Collier, Glades, Hendry & Lee Countieshealthystartbaby.org/wp-content/uploads/2011/11/... · Submitted to DOH 10-10-13 2013 Service Delivery Plan . Collier, Glades, Hendry & Lee Counties

Healthy Start Southwest FL Service Delivery Plan Submitted to DOH 10-10-13

2013 Service Delivery Plan

Collier, Glades,

Hendry & Lee Counties


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Table of Contents

Action Plan Overview ................................................................................................................... 3

Category A Activities .................................................................................................................... 4

Resource Inventory .................................................................................................................. 4

Selection of Healthy Start Providers ................................................................................... 12

Development of Contracts .................................................................................................... 12

Programmatic Service Delivery Report .............................................................................. 13

Category B Activities .................................................................................................................. 16

1. Late or No Access to Care ................................................................................................... 19

2. Racial Disparity in Birth Outcomes ..................................................................................... 20

3. Well-Woman Health (Between Pregnancy Care) ................................................................. 22

4. Healthy Start Redesign ........................................................................................................ 24

5. Substance Exposed Newborns ............................................................................................. 26

6. Repeat Teen Births ............................................................................................................ 28

7. Outreach, Education, and Risk Screening ..................................................................... 29

8. Maternal Deaths ................................................................................................................ 32

9. Infant & Toddler Resource Center .................................................................................. 34

Allocation & Fiscal Monitoring Plans ....................................................................................... 36

Allocation Plan ....................................................................................................................... 36

Fiscal Monitoring Plan .......................................................................................................... 39

Quality Assurance (QA) Plan .................................................................................................... 40

Care Coordination ................................................................................................................. 40

Prenatal Care .......................................................................................................................... 42

Wrap Around Services .......................................................................................................... 42

Coalition .................................................................................................................................. 44


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Action Plan Overview

2008-13 Old Plan 1. Access to care and adequate prenatal care

1) Healthy Start funding 2) Advocacy for Medicaid application assistance

and education 3) Transportation 4) Outreach and education

2. Racial disparity in birth outcomes

1) Provider education on focus group findings & cultural sensitivity training needs

2) Target grant funded programs for highest risk neighborhoods (ie, Close the Gap Grant)

3. Well-Woman Health (Inter-Pregnancy Care)

1) Obesity intervention & prevention i. Outreach and education program

focus ii. Partnerships with schools and

universities 2) Wellness program for postpartum mothers in

targeted neighborhoods 3) Baby spacing 4) Grant funding for sterilization of extremely

high risk mothers (ie, drug addicts) 4. Injury Prevention

1) Nurse home visiting program 2) Outreach and education 3) Parenting skills

i. Happiest Baby on the Block ii. Client based services

4) Death certificate reviews in Hendry County (post-neonatal deaths)

5. Substance Use and Abuse

1) Zero Exposure education and outreach program

2) Grants and partnership with SWFAS and/or David Lawrence to develop a specialized outpatient program for new mothers with young children.

6. Teen Births

• Grants to expand the Collier teen program

7. Outreach, Education, and Risk Screening

2013-18 --New Plan 1. Access to care & adequate prenatal care

a. insurance access education b. outreach & education on importance of prenatal care--see item 7 below

2. Racial disparity in birth outcomes a. funding b. partnerships

3. Well woman health (between pregnancy health)

a. outreach and education on obesity risks & baby spacing--see item 7 below b. partnerships with pediatricians c. family planning

4. Healthy start redesign a. training b. implementation

5. Substance exposed newborns a. collier substance exposed newborn task force b. funding c. advocate for substance abuse treatment in Clewiston

6. Repeat teen births a. focus program

7. Outreach and education a. risk screening b. educational baby showers in high risk neighborhoods c. educate the community on five key health messages d. hispanic outreach

8. Maternal deaths a. research potential causes of the increase of maternal deaths b. develop educational materials and resource list c. educate prenatal clients on risks and safety tips

9. Infant & toddler resource center a. location: research new potential partnership b. funding: identify potential funding sources c. advisory council: expand advisory council


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Category A Activities

Category A Activities include the selection of Healthy Start providers, development of contracts and memorandums of agreement and monitoring of providers who have been awarded funds by the coalition. (This includes implementation of the Healthy Start Care Coordination System and involves use of the Healthy Start service dollars in accordance with the Healthy Start Implementation Standards and Guidelines).

Resource Inventory Healthy Start system components 2013-14 providers

Active partner

Uses Healthy Start financial resources Yes No

Begin and end date of contract, if applicable

Outreach services for pregnant women Collier County Collier County Human Services County Health Department X X 7/1/13 –

6/30/14 Marion E. Fether Medical Center X X Healthy Families / Children’s Home Society X X Glades County County Health Department X X 7/1/13 –

6/30/14 Healthy Families (County Health Dept.) X X Redlands Christian Migrant Association X X Early Intervention Program X X Catholic Charities X X Hendry County County Health Department X X 7/1/13 –

6/30/14 Healthy Families (County Health Dept.) X X Redlands Christian Migrant Association X X East Coast Migrant Association X X Catholic Charities X X Early Intervention Program / Early Steps X X Family Health Centers X X Florida Community Health Center X X Lee County Lee County Human Services X X Childcare of Southwest Florida X X Catholic Charities X X Clothes closet X X


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Healthy Start system components 2013-14 providers

Active partner



Community Cooperative Ministries (CCMI) X X Community Services – Lehigh

X X

County Health Department X X 7/1/13 – 6/30/14

Destiny Diaper Bank X X Early Head Start X X Family Health Centers X X Good Wheels X X Healthy Families / Children’s Home Society X X Impact for Development and Education, Inc. X X Lee Adolescent Mothers Program X X Lee Memorial Health System X X 7/1/13 –

6/30/14 Lifeline X X Planned Parenthood X X Southwest Florida Addiction Services X X WIC X X Our Mother’s Home X X Outreach services for children Collier County KidCare (funded by the County Health Dept.) X X Child Find / FDLRS X X Childcare of Southwest Florida X X County Health Department X X 7/1/13 –

6/30/14 Early Head Start / Redlands Christian Migrant Association

(RCMA) X X

Even Start X X First Start / Parents as Teachers X X Head Start X X Healthy Families / Children’s Home Society X X Naples Alliance for Children

X

Glades and Hendry Counties County Health Department X X 7/1/13 –

6/30/14 United Way Success By Six X X Redlands Christian Migrant Association X X Healthy Families (County Health Department) X X East Coast Migrant Association X


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Active partner



Early Intervention Program / Early Steps X X Catholic Charities X X Family Health Centers X X Florida Community Health Center X X Head Start X X Child Care of Southwest Florida X X Florida Diagnostic Learning Resource System X Lee County Calvary Ministries Childcare of Southwest Florida X X Children’s Home Society X X County Health Department X X 7/1/13 –

6/30/14 Early Head Start X X Early Intervention Program (CMS) X X Early Intervention Program (School District) X X Family Health Centers X X Head Start X X Healthy Families/Children’s Home Society X X Lee County Health and Human Services X X Lee Memorial Health System X X 7/1/13 –

6/30/14 Lifeline X WIC

X X

Process for assuring access to Medicaid (PEPW, ongoing, emergency Medicaid for deliveries, and sign-up of newborns) Collier County Healthcare Network (formerly Collier Health Services Inc.)

