health care for the homeless co-applicant board · 8/1/2017 · health care for the homeless...

HEALTH CARE FOR THE HOMELESS CO-APPLICANT BOARD

HHS|HRSA – PINELLAS COUNTY BOARD OF COUNTY COMMISSIONERS HEALTH CARE FOR THE HOMELESS GRANT | #H80CS00024

MEETING AGENDA

AUGUST 1, 2017 | 3:00 PM – 5:00 PM JUVENILE WELFARE BOARD, 14155 58TH STREET N, CLEARWATER FL 33760

CONFERENCE CALL-IN: DIAL 1-727-582-2255; PASSCODE: 718007

3:00 – 3:30 pm Standing Committees (Clinical & Strategic Planning) 3:30 pm – 5:00 pm Regular Monthly Meeting

1. Chairman’s Report i) Consent Agenda ............................................................................................................ Action/Vote

• Approval of Minutes, July 11, 2017 • Credentialing & Privileging of Additional Providers

ii) Unfinished Business/Follow-Up • Board/Officer Nominations .................................................................................... Action/Vote

2. Governance/Operations i) HRSA Site Visit Debriefing – Daisy Rodriguez ............................................................ Informational ii) Strategic Planning/Communications

• HCH Monthly Email Update/Newsletter iii) MMU/Bayside Health Clinic Calendar – Drew Wagner ............................................. Informational iv) Client Satisfaction Survey Results/Benchmarks – Drew Wagner .............................. Informational

3. Fiscal i) Notice of Awards – Elisa DeGregorio ............................................................................ Action/Vote ii) New Funding Opportunities – Elisa DeGregorio ........................................................ Informational

• Access to Mental Health and Substance Abuse Services (AIMS), HRSA

4. Clinical i) HCH Client Trend Reports – Drew Wagner ................................................................ Informational

• Medical • No-Show Rates • Dental • Telephone

5. Other Updates i) New Business ............................................................................................................. Informational

Adjournment

Next Meeting: Tuesday, September 12, 2017 @ 3:00 pm Juvenile Welfare Board, 14155 58th Street N., Clearwater, FL 33760

TAB 1 – CHAIRMAN’S REPORT

• Meeting Minutes – July 11, 2017

• Credentialing & Privileging of Providers

Minutes of the Monthly Meeting of the Mobile Medical Unit Advisory Council (MMUAC)

July 11, 2017 | 3:00 pm Location of Meeting: Juvenile Welfare Board 14155 58th Street North Clearwater, FL 33760 Present at Meeting: Valerie Leonard1, Clare Young (phone), Jerry Wennlund, Rhonda Abbott, Lt. Zach Haisch, and Sandes Boulanger2. Staff and community members present: Daisy Rodriguez, Elisa DeGregorio, Dale Williams, Meghan Lomas, Dr. Chitra Ravindra, Rhonda O’Brien, Melissa Van Bruggen, April Lott, Renée Filson3, Susan Thorner3, and Sally Neville3. (1Consumer, 2Alternate, 3HRSA Site Reviewer) The regular meeting of the Mobile Medical Unit Advisory Committee (MMUAC) was called to order at 4:03 pm. HRSA Site Reviewers spent the first hour conversing with

i. Chairman’s Report

i. Consent Agenda:

a. Approval of Minutes: A motion to approve the April meeting minutes was made by Rhonda Abbott and seconded by Helen Rhymes. The Council unanimously approved the minutes.

b. Credentialing & Privileging: Rhonda explained the Medical Executive Committee met twice this month to review specialists and DOH providers for credentialing and privileging. Rhonda presented the he providers highlighted in the attachment for whom the Medical Executive Committee recommended for credentialing and privileging. Lt. Haisch made a motion to approve the credentialing and privileging of the recommended providers which was seconded by Rhonda Abbott. The Council unanimously approved the providers presented for credentialing and privileging.

ii. Unfinished Business/Follow-Up:

a. Board/Officer Nominations: Ms. Rodriguez indicated that at the last meeting discussion occurred about officer nominations, of which Sean was nominated for Chair pending his acceptance. She indicated Sean anticipates being in attendance at the next meeting, this topic will be addressed at that time.

Ms. Rodriguez introduced April Lott, CEO of Directions for Living, to the Board. She explained the process for nomination and acceptance to the Council. She further indicated votes typically occur after the second meeting.

I. Governance/Operations

i. Strategic Planning/Communications

a. HCH Monthly Email Update/Newsletter: The newsletter continues to go out to interested community members. Ms. DeGregorio indicated the Homeless Leadership Board (HLB)

recently promoted the newsletter to their list serve, which has brought in some new subscribers. She thanked the HLB for this promotion.

Ms. Rodriguez discussed with the Council the need to continue attempts to recruit consumer members. Ms. Lott inquired about requirements: Ms. Rodriguez informed the Council a consumer member must have had a service visit within the last 12 months. Mr. Wagner indicated flyers have continued to be distributed during satisfaction survey administration.

ii. MMU/Bayside Clinic Calendar: Mr. Wagner presented the calendar and indicated there were no major changes. Bay Area Legal Services will be back this month. Lt. Haisch offered to have clients sign up ahead of time. Also, this is the third month of the three month trail for Tarpon Shepherd Center. Mr. Wagner will discuss later.

iii. Patient Satisfaction Survey Results/Benchmarks: Discussed survey results. Ms. Rodriguez inquired about the “Never” responses. Mr. Wagner indicated he attempts to address concerns/issues at the time of the occurrence, but the anonymity does not always allow for these items to be addressed with the survey respondents.

II. Fiscal

i. Notice of Awards: No items at this time.

ii. New Funding Opportunities: Ms. DeGregorio presented the Access Increases in Mental Health and Substance Abuse Services (AIMS) supplemental funding opportunity from HRSA. The opportunity is for $150,000; of which $75,000 is a one-time opportunity to increase technology or training and $75,000 would be recurring funds to provide staff to increase mental health ($37,500) and substance abuse ($37,500) services. Human Services is working with partners to determine areas best suited for this funding.

Ms. Lott added that the state’s legislature has sent down cuts to these behavioral health services. Approximately $2 million dollars will be the local impact, which are to be retroactive to July 1st. Agencies were notified recently. She is supportive of any funding that can help fill gaps.

Ms. Lott made a motion to approve the HCH Program seeking AIMS funding which was seconded by Lt. Haisch. The Council unanimously approved.

III. Clinical

i. HCH Client Trend Reports:

Medical: Mr. Wagner reported 1,878 unique patients through June 30th. When running figures through July 10th, this number increased to 1,917. Patients are averaging 2 visits.

Tarpon Shepherd Center: May – the first month – the team saw 9 patients, June – the second month – the team saw 2 patients and had one no-show. This month will be the third month. Lt. Haisch will push information out to the homeless outreach team in Tarpon.

No-Show Rates: Mr. Wagner presented no-show rates for the first time which is approximately 30.7%.

Ms. Lott discussed the need to share this kind of information amongst different Boards, as she is part of the homeless provider’s council and HLB. She indicated she hears very similar conversations about no shows and ways to engage clients in the services offered.

Mr. Wagner indicated the evening weather recently (thunderstorms) have attributed, in part, to the more recent no-shows. Ms. Lott posed the possibility of untreated mental health problems attributing to these numbers. Ms. Rhymes pointed out these figures are somewhat in line with national statistics. Lt. Haisch offered if there are opportunities that Safe Harbor can assist, without breaching confidentiality to let him know. Ms. Rodriguez reminded the Council that we are dealing with individuals at any given point in their lives and healthcare services may not be their current top priority.

Mr. Wagner indicated a large number of the no-shows appear to be bloodwork follow ups. Ms. Leonard inquired if there is a way to provide results that are normal without an office visit. Individuals are busy with many other priorities and often feel these appointments may be a “waste of everyone’s time.” Ms. Van Bruggen indicated there are certain processes that limit the way the DOH can provide results to clients.

Dental: Mr. Wagner presented the dental report, which shows 463 unduplicated patients.

Phone: Ms. Lott voiced opinion that the 26 calls that pressed “4” for BH seemed low. Mr. Wagner indicated that the BH Care Coordinator was on maternity leave and clients have been directed to the front desk, which may be partial reasoning behind the low figures.

IV. Other Updates

i. New Business: Ms. Rodriguez indicated that HRSA Reviewer Susan Thorner requested that within the By-Laws, the verbiage regarding composition include “or adoption” when discussing relationships. Ms. Lott made a motion to accept adding this verbiage which was seconded by Jerry Wennlund. The Council unanimously approved the addition of “or adoption. Ms. Rodriquez thanked everyone for their assistance and cooperation during the site visit.

The meeting was adjourned at 4:45 pm. The next meeting will be held at 3:00 pm on Tuesday, August 1, 2017, at JWB.

Health Care for the Homeless Program Medical Executive Committee Meeting Minutes

Date/Time: July 25, 2017 from 1:00-1:30 PM EST Location: FL DOH, Pinellas, St. Petersburg Health Center room 2-112 and

Conference Call (888) 670-3525 and Passcode: 1725311556 then #

1

Team Member Attendance

Dr. Raju Mungara M.D. Senior Physician, FL DOH in Pinellas County

Rhonda O’Brien, MSN, ARNP Quality Assurance Coordinator, County Medical Services FL DOH in Pinellas County Dr. Chitra Ravindra M.D. MPH. MBA. FAAFP County Medical Director, FL DOH in Pinellas County

Daisy Rodriguez MS, MBA Health Care Administrator, Pinellas County Human Services Dr. Ioana Stoici, Senior Dentist, FL DOH in Pinellas County

Melissa VanBruggen: Clinical Health Services Director, FL DOH in Pinellas County

Minutes Presenter Welcomed members.

Rhonda

1. Reviewed the FL DOH employee for Initial Credentialing & Privileging.

Documentation is complete as required by HRSA for this purpose. The Request for Clinical Privileges form was reviewed for:

• Steven Fine, MD Team agreed to recommend to the board for approval.

2. Reviewed the FL DOH employees for re-credentialing.

Documentation is complete as required by HRSA for this purpose. The Request for Clinical Privileges forms were reviewed for:

• Jennifer Griffin, MD • Joyce O’Brien, Dental Hygienist • Anjeza Islami, Dental Hygienist • Haychell Saraydar, DDS

Team agreed to recommend to the board for approval. 3. The team discussed how to proceed with reviewing and recommending

contracted “Specialists” to the board, and agreed to wait for additional guidance from the HRSA Project Manager. Daisy will provide information back to the committee about this.

Team

The next scheduled meeting will be August 29, 2017 from 1-1:30 PM EST.

l.

Request for Privileges Sr. Physician Specialty:

Applicant: Steven Scott Fine, MD

Pri~eges OFFICE USE ONLY

Effective from: __ / __ / __

Effective to: __ / __ / __

· Sites

\Jz:i Initial Appointment

D Reappointment

The applicant may perform granted privileges at any of the Florida Department of Health, Pinellas County Health Center clinics, Mobile Medical Unit and the Bayside Clinic, with the provision that privileges only be exercised when appropriate equipment, license, staff and other support are available.

Core Privileges

Fa~ly . Medicine Core Privileges

~ Requested Evaluate, diagnose, 'treat, and provide consultation to adolescent and adult patients with illnesses, diseases and functional disorders of the circulatory, respiratory endocrine, metabolic, musculoskeletal, hematopoietic, gastroenteric, and genitourinary systems. Assess, stabilize, and determine disposition of patients with emergency conditions consistent with policy regarding emergencies. The· core privileges in this specialty include the procedures on the procedure list and such other procedures that are extensions of the same techniques and skills.

Pediatric Core Privileges

• Criteria Must qualify for and be granted privileges in family medicine plus

• Required previous experience

•

Demonstrated current competence and evidence of the provision of care, reflective of the scope of privileges requested, to at least 10 pediatric patients in the past 12 months.

Maintenance of privilege · Demonstrated current competence and evidence of the provision of care to at least 25 pediatric patients in the past 24 months based on results of ongoing professional practice evaluation and outcomes.

Requested Evaluate, diagnose, and treat pediatric patients up to age 18 with common illnesses, injuries or disorders. This includes the care of the normal newborn as well as the uncomplicated premature infant equal to or greater than 36 weeks gestation. Assess, stabilize, and determine disposition of patients with emergency conditions consistent with policy regarding emergencies. The core privileges in this specialty include the procedures on the procedure list and such other procedures that are extensions of the same techniques and skills.

Gynecology Core Privileges

• Criteria Must qualify for and be granted ·privileges in family medicine plus

• Required previous experience Demonstrated current competence and evidence of provision of care, reflective of the scope of privileges requested to at least 10 gynecologic outpatients in the past 12 months.

• Maintenance of privilege

\ Demonstrated current competence and evidence of provision of care, reflective of the scope of privileges requested to at least 25 gynecologic outpatients in the past 24 months based on results of ongoing professional practice evaluation and outcomes.

