.(DONOTuploadtheClientDataWorkbookintoIowaGrants.gov.)SummaryFormsmustbeuploadedtoIowaGrants.govwithin30daysfromthestartofthereviewprocess.PlansforQualityImprovementContractagenciesareexpectedtoadheretothesignifycommunity™ServiceNoteReviewrequirementsastheyrelatetoprogramming,documentingservices,trainingstaff,andalteringpracticesifrequirementsarenotmet.Foragenciesthatdonotachieve90%documentationcompliance,aServiceNoteReviewQualityImprovement(QI)Planisrequired.QualityImprovementPlansarealsouploadedintoIowaGrants.gov.Theplan


includesQIactivitiesdesignedtoaddressdeficiencies,thepersonresponsible,andaprojectedcompletiondate.Contractagencieswithcontinuednon‐compliancemayberequiredtocompletequarterlyreviews.UponsatisfactorycompletionoftheServiceNoteReviewprocess,a‘ServiceNoteReviewApproved’fieldinIowaGrants.govwillbecompletedbyyourRegionalConsultant.

38 Iowa Department of Public Health EPSDT Informing and Care Coordination Handbook August 2019

Chapter9 Appendices

Appendix1. SampleProtocolsAppendix2. SampleInitialInformingLetter&CallScriptAppendix3. SampleJobDescription:CareCoordinatorAppendix4. LinkstoResourceMaps

The Informing & Care Coordination Handbook Handbook 2019.pdf · Periodic Children should receive...

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