(PEPW, deliveries) X X

Department of Children and Families (ongoing) X X Foundation for Women’s Health (PEPW, deliveries, and

newborns) X X

Naples Community Hospital (deliveries) X X Glades and Hendry Counties County Health Department (PEPW) X X 7/1/13 –

6/30/14 Department of Children and Families (ongoing) X X Lee Memorial Health System (deliveries and newborn) X X Lee County County Health Department (PEPW) X X Department of Children and Families (ongoing) X X


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Active partner



Family Health Centers (PEPW, deliveries, and newborn) X X 7/1/13 – 6/30/14

Lee Memorial Health System (PEPW, deliveries, and newborns)

X X

MomCare X X Clinical prenatal care for all unfunded women Collier County Healthcare Network (formerly Collier Health Services Inc.)

(Immokalee) X X 7/1/13 –

6/30/14 Women’s Health Foundation (Naples) X X 7/1/13 –

6/30/14 Glades and Hendry Counties County Health Department / Lee Memorial Health System

X X 7/1/13 – 6/30/14

Dr. A.H. Barhoush, MD, PA X X 7/1/13 – 6/30/14

Lee County Family Health Centers X X 7/1/13 –

6/30/14 Lee Memorial Health System X X 7/1/13 –

6/30/14 Clinical well-child care for all unfunded infants and young children Collier County County Health Department (immunizations only) X X Healthcare Network (formerly Collier Health Services Inc.) X X Children’s Health Network X The Neighborhood Clinic X Glades and Hendry Counties County Health Department X X Family Health Centers (Hendry) X X Lee County County Health Department (immunizations only) X X

Family Health Centers X X Mama’s Chiropractic Center (pediatric chiropractor) X X Funding to support county health departments’ Vital Statistics Healthy Start screening infrastructure All Counties County Health Departments X X 7/1/13 –

6/30/14 Ongoing training for providers doing screens and referrals Collier County


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Active partner



County Health Department X X 7/1/13 – 6/30/14

Healthy Start Coalition X Glades and Hendry Counties Healthy Start Coalition

X

County Health Departments X X 7/1/13 – 6/30/14

Lee County County Health Department X X 7/1/13 –

6/30/14 Healthy Start Coalition X Lee Memorial Health System X X 7/1/13 –

6/30/14 Initial contact after screening assessment of service needs ongoing care coordination. Collier County County Health Department X X 7/1/13 –

6/30/14 Glades and Hendry Counties County Health Departments X X 7/1/13 –

6/30/14 Lee County County Health Department X X 7/1/13 –


6/30/14 Childbirth Education Collier County Planned Parenthood of SW FL - Spanish and English classes X Physicians Regional Healthcare System X Mommy & Me–Collier Pregnancy Center X County Health Department—Spanish X X 7/1/13 –

6/30/14 Denis Maine, Independent, Family Midwifery X Naples Community Hospital X X Phyllis Estes, High School Teenage Parent (TAP) program X X X Glades and Hendry Counties County Health Departments X X Lee County United Way X X 7/1/13 –

6/30/14 Lee Memorial Health System X X


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Active partner



Verity Pregnancy & Medical Resource Center X X Parenting support and education Collier County Healthcare Network (formerly Collier Health Services Inc.) X X County Health Department X X Head Start X X Healthy Families / Children’s Home Society X X Naples Community Hospital X X Parents as Teachers X Glades and Hendry Counties County Health Departments X X Healthy Families X X Hendry Glades Mental Health Center X Catholic Charities X Redlands Christian Migrant Association—Early Head Start X X

Child Care of Southwest Florida X X School District—Teenage Parent (TAP) /Migrant X Lee County African Caribbean American Catholic Center X X Children’s Home Society / Healthy Families X X Early Head Start X X Verity Pregnancy & Medical Resource Center X Healthy Families / Children’s Home Society X X Children’s Advocacy Center of Southwest Florida X X The Children’s Hospital X Lee Memorial Health System X X Southwest Florida Addiction Services X X Nutritional Counseling Collier County Naples Community Hospital (diabetic nutrition) X X WIC–Healthcare Network X X Collier County Health Dept. X X 7/1/13 –

6/30/14 Glades County WIC X X Hendry County WIC X X Lee County Lee Memorial Health System (general and diabetic nutrition) X X 7/1/13 –

6/30/14 Family Health Center X X


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Active partner



WIC X X Psychosocial Counseling Collier County Catholic Charities X X David Lawrence Center X X Glades and Hendry Counties Hendry Glades Mental Health Center X X Children’s Alliance X Lee County Vista X County Health Department X X 7/1/13 –

6/30/14 ACT X Lee Memorial Health System X X 7/1/13 –

6/30/14 SalusCare X Park Royal Hospital X Children’s Advocacy X Lutheran Services (teens) X Children’s Home Society (psychosocial counseling and infant

mental health) X X

Smoking Cessation—Care Coordination providers implement the Fresh Start Family program Collier County American Lung Association X X County Health Department X X 7/1/13 –

6/30/14 Quit Line X X Glades and Hendry Counties Quit Line X X County Health Department X X 7/1/13 –

6/30/14 Lee County American Lung Association X County Health Department X X 7/1/13 –


6/30/14 Quit Line X X Breastfeeding education and support Collier County La Leche League X Naples Community Hospital (breast pump rentals) X X


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Active partner



Baby’s Best X X WIC / County Health Department X X Glades and Hendry Counties WIC X X County Health Department X X Lee County County Health Department

X X

Lee Memorial Health System X X 7/1/13 – 6/30/14

WIC–La Leche League X X Data entry in the CIS/HMC All Counties County Health Departments X X 7/1/13 –

6/30/14 Substance abuse treatment and counseling Collier County Children’s Home Society substance abuse prevention services X X David Lawrence Center X X Glades and Hendry Counties Children’s Home Society substance abuse prevention services X X Hendry Glades Mental Health Center (AA) X X Lee County Children’s Home Society substance abuse prevention services X X First Steps in Sarasota X Operation PAR (Parental Awareness and Responsibility)

Methadone clinics for heroin and opiate addiction. X

SalusCare X Southwest Florida Addiction Services X X Word of Life X Lighthouse Addiction Services X David Lawrence Center X


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Selection of Healthy Start Providers Every four years the Coalition will review the need to initiate Requests for Proposals (RFPs) for Healthy Start Services. Proposals from new/additional providers of services will be accepted for review at the time of an RFP, or when a provider is identified that delivers services that fill a service gap/address a barrier (i.e., insufficient number of providers, language, geographic location). Because the Coalition sets reimbursement rates, RFPs are not needed for competitive pricing. RFPs may also be initiated when a current provider under contract is not providing quality service, and has refused, or is unable to meet standards of care set by the Coalition and the Healthy Start Guidelines. An RFP Task Force reviews all proposals using appropriate criteria and processes, and makes recommendations to the Board of Directors.