Requested Evaluate, diagnose, treat and provide consultation to post-pubescent female patients with disorders of the female reproductive system and the genitourinary system. Assess, stabilize, and determine disposition of patients with emergent conditions consistent with policy regarding emergencies. The core privileges in this specialty include the procedures on the procedure list and such other procedures that are extensions of the same techniques and skills.

.... ,, ...... . '• .... •,,••"• ••• -, .... _•••Me ,, :

Core Procedure List

This list is a sampling of procedures included in the core. This is not intended to be an al/encompassing list but rather reflective of the categories/t.ypes of procedures included in the core. If you wish to exclude any procedures please strike through those procedures that you do not wish to request, initial and date.

General 1. Burn care, minor superficial 2. Incision and drainage abscess 3. Perform history and physical exam 4. Remove non-penetrating foreign body from the eye, nose, or ear 5. Suture uncomplicated lacerations 6. Blood Glucose Point of Care Testing 1.· Pregnancy Point of Care Testing 8. Urinalysis Point of Care Testing 9. Suture removal 10. Staple removal

Pediatrics 1. Incision and drainage abscess 2. Perform history and physical exam 3. Remove non-penetrating corneal foreign body 4. Suture uncomplicated lacerations 5. Urinalysis Point of Care Testing

Gynecology 1. Biopsy of Cervix, endometrium (Pap) 2. Perform history and physical exam 3. Removal of foreign body from vagina 4. Blood Glucose Point of Care Testing 5. Pregnancy Point of Care Testing 6. Urinalysis Point of Care Testing

,. Acknowledgement of Practitioner

I have requested only those privileges for which by education, training, current experience, and demonstrated performance I am qualified to perform and that I. wish to exercise at designated Florida Department of Health, Pinellas County sites including the Mobile Medical Unit and Safe Harbor Clinic, and I understand that:

a: In exercising any clinical privileges granted, I am constrained by the Florida Department of Health, Pinellas County policies and rules applicable generally and any applicable to the particular situation.

b. Any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actions are governed by the applicable section of

~rrelated doc. umenIB. j t . ~ . . ~ o/~

. ,('>'-Signature · Date

Service Line Medical Director Recommendation

I have reviewed the requested clinical privileges and supporting documentation for the above names applicant and make the following recommendation(s):

,# Recommend all requested privileges

D Recommend all requested privileges with the changes as noted below

• The following privilege(s) are granted with conditions and/or modifications:

Privilege

1.

Condition/Modification

2.

• The following privilege(s) are not granted:

Privilege·

1.

2.

~

Explanation

Family Practice Medical Director Signature

OFFICE USE ONLY

Medical Executive Committee Action: ~Lo«) mecJe:.& Board of Directors Action: ---...,.......------

Date 1

Date

Date -------

;J

Request for Privilegesl Specialty: @:jl"e..t.£J ?'.( <5'

Applicant: Jennifer Griffin, MD

Privileges OFFICE USE ONLY

D Initial Appointment

~ Reappointment

Sites

Effective from: __ / __ / __

Effective to: __ / ___ / __

The applicant may perform granted privileges at any of the Florida Department of Health, Pinellas County Health Center clinics, Mobile Medical Unit and the Bayside Clinic, with the provision that privileg~s only be exercised when appropriate equipment, license, staff and other support are available.

Core Privileges

Family Medicine Core Privileges

':L Requested _ . · . . . . . _ _ · · Evaluate, diagnose, treat, and provide consultatiori to adolescent and

adult patients with illnesses, diseases and functional disorders of the circulatory, respiratory endocrine, metabolic, musculoskeletal, hematopoietic, gastroenteric, and genitourinary systems. Assess, stabilize, and determine disposition of patients with emergency conditions consistent with policy regarding emergencies. The core privileges in this specialty include the procedures on the prbcedure·list and such other procedures that are extensions of the same techniques and skills.

Pediatric Core Privileges

• Criteria Must qualify .for and be granted privileges in family medicine plus

• Required previous experience Demonstrated current competence and evidence of the provision of care, reflective of the scope of privileges requested, to at least 10 pediatric patients in the past 12 months.

• Maintenance of privilege Demonstrated current competence and evidence of the provision of care to at least 25 pediatric patients in the past 24 months based on results of ongoing professional practice evaluation and outcomes.

D Requested Evaluate, diagnose, and treat pediatric patients up to age 18 with common illnesses, injuries or disorders. This includes the care of the normal newborn as well as the uncomplicated premature infant equal to or greater than 36 weeks gestation. Assess, stabilize, and determine disposition of patients with emergency conditions consistent with policy regarding emergencies. The core privileges in this specialty include the procedures on the procedure list and such other procedures that are extensions of the same techniques and skills.

• Criteria Must qualify for and be granted privileges in family medicine plus

• Required previous experience Demonstrated current competence and evidence of provision of care, reflective of the scope of privileges requested to at least 10 gynecologic outpatients in the past 12 months.

• Maintenance of privilege Oemonstrated current competence and evidence of provision of care, reflective of the scope of privileges requested to at least 25 gynecologic outpatients in the past 24 months based on results of ongoing professional practice evaluation and outcomes.

D Requested

Core Procedure List

Evaluate, diagnose, treat and provide consultation to post-pubescent female patients with disorders of the female reproductive system and the genitourinary sy$tem. Assess, stabilize, and determine disposition of patients with emergent conditions consistent with policy regarding emergencies. The core privileges in this specialty include the procedures on the procedure list and such other procedures that are extensions of the same techniques and skills.

This list is a sampling of procedures included in the core. This is not intended to be an al/encompassing list but rather reflective of the categories/types of procedures included in the core. If you wish to exclude any procedures please strike through those procedures that you do not wish to request, initial and date.

General 1. Burn care, minor superficial 2. Incision and drainage abscess

· 3. Perform history and physical exam 4. Remove non-penetrating foreign body from the eye, nose, or ear 5. Suture uncomplicated lacerations 6. Blood Glucose Point of Care Testing 7. Pregnancy Point of CareTesting 8. Urinalysis Point of Care Testing 9. Suture removal 10. Staple removal

Pediatrics 1. lncisioR end d1alnage-eb-sc ... :e.u:s~s __ 2.. PeFferm I 1isto1 y ana pnysleal exam 3. Remove oaa-peRetretil"lg co111eal foreisri body

< 4 s, 1tL.11:e unceFRplieeted lace, ations ~- Urin~irit of Ca,e Testing-

Gynecology 1. Biopsy of Cervix, endometrium Pap) 2. Perform history and physical exam 3. Removal of foreign body from vagina 4. Blood Glucose Point of Care Testing 5. Pregnancy Point of Care Testing 6. Urinalysis Point of Care Testing

I i

• I ;

"'

Acknowledgement of Practitioner

I have. requested only those privileges for which by education, training, current experience, and demonstrated performance I am qualified to perform and that I wish to exercise at designated Florida Department of Health, Pinellas County sites including the Mobile Medical Unit and Safe Harbor Clinic, and I understand that:

a. In exercising any clinical privileges granted, I am constrained by the Florida Department of Health, Pinellas County policies and rules applicable generally and any applicable to the particular situation.

b. Any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actions are governed by the applicable section of the ppr priate policies or related documents.

Date

Service Line Me~ical Director Recommendation

I have reviewed the requested clinical privileges and supporting documentation for the above names applicant and make the following recommendation(s):

%Recommend all requested privileges




2.

• The.following privilege(s) are not granted:

Privilege

1.

2.

Explanation

amily Practice Medical Director Signature

OFFICE USE ONLY

Medical Executive Committee Action: 'tk_~~

Board of Directors Action: ------------

Date 1-25 -\.::J

Date ______ _

Other Licensed or Certified Health Care. Practitioner·

R~quest for Dental Hygienist Privileges

Date: 7/JJ/IJ , I

Print Name: UtJljec L ) ~/2/e-A/ Hire Date: tJ-~ t/-d20tJ(

I hereby requestthe privileges identified above. Furthermore, I am physically and mentally ca a le to perform the above requested privileges.

7/;J/17 Dafe / .

The following recommendation is made to the Governing Board that has authority to grant or deny privileges.

On behalf of the Credentialing and Privileging Committee, the Senior Dentist recgmmends that: Privileges for · ,:f6'(·~ C)' 13 ~, ~N · at the Florida Department of Health, Pinellas County Health Centers, Mobile Medical Unit and Bayside Clinic are: ,/ Approved ___ Approved with modifications Denied

Modifications:

Pedro P. Lense, D.M.D.

Senior Dentist Printed Name

. ~&-~ -tist Signature -.:.::::::: · Date

Other Licensed or Certified Health Care Practitioner

Request for Dental Hygienist Privileges

Date: ·3:18 -1 ·9: Print Name: frN1 E-Z,4 .rs LA lLl.1-

10 - :J L( - ·1'1 Hire Date:

Oral H iene ln.structions Sealants Scalin and Root Planin Full Mouth Debridement Local Anesthetic

(., ....... -

1. .• /

I hereby request the privileges identified above. Furthermore, I am physically and mentally capable to perform the above requested privileges.

~ . a A\fil..&l& A~\Wgnature

"1:~l ~ .-l' Date

The following recommendation is made to the Governing Board that has authority to grant or deny privileges.

On behalf of the redentialilJ.9 and Privileging Committee, the Senior Dentist recommends that: Privileges for " J .. U. 5\ at the Florida Department of Health, Pin~s County Healt Centers, Mobile Medical Unit and Bayside Clinic are: \.L. Approved _ Approved with modifications _ Denied

Modifications:

fD----SeniofDentistPrinted Name

---=~-=-----""---·····_---~----------1 ........... L.\ ____ ' _fil..._. .::\--( \~ ( ' )--. Senior Dentist Signature Date

Request for Privileges Specialty: Dentist

Applicant: Ho.ycheH 5araqdet( t)O~:

Privileges OFFICE USE ONLY

Effective from:_/ __ / __

Effective to: __ / __ / __

Sites

D Initial Appointment

b( Reappointment

The applicant may perform granted privileges at any of the Florida Department of Health, Pinellas County Health Center c!inics, Mobile Medical Unit and the Safe Harbor Clinic, with the provision that privileges only be exercised when appropriate equipment, license, staff and other support are available. ·

Core Privileges ·

Family 8 Core Privileges

( Requested

Evaluate, prevent, diagnose, and treat adolescent and adult patients with diseases, · disorders and conditions of the oral cavity, commonly in the dentition but also the oral m.ucosa, and of adjacent and related structures and tissues, particularly in the maxillofacial Gaw and facial) area.

Assess, stabilize, and determine disposition of patients'with emergency conditions consistent with policy regarding emergencies. The core privileges in this specialty include the procedures on the procedure list and such other procedure~ that are extensions of the same techniques.and skills.

Pediatric Dental Core Privileges

• Criteria Must qualify for and be granted privileges in family dental plus

• Required previous experience Demonstrated current competence and evidence of th~ provision of care, reflective of the scope of privileges requested, to at least 10 pediatric patients in the past 12 months. · · ·

• Maintenance of privilege Demonstrated current competence and evidence of the provision of care to at least 25 pediatric patients in the past 24 months based on results of ongoing professional practice evaluation and outcomes.

1 .,

. j

. ! '

I I r--

b( Requested

Evaluate, prevent, diagnose and treat pediatric patients up to 18 with diseases, disorders and conditions of the oral cavity, commonly in the dentition but also the oral mucosa, and of adjac~nt and related structures and tissues, particularly in the maxillofacial Oaw and facial) area. This includes the care of the normal newborn as well as the uncomplicated premature infant equal to or greater than 36 weeks gestation.

Assess, stabilize, and determine disposition of patients with emergency conditions consistent with policy regarding.emergencies. The core privileges in this specialty include the procedures on the pro9edure list and such other procedures that are extensions ofthe same techniques and skills.

Core Procedure List This list is a -sampling of procedures included in the core. This is not intended to be an al/encompassing list but rather reflective of the categories/types of procedures included in the core. If you wish to exclude any procedures please strike through those procedures that you do not wish to request, initial and date.

General 1. Comprehe_nsive/New Patient Exam 2. Periodic/Recall Exam 3. Limited Exam (Emergencies) 4. Bitewing Radiographs 5. Periapical Radiographs 6. Panoramic Radiograph 7. Adult and Adolescent Prophylaxis 8. Fluoride Varnish Application 9. Oral Hygiene lnstruptions 10. Sealants (Molars only) 11, Space Maintainers 12. Amalgams-Posterior . 13. Composites-Anterior and Posterior 14. Stainless Steel Crowns-Primary Teeth only. 15. Pulp Cap-Indirect and Direct 16. Pulpotomy-Primary Teeth 17. Scaling and Root Planning 18. Full Mouth Debridement 19. Extractions-Simple and Surgical 20. Sedative Fillings 21. Blood Pressure Readings 22. Post-Opera_tive Consultation 23. Local Anesthetic · 24. Behavioral Management

Pediatrics 1. Comprehensivf?/New Patient Exam 2. Periodic/Recall Exam 3. Limited Exam (Emergencies) 4. Bitewing Radiographs 5. Periapical Radiographs 6. Panoramic Radiograph 7. Pediatric Prophylaxis· 8. Fluoride Varnish Application 9. Oral Hygiene Instructions 10. Sealants (Molars only) 11. Space Maintainers 12. Amalgams-Posterior 13. Composites,-Anterior and Posterior 14. Stainless Steel Crowns-Primary Teeth only 15. Pulp Cap-Indirect and Direct · 16. Pulpotomy-Primary Teeth 17. Scaling and Root Planning 18. Full Mouth Debridement 19. Extractions-Simple and Surgical 20. Sedative Fillings 21. Blobd Pressure Readings 22. Post-Operative Consultation 23. Local Anesthetic 24. Behavioral Management

I I

I I

~

i r

Acknowledgement of Practitioner

I have requested only those privileges for which by education, training, current experience, and demonstrated performance I am qualified to perform and that I wish to exercise at designated Florida Department of Health, Pinellas County sites including the Mobile Medical Unit and Safe Harbor Clinic, and I understand that:

a. In exercising any clinical privileges granted, I am constrained by the Florida Department of Health, Pinellas County policies and rules applicable generally and any applicable to the particular situation.

b. Any restriction on the clinical privileges granted to me is waived in an emergency situation and in such situation my actions are governed by the applicable section of the appropriate policies or related documents. ·

. /Ir . ~) . . -rltBI ,, Si~ j::P Date

. .

Service Line Sr. Dentist Recommendation

I have reviewed the requested clinical privileges and supporting documentation for the above names applicant and make the following recommendation(s): f. Recommend all requested privileges



Privilege

1.


2.

• The following privilege(s) are not granted:

Privilege

1.

Explanation

s ~-:-:-t-------1s 1gna ure

OFFICE USE ONLY

Date

Medical Executive Committee Action: 8c; t om N)e.Jx:"et?\ Date l ,'2. S -) i

Board of Directors Action:---------- Date _____ _ ;i i ! i i i '

TAB 2 – GOVERNANCE/OPERATIONS

• HRSA Site Visit Debriefing • Strategic Planning/Communications

o June E-news • Monthly Calendar • Client Satisfaction Survey Results

1

Chapter - Topic Demonstrating Compliance Status Reason for Non-Compliance

1 - N

eeds

As

sess

men

t

The health center identifies and annually reviews its service area1 based on where current or proposed patient populations reside as documented by the ZIP codes reported on the health center’s Form 5B: Service Sites. In addition, these service area ZIP codes are consistent with patient origin data reported by ZIP code in its annual Uniform Data System (UDS) report. The health center completes or updates a needs assessment of the current or proposed population for the purposes of informing and improving the delivery of health center services.

Met Not Applicable

The health center provides access to all services included in its HRSA-approved scope ofproject (Form 5A: Services Provided) through one or more service delivery methods defined as "DIRECTLY" (service is provided directly by the health center); "FORMAL CONTRACT/AGREEMENT" (health center pays vendor/subrecipients); or "FORMAL REFERRAL ARRANGEMENTS" (health center refers, does not pay entity). Agreements must reflect how the services is documented in the patient's health center record; how the health center will pay for the service; the manner by which referrals will made and managed; and the process for tracking and referring patients back to the health center for apprporiate follow-up care.

Health center patients with limited English proficiency are provided with interpretation and translation (for example, through bilingual providers, on-site interpreters, language telephone line) that enables them to have reasonable access to health center services.

The health center makes arrangements and/or provides resources that enable its staff to deliver services in a manner that is culturally sensitive and bridges linguistic and cultural differences.

The health center’s staffing plan ensures that clinical and related support staff are in place to carry out all required and additional services included in the HRSA-approved scope of project.

The health center has considered the size, demographics, and health needs (for example, large number of children served, high prevalence of diabetes) of its patient population in determining the number and mix of clinical staff necessary to ensure reasonable patient access to health center services.

The health center has operating procedures for the initial and recurring review (for example, every two years) of credentials for all clinical staff members who are health center employees, individual contractors, or volunteers.

The health center has operating procedures for the initial granting and renewal (for example, every two years) of privileges for clinical staff members who are health center employees, individual contractors, or volunteers.

The health center maintains files or records for its clinical staff (employees, individual contractors, and volunteers) that contain documentation of licensure and credentialing verification and recording of privileges, consistent with operating procedures.

The health center’s contracts with provider organizations (for example, group practices, staffing agencies) and formal, written referral agreements with other provider organizations, and contain required provisions.

2 - R

equi

red

and

Addi

tiona

l Ser

vice

s

Not Met

1) We have services identified in Column I (Directly) that are not provided by HS Staff. All areas checked in Column A need to be reviewed and remove the "x"

if appropriate.

2) Some services need to be moved to Column II (i.e. Transportation); some services need to be removed

from Column II and moved to Column III and vice versa.

3) All contracts (Column II) and MOUs (Column III) need to include language related to referral tracking

and referral back to the health center)

3 - C

linic

al S

taff

ing

Not Met

1) Contracted Organizations (i.e. Behavioral Health Organizations) are not credentialed

according to HRSA Standards and/or not documented in files, contracts, or policy.

2) Privileges have not formally be granted by the Board, due to no documentation of

request for privileges shared with board; no minutes documenting "the granting of

privileges"

2

Chapter - Topic Demonstrating Compliance Status Reason for Non-ComplianceThe health center’s service site(s) are accessible to the patient population relative to where this population lives or works (for example, at migrant camps for health centers targeting agricultural workers, in areas immediately accessible to public housing for health centers targeting public housing residents). Specifically, the health center has considered the following factors to ensure the accessibility of its sites:

Access barriers (for example, barriers resulting from the area's physical characteristics, residential patterns, or economic and social groupings); and Distance and time taken for patients to travel to or between service sites in order to access the health center’s full range of in-scope services.

The health center’s total number and scheduled hours of operation of its service sites are responsive to patient needs by facilitating their ability to schedule appointments and access services1 (for example, a health center service site might offer extended evening hours 3 days a week based on input or feedback from patients who cannot miss work for appointments during normal business hours).

The health center accurately records the sites in its HRSA-approved scope of project on its Form 5B: Service Sites in the HRSA’s Electronic Handbooks (EHB).

The health center has the clinical capacity to respond to patient medical emergencies at all health center service sites (as documented on Form 5B: Service Sites) during the health center’s regularly scheduled hours of operation by having at least one staff member certified in basic life support skills present at each HRSA-approved service site.

The health center has and follows its applicable operating procedures when responding to patient medical emergencies during regularly scheduled hours of operation.

The health center has after-hours coverage operating procedures, which may include other formal arrangements with non-health center providers/entities

The health center has documentation of after-hours calls and any necessary follow-up resulting from such calls for the purposes of continuity of care.

The health center has Provider employment contracts or other appropriate documentation that address the delivery of care in a hospital setting to health center patients, including hospital admitting for those health center providers who have such privileges; and/or Formal arrangements between the health center and non-health center provider(s) or entity(ies) (for example, hospital, hospitalists, obstetrics group practice) that address health center patient admissions.

The health center has internal operating procedures and, if applicable, related provisions in its formal arrangements with non-health center provider(s) or entity(ies) that address tracking and follow-up of patients who are hospitalized as inpatients or who visit a hospital’s emergency department.

The health center follows its operating procedures and written agreements as documented by receipt and recording of notifications to the health center of patient hospitalization or emergency department visits and of patient discharges; Receipt and recording of medical information from non-health center providers, such as discharge follow-up instructions and laboratory, radiology, or other results; and Evidence of follow-up actions taken by health center staff based on the information received, when appropriate.6

- Con

tinui

ty o

f Car

e an

d Ho

spita

l Ad

mitt

ing

Met Not Applicable

4 - A

cces

sible

Loc

atio

ns a

nd

Hour

s of O

pera

tion

Met Not Applicable

5 - C

over

age

for M

edic

al

Emer

genc

ies

Durin

g an

d Af

ter H

ours

Met Not Applicable

3

Chapter - Topic Demonstrating Compliance Status Reason for Non-ComplianceThe health center has a sliding fee discount program that applies to all required and additional services within the HRSA-approved scope of project, for which there are distinct fees.

The health center has board-approved policies for its sliding fee discount program that apply uniformly to all patients and address the HRSA required areas for assessment based on income and family size (including definitions).

The health center has operating procedures for and records of assessing/re-assessing patients for income and family size (unless the patient declines/refuses to be assessed)consistent with board-approved policies.

The health center has mechanisms for informing patients of the availability of sliding fee discounts (for example, using materials in language(s) and literacy levels appropriate forth patient population).

The health center evaluates its sliding fee discount program to ensure its effectiveness in reducing financial barriers to care and to identify and implement changes as needed.

The health center’s SFDS(s) is structured consistent with board-approved policy and provides discounts as follows: A full discount is provided for individuals and families with annual incomes at or below 100 percent of the current FPG, unless a health center elects to have a nominal charge. Partial discounts are provided for individuals and families with incomes above 100percent of the current FPG and at or below 200 percent of the current FPG that adjust in accordance with income (for example, three (3) to five (5) discount pay classes based on gradations in income levels above 100 percent of the FPG and at or below 200 percent of the FPG). No discounts are provided to individuals and families with annual incomes above200 percent of the current FPG.

The health center has board-approved policies that establish a QI/QA program and procedures to address adherence to current evidence-based clinical guidelines, and processes for identifying, analyzing and addressing patient safety, patient satisfaction, hearing and resolving grievences; produces and shares reports to support decision making by the staff and board; completes QI/QA assessments and has a process for modifying services based on the findings.

The health center’s physicians or other licensed health care professionals conduct QI/QA assessments using data systematically collected from patient records.

The health center designates an individual(s) to oversee the QI/QA program. This individual's responsibilities would include, but not be limited to ensuring the implementation of QI/QA operating procedures and completion of QI/QA assessments, monitoring QI/QA outcomes, and updating QI/QA operating procedures.

The health center maintains a retrievable health record (for example, the health center has implemented a certified Electronic Health Record) for each patient, the format and content of which is consistent with both federal and state laws and requirements.

The health center has systems and procedures for protecting the confidentiality of patient information and safeguarding this information against loss, destruction, or unauthorized use, consistent with federal and state requirements.

The health center has determined the makeup of its key management staff and the percentage of time dedicated to the health center project for each position, as necessary to carry out the HRSA-approved scope of project.

The health center has identified the training and experience qualifications for each key management staff position in position descriptions.

The health center has implemented a process for filling open key management positions(for example, vacancy announcements have been published and reflect the identified qualifications).

The health center’s Project Director/CEO reports to the health center’s governing board and is responsible for overseeing other key management staff in carrying out the day-to-day activities necessary to fulfill the HRSA-approved scope of project.

8 - Q

ualit

y Im

prov

emen

t/As

sura

nce

Met Not Applicable

9 - K

ey M

anag

emen

t Sta

ff

Met 1) Recommend to include County Staff % of time in Non-Federal Budget

7 - S

lidin

g Fe

e Di

scou

nt P

rogr

am

Not Met

1) The SFDS Policy does not include a definition of family size or income.

2) Remove frequency of re-eligibility

3) Reference "all services in the scope of project" rather than just medical.

4) Contracts with providers must include language that they will offer a SFDS the same

or better than what we offer.

4

Chapter - Topic Demonstrating Compliance Status Reason for Non-ComplianceThe health center’s contracts and subawards that support the HRSA-approved scope of project include provisions that address performance; Requirements for the contractor or subrecipient to provide data necessary to meet the recipient’s applicable federal financial and programmatic reporting requirements, as well as provisions addressing record retention and access, audit, and property management; the specific activities or services to be performed or goods to be provided; Requirements that all costs directly attributable to the federal grant are allowable consistent with Federal Cost Principles; the integration of applicable requirements of the Health Center Program (for example, sliding fee discounts, credentialing and privileging); and The applicability of distinct statutory, regulatory, and policy requirements for health centers that participate in other Federal programs associated with their HRSA-approved scope of project (for example, FTCA coverage, reimbursement as a Federally Qualified Health Center (FQHC) under Medicare/ Medicaid/Children’s Health Insurance Program, 340B Program drug discount pricing as an FQHC).

The health center retains final subrecipient agreements, contracts, and related records consistent with federal document maintenance requirements.

The health center has written procurement procedures that comply with federal procurement standards.

The health center has access to contractor records and reports related to health center activities in order to ensure that all activities and reporting requirements are being carried out in accordance with the provisions and timelines of the related contract (for example, performance goals are achieved, Uniform Data System (UDS) data is submitted by appropriate deadlines, funds are used for authorized purposes).

If the health center makes subawards, it monitors the activities of the subrecipient to ensure that the subaward is used for authorized purposes and that the subrecipient maintains compliance with all applicable requirements specified in the Federal award(including those found in section 330 of the PHS Act, implementing program regulations, Health Center Federal Tort Claims Act (FTCA) Program requirements (where applicable),and grants regulations in 45 CFR Part 75).