Development of Contracts The Coalition manages contracts with more than 10 providers that are reviewed for renewal on an annual basis. Each contract includes the following:

Services to be provided Performance Measures Specification of governing Florida and federal laws Audits, records, and records retention Monitoring by the Coalition Indemnification Insurance Safeguarding information Assignments and subcontracts Return of funds Incident reporting Transportation Disadvantaged Purchasing

Civil Rights requirements Independent capacity of the Contractor Sponsorship Invoices Use of funds Public entity crime Patents, copyrights, and royalties Contract amount, payment Effective & ending dates Termination Renegotiation or modification Dispute resolution Minority business expenditures E-Verify Criminal background screen/fingerprints


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Programmatic Service Delivery Report (YEAR END FISCAL REPORT) FY 2012-2013 Healthy Start Coalition of Southwest Florida

Healthy Start Provider (list name)

Lee Memorial Home Health

Lee County Health Department

Collier County Health Department

Hendry/Glades County Health

Department & Dr. Barhoush

Services Provided Care Coordination Care Coordination Care Coordination Care Coordination

Contract Amount 572,730 443,015 395,880 248787

1. Total expenditures for Healthy Start services provided during the contract year.

921,648 651,476 605,234 439,558

2. Total number of clients receiving Healthy Start services during contract year.

2051 2490 1926 570

3. Total number of services provided during contract year. 65,832 46,534 43,231 31,397

4. Expenditure per service provided during the contract year.

Line 1/Line 3

14.00 14.00 14.00 14.00

5. Expenditure per client served during the contract year.*

Line 1/Line 2

449.37 261.64 314.24 771.15

Note: Care Coordination Providers unreimbursed services

348,918 208,461 209,354 202,011

* Cost per patient is calculated utilizing reimbursed (contract amount) and unreimbursed totals.


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A.H Barhoush, MD

& Hendry/Glades CHD

Healthcare Network of SWFL

(CHSI)

Family Health Centers

Women’s Health Foundation

Lee OB/GYN

Services Provided Prenatal Care Prenatal Care Prenatal Care Prenatal Care Prenatal Care

Contract Amount 81,014 162,189 54,674 248,257 89,816


89,095 100,746 109,919 214,670 88,846


168 413 462 798 351

3. Total number of services provided during contract year. N/A – VARIES N/A – VARIES N/A – VARIES N/A – VARIES N/A – VARIES


Line 1/Line 3

N/A-VARIES N/A – VARIES N/A – VARIES N/A – VARIES N/A – VARIES

5. Expenditure per client served during the contract year.*

Line 1/Line 2

530.33 243.94 237.92 269.01 253.13

Note: Provider unreimbursed, billed services. 8,081 <61,443> 55,245 <33,587> <969>

* Cost per patient is calculated utilizing reimbursed (contract amount) and unreimbursed totals.

Does not include PEPW and Patient Payments.


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Lee Diabetes Care Collier County Health Department

Services Provided

Diabetes Nutrition Education

Diabetes Nutrition Education

Contract Amount 15,139 13,021


15,479 16,385


140 102

3. Total number of services provided during contract year. 387 410


Line 1/Line 3

40 40

5. Expenditure per client served during the contract year.

Line 1/Line 2

110.56

160.64

• A service is defined as one hour for these contracts.


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Category B Activities

Quarterly Progress Implementing Community-Wide and System Related

Activities

(Documentation that action steps of strategies were implemented as planned or rationale as to why they

were not)


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Category B Activities include Community Wide and System related strategies. This category encompasses a wide range of activities outside of the scope of the actual development, implementation, and monitoring of the Healthy Start system of services. The table below is a 5-year overview of these activities: FIVE YEAR OVERVIEW Year End:

2014

2015

2016

2017

2018

1. ACCESS TO CARE & ADEQUATE PRENATAL CARE A. Insurance

Assist clients with accessing Medicaid & Health Exchanges Advocate for the continuation of the MomCare program

B. Outreach & education on importance of prenatal care--see item 7 below 2. RACIAL DISPARITY IN BIRTH OUTCOMES A. Funding • Identify additional grant opportunities to increase services in neighborhoods of

concern identified in the Needs Assessment for each County. • Implement programs if funding is awarded B. PARTNERSHIPS • Continue partnership with the 21st Century Collaboration in Dunbar • Explore new partnerships to reach this population (ie, Haitian Coalition, faith based,

Lee Pitts Live, etc) 3. WELL WOMAN HEALTH (BETWEEN PREGNANCY HEALTH) A. Outreach and education on obesity risks & baby spacing--see item 7 below B. Partnerships with Pediatricians • Meet with pediatric offices at least once per year to orient to Healthy Start and

provide ICC & other educational materials for patients. C. Family Planning • Educate providers and advocate for patients who want tubals, but are being denied. • Educate and advocate for high risk women to use LARCs (ie, teens and substance

abusing pregnant women. 4. HEALTHY START REDESIGN A. Training • Conduct local quarterly trainings • Collaborate with FL Assoc. of Healthy Start Coalitions on training opportunities B. Implementation • Implement Partners for a Healthy Baby • Implement Prenatal Plus • Implement Parents as Teachers (PAT) 5. SUBSTANCE EXPOSED NEWBORNS A. COLLIER SUBSTANCE EXPOSED NEWBORN TASK FORCE • Develop & implement a presentation for physician leadership • Develop & implement prenatal clinic trainings on referral resources & encourage

drug testing • Lead the development and hosting of a formal CME • Pilot the referral of pregnant women who test positive for drugs to home visiting. • Advocate for local access for detox and methadone/Suboxone for pregnant women. B. FUNDING • Identify additional funding sources for one additional nurse in each county to

provide services for substance exposed pregnant women and babies. C. ADVOCATE FOR SUBSTANCE ABUSE TREATMENT IN CLEWISTON 6. REPEAT TEEN BIRTHS A. FOCUS Program • Seek funding for expansion and sustainability • Implement FOCUS • Establish a mentor network • Evaluate the program


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FIVE YEAR OVERVIEW Year End:

2014

2015

2016

2017

2018

7. OUTREACH AND EDUCATION A. RISK SCREENING • Provide an in-service for every prenatal provider and delivery hospital at least once

per year and when screening rates drop. B. EDUCATIONAL BABY SHOWERS IN HIGH RISK NEIGHBORHOODS • Continue Lee & Hendry County Showers • Seek funding to expand to Collier C. EDUCATE THE COMMUNITY ON: • Signs and symptoms of preterm labor • Safe sleep / injury prevention • Substance abuse prevention / resources • Why 39 weeks is important • Racial disparity in birth outcomes D. HISPANIC OUTREACH • Partner with Hispanic media such as D’Latinos TV • Identify funding for Hispanic outreach worker 8. MATERNAL DEATHS • Research potential causes of the increase of maternal deaths • Develop educational materials and resource list • Educate prenatal clients on risks and safety tips 9. INFANT & TODDLER RESOURCE CENTER • LOCATION: research new potential partnership • FUNDING: identify potential funding sources • ADVISORY COUNCIL: expand advisory council


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1. Late or No Access to Care

1. Contract requirement or identified community-wide/system issue: A. What is the requirement or system/community-wide problem or need identified to be addressed by a strategy? Families

have difficulty finding and accessing health insurance / Medicaid and medical care. Also, the MomCare program is threatened by a potential 75% cut in 2014. This program’s goal to help pregnant women find and select a doctor and access prenatal care.

B. What health status indicator/coalition administrative activity is being addressed by this strategy? Late or no access to

prenatal care and the rate of uninsured. C. What information, if any, was used to identify the issue/problem (ie, HPA, FIMR, screening, client satisfaction,

interviews, QI/QA)? Coalition Needs Assessment 2. Planning Phase questions A. What strategies have been selected to address this?

• Facilitate access to insurance and medical care o Assist clients with accessing Medicaid, Kidcare & Health Exchanges o Advocate for the continuation of the MomCare program

• Provide community outreach & education on importance of early and regular prenatal care and well child care

B. What information will you gather to demonstrate that you have implemented this strategy as intended (who, what, how many, where, etc.)? MomCare information system reports on the number clients where we facilitated access to KidCare and pediatrician. Quarterly outreach management reports on the number of people reached with the key health message.

C. Where/how will you get the information? Outreach management reports and MomCare information system reports D. What do you expect will be the observed impact of the strategies on the system or community-wide problem/need?

• Decrease in the rate of late or no prenatal care; • Decrease in the rate of uninsured; • Continuation of families receiving MomCare services

F. Where will you get the information? FL CHARTS. 3. Strategy Action Steps Person Responsible Start

Date End Date

1. Facilitate access to insurance and medical care A. Assist clients with accessing Medicaid, Kidcare & Health

Exchanges MomCare Advisors Care Coordination providers

Oct 2013

Jun 2014

B. Advocate for the continuation of the MomCare program • Coordinate with FAHSC on contract negotiations with AHCA. • Educate legislators, if needed

Executive Director Nov 2013

Mar 2014

2. Outreach & Education • Provide community outreach & education on importance of

early and regular prenatal care and well child care. See Outreach Section 7 below.


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2. Racial Disparity in Birth Outcomes

1. Contract requirement or identified community-wide/system issue: A. What is the requirement or system/community-wide problem or need identified to be addressed by a strategy? Racial

disparity in birth outcomes

B. What health status indicator/coalition administrative activity is being addressed by this strategy? Black infant deaths (neonatal and post neonatal), black low birth weight babies, black late or no access to prenatal care.

C. What information, if any, was used to identify the issue/problem (ie, HPA, FIMR, screening, client satisfaction,

interviews, QI/QA)? Coalition Needs Assessment 2. Planning Phase questions A. What strategies have been selected to address this?

• Funding A. Identify additional grant opportunities to increase services in neighborhoods of concern identified in the

Needs Assessment for each County. B. Implement programs if funding is awarded

• Partnerships A. Continue partnership with the 21st Century Collaboration in Dunbar B. Explore new partnerships to reach this population (ie, Haitian Coalition, faith based, Lee Pitts Live, etc)

B. What information will you gather to demonstrate that you have implemented this strategy as intended (who, what, how many, where, etc.)? Copies of grant applications, program progress reports, notes from collaboration meetings, and monthly Executive Director’s Report.

C. Where/how will you get the information? Staff will document the reports and maintain the files. D. What do you expect will be the observed impact of the strategies on the system or community-wide problem/need?

• Decrease in infant deaths, neonatal deaths, post neonatal deaths and low birth weight black babies. F. Where will you get the information? FL CHARTS. 3. Strategy Action Steps Person Responsible Start

Date End Date

1. Target grant funded programs for the highest risk neighborhoods A. Identify additional grant opportunities to increase services in

neighborhoods of concern identified in the Needs Assessment for each County.

Executive Director Jul 2016

Jun 2017

B. Implement programs if funding is awarded (1) Nurse Family Partnership Executive Director &

Finance/Contracts Dir. Oct 2013

June 2018

(2) FOCUS Teen Program Executive Director & Finance/Contracts Dir.

Oct 2013

Oct 2014

(3) Educational Baby Showers (see Outreach Section 7 below) 2. Partnerships

A. Continue partnership with the 21st Century Collaboration in Executive Director Oct Jun


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Action Steps Person Responsible Start Date

End Date

Dunbar 2013 2018 B. Explore new partnerships to reach this population (ie, Haitian

Coalition, faith based groups, Lee Pitts Live, etc.) Executive Director

Quarterly Progress Reports: Quarter 1: Quarter 2: Quarter 3: Quarter 4:


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3. Well-Woman Health (Between Pregnancy Care)

1. Contract requirement or identified community-wide/system issue: A. What is the requirement or system/community-wide problem or need identified to be addressed by a strategy? The

majority of fetal and infant deaths are due to the health of the mother before she gets pregnant. Also, obesity / being overweight were identified as leading risk factors for poor birth outcomes for the region.

B. What health status indicator/coalition administrative activity is being addressed by this strategy? Fetal and infant

deaths and obesity.

C. What information, if any, was used to identify the issue/problem (ie, HPA, FIMR, screening, client satisfaction, interviews, QI/QA)? Perinatal Periods of Risk and the Coalition’s 2013 Needs Assessment

2. Planning Phase questions A. What strategies have been selected to address this?

• Outreach and education on obesity risks & baby spacing--see Outreach Section 7 below • Partnerships with Pediatricians

o Meet with pediatric offices at least once per year to orient to Healthy Start and provide ICC & other educational materials for patients.

• Family Planning o Educate OB/GYN providers and advocate for patients who want tubals, but are being denied. o Educate and advocate for high risk women to use LARCs (ie, teens and substance abusing pregnant women.

B. What information will you gather to demonstrate that you have implemented this strategy as intended (who, what, how

many, where, etc.)? Number of pediatrician offices visited; types of brochures left at the clinics for distribution; documentation of feedback from pediatric offices on Healthy Start in-services and materials; documentation in the prenatal care client record of family planning method chosen.

C. Where/how will you get the information? Quarterly Outreach management report, care coordination record reviews;

FOCUS program reports, prenatal provider record reviews. D. What do you expect will be the observed impact of the strategies on the system or community-wide problem/need?

1. Decrease in obesity rates. 2. Increased number of women who space their pregnancies at least 18 months apart. 3. Increased number of very high risk women who agree to use a LARC.

F. Where will you get the information? See letter C above plus FL CHARTS. 3. Strategy Action Steps Person Responsible Start

Date End Date

1. Outreach and Education on obesity risks-- See Outreach Section 7 below.

Community Liaison Oct 2013

June 2018

2. Partnerships with Pediatricians A. Meet with pediatric offices at least once per year to orient to Healthy

Start and provide ICC & other educational materials for patients. Community Liaison Oct

2013 June 2018

3. Healthy Lee Coalition


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End Date

A. Work in Collaboration with the Lee County Obesity Prevention Partnership led by the Lee County Health Dept. and Lee Memorial Health System. Attend and assist in promoting coalition activities.