The health center documents its efforts to coordinate and integrate activities with other providers or programs in the service area (for example, social service organizations, specialty practices, hospitals) in order to support patient continuity of care across community providers; and access to services that are beyond the scope of the health center.

The health center documents its efforts to collaborate with other primary care providers serving similar patient populations in the service area (at a minimum, this would include establishing and maintaining relationships with other health centers in the service area).

The health center has and utilizes a financial management and internal control system that reflects GAAP for private non-profit health centers or Government Accounting Standards Board (GASB) principles for public agency health centers.

The health center’s financial management system is able to account for all Federal award(s) (including Federal awards made under the Health Center Program) in order to identify the source4 (receipt) and application (expenditure) of funds for federally-funded activities. Specifically, the health center’s financial records contain information and related source documentation pertaining to authorizations, obligations, unobligated balances, assets, expenditures, income, and interest under the Federal award(s).

The health center has written procedures for Implementing the Federal Payment Management System requirements in 45 CFR75.305; and Assuring that costs expended under the award are allowable in accordance with the terms and conditions of the Federal award and with the Federal CostPrinciples5 in 45 CFR Part 75 Subpart E.

If a health center expends $750,000 or more in award funds from all federal sources during its fiscal year, the health center ensures a single or program-specific audit is conducted and submitted for that year in accordance with the provisions of 45 CFR Part75, Subpart F: Audit Requirements and ensures that subsequent audits demonstrate corrective actions have been taken to address all findings, questioned costs, reportable conditions, and material weaknesses cited in the previous audit report, if applicable.

The health center can document that any non-grant funds generated from health center activities in excess of what is necessary to support the HRSA-approved total health center project budget were utilized to further the objectives of the project by benefiting the current or proposed patient population and were not utilized for purposes that are specifically prohibited by the Health Center Program.12

- Fi

nanc

ial M

anag

emen

t and

Acc

ount

ing

Syst

ems

Met 1) Recommend to share the County Audit with the HCH Co-Applicant Board

10 -

Cont

ract

s and

Sub

awar

ds

Met Not Applicable

11 -

Colla

bora

tive

Rela

tions

hips

Met Not Applicable

5

Chapter - Topic Demonstrating Compliance Status Reason for Non-ComplianceThe health center has a fee schedule for services that are within the HRSA-approved scope of project and that are typically billed for in the local health care market.

The health center uses data on locally prevailing rates and health center costs to develop /update its fee schedule.

The health center participates in Medicaid, CHIP, Medicare, and as appropriate, other public or private assistance programs or health insurance.

The health center has systems, which may include operating procedures for billing and collections.

The health center has billing records that show claims are submitted in a timely and accurate manner to the third party payor sources with which it participates (Medicaid, CHIP, Medicare, and other public and private insurance) in order to collect reimbursement for its costs.

The health center has and utilizes board-approved policies and operating procedures that address the waiving or reducing of amounts owed by patients due to a patient's specific circumstances related to inability to pay.

The health center has billing records or other forms of documentation that reflect that the health center charges patients in accordance with its fee schedule and, if applicable, the sliding fee discount schedule; and Makes reasonable efforts to collect such amounts owed from patients.

If a health center provides supplies or equipment that are related to, but not included in the service itself as part of prevailing standards of care (for example, eyeglasses, prescription drugs, including those purchased under discount programs, dentures) and charges patients for these items, the health center informs patients of such charges(“out of pocket costs”) prior to the time of service.

If a health center elects to limit or deny services based on a patient’s refusal to pay, the health center has a board-approved policy that distinguishes between refusal to pay and inability to pay.

The health center develops and submits to HRSA (for new or continued funding or designation from HRSA) an annual operating budget, also referred to as a “total budget,”, that reflects projected costs and revenues necessary to support the health center's proposed or HRSA-approved scope of project.

In addition to the Federal Health Center Program award, the health center’s annual operating budget includes all other projected revenue sources that will support the health center project (i.e. fees, premiums, reimbursements, revenues from state, local or other federal grants; private support or income)

The health center’s annual operating budget identifies the portion of projected costs to be supported by the federal Health Center Program award. Any proposed costs supported by the federal award are consistent with the Federal Cost Principles and the terms and conditions of the award.

The health center has a system in place for monitoring program performance to ensure oversight of the operations of the Federal award-supported activities in compliance with applicable Federal requirements and that performance expectations are being achieved.

The health center produces data-based reports on patient service utilization and trends and patterns in the patient population1, as necessary to inform and support decision-making and oversight by the health center’s key management staff and the governing board.

Is the health center’s scope of project accurate, in terms of services and sites observed while onsite, when compared to the approved scope of project as documented by the health center on its current Form 5A and Form 5B .

Has the grantee received any additional BPHC grant awards in the last 3 years that have expanded its funded scope of project (e.g., New Access Point, Service Expansion, Expanded Medical Capacity)? If yes, has the grantee successfully implemented the newly funded activity(ies) within the expected timeframe (e.g., hired new staff, expanded services, opened new sites, begun or completed minor alterations and renovations, as applicable)?

16 -

Scop

e

Not Met 1) Form 5A Check boxes not accurate

14 -

Budg

et

Met 1) Recommend include % of County staff in budget non-federal share

15 -

Prog

ram

Mon

itorin

g an

d Da

ta R

epor

ting

Syst

ems

Not Met

1) Financial Reports are not given to the Board to assist in informed decision making

2) Continue implementation of Clinical Quality Sub-Committee to review clinical

measures quarterly

13 -

Billi

ngs a

nd C

olle

ctio

ns

Not Met1) Waiving of Charges Policy does not reflect the "reason" for which the health center will

waive charges (i.e. homelessness)

6

Chapter - Topic Demonstrating Compliance Status Reason for Non-ComplianceThe health center’s organizational structure, articles of incorporation, bylaws, and other relevant documents ensure the health center governing board maintains the authority for oversight of the health center project and is confirmed in its board minutes. (For public agencies with a co-applicant board, the health center has a co-applicant agreement that delegates the required authorities and functions to the co-applicant board and delineates the roles and responsibilities of the public agency and the co-applicant in carrying out the health center project.)

The health center’s bylaws outline the following required authorities and responsibilities of the governing board Holding monthly meetings; Approving the selection (and termination or dismissal, as appropriate) of the health center’s Project Director/CEO; Approving the health center’s annual budget and applications; Approving health center services and the location and hours of operation of health center sites; Evaluating the performance of the health center; Establishing or adopting policy related to the operations of the health center; and Assuring the health center operates in compliance with applicable Federal, State, and local laws and regulations.

The health center board has adopted, evaluated at least once every three years, and, as needed, approved updates to policies in the following areas: Sliding Fee Discount Program, Quality Improvement/Assurance Program, and Billing and Collections.

The health center board has adopted, evaluated at least once every three years, and, as needed, approved updates to Financial Management and Personnel policies. However, in cases where a public agency is the recipient of the Health Center Program Federal award or designation, the public agency may establish and retain the authority to adopt and approve financial management and personnel policies.

The health center has bylaws or other relevant documents that specify the process for ongoing selection and removal of board members.

The health center has bylaws and documentsthre required board composition elements as follows:

Board size is at least 9 and no more than 25 members, with either a specific number or a range of board members prescribed; At least 51 percent of board members are patients served by the health center. For the purposes of board composition, a patient is an individual who has received at least one service in the past 24 months that generated a health center visit, where both the service and the site where the service was received are within the HRSA-approved scope of project; Patient members of the board, as a group, reasonably represent the individuals who are served by the health center in terms of demographic factors, such as race, ethnicity, and gender; Non-patient members are representative of the community served by the health center or the health center’s service area; Non-patient members are selected to provide relevant expertise and skills such as Community affairs; local governent, Finance and Banking, Legal Affairs, Trade Unions and other commercial and industrial concerns; and Social services. No more than one-half of non-patient board members derive more than 10percent of their annual income from the health care industry; and Health center employees,10 individual contractors working for the health center, and immediate family members (i.e. spouses, children, parents, or siblings through blood, adoption, or marriage) of employees may not be health centerboard members.

The health center has bylaws or other relevant documents requiring a quorum of not less than 51 percent of board members (absent a different quorum requirement in state law).

The health center verifies periodically (for example, annually or during the selection or renewal of board member terms) that the governing board does not include members who are current employees of the health center, immediate family members of current health center employees, or individual contractors currently working for the health center.

Health centers requesting a waiver of the patient majority board composition requirements present to HRSA for review and approval: “Good cause” that justifies the need for the waiver by documenting the unique characteristics of the population (homeless, migratory or seasonal agricultural worker, and/or public housing patient population)or service area that create an undue hardship in recruiting a patient majority; and its attempts to recruit a majority of special population board members and why these attempts have not been successful; and

Strategies that will ensure patient participation and input in the direction and ongoing governance of the organization For health centers with approved waivers, the health center has board minutes or other documentation that demonstrates how special population patient input is utilized in making governing board decisions in key areas as addressed in the health center's waiver request.

18 -

Boar

d Co

mpo

sitio

n

Not Met (After review by PO, this was overturned)

1) No Race/Ethnicity Data

2) Recommend getting closer to gender balance

17 -

Boar

d Au

thor

ity

Not Met

1) Co-App Board not receiving financial data

2) Share the County Audit with the Board

3) Co-App Board not granting privileges on C&P

7

Chapter - Topic Demonstrating Compliance Status Reason for Non-ComplianceThe health center has and implements written standards of conduct applicable to all health center employees, officers, and agents regarding the selection, award, or administration of contracts that: Require written disclosure of any conflicts of interest related to procurements; Prohibit individuals with actual or apparent conflicts of interest from participating in the selection, award, or administration of the contract;4 Restrict health center employees, officers, and agents from soliciting or accepting gratuities, favors, or anything of monetary value from contractors or parties to sub-agreements (including subrecipients or affiliation organizations);and Enforce disciplinary actions on health center employees, board members, and agents for violating these standards.

If the health center has a parent, affiliate, subsidiary, or subrecipient organization (that is not a State, local government, or Indian tribe), the health center has and implements written standards of conduct covering organizational conflicts of interest5 that might arise when conducting a procurement action involving a related organization. These standards of conduct require: Written disclosure of conflicts of interest that arise in procurements from a related organization; and Avoidance and mitigation of any identified actual or apparent conflicts during the procurement process.

The health center has mechanisms or procedures for informing its employees, officers, and agents of the health center’s standards of conduct covering conflicts of interest, including organizational conflicts of interest, and governing their actions with respect to the selection, award and administration of contracts.

In cases where a conflict of interest was identified, the health center’s procurement records document adherence to its standards of conduct (for example, an employee whose family member was competing for a health center contract was not permitted to participate in the selection, award, or administration of that contract).

19 -

Conf

lict o

f Int

eres

t

Met1) Recommend asking at start of HCH Co-

App Board meeting of any conflicts; document in minutes

1

DeGregorio, Elisa N

Subject: August 2017 E-News - Health Care for the Homeless Program, Pinellas CountyAttachments: Calendar - Aug 2017.pdf; The Ten Screening Criteria to Qualify Referral SOAR Program

6.27.17.pdf

HEALTH CARE FOR THE HOMELESS PROGRAM MOBILE MEDICAL UNIT & BAYSIDE HEALTH CLINIC

AUGUST 2017 Welcome to the Pinellas County’s Health Care for the Homeless Program Monthly Update. This monthly publication will deliver the monthly calendar, announcements and upcoming events for the Health Care for the Homeless program. The Pinellas County Human Services Department and our partners at the Florida Department of Health are committed to providing quality care for our County’s homeless residents. Please pass this on to those in your organization who will benefit from the information. If you were forwarded this email by a friend, subscribe here. If you wish to be removed from this list, please reply with the word “Remove” in the subject line.

Monthly Calendar The August Calendar for the Mobile Medical Unit and Bayside Health Clinic is attached. After Hours Help: Clients have access to an on‐call physician or nurse after regular business hours through the Florida Department of Health by calling the clinic’s main phone # 727‐453‐7866.

Announcements

DID YOU KNOW? People who are homeless have higher rates of chronic disease and live on average 12 years less than the general US population (66.5 vs. 78.8 years)* See the attached infographic for more information on healthcare for homeless individuals.

Bay Area Legal Services Representative Available at Bayside Health Clinic – August 17, 2017 from 4:00 pm – 7:00 pm Bay Area Legal Services will co‐locate at Bayside Health Clinic the third Thursday each month from 4pm – 7pm to provide screenings and referrals for legal services. The partnership will assist clients of Bayside Health Clinic who are seeking support on issues such as: domestic violence, foreclosure, senior advocacy, family law, public benefits, housing and tax assistance.

NEW 10‐STEP CRITERIA FOR DETERMINING REFERRALS FOR SSI/SSDI Outreach, Access, and Recovery (SOAR) Program To clarify the criteria for a person to qualify for the SOAR Program, a 10‐question pre‐screening criteria form has been created. Please see attached. Pinellas County residents who are identified by referral or community outreach as homeless and those who also have a mental health, substance abuse disorder, and/or a co‐occurring medical impairment may be eligible to receive SSI/SSDI benefits. The SOAR target population is not limited to individuals’ already receiving homeless, health, or behavioral health services and include individuals referred by community stakeholders for SOAR assistance. SOAR offers hope to those who are mentally and physically wounded by a traumatic life change through a care connection of compassion, guidance, and support. The

2

individual must have a significant mental health or physical disability that meets SSA criteria from the Blue Book and meets functional restrictions. They must also have a diagnosis from a physician, psychiatrist, or psychologist with 1‐2 years of medical records. We cannot submit a social security application without meeting criteria or without these medical records.

The County has SOAR trained Disability Advocacy Specialists available at Safe Harbor and Human Services locations – learn more. There are also four SOAR Benefit Specialist with the Directions for Living (DFL) SOAR Program for Pinellas County ready to assist. Two benefit specialist are located at the DFL Clearwater Center and two are located at the Public Defender’s Office with the Jail Diversion Program. See the attached flyer for distribution or call (727) 524‐4464 for more information.

Upcoming Events

Tues., August 1, 2017, 3pm – 5pm HCH Co‐Applicant Board Meeting Thurs., August 17, 2017, 4pm – 7pm Bay Area Legal Services Representative @ Bayside Health Clinic

HCH Co‐Applicant Board (formerly Mobile Medical Unit Advisory Council)

NEXT MEETING – AUGUST 1, 2017 @ 3:00 pm The Next Meeting of the HCH Co‐Applicant Board will be Tuesday, August 1, 2017 @ 3:00 pm, Juvenile Welfare Board, 14155 58th Street North, Clearwater FL 33760 | ROOM 185 | Current Agenda‐Meeting Minutes/Supporting Documents The HCH Co‐Applicant Board is the governing board for the Health Care for the Homeless Program. Community feedback and consumer participation is key to the success of the program…come join the discussion. Meetings are held the first Tuesday of every month at 3:00 pm at the Juvenile Welfare Board office. We are currently seeking new members…if you know a patient who wants to have input into the program, please contact Daisy Rodriguez for more information.

If you were forwarded this email by a friend, subscribe here. If you wish to be removed from this list, please reply with the word “Remove” in the subject line. Elisa N. DeGregorio Grants Manager, Planning & Contracts Services Department of Human Services Pinellas County 440 Court Street Clearwater, FL 33756 TEL: (727) 464‐8434 [email protected] Follow Pinellas County:

www.pinellascounty.org Subscribe to county updates and news All government correspondence is subject to the public records law.

August 2017 Mobile Medical Unit Calendar Monday Tuesday Wednesday Thursday Friday

1 St Petersburg SVDP Center of Hope 401 15th Street North

St. Petersburg, FL 33713 8:30am –5:00 pm

HCH Board Meeting 3:00 pm JWB

2 Clearwater Pinellas Hope

5726 126th Ave. North Clearwater, FL 33760

8:30am –5:00 pm

3 St. Petersburg Salvation Army ARC

5885 66th St. North St. Petersburg, FL 33709

8:30am –5:00 pm

4 St. Petersburg Salvation Army One Stop

1400 4th St. South St. Petersburg, FL 33701

8:30am – 4:00 pm

7 Clearwater

SVDP Soup Kitchen 1340 Pierce Street

Clearwater, FL 33756 8:30am – 12:30 pm

HEP 1051 Holt Ave

Clearwater, FL 33755 1:30pm – 5:00 pm





8:30am –5:00 pm



8:30am –5:00 pm



8:30am – 4:00 pm

14 Clearwater SVDP Soup Kitchen 1340 Pierce Street


HEP 1051 Holt Ave






8:30am – 5:00 pm



8:30am – 5:00 pm



8:30am – 4:00 pm



Staff meeting 1:00 pm -4:00 pm





8:30 am–5:00 pm



8:30am – 5:00 pm



8:30am – 4:00 pm



HEP 1051 Holt Ave






8:30 am–5:00 pm



8:30am – 5:00 pm

**No Appointment Necessary--Walk-ups Preferred** Last appointment 30 minutes before closing time

www.pinellascounty.org/humanservices/hch 727-453-7866

http://www.pinellascounty.org/humanservices/hch.htm

.

August 2017 Bayside Health Clinic Calendar

14808 49th St. No. Clearwater, FL 33762

Monday Tuesday Wednesday Thursday Friday Saturday

1 Clearwater Bayside Clinic

8:00 am - 8:00 pm HCH Board Meeting

3:00 pm JWB


8:00 am – 8:00 pm


8:00 am – 8:00 pm


8:00 am – 5:00 pm


8:00 am- 12:00 pm


8:00 am - 8:00 pm


8:00 am - 8:00 pm


8:00 am - 8:00 pm 10 Clearwater

Bayside Clinic 8:00 am - 8:00 pm


8:00 am – 5:00 pm 12 Clearwater

Bayside Clinic 8:00 am- 12:00 pm


8:00 am – 8:00 pm


8:00 am - 8:00 pm


8:00 am – 8:00 pm


8:00 am – 8:00 pm

Bay Area Legal 4 pm to 7pm



Bayside Clinic 8:00 am- 12:00 pm


8:00 am – 12:00 pm 4:00 pm to 8:00 pm

Staff meeting 1:00 pm -4:00 pm


8:00 am -8:00 pm


8:00 am – 8:00 pm



Bayside Clinic 8:00 am – 5:00 pm


8:00 am- 12:00 pm



Bayside Clinic 8:00 am -8:00 pm


8:00 am -8:00 pm

**No Appointment Necessary--Walk-ups Preferred** Last appointment 30 minutes before closing time

www.pinellascounty.org/humanservices/hch 727-453-7866

http://www.pinellascounty.org/humanservices/hch.htm

Pinellas County l HCHP

Patient Satisfaction Survey Results Report July 2017: Total surveys = 67

2%

7%

32%

60%

84% 84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Never Sometimes Usually Always

1. How often did you get an appointment as soon as you needed?

10

1

4

18

34

0

5

10

15

20

25

30

35

40

N/A Never Sometimes Usually Always

How often did you get an appointment as soon as you needed?



10

1 10 0

7

10 0

10 0 0 0 0 0 0 0

4

01 1

0

2

0 0 0

18

21

01

10

2

0 0

34

11

21

9

3

6

0 00

5

10

15

20

25

30

35

40

Total Answers SVDP St Pete SVDP Clearwater SA 1 - Stop SA ARC Bayside Pinellas Hope HEP Tarpon





15%12%

18%

56%

75% 75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


2. If you phoned after normal business hours, how often did you get an answer to your medical

question as soon as you needed?

33

54

6

19

0

5

10

15

20

25

30

35


2. If you phoned after normal business hours, how often did you get an

answer to your medical question as soon as you needed?



33

7

2

0

4

16

3

0 0

5

2

01

01

0 0 0

4

0 01

0

21

0 0

6

1 10

1 10 0 0

19

4

2

0

5

2

5

0 00

5

10

15

20

25

30

35


2. If you phoned after normal business hours, how often did you get an answer to your medical question as soon as you needed?




0%2%

17%

81%

90% 90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


3. How often did the doctor explain things in a way that was easy to understand?

8

0 1

10

48

0

10

20

30

40

50

60


3. How often did the doctor explain things in a way that was easy to

understand?



8

10 0 0

6

10 00 0 0 0 0 0 0 0 0

10 0 0 0

10 0 0

10

12

01

3

0 0 0

48

12

32

9

12

8

0 00

10

20

30

40

50

60






0%

5%

13%

82%

92% 92%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


4. How often did staff listen to you carefully and show respect for what you had to say?

5

0

3

8

49

0

10

20

30

40

50

60


4. How often did staff listen to you carefully and show respect for what

you had to say?



5

0 0 0 0

4

10 00 0 0 0 0 0 0 0 0

3

0 0 01

20 0 0

8

12

0 0

3

0 0 0

49

13

32

9

12

7

0 00

10

20

30

40

50

60






2%5%

7%

86%90% 90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


5. If you had a blood test, x-ray or other test, how often did someone follow up to give you the

results?

24

12

3

36

0

5

10

15

20

25

30

35

40


5. If you had a blood test, x-ray or other test, how often did someone follow up to give you the results?



24

6

10

4

10

2

0 01

01

0 0 0 0 0 0

2

0 0 01 1

0 0 0

3

0 01

01

0 0 0

36

8

3

1

5

10

7

0 00

5

10

15

20

25

30

35

40


5. If you had a blood test, x-ray or other test, how often did someone follow up to give you the results?




3%

13% 13%

72%

84% 84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


6. If you were referred to a specialist for a particular health problem, how often did the

staff seem informed and up-to-date about the care you got from the specialist?

27

1

5 5

28

0

5

10

15

20

25

30


6. If you were referred to a specialist for a particular health problem, how

often did the staff seem informed and up-to-date about the care you got

from the specialist?



27

5

21

3

12

2

0 01 1

0 0 0 0 0 0 0

5

0 0 0 0

4

0 0 0

5

21

01 1

0 0 0

28

6

21

6

4

7

0 00

5

10

15

20

25

30


6. If you were referred to a specialist for a particular health problem, how often did the staff seem informed and up-to-date about the care you got from

the specialist?N/A Never Sometimes Usually Always



5%9%

13%

73%

85% 85%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


7. How often did someone talk to you about specific goals for your health?

11

3

5

7

41

0

5

10

15

20

25

30

35

40

45





11

21

0 0

7

10 0

3

0 0 0 0

2

0 0 0

5

01

01

3

0 0 0

7

21

0 0

2

0 0 0

41

10

2 2

98 8

0 00

5

10

15

20

25

30

35

40

45






5%

11%9%

75%80% 80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


8. How often did someone talk with you about a personal problem, family problem, alcohol use,

drug use, or a mental or emotional illness?

11

3

65

41

0

5

10

15

20

25

30

35

40

45


8. How often did someone talk with you about a personal problem, family problem, alcohol use, drug use, or a

mental or emotional illness?



11

1 1 10

7

10 0

3

10 0 0

2

0 0 0

6

1 10 0

3

0 0 0

5

01

01 1

0 0 0

41

11

21

9 98

0 00

5

10

15

20

25

30

35

40

45


8. How often did someone talk with you about a personal problem, family problem, alcohol use, drug use, or a mental or emotional illness?




2%

19%

10%

69%

86% 86%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


9. How frequently do you find useful the information provided to you by staff about

available Community Resources?

8

1

11

6

40

0

5

10

15

20

25

30

35

40

45


9. How frequently do you find useful the information provided to you by staff about available Community Resources?



8

0 0 0 0

7

10 0

10 0 0 0

10 0 0

11

21

01

5

0 0 0

6

2

0 0 0

21

0 0

40

10

4

2

9

67

0 00

5

10

15

20

25

30

35

40

45






2%5%

13%

81%

90% 90%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


10. How often have you been satisfied with the overall services received?

5

13

8

50

0

10

20

30

40

50

60





5

0 0 0 0

4

10 0

10 0 0 0 0 0 0 0

3

01 1

0 0 0 0 0

8

20 0

1

5

0 0 0

50

12

4

1

9

13

8

0 00

10

20

30

40

50

60




Pinellas County l HCHP Patient Satisfaction Survey 6 Month Trend Report

January-June 2017

1

8%

2%

18%

72%

4%

15%

19%

85%

0%

4%

22%

73%

0%2%

14%

85%

8%

15%

21%

56%

6%

11%

17%

66%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%



Jan Feb Mar Apr May Jun


January-June 2017

2

7%5%

17%

71%

12%

7%

26%

56%

8%10%

18%

65%

2% 2%

14%

82%

11%

24%

11%

54%

17%

6%

13%

65%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%


2. When you phoned after normal business hours, how often did you get an answer to your medical question as soon as you needed?



January-June 2017

3

0% 0%2%

98%

2%0%

11%

87%

0% 0%2%

98%

0% 0%

9%

91%

3%5%

13%

79%

3%1%

9%

87%

0%

20%

40%

60%

80%

100%

120%





January-June 2017

4

2%0%

2%

96%

6%2%

13%

80%

0% 0%

6%

94%

0% 0%

7%

93%

2%

8%

13%

77%

3%7%

9%

81%

0%

20%

40%

60%

80%

100%

120%





January-June 2017

5

2%0%

11%

87%

6%

11%

15%

68%

0%2%

9%

89%

0% 0%

11%

89%

7% 7% 7%

79%

4% 5%7%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


5. When you had a blood test, x-ray or other test, how often did someone follow up to give you the results?



January-June 2017

6

5%

0%

10%

85%

8%

15%

10%

68%

5%3%

10%

82%

2%4%

2%

92%

7% 7%

13%

73%

2%

14%

8%

76%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


6. If you were referred to a specialist for a particular health problem, how often did the staff seem informed and up-to-date about the care you got from the specialist?