Executive Director Oct 2013

June 2018

4. Outreach and education on baby spacing education-- See Action Plan Section 7 below.

Community Liaison Oct 2013

June 2018

5. Family Planning A. Educate OB/GYN providers and advocate for patients who want

tubals, but are being denied. Executive Director Jul

2017 Jun 2018

B. Educate and advocate for high risk women to use LARCs (ie, teens and substance abusing pregnant women.


Jun 2018



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4. Healthy Start Redesign

1. Contract requirement or identified community-wide/system issue: A. What is the requirement or system/community-wide problem or need identified to be addressed by a strategy?

Program standardization of the core curricula is necessary to increase the quality of services and allow for a statewide program evaluation.

B. What health status indicator/coalition administrative activity is being addressed by this strategy? .

Quality of services and sustainability of the program by allowing an evaluation to show the impact/outcomes the program is achieving.


interviews, QI/QA)? DOH and FAHSC commitment to redesign. 2. Planning Phase questions A. What strategies have been selected to address this?

• Training o Conduct local quarterly trainings o Collaborate with FL Assoc. of Healthy Start Coalitions on training opportunities

• Implementation o Implement Partners for a Healthy Baby o Implement Prenatal Plus o Implement Parents as Teachers (PAT)

B. What information will you gather to demonstrate that you have implemented this strategy as intended (who, what, how

many, where, etc). Training logs that contain number and percentage of people trained and the topics. Service Delivery & management progress reports on implementation of the three curricula.

C. Where/how will you get the information? Staff reports and the Healthy Start information system / HMS. D. What do you expect will be the observed impact of the strategies on the system or community-wide problem/need?

• Higher quality of services delivered • Successful future evaluations

F. Where will you get the information? See letter C. 3. Strategy Action Steps Person Responsible Start

Date End Date

1. Training A. Conduct local quarterly trainings Executive Director and

Finance & Contracts Dir. Oct 2013

June 2014

B. Collaborate with FL Assoc. of Healthy Start Coalitions on training opportunities

Executive Director and Finance & Contracts Dir.

Oct 2013

June 2014

2. Implementation A. Implement Partners for a Healthy Baby Executive Director and July June


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End Date

Finance & Contracts Dir. 2014 2018

B. Implement Prenatal Plus Executive Director and Finance & Contracts Dir.

July 2014

June 2018

C. Implement Parents as Teachers (PAT) Executive Director and Finance & Contracts Dir.

July 2015

June 2018



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5. Substance Exposed Newborns

1. Contract requirement or identified community-wide/system issue A. What is the requirement or system/community wide problem or need identified to be addressed by a strategy? The

large increase in the number of substance exposed newborns.

B. What health status indicator/coalition administrative activity is being addressed by this strategy? Substance exposed newborns.


interviews, QI/QA)? NAS data by county. 2. Planning Phase Questions A. What strategy has been selected to address this?

• Collier Substance Exposed Newborn Task Force o Develop & implement a presentation for physician leadership o Develop & implement prenatal clinic trainings on referral resources & encourage drug testing o Lead the development and hosting of a formal CME o Pilot the referral of pregnant women who test positive for drugs to home visiting. o Advocate for local access for detox and methadone/Suboxone for pregnant women.

• Funding o Identify additional funding sources for one additional nurse in each county to provide services for substance exposed

pregnant women and babies. • Advocate for Substance Abuse Treatment in Clewiston

B. What information will you gather to demonstrate that you have implemented this strategy as intended?

Meeting minutes/notes, partnership plan, partnership agreements, grant proposal(s) C. Where/how will you get the information? Staff will document and maintain the files.

D. What do you expect will be the observed impact of the strategies on the system or community-wide problem/need?

• Decrease in the number of women who drink alcohol during their pregnancy; • Decrease in the number of women who report smoking during their pregnancy; • Increased access for women with children to substance abuse treatment.

F. Where will you get the information? See letter C plus CHARTS reports.

3. Strategies Action Steps Person

Responsible Start Date

End Date


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Action Steps Person Responsible

Start Date

End Date

1. Collier Substance Exposed Newborn Task Force

A. Develop & implement a presentation for physician leadership Executive Director Oct 2013

Dec 2014

B. Develop & implement prenatal clinic trainings on referral resources & encourage drug testing


Mar 2014

C. Lead the development and hosting of a formal CME Executive Director Oct 2013

Jun 2014

D. Pilot the referral of pregnant women who test positive for drugs to home visiting.

Executive Director Jan 2014

Jun 2014

E. Advocate for local access for detox and methadone/Suboxone for pregnant women.


Jun 2016

2. Funding

A. Identify additional funding sources for one additional nurse/Healthy Start worker in each county to provide services for substance exposed pregnant women and babies.


Jun 2016

3. Advocate for Substance Abuse Treatment in Clewiston

A. Meet with community partners to assess current services and their potential future expansion plans.


Jun 2018

B. Gather data by zip code to make a case for the need. Executive Director Jul 2016

Dec 2016

C. Explore potential funding options with partners. Executive Director Jul 2016

Jun 2018

Quarterly Progress Reports: Quarter 1: Quarter 2:

Quarter 3:

Quarter 4:


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6. Repeat Teen Births

1. Contract requirement or identified community-wide/system issue

A. What is the requirement or system/community wide problem or need identified to be addressed by a strategy? Repeat teen births

B. What health status indicator/coalition administrative activity is being addressed by this strategy? Repeat teen births

C. What information, if any, was used to identify the issue/problem (ie, HPA, FIMR, screening, client satisfaction, interviews, QI/QA)? Coalition’s 2013 Needs Assessment

2. Planning Phase Questions

A. What strategies have been selected to address this?

• FOCUS evidenced based program • Seek funding for expansion and sustainability • Implement FOCUS • Establish a mentor network • Evaluate the program

B. What information will you gather to demonstrate that you have implemented this strategy as intended? Service reports

that include: the number of clients served, site locations, number of mentors, etc. Also, an evaluator has been hired to report on outcomes such as repeat teen births, STDs, graduation rates, etc.

C. Where/how will you get the information? Class sign-in sheets, management reports, evaluation report.

D. What do you expect will be the observed impact of the strategies on the system or community-wide problem/need? Decrease in the number of repeat teen births

F. Where will you get the information? FL CHARTS

3. Strategies

Action Steps Person Responsible Start Date End Date 1. FOCUS evidenced based program

A. Seek funding for expansion and sustainability Executive Director Jul 2014

Jun 2015

B. Implement FOCUS in highest need areas such as Golden Gate, Dunbar, Lehigh Acres


Oct 2014

C. Establish a mentor network Executive Director Oct 2013

Jun 2014

D. Evaluate the program Executive Director Oct 2013

June 2016


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7. Outreach, Education, and Risk Screening

1. Contract requirement or identified community-wide/system issue A. What is the requirement or system/community wide problem or need identified to be addressed by a strategy? Not

every pregnant woman or family with a newborn can receive Healthy Start care coordination and home visiting; therefore, outreach and education in the general community is needed to promote key health messages identified in the Needs Assessment that will increase healthy births and decrease infant deaths. Also, outreach & education to consumers and prenatal medical providers is needed to promote risk screening and appropriate referrals to Healthy Start care coordination.