January-June 2017

7

4%2% 2%

92%

6% 6%

18%

71%

2%

9%6%

83%

2% 2%

11%

86%

7%9%

21%

63%

5% 5%

18%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





January-June 2017

8

4%2%

11%

83%

2%

12%

18%

69%

5%

12%

7%

77%

2% 2%

7%

89%

9%11%

18%

62%

9% 8%11%

72%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


8. How often did someone talk with you about a personal problem, family problem, alcohol use, drug use, or a mental or emotional illness?



January-June 2017

9

4%2%

9%

85%

2%

10%

19%

69%

2%

6%4%

87%

2%4%

7%

88%

9%

13%

7%

71%

6%9%

12%

73%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%





January-June 2017

10

2%0%

8%

90%

2%4%

22%

72%

0%

4%

8%

88%

0%

7%

3%

90%

3%

16%

10%

71%

6% 7%

13%

74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%




TAB 3 - FISCAL

• Notice of Award(s) • Funding Opportunities

Application Submitted to HRSASubmitted to HRSA

Organization: PINELLAS, COUNTY OF, CLEARWATER, Florida

Grants.gov Tracking Number: N/A

EHB Application Number: 149919

Grant Number: 6 H80CS000241602

Funding Opportunity Number: HRSA17118

Received Date:

Total Number of Pages Submitted by the Applicant: 19

(Number of pages counted in accordance with program guidance: 5)

A printer version document only. The document may contain some accessibility challenges for the screen reader users. To access same information, a fully 508 compliant accessible HTML version is available on the HRSA Electronic Handbooks. If you need moreinformation, please contact HRSA contact center at 877-464-4772, 8 am to 8 pm ET, weekdays.

Table Of Contents

1. Application for Federal Assistance (SF424)

2. Project Description

3. SF424A: Budget Information NonConstruction Programs

4. SF424B: Assurances NonConstruction Programs

5. Attachment 1: Budget Narrative (PINELLAS DRAFT aimsbudgetnarrative.pdf)

6. Federal Budget Information Table

7. Federal Object Class Categories

8. Staffing Impact

9. Patient Impact

10. Project Narrative

11. Equipment List

Skip to Main Content

Application for Federal Assistance SF424OMB Approval No. 40400004

Expiration Date 8/31/2016* 1. Type of Submission * 2. Type of Application * If Revision, select appropriate letter(s):

Preapplication New

Application Continuation * Other (Specify)

Changed/Corrected Application Revision

* 3. Date Received: 4. Applicant Identifier:

* 5.a Federal Entity Identifier: 5.b Federal Award Identifier:

Application #:149919Grants.Gov #:

H80CS00024

* 6. Date Received by State: 7. State Application Identifier:

8. Applicant Information:

* a. Legal Name PINELLAS, COUNTY OF

* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. Organizational DUNS:

596000800 055200216

d. Address:

* Street1: 14 S. FORT HARRISON OMB 5TH FLOOR

Street2:

* City: CLEARWATER

County:

* State: FL

Province:

* Country: US: United States

* Zip / Postal Code: 337565338

e. Organization Unit:

Department Name: Division Name:

Human Services Planning & Contracts Division

f. Name and contact information of person to be contacted on matters involving this application:

Prefix: Ms. * First Name: Daisy

Middle Name: Middle Name:

Last Name: Rodriguez

Suffix:

Title: Health Care Administrator/Project Director

Organizational Affiliation:

* Telephone Number: (727) 4644206 Fax Number:

* Email: [email protected]

9. Type of Applicant 1:

B: County Government

Type of Applicant 2:

Type of Applicant 3:

* Other (specify):

* 10. Name of Federal Agency:

N/A

11. Catalog of Federal Domestic Assistance Number:

93.224

CFDA Title:

Community Health Centers

* 12. Funding Opportunity Number:

HRSA17118

* Title:

Fiscal Year 2017 Access Increases in Mental Health and Substance Abuse Services (AIMS) Supplemental Funding

EHB Application Number: 149919 Grant Number: 6 H80CS00024-16-02

Tracking Number: N/A Page Number: 3 Funding Opportunity Number: HRSA-17-118 Received Date:

13. Competition Identification Number:

7195

Title:

Fiscal Year 2017 Access Increases in Mental Health and

Areas Affected by Project (Cities, Counties, States, etc.):

See Attachment

* 15. Descriptive Title of Applicant's Project:

Health Center Cluster

Project Description:

See Attachment

16. Congressional Districts Of:

* a. Applicant FL13 * b. Program/ProjectFL13

Additional Program/Project Congressional Districts:

See Attachment

17. Proposed Project:

* a. Start Date: 9/1/2017 * b. End Date: 8/31/2018

18. Estimated Funding ($):

* a. Federal $133,080.00

* b. Applicant $0.00

* c. State $0.00

* d. Local $0.00

* e. Other $0.00

* f. Program Income $0.00

* g. TOTAL $133,080.00

* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?

a. This application was made available to the State under the Executive Order 12372 Process for review on

b. Program is subject to E.O. 12372 but has not been selected by the State for review.

c. Program is not covered by E.O. 12372.

* 20. Is the Applicant Delinquent Of Any Federal Debt(If "Yes", provide explaination in attachment.)

Yes No

21. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statementsherein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree tocomply with any resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims maysubject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)

I Agree

** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agencyspecific instructions.

Authorized Representative:

Prefix: * First Name: Daisy

Middle Name: M

* Last Name: Rodriguez

Suffix:

* Title:

* Telephone Number: (727) 4644206 Fax Number:

* Email: [email protected]

* Signature of Authorized Representative: Daisy M Rodriguez * Date Signed:



US

HIG

HW

AY

19 N

66th

St

Park Blvd

E Bay Dr

Sunset Point Rd

STATE ROAD 580

Ulmerton Rd

Pin

el la

s B

ayw

ay S

14

13

12

116

118

112

105 109

108

123

122

162161

156155

165

110218

206208

207

227

223 125

129

136131

239

132

139243

225

220219

221

217

229

231

275

230

210

150

152

259

159

248

249

244

265

270

222

240

216

212

261

203

344

511

342

622

236

242

512

516514

421

537

528

620

130

144

241

407

408

303

253

251

245254

262

256

255

267264263

404

327

338

337

266

523

520

605

603

607505

527

518

602

503

619531

614524

525

535

306

301

307

348

316314

309

319

419

420

340

323

326

401

202

201200

111

402

538

543 636

625

536

541

712703

628

631 629

633

634

638

635

710

630627

701

545

705

542

14

13

12

116

118

112

105 109

108

123

122

162161

156155

165

110218

206208

207

227

223 125

129

136131

239

132

139243

225

220219

221

217

229

231

275

230

210

150

152

259

159

248

249

244

265

270

222

240

216

212

261

203

344

511

342

622

236

242

512

516514

421

537

528

620

130

144

241

407

408

303

253

251

245254

262

256

255

267264263

404

327

338

337

266

523

520

605

603

607505

527

518

602

503

619531

614524

525

535

306

301

307

348

316314

309

319

419

420

340

323

326

401

202

201200

111

402

538

543 636

625

536

541

712703

628

631 629

633

634

638

635

710

630627

701

545

705

542

101 102

103

104106

113 114 115

117 119120

121

126127

128

133

134 135

137

138

140

141

142143

145

146147

148

149151

153 154

157158

160

163

164

204205

209

211 213

214

215224

226

228

232

233

234

235

237238

246

247

250

252

257258 260

268

269

271

272273

274

302304

305

308

310

311 312 313315

317318

320321 322

324

325328 329

330

331332

333334

335

336

339341

343

345346

347

349

350

403

405

406

409

415

416

417

418

422

500

501

502504

506507508

509510

513

515517

519

521

522

526

529

530

532

533

534

539

540

544

601

604

606

608

609

610

611 612

613

615

616

617 618

621

623

624

626

632

637

702

704

706 711

Congressional DistrictsPinellas County, Florida

12

13

14

Major Roads

Precinct Line

CONGRESSIONAL DISTRICTSAND VOTER PRECINCTS

Created By: IT Dept, Pinellas County Supervisor of Elections 2012




SF424A: BUDGET INFORMATION NonConstructionPrograms

OMB Approval No. 40400004

Expiration Date 8/31/2016

SECTION A BUDGET SUMMARY

Grant Program Function orActivity

Catalog ofFederalDomesticAssistanceNumber

Estimated UnobligatedFunds

New or Revised Budget

Federal NonFederal FederalNon

FederalTotal

Health Care for the Homeless 93.224 $0.00 $0.00 $133,080.00 $0.00 $133,080.00

Total $0.00 $0.00 $133,080.00 $0.00 $133,080.00

SECTION C NONFEDERAL RESOURCES

Grant Program Function or Activity Applicant State Other Sources TOTALS

Health Care for the Homeless $0.00 $0.00 $0.00 $0.00

Total $0.00 $0.00 $0.00 $0.00




SF424B: ASSURANCES, NONCONSTRUCTION PROGRAMSOMB Approval No. 40400007

Expiration Date 06/30/2014

Public reporting burden for this collection of information is estimated to average 15 minutes per response, includingtime for reviewinginstructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewingthe collection ofinformation. Send comments regarding the burden estimate or any other aspect of this collection of information,including suggestions forreducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (03480040),Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENTAND BUDGET. SENDIT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact theawarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances.If such is the case, you will be notified.

As the duly authorized representative of the applicant, I certify that the applicant:

1. Has the legal authority to apply for Federal assistance and theinstitutional, managerial and financial capability (including fundssufficient to pay the nonFederal share of project cost) to ensureproper planning, management and completion of the projectdescribed in this application.

2. Will give the awarding agency, the Comptroller General of theUnited States and, if appropriate, the State, through any authorizedrepresentative, access to and the right to examine all records,books, papers, or documents related to the award; and willestablish a proper accounting system in accordance with generallyaccepted accounting standards or agency directives.

3. Will establish safeguards to prohibit employees from using theirpositions for a purpose that constitutes or presents the appearanceof personal or organizational conflict of interest, or personal gain.

4. Will initiate and complete the work within the applicable time frameafter receipt of approval of the awarding agency.

5. Will comply with the Intergovernmental Personnel Act of 1970 (42U.S.C. §§47284763) relating to prescribed standards for meritsystems for programs funded under one of the 19 statutes orregulations specified in Appendix A of OPM's Standards for aMerit System of Personnel Administration (5 C.F.R. 900, SubpartF).

6. Will comply with all Federal statutes relating to nondiscrimination.These include but are not limited to: (a) Title VI of the Civil RightsAct of 1964 (P.L. 88352) which prohibits discrimination on thebasis of race, color or national origin; (b) Title IX of the EducationAmendments of 1972, as amended (20 U.S.C.§§1681 1683, and16851686), which prohibits discrimination on the basis of sex; (c)Section 504 of the Rehabilitation Act of 1973, as amended (29U.S.C. §794), which prohibits discrimination on the basis ofhandicaps; (d) the Age Discrimination Act of 1975, as amended (42U.S.C. §§61016107), which prohibits discrimination on the basisof age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L.92255), as amended, relating to nondiscrimination on the basis ofdrug abuse; (f) the Comprehensive Alcohol Abuse and AlcoholismPrevention, Treatment and Rehabilitation Act of 1970 (P.L. 91616), as amended, relating to nondiscrimination on the basis ofalcohol abuse or alcoholism; (g) §§523 and 527 of the PublicHealth Service Act of 1912 (42 U.S.C. §§290 dd3 and 290 ee3), as amended, relating to confidentiality of alcohol and drug abusepatient records; (h) Title VIII of the Civil Rights Act of 1968 (42U.S.C. §§3601 et seq.), as amended, relating to nondiscriminationin the sale, rental or financing of housing; (i) any other

9. Will comply, as applicable, with the provisions of the DavisBaconAct (40 U.S.C. §§276a to 276a7), the Copeland Act (40 U.S.C.§276c and 18 U.S.C. §874), and the Contract Work Hours andSafety Standards Act (40 U.S.C. §§327333), regarding laborstandards for federallyassisted construction subagreements.

10. Will comply, if applicable, with flood insurance purchaserequirements of Section 102(a) of the Flood Disaster Protection Actof 1973 (P.L. 93234) which requires recipients in a special floodhazard area to participate in the program and to purchase floodinsurance if the total cost of insurable construction and acquisition is$10,000 or more.

11. Will comply with environmental standards which may be prescribedpursuant to the following: (a) institution of environmental qualitycontrol measures under the National Environmental Policy Act of1969 (P.L. 91190) and Executive Order (EO) 11514; (b)notification of violating facilities pursuant to EO 11738; (c)protection of wetlands pursuant to EO 11990; (d) evaluation offlood hazards in floodplains in accordance with EO 11988; (e)assurance of project consistency with the approved Statemanagement program developed under the Coastal ZoneManagement Act of 1972 (16 U.S.C. §§1451 et seq.); (f)conformity of Federal actions to State (Clean Air) ImplementationPlans under Section 176(c) of the Clean Air Act of 1955, asamended (42 U.S.C. §§7401 et seq.); (g) protection ofunderground sources of drinking water under the Safe DrinkingWater Act of 1974, as amended (P.L. 93523); and, (h) protectionof endangered species under the Endangered Species Act of 1973,as amended (P.L. 93205).

12. Will comply with the Wild and Scenic Rivers Act of 1968 (16U.S.C. §§1271 et seq.) related to protecting components orpotential components of the national wild and scenic rivers system.

13. Will assist the awarding agency in assuring compliance with Section106 of the National Historic Preservation Act of 1966, as amended(16 U.S.C. §470), EO 11593 (identification and protection ofhistoric properties), and the Archaeological and HistoricPreservation Act of 1974 (16 U.S.C. §§469a1 et seq.).

14. Will comply with P.L. 93348 regarding the protection of humansubjects involved in research, development, and related activitiessupported by this award of assistance.

15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L.89544, as amended, 7 U.S.C. §§2131 et seq.) pertaining to thecare, handling, and treatment of warm blooded animals held forresearch, teaching, or other activities supported by this award of



nondiscrimination provisions in the specific statute(s)under whichapplication for Federal assistance is being made; and, (j) therequirements of any other nondiscrimination statute(s) which mayapply to the application.

7. Will comply, or has already complied, with the requirements ofTitles II and III of the Uniform Relocation Assistance and RealProperty Acquisition Policies Act of 1970 (P.L. 91646) whichprovide for fair and equitable treatment of persons displaced orwhose property is acquired as a result of Federal or federallyassisted programs. These requirements apply to all interests in realproperty acquired for project purposes regardless of Federalparticipation in purchases.

8. Will comply, as applicable, with provisions of the Hatch Act (5U.S.C. §§15011508 and 73247328) which limit the politicalactivities of employees whose principal employment activities arefunded in whole or in part with Federal funds.

assistance.16. Will comply with the LeadBased Paint Poisoning Prevention Act

(42 U.S.C. §§4801 et seq.) which prohibits the use of leadbasedpaint in construction or rehabilitation of residence structures.

17. Will cause to be performed the required financial and complianceaudits in accordance with the Single Audit Act Amendments of1996 and OMB Circular No. 45 CFR 75, "Audits of States, LocalGovernments, and NonProfit Organizations."

18. Will comply with all applicable requirements of all other Federallaws, executive orders, regulations, and policies governing thisprogram.

19. Will comply with the requirements of Section 106(g) of theTrafficking Victims Protection Act (TVPA) of 2000, as amended(22 U.S.C. 7104) which prohibits grant award recipients or a subrecipient from (1) Engaging in severe forms of trafficking in personsduring the period of time that the award is in effect (2) Procuring acommercial sex act during the period of time that the award is ineffect or (3) Using forced labor in the performance of the award orsubawards under the award.

* SIGNATURE OF AUTHORIZED CERTIFYINGOFFICIAL

* TITLE

Daisy M Rodriguez

* APPLICANT ORGANIZATION * DATE SUBMITTED

PINELLAS, COUNTY OF 7/25/2017



FY 2017 AIMS Sample Budget Narrative – Page 1 of 4

Access Increases in Mental Health and Substance Abuse Services (AIMS) Supplemental Funding Opportunity: Sample Budget Narrative

Instructions for Completing the Budget Narrative

You must provide a 12-month Budget Narrative (9/1/2017 to 8/31/2018) that explains the amounts requested for each line item in the Federal Object Class Categories Form (see a sample copy of the form on the AIMS technical assistance website). The Budget Narrative must outline federal and non-federal (if any) costs for each line-item. Include detailed calculations explaining how each line-item expense is derived (e.g., cost per unit) with sufficient detail to enable HRSA to determine if costs are allowed.

• AIMS ongoing funding (up to $75,000) can only be used to add new direct hire staff and/or contractor full time equivalents (FTEs) by hiring new or increasing the hours of existing personnel who will support the expansion of mental health services, and substance abuse services focusing on the treatment, prevention, and awareness of opioid abuse (i.e., personnel, fringe, and/or contractual costs). Personnel costs must comply with salary limitation requirements.

• AIMS one-time funding (up to $75,000) can be used to support the expansion of mental health

services, and substance abuse services focusing on the treatment, prevention, and awareness of opioid abuse, and their integration into primary care. Activities initiated with AIMS one-time funding will not receive future AIMS funding support.

AIMS funding may not supplant existing resources and cannot support the following:

• Costs incurred prior to award • Purchase or upgrade of an EHR that is not ONC-certified • Fixed equipment costs, such as permanent signage or heating, ventilation, and air conditioning

(HVAC) units • Construction or minor alterations and renovation • Facility, land, or vehicle purchases

The Budget Narrative should describe how each cost will support the proposed AIMS project. Include the following information for the 12-month period starting 9/1/2017 through 8/31/2018. Sample Budget Narrative

Budget Line Item Federal Non-Federal

PERSONNEL – List each direct hire staff member who will be supported by AIMS ongoing funding. Salary limitation requirements apply. Refer to the Sample Personnel Justification Table for required information.

SEE CONTRACTUAL

TOTAL PERSONNEL $0



https://bphc.hrsa.gov/programopportunities/fundingopportunities/supplement



FRINGE BENEFITS – List the components that comprise the fringe benefit rate (e.g., health insurance, taxes, unemployment insurance, life insurance, retirement plan, tuition reimbursement) for the proposed direct hire staff. The fringe benefits should be directly proportional to the personnel costs allocated for the AIMS project.

SEE CONTRACTUAL

TOTAL FRINGE BENEFITS $0

TRAVEL – The travel budget should reflect expenses associated with travel for consultants, direct hire staff, and/or contractors to attend trainings. List travel costs according to local and long distance travel. For local travel, include the mileage rate, number of miles, reason for travel, and individuals traveling.

Local travel: 200 miles per mo x $0.485 per mile for contracted therapist to travel to locations to facilitate group sessions, meet with clients, etc.

$1,164

Behavioral Health Integration Conference (2 people @ $1,250 per person – 2 nights) $2,500

Health Care for the Homeless National Conference (2 people @ $1,550 per person – 4 nights) $3,100

TOTAL TRAVEL $6,764

EQUIPMENT List equipment costs consistent with those provided in the Equipment List Form. Equipment means tangible personal property (including information technology systems) having a useful life of more than one year and a per-unit acquisition cost which equals or exceeds the lesser of the capitalization level established by the non-federal entity for financial statement purposes, or $5,000. Equipment that does not meet the $5,000 threshold should be considered Supplies.

Not Apllicable $0

TOTAL EQUIPMENT $0

SUPPLIES – List the items necessary for implementing the proposed project. Equipment that does not meet the $5,000 threshold listed above should be included here.

Computer bundle for contracted therapist $700

Telehealth Nodes @ 6 nodes x $2,500 per node (less than $5,000 per unit) $15,000

Education Materials – handouts, etc. to be available at service and enrollment sites to inform clients of behavioral health availability, benefits, etc.

$3,000

TOTAL SUPPLIES $18,700





CONTRACTUAL – Provide a clear explanation as to the purpose of each contract, how the costs were estimated, and the specific contract deliverables. Each applicant is responsible for ensuring that its organization or institution has in place an established and adequate procurement system with fully developed written procedures for awarding and monitoring contracts.

BEHAVIORAL HEALTH PROVIDER (OPERATION PAR) (includes salary, fringe, administrative costs associated with each position)

Licensed Therapist @ 1.0 FTE $68,210

Director of Outpatient Services @ 0.05 FTE – required for oversight of licensure activities $4,926

Telehealth Software Solution @ $3,000 $3,000

EtransX Development - to develop data integration for QI activities regarding behavioral health crisis/emergency services for clients – 40 hours @ $8,000

$8,000

.Net Developer - to develop data integration for QI activities regarding behavioral health crisis/emergency services for clients – 160 hours x $90/hour

$14,400

Staff Training (topics to include Substance Abuse Awareness, Client Education/Engagement, and Verbal De-Escalation) – 4 classes estimated @ 4 hours per class x $125/hour

$2,000

Client Education Classes regarding behavioral health topics – 6 classes estimated @ 2 hours per class x $125/hour $1,500

TOTAL CONTRACTUAL $102,036

OTHER – Include all costs that do not fit into any other category and provide an explanation of each cost.

Conference Registration and workshop for 2 staff to attend Integrating Behavioral Health and Primary Care Models $4,390

Conference Registration for National Health Care for the Homeless Conference for 2 staff $1,190

TOTAL OTHER $5,580

TOTAL DIRECT CHARGES (Sum of all TOTAL Expenses) $133,080

INDIRECT CHARGES – Include approved indirect cost rate if applicable

$0





TOTALS (Total of TOTAL DIRECT CHARGES and INDIRECT CHARGES) $133,080

Instructions for Completing the Personnel Justification Table

The information included in the Personnel Justification Table (sample below) must be provided for all direct hire staff and contractors to be supported by AIMS funding. Direct hire staff and contractors supported entirely with non-federal funds do not require this level of information. Personnel costs must comply with salary limitation requirement.

Salary Limitation Requirements The Consolidated Appropriations Act, 2017 Division H, § 202, (P.L. 115-31), states, “None of the funds appropriated in this title shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive Level II.” This salary limitation also applies to subawards/subcontracts under a HRSA grant or cooperative agreement. Note that these or other salary limitations may apply in FY 2017, as required by law.

Sample Personnel Justification Table for Proposed Personnel

Name Position Title % of FTE Base Salary Adjusted Annual

Salary

Federal Amount

Requested

TBD Licensed Therapist 100% $68,210 $68,210 $68,210

Laura Rosenbluth

Director of Outpatient Services 5% $98,524 $4,926 $4,926

TOTAL



00149919: PINELLAS, COUNTY OF Due Date: 07/26/2017 (Due In: 1 Days)

Resources

As of 07/25/2017 02:12:35 PM

OMB Number: 09150285 OMB Expiration Date: 1/31/2020

Federal Budget Information Table

Announcement Number: HRSA17118 Announcement Name: Fiscal Year 2017 Access

Increases in Mental Health and Substance Abuse

Services (AIMS) Supplemental Funding

Application Type: Revision (Supplemental)

Grant Number: H80CS00024 Federal Funding Request Amount: $133,080.00

Federal Budget Information

Use of Funds Federal Funds Requested

Ongoing Service Expansion Funding for Increasing Access

Mental Health Service Expansion Personnel (Required) $37,500.00

Substance Abuse Service Expansion Personnel (Required) $37,500.00

OneTime Funding to Support Expanded Services

Health IT and/or Training Investments $58,080.00

Total $133,080

OneTime Funding Focus Areas

If onetime funding is requested for health IT and/or training to support the expansion of mental health and substance abuse services and their integration into primary care,

indicate which of the following focus areas the onetime funding will address. Select all that apply. If Other Training and/or Other Health IT are selected, describe the

proposed activities related to the selected focus area(s) in the Response section of the Project Narrative.

Focus Areas Select All That Apply

Medication Assisted Treatment [_] Medication Assisted Treatment

Telehealth [X] Telehealth

Prescription Drug Monitoring Program [_] Prescription Drug Monitoring Program

Clinical Decision Support [_] Clinical Decision Support

Electronic Health Record Interoperability [X] Electronic Health Record Interoperability

Quality Improvement [X] Quality Improvement

Cybersecurity [_] Cybersecurity

Other Training (describe in the Response section of the Project Narrative) [X] Other Training (describe in the Response section of the Project Narrative)

Other Health IT (describe in the Response section of the Project Narrative) [_] Other Health IT (describe in the Response section of the Project Narrative)

Scope of Services

Review the currently approved Form 5A: Services Provided for your organization by clicking this link: Current Approved Form 5A.

Indicate below whether a Scope Adjustment or Change in Scope request will be necessary to ensure that all planned changes to mental health and substance abuse services are

on your Form 5A (e.g., to move mental health services from formal referral (Column III) to direct provision (Column I), to add substance abuse services for the first time).

Access the technical assistance materials on the Scope of Project resource website for guidance in determining whether a Scope Adjustment or Change in Scope will be necessary

(click on the “Services” header in the Resources section to access the Form 5A information).

Note the following before selecting "Yes" or "No" below:

AIMS funding may support the expansion of existing services in scope as well as new mental health and substance abuse services that are not currently in your scope of

project if they align with the AIMS purpose.

You must separately submit a Scope Adjustment or Change in Scope request to HRSA to add new services to your scope of project or to move one or more services

currently provided only in Form 5A Column III to Column I and/or Column II. You may not modify your approved Form 5A through this application.

You do not need to submit a Scope Adjustment or Change in Scope request if AIMS funding will expand services that you are already providing in the same modes of

provision (i.e., Form 5A Column I, Column II).

AIMS funded services must be listed in Column I and/or II on Form 5A, either currently or after you submit and are approved for a Scope Adjustment or Change in Scope.

AIMS funded services are limited to: Mental Health, HCH Required Substance Abuse, Substance Abuse, Case Management, and/or Health Education.