B. What health status indicator/coalition administrative activity is being addressed by this strategy?

Premature births, SIDS/co-sleeping deaths, substance exposed newborns, early elective deliveries, racial disparity in birth outcomes, and risk screening.


interviews, QI/QA)? Coalition’s 2013 Needs Assessment and risk screening rates. 2. Planning Phase Questions A. What strategies have been selected to address this?

A. RISK SCREENING • Provide an in-service for every prenatal provider and delivery hospital at least once per year and when screening

rates drop. B. EDUCATIONAL BABY SHOWERS IN HIGH RISK NEIGHBORHOODS • Continue Lee & Hendry County Showers • Seek funding to expand to Collier C. EDUCATE THE COMMUNITY ON: • Risks of obesity • Signs and symptoms of preterm labor • Safe sleep / injury prevention • Substance abuse prevention / resources • Why 39 weeks is important • Racial disparity in birth outcomes D. HISPANIC OUTREACH • Partner with Hispanic media such as D’Latinos TV • Identify funding for Hispanic outreach worker

B. What information will you gather to demonstrate that you have implemented this strategy as intended? Reports on risk screening rates, number of educational bags distributed, number of community events and educational baby showers, copies of press releases and articles, reports on TV appearances and PSAs, reports on newsletter articles and number of people reached.

C. Where/how will you get the information? Staff will compile the reports and copies of articles.


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Risk screening rates will remain at 90% or higher Decrease in obesity rates Decrease in premature births Decrease in SUID Decrease in substance exposed newborns Decrease in early elective deliveries Decrease in racial disparity in birth outcomes

F. Where will you get the information? See letter C plus FL CHARTS.



End Date

1. Risk Screening

A. Provide on-site visits at least two times per year at every clinic and delivery hospital with additional time spent with facilities with rates less than 90%.

Community Liaisons

Oct 2013

Jun 2018

2. Risk Screening Educational Incentive Bags (with info on priority risk factors— • Risks of obesity • Signs and symptoms of preterm labor • Safe sleep / injury prevention • Substance abuse prevention / resources • Why 39 weeks is important • Racial disparity in birth outcomes

A. Distribute at least 5,000 bags per year at prenatal care provider offices Community Liaisons

Oct 2013

Jun 2018

B. Distribute at least 5,000 bags per year at delivery hospitals Community Liaisons

Oct 2013

Jun 2018

C. Distribute at least 500 bags per year at community events. Community Liaisons

Oct 2013

Jun 2018

3. Pediatrician Outreach—see Well Woman Health Section 3 above

4. Community Events

A. Participate in at least twelve community outreach events and distribute info on priority risk factors.

Community Liaisons

Oct 2013

Jun 2018

B. Participate in at least twelve interagency meetings. Community Liaisons

Oct 2013

Jun 2018


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Action Steps Person Responsible

Start Date

End Date

5. Media Relations

A. Submit at least six press releases or responses to media requests for information each year.

Executive Director

Oct 2013

Jun 2018

B. Appear on at least four TV spots. Executive Director

Oct 2013

Jun 2018

6. Social Media

A. Distribute prevention information on each of the priority health messages in action step #2 above through Facebook Twitter, website, and more.

PR Volunteer / Intern

Oct 2013

Jun 2018

7. HISPANIC OUTREACH

A. Partner with Hispanic media such as D’Latinos TV Executive Director

Oct 2013

Jun 2018

B. Identify funding for a Hispanic outreach worker for Collier County Executive Director

Oct 2015

Jun 2017

Quarterly Progress Reports:

Quarter 1:

Quarter 2:

Quarter 3:

Quarter 4:


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8. Maternal Deaths

1. Contract requirement or identified community-wide/system issue A. What is the requirement or system/community wide problem or need identified to be addressed by a strategy? An

increase in the number of maternal deaths in Lee County. B. What health status indicator/coalition administrative activity is being addressed by this strategy?

Maternal deaths C. What information, if any, was used to identify the issue/problem (ie, HPA, FIMR, screening, client satisfaction,

interviews, QI/QA)? Coalition’s 2013 Needs Assessment. 2. Planning Phase Questions A. What strategies have been selected to address this?

• Research potential causes of the increase of maternal deaths • Develop educational materials and resource list • Educate prenatal clients on risks and safety tips

B. What information will you gather to demonstrate that you have implemented this strategy as intended? Needs Assessment committee meeting minutes/notes. Copy of educational materials selected for distribution. Number of clients served / who received the education.

C. Where/how will you get the information? Staff will compile the reports and copies educational materials and meeting minutes.


Decrease in maternal deaths

F. Where will you get the information? See letter C plus FL CHARTS.



End Date

1. Research potential causes of the increase of maternal deaths Needs Assessment Task Force / Committee

Jul 2016

Jul 2017

2. Develop educational materials and resource list Executive Director

Jul 2017

Jun 2018

3. Distribute materials and educate prenatal clients on risks and safety tips

Care Coordinators MomCare Advisors

Jul 2017

Jun 2018


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Quarterly Progress Reports:

Quarter 1:

Quarter 2:

Quarter 3:

Quarter 4:


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9. Infant & Toddler Resource Center

1. Contract requirement or identified community-wide/system issue A. What is the requirement or system/community wide problem or need identified to be addressed by a strategy? Lack of

access to injury prevention and parenting information and developmental assessments for families with young children.

B. What health status indicator/coalition administrative activity is being addressed by this strategy?

Infant deaths, early identification of developmental delays and other health issues, child abuse prevention. C. What information, if any, was used to identify the issue/problem (ie, HPA, FIMR, screening, client satisfaction,

interviews, QI/QA)? Coalition’s focus group report and business plan conducted by Florida Gulf Coast University 2. Planning Phase Questions A. What strategies have been selected to address this?

• LOCATION: research new potential partnership • FUNDING: identify potential funding sources • ADVISORY COUNCIL: expand advisory council

B. What information will you gather to demonstrate that you have implemented this strategy as intended? Copies of grant

applications, list of advisory board members, and the name of a new community partner where the resource center could be located.

C. Where/how will you get the information? Staff will compile the reports and copies grant applications. When the center is up and running, the information system will capture the information needed in letter D below.


Based on the experience in Hillsborough County:

96% of adults who received educational services increased their knowledge about car seats, first aid, or CPR.

99% of children had access to immunizations and well child care based on their caregiver's knowledge of preventive health care.

60% of children were developmentally on track or were linked with additional developmental services.

81% of caregivers demonstrated increased understanding of child development.

99% of children were developmentally on track or were linked with additional developmental services.

83% of participants improved their skill development in self-sufficiency services as indicated by the G.A.S. tool.

93% of participants reported positive attitudes about the support and connections they received from participation. F. Where will you get the information? See letter C above.


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End Date

1. Launch an infant and toddler resource center A. LOCATION: research new potential partnership to share space

Executive Director

Oct 2013

Jun 2017

B. FUNDING: identify potential funding sources and submit applications

Executive Director

Oct 2013

Jun 2018

C. ADVISORY COUNCIL: expand advisory council Executive Director

Oct 2013

Jun 2018


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Allocation & Fiscal Monitoring Plans

Allocation Plan

PRIORITIES In 2012-13 our contracted providers gave more than $571,000 in un-reimbursed services because the funding ran out. Due to these limited resources, the Coalition has specified the following priorities for direct services based on the Community Needs Assessment, contract requirements with the Florida Department of Health, and financial risks associated with potential paybacks from federal audits if service delivery requirements for the Medicaid Waiver are not met.

1. Care Coordination 2. Prenatal Care 3. MomCare 4. Diabetes Nutrition 5. Wrap-Around Services (childbirth, parenting, breastfeeding support, general nutrition, and psychosocial

counseling)

Care Coordination is first priority because it is the “heart” of the Healthy Start program. These services must meet stringent service delivery requirements in order to avoid potential paybacks. More than 95% of the Coalition’s funding is currently from the Healthy Start program; therefore, the survival of the Coalition is presently contingent on keeping these contracts. Prenatal Care is a close second priority because of the crucial link to healthy birth outcomes. Due to the high number of uninsured pregnant women in our area and lack of local resources, the Coalition feels strongly that we need to partner with prenatal clinics that serve the low income and uninsured to ensure continued access to care. MomCare is a program funded by the Medicaid Waiver. Since this program relies on critical provider partnerships to be successful, this program is ranked as the third highest priority. Diabetes Nutrition is the next priority because these pregnancies are high risk and Healthy Start funding is needed to help ensure continued access to these services for uninsured, low-income pregnant women with gestational diabetes. Wrap-Around Services are important; however, due to limited Healthy Start resources and the availability of these services from outside resources, payments for these services are reserved for only the highest risk mothers.

PROCESS

The Board of Directors is responsible for allocating more than $2 million dollars into the community each year for the services listed above. The process includes:

• The Board of Directors determines what percent of the direct services dollars will be used to support staff activities related to direct services. The contract allows up to 10% of non-Waiver direct service dollars to be used for these activities. The Florida Department of Health must approve the Board’s request each year.

• Annually, staff presents the following information to the Board to help guide their decisions:

1. Board priorities based on it’s Guiding Principles, the Needs Assessment and other data;

2. Previous year’s provider utilization (reimbursed and un-reimbursed services) by provider;

3. Unduplicated number of clients served by provider;


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4. Quality assurance report summaries;

5. Service reimbursement rates; and

6. Other background information as needed.

• The Board meets in March to determine the percentage of funding for each major service category: Encoding, Care Coordination, Prenatal Care, and Wrap-Around Services. There is opportunity for public comment at all Board meetings.

• The Board meets in April for a full day to determine the percentage of funding for each individual contracted provider. The first half of the meeting is set aside to review the information compiled and presented by staff. Providers are required to give presentations and participate in this portion of the meeting to provide context and feedback on the information presented. After reviewing the information, the Board considers the recommendations made by staff for allocation methodology. During this discussion, providers are allowed to provide input and feedback. Prior to the final vote, additional public comment is requested. .

• The Board meets in August to determine final re-allocations of the previous fiscal year dollars. Any unexpended direct service dollars are allocated to providers who have un-reimbursed services.

• Approximately every three years, the Board of Directors are invited to participate in a bus tour of Care Coordination and prenatal care provider sites in all four counties.

CURRENT METHODOLOGY—REVIEWED ANNUALLY

In 2012-13, the following allocations were made by service type:

0.48% Encoding 60.4% Care Coordination 22.99% Prenatal Care 1.04% Diabetes Nutrition Education 8.7% Service Administration 2.5% Community Liaison

Encoding Recommendation: Fund the County Health Department Encoding providers based on their percentage of total forms entered. Rationale: Distributes funds based on share of workload. Gestational Diabetes Nutrition Education Recommendation: Fully fund these services based on the previous year’s utilization / billings. Rationale: Board has placed a high priority on these services because of the direct impact on birth outcomes for this population. They are fully funded to ensure continued access because they are relatively small contracts. Prenatal Care Recommendation: Step 1: Fund rural providers in Hendry & Glades Counties at 100% of previous year’s contract (no cuts). Step 2: Fund remaining providers at their percentage share of the previous year’s utilization. Rationale: Follows rural funding guidelines adopted by the Board. The remaining funding is

Allocation Calendar Summary

March Allocations by service type

April Allocations by individual provider

May Staff contract review with providers

July New fiscal year

Aug/Sep Final re-allocations for previous year

January Re-allocations, if needed


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distributed based upon utilization which accounts not only for the documented needs, but also the differences between providers including levels of risk, intensity and types of services, timing of entry into care, etc. Care Coordination Recommendation: Level fund Hendry/Glades rural areas from the previous fiscal year’s contract (not cuts), and allocate the balance to the remaining providers based upon each provider’s percentage share of the most recent 3-year rolling average of utilization. The Committee used the methodology from previous years where we fund all Care Coordination providers utilizing 3 year rolling averages providing that Hendry/Glades receives at least level funding. Allocated the remaining balance to remaining providers based upon each provider’s percentage share of utilization. Rationale: 3-year rolling averages smooth out fluctuations from temporary staff vacancies, hurricanes, etc. Utilization best reflects the difference in intensity of services and differences in caseload breakouts between providers. Level funding of Hendry and Glades follows the rural funding guidelines and previous years’ methodology.

Wrap Around / Enhanced Services (childbirth, parenting, general nutrition, breastfeeding support, and smoking cessation) No specific allocations are made anymore due to the small amount of funds available. Care Coordination providers are given all the funds and either provide the services needed or arrange for subcontracted providers. Staff monitors service delivery reports to ensure these services continue to be provided at appropriate levels given funding constraints.

Service Administration The Board of Directors sets this percentage, and it is currently set at the maximum of 10% of direct service and 5% Waiver funds. Risk Screening This line item covers the costs of the community liaison staff expense and program implementation costs including travel, education materials, and incentives.

MomCare There are no allocations to be made. Most services are provided in-house except for first contact tasks. The majority of first contact tasks are completed by prenatal care clinics that receive $6.50 per client to do these services.


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Fiscal Monitoring Plan

The Finance Committee and the Board of Directors review monthly financial reports by program including a provider spreadsheet that shows provider billings by month along with a year-to-date contract balance. The report also shows the amount of un-reimbursed services after the contract funding has run out.

Staff performs annual site audits and record reviews to verify providers are meeting contract requirements and appropriately billing Healthy Start. Care Coordination records are reviewed to ensure appropriate encounters have been billed. Prenatal Care records are reviewed to ensure Healthy Start is the payer of last resort by looking for a Medicaid letter of denial is in the chart that specifies a reason other than non-compliance with the application process. Staff also looks for the patient share of cost/payment plan in the record. Diabetes Nutrition records are reviewed to ensure appropriate billing to Healthy Start.

Board has specified that staff must investigate prenatal providers who submit a monthly invoice that varies their average billing by more than 10% trend over three months. This financial record audit is conducted to ensure that Healthy Start is the payer of last resort and that patient share of cost payments are being collected. Care Coordination providers submit an annual budget for Coalition approval. Staff verifies at the annual on-site audit that funds were used in accordance with the approved budget. The Board of Directors hires an independent auditor each year to conduct both a financial and contract compliance audit.


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Quality Assurance (QA) Plan

Staff is responsible for implementing quality assurance activities and reporting findings to the Board of Directors on a regular basis. QA activities include the monitoring of a comprehensive set of maternal and child health indicators, contract performance measures tracking, desk audits, record reviews, service delivery reports, surveys for clients and staff, and financial audits. Prenatal Care, Care Coordination, and MomCare providers have more rigorous QA requirements because of the relatively higher amount of funding received. Providers of wrap-around services receive a significantly smaller amount of funding; therefore, reporting requirements are scaled back appropriately. The Coalition requires contracted providers to have their own internal QA plans, or to adopt the Coalition plan. Providers are required to conduct their own internal quality assurance reviews quarterly, and to report the findings to the Coalition. Coalition staff conducts annual on-site audits. Additional site audits may be conducted as needed. The timing of surveys varies by the type of service offered. Below is a summary of the Coalition’s comprehensive QA Plan that is updated annually.

Below is a summary of QA activities by contract type and report due dates.

Service Delivery Reports

(Quarterly)

Record Reviews

(Quarterly)

Fiscal Reviews

(Annually)

Client Surveys

(Annually)

Provider Staff

Surveys

(Annually)

Provider Credentials

Review

(Annually)

Desk Audits

(Monthly)

Class Observation

(Annually)

Care Coordination X X X X X X X

Prenatal Care X X X X X X X

MomCare X X X X X

Diabetes Nutrition Education Annual X X X X

Care Coordination Service delivery summary reports are prepared by staff and presented to providers and the Board quarterly to ensure:

− Contract performance measures are being met; − Screening rates are sufficiently high; − The number of referrals to Healthy Start based on other factors is within a normal range; − Consent to program participation is adequate; − Women and babies needing services are receiving appropriate follow-up and services; − The number of women who are unable to be located are within an acceptable range; − Percentage of clients being served by level is appropriate. − The number of services and encounters provided are appropriate


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Client Record Reviews are conducted by Care Coordinators quarterly and by staff annually to ensure:

− Service delivery requirement are being met; − Risk appropriate care is being provided; − Appropriate coding; and − Tracking of health outcomes.

Service Delivery Verification Calls are made by Care Coordination supervisors randomly for a sample of clients to verify that home visits and other services are being rendered.

Fiscal Reviews are conducted by staff annually. Staff reviews department budgets and actual expenses to monitor the actual cost of providing services (vs. amounts reimbursed) and that funds are used in compliance with contract requirements.

Client Surveys are offered to clients at case closure, and a summary of findings is reported to staff at least annually. Surveys are administered by telephone or by mail to determine:

− Awareness of the program and caseworker; − Satisfaction with the services received; − Recognition of the signs and symptoms of pre-term labor; and − Unmet needs/services wanted, but not received.

Provider Staff Surveys are conducted by Coalition staff annually at the site audit to determine if:

− Adequate training to perform job functions has been received; − Adequate resources are available to do the job; and − If the work environment is conducive to providing quality services.

Provider Staff Credentials Reviews are conducted by Coalition staff annually to verify:

− Staff meet educational / competency requirements per the Healthy Start Standards and Guidelines; and − Annual coding training has been received

Desk Audits are conducted by Coalition staff monthly to ensure:

− Contract deliverables are completed and submitted prior to paying for invoices


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Prenatal Care Service delivery summary reports are submitted by Prenatal Care Providers annually to monitor:

− Number of Healthy Start patients served; − Number of deliveries; and − Revenue resources

Record Reviews are conducted by Prenatal Care Providers quarterly and by staff annually to monitor:

− Healthy Start is the payer of last resort (copy of Medicaid letter of denial for a reason other than non-compliance is in the chart);

− Services billed are within Medicaid limits/requirements.

Patient Surveys are conducted at the clinic, and a summary of findings is reported annually to determine

− Awareness of the Healthy Start and MomCare programs and caseworkers; − Satisfaction with the services received;

Provider Staff Interviews and surveys are conducted by Coalition staff annually at the site audit to evaluate:

− Intake/eligibility process for Medicaid; − Screening timeframes; − Access to care; − Average length of Presumptive Eligibility for Pregnant Women (PEPW); − Patient share of cost information process; − MomCare first contact process.


− Providers and staff meet educational / competency requirements

Desk Audits are conducted by Coalition staff monthly to ensure:

− Contract deliverables are completed and submitted prior to paying for invoices; − Patient payments collected are within the expected range; and Wrap Around Services These services include: gestational diabetes nutrition education, childbirth, parenting, breast feeding support, psychosocial counseling, and smoking cessation, etc.

Executive Summary Reports, GH330 reports, and performance measure reports are reviewed by staff to ensure:


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− An appropriate number of services are being provided given resource constraints − Wrap-around services are being coded and entered into the state information system.

Client Record Reviews for gestational diabetes are conducted by contracted providers quarterly and by Coalition staff annually to ensure:

− Service delivery requirement are being met; − Follow-is being done with the care coordination provider.

Fiscal Reviews are conducted by Coalition staff annually. Staff reviews department budgets and actual expenses to monitor the actual cost of providing services (vs. amounts reimbursed) and that funds are used in compliance with contract requirements.

Client Surveys Surveys are administered by telephone or by mail to determine:

− Satisfaction with the services received; − Unmet needs/services wanted, but not received.


− Staff meet educational / competency requirements per the Healthy Start Standards and Guidelines; and

Desk Audits are conducted by Coalition staff monthly for gestational diabetes nutrition education only to ensure:

− Contract deliverables are completed and submitted prior to paying for invoices;


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Coalition Annual finance and contract audit--An independent auditing firm conducts the annual audit to monitor finance and contract compliance. The field work takes one to two weeks. The financial audit includes a review of financial statements, bookkeeping, invoice processing, internal controls, personnel files, random sample of expenditures and supporting documentation, Board of Directors minutes, allocation processes and documentation, and annual organization registrations. The contract compliance audit is a comprehensive review of the supporting documentation to prove contract compliance. It also includes client record reviews for MomCare services provided in-house. The auditors report preliminary findings to management (Executive Committee and key staff), and then present the final report to the Board of Directors. Annual community assessment—The Coalition conducts an annual survey of tcommunity partners, Healthy Start members and providers. The results are presented to the Board of Directors. Quarterly reports—The Executive Director is responsible for presenting regular progress reports on the Action Plan to the Board of Directors. Monthly reports—The Finance and Contracts Director is responsible for ensuring financial reports and progress reports are presented to committees and/or the Board of Directors on a quarterly basis.

Documents

Collier, Glades, Hendry & Lee Countieshealthystartbaby.org/wp-content/uploads/2011/11/... · Submitted to DOH 10-10-13 2013 Service Delivery Plan . Collier, Glades, Hendry & Lee Counties