All services supported by AIMS funding, including those to be added to or changed on Form 5A, must be implemented within 120 days of award.

[ ] Yes, I have reviewed my Form 5A and have determined that my proposed activities will require a Scope Adjustment or Change in Scope request to modify Form 5A.



https://grants2.hrsa.gov/WebSCPExternal/Interface/Common/SelfUpdates/SelfUpdatesGateway.aspx?Mode=services&orgid=afa5a495-890d-4b14-beb2-8b1d1454d739&GrantId=912985fb-3871-49df-a5e5-bff1dbf204a3&viewType=2&ResourceType=47

https://bphc.hrsa.gov/programrequirements/scope.html

[X] No, I have reviewed my Form 5A and determined that my proposed activities will not require a Scope Adjustment or Change in Scope request to modify Form 5A.

If yes, describe the proposed changes and a timeline for requesting necessary modifications to your Form 5A through a Scope Adjustment or Change in Scope request. You must

receive HRSA approval prior to implementation, which must occur within 120 days of award.

Approximately 1/4 page. (Max 1000 Characters with spaces)




Resources

As of 07/25/2017 02:12:40 PM


Federal Object Class Categories






Total Proposed Budget Amount

Section 330 federal funding (from Total Federal New or Revised Budget on Section A –

Budget Summary)$133,080.00

Nonfederal funding (from Total NonFederal New or Revised Budget on Section A – Budget

Summary)$0.00

Total $133,080.00

Budget Categories

Object Class Category Federal NonFederal Total

a. Personnel $0.00 $0.00 $0.00

b. Fringe Benefits $0.00 $0.00 $0.00

c. Travel $6,764.00 $0.00 $6,764.00

d. Equipment $0.00 $0.00 $0.00

e. Supplies $18,700.00 $0.00 $18,700.00

f. Contractual $102,036.00 $0.00 $102,036.00

g. Construction N/A N/A N/A

h. Other $5,580.00 $0.00 $5,580.00

i. Total Direct Charges (sum of a h) $133,080.00 $0.00 $133,080.00

j. Indirect Charges $0.00 $0.00 $0.00

k. Total Budget Specified in this application (sum

of i j) $133,080.00 $0.00 $133,080.00




Resources

As of 07/25/2017 02:12:45 PM


Staffing Impact






Position New Direct Hire Staff FTEs Proposed New Contractor FTEs Proposed

Psychiatrists

0.00 0.00

Licensed Clinical Psychologists

0.00 0.00

Licensed Clinical Social Workers

0.00 0.00

Other Mental Health Staff

Please Specify:

Licensed Therapist

0.00 0.50

Other Licensed Mental Health Providers

Please Specify:

0.00 0.00

Substance Abuse Providers

0.00 0.50

Case Managers

0.00 0.00

Patient/Community Education Specialists (Health Educators)

0.00 0.00

Community Health Workers

0.00 0.00

Total 0.00 1.00




Resources

As of 07/25/2017 02:12:50 PM


Patient Impact






Patient Impact Questions

Existing Patient Impact

1. Unduplicated Total (Existing Patients): Enter the number of existing patients who will newly access mental health and/or substance abuse services in calendar year 2018 as

a result of AIMS funding (e.g., existing medical patients not currently accessing these services that will begin to do so).

Attribute the total projected existing patients to EITHER mental health OR substance abuse in your response to Question 1, even if some existing patients are expected to access

both expanded services (i.e., count each existing projected patient only once in this unduplicated patient projection).

120

2. Patients by Service Type (Existing Patients): Enter the number of existing patients who will access each service in calendar year 2018 in the table below.

Count each projected existing patient according to the services they are expected to access. If a patient will start accessing both mental health and substance abuse services, they

should be counted once for each service type in this table (e.g., an individual who will newly access both mental health and substance abuse services should be counted once for

mental health and once for substance abuse).

Mental Health Services Substance Abuse Services

30 90

New Patient Impact

3. Unduplicated Total (New Patients): Enter the number of new patients (new to the health center) who will access mental health and/or substance abuse services in calendar

year 2018 as a result of AIMS funding.

Attribute the total projected new patients to EITHER mental health OR substance abuse in your response to Question 3, even if some new patients are expected to access both

expanded services (i.e., count each new projected patient only once in this unduplicated patient projection).

0

4. Patients by Service Type (New Patients): Enter the number of new patients (new to the health center) who will access each service in calendar year 2018 in the table below.

Count each projected new patient according to the services they are expected to access. If a new patient will access both mental health and substance abuse services, they should

be counted once for each service type in this table (e.g., an individual new to the health center as a result of this funding who will access both mental health and substance abuse

services should be counted once for mental health and once for substance abuse).

Mental Health Services Substance Abuse Services

0 0

New Patients by Population Type

Population Type NEW Patients Projected

Total NEW Patients (from Question #3) 0

General Underserved Community 0

Migratory and Seasonal Agricultural Workers 0

Public Housing Residents 0

People Experiencing Homelessness 0

Total 0




Resources

As of 07/25/2017 02:12:55 PM


Project Narrative






Fields with are required

Need

1. Describe the need to expand or begin providing mental health services, and substance abuse services focusing on the treatment, prevention, and awareness of opioid

abuse.


The Pinellas County Health Care for the Homeless has realized a high demand for the Medication Assisted Treatment (MAT) provided to clients through Substance Abuse

Expansion funding. During the first 13 months of the project, Pinellas County was able to provide MAT services to 81 unduplicated clients (202.5% of the 40 proposed clients). 2016

UDS data shows that the program provided 602 unduplicated mental health patients a total of 1,447 clinic visits and 60 unique substance abuse patients received 474 clinic visits.

Compared to 2015 UDS data, Pinellas County saw an 87% increase in mental health patients (322 unduplicated in 2015), a 147% increase in mental health visits (587 in 2015), a

9% increase in substance abuse patients (55 unduplicated in 2015) and a 123% increase in substance abuse visits (213 in 2015). This significant increase in conjunction with the

continued demand for MAT services is indicative of the need to expand mental health and substance abuse services to our clients.Beyond the homeless population seen by the

health center, the local area has seen a significant increase in opioid misuse. Data from the local emergency medical services (EMS) provider and medical examiner shows an

increase in EMS naloxone administrations (19%) and opioid related deaths (52%) between 2015 and 2016. This trend appears to be continuing into 2017. Given the local

landscape related to opioids coupled with the service data regarding the health center’s clients, there is a significant need to expand the services that are currently being offered.

Response

1. Describe the proposed direct hire staff and/or contractor(s) to be supported with AIMS funding, including how they will meet the identified needs through the use of

evidencebased strategies.


The Pinellas County Health Care for the Homeless program will utilize AIMS funding to contract for 1.0 FTE licensed therapist to provide clients with group therapy, substance

abuse counseling, and cooccurring counseling. One area that has been realized as a barrier to successful treatment is maintaining client engagement. Through the addition of

this FTE, the program anticipates the ability to seek increased engagement of clients in the evidence based provision of MAT services and evidence based therapeutic practices.

The proposed contracted provider (Operation PAR) utilizes evidence based practices for substance abuse and cooccurring treatments. Proposed funds include 1.0 FTE licensed

therapist, 0.05 FTE Director of Outpatient Services, local travel associated with the travel to the various service sites, and a computer bundle for the FTE.

2. Provide a timeline that lists the implementation steps and expected outcomes of the proposed mental health and substance abuse service expansion activities. The

timeline must show that expanded access to mental health services, and substance abuse services focusing on the treatment, prevention, and awareness of opioid abuse,

will be implemented within 120 days of award.


Pinellas County will leverage an existing contractual relationship with Operation PAR to hire staff through the AIMS funding. Operation PAR has extensive experience working on

Federal grants and within specified timelines. Through leveraging the current contract with Operation PAR, the specific position for this funding opportunity will be posted upon

notice of award. Operation PAR is an organization of more than 400 employees and is a wellknown name throughout the community. The organization will leverage current

recruitment strategies to maximize the number of eligible candidates for the position. Given the current contractual relationship between Pinellas County and Operation PAR, we

will be able to provide assurance to make the contractual arrangement retroactive to the funding start date. Through this, the contracting and recruitment activities can occur

simultaneously. The timeline is as follows:Notice of Award: Position to be posted and contractual agreement between Pinellas County and Operation PAR to be initiated.Days 030:

Position to be posted and applications accepted.Days 3160: Interviews and background checks of eligible applicants. Day 6190: Job offer and new hire processing.Day 91120:

Implementation of services to the Health Center’s clients.

3. If onetime funding is requested for health IT and/or training investments, describe how that funding will be utilized to support the expansion of mental health services,

and substance abuse services focusing on the treatment, prevention, and awareness of opioid abuse and address the need for integration with primary care. Include a

timeline that demonstrates all onetime funding will be expended within 12 months of award.

If onetime funding for health IT and/or training is not requested, enter N/A below.


OneTime funding is being requested for IT and training investments. IT investments include: telehealth software and equipment, EtransX development, and .NET developer. The

telehealth equipment and software will be utilized by clinic staff to enhance client engagement in healthcare services. Through increased engagement, the health center can treat

the whole person, to include their behavioral health needs. EtransX amd .NET development will be utilized to allow the health center to integrate behavioral health crisis data and

emergency room data for clinic clients to provide better performance reporting to evaluate clinical quality and identify areas for innovation to better improve and manage the

population’s health. Through integrating data, the health center will be able to facilitate performance reporting through multiple disparate systems to determine areas for

improvement to better assist client health. Training investments identified for use of AIMS funding include staff attendance at the Integrating Behavioral Health and Primary Care

Models Conference in May of 2018 and the 2018 National Health Care for the Homeless Conference. These conferences will provide two higher level staff perspectives on best

practices associated with behavioral health and primary care integrations, substance abuse opportunities, and population specific best practices. Training opportunities for all

health center staff have been identified by the management team to provide the resources to ensure staff have the opportunities and appropriate tools to be aware of the concerns

associated with substance abuse, provide an additional opportunity to seek client engagement, and to learn verbal deescalation techniques to assist in rapport development,

which is key to clients engaging in active management of the primary and behavioral health care needs. Lastly, training for clients regarding various behavioral health topics have



been identified as an opportunity to educate and encourage an individual’s active participation in their overall health. Through these trainings, clients will be provided opportunities

to receive additional information regarding the effects of substance abuse, untreated behavioral health conditions and local opportunities for treatment.The timeline is as

follows:SepNov 2017: contract development/execution – training class scheduling/initiationDec 2017: purchase of telehealth equipmentMay/June 2018: Conference attendance by

health center staff




Resources

As of 07/25/2017 02:12:58 PM


Equipment List






Alert:

This form is not applicable to you as you have not requested federal funds for the Equipment category in the Federal Object Class Categories form of this application.



TAB 4 – CLINICAL

• PATIENT TREND REPORT: The medical trend report for July 2017 is attached. • NO SHOW REPORT: The No Show report for January – July 2017 is attached. • DENTAL TREND REPORT: The dental trend report for July 2017 is attached. • BAYSIDE PHONE TREND REPORT: The phone trend report for July 2017 is attached.

The 2017 patient target for unduplicated patients is 2,980.

Data source: NextGen EPM 08/01/17 @ 7:45 AM; and 2016 Trend Reports

2016 Totals

Monthly increase, all sites except Bayside

Bayside ONLY monthly increase

Monthly cumulative including Bayside

Monthly cumulative including expanded clinic

January 219 329 548 351February 123 247 918 570

March 104 181 1203 737April 110 131 1444 915May 77 139 1660 1092June 87 131 1878 1313July 74 115 2067 1487

August 1657September 1833

October 1985November 2157December

Total for year 794 1273

2016 Totals

Monthly increase, all sites except Bayside

Bayside ONLY monthly increase

Monthly cumulative including Bayside

Monthly cumulative including expanded clinic

January 261 375 636 461February 219 429 1284 902

March 268 474 2026 1338April 253 390 2669 1821May 252 361 3282 2316June 237 409 3928 2869July 228 416 4572 3393

August 3989September 4623

October 5272November 5916December

Total for year 1718 2854

HCHP Trend Report for Unduplicated Patients & Qualified Medical Encounters by RM O'Brien

4572

Calendar Month

Calendar Month 2017 Totals

2017 Totals

2067 2308

6517

Unduplicated Patients

Qualified Medical Encounters

HCHP Unduplicated Patients report for CY 2017 by RM O'Brien Data source: NextGen EPM 08/01/17 @ 7:45 AM

Unduplicated Patient Count Percentage of Total Unduplicated Patient

Count

Pinellas Hope 149 7%Bayside 1273 62%Salvation Army (ARC) 174 8%Salvation Army 1-Stop (St. Petersburg) 161 8%St. Vincent DePaul (Clearwater) 79 4%St. Vincent DePaul (St. Petersburg) 174 8%Homeless Emergency Project (HEP) 47 2%TS Shepherd Center 10 0%Totals (2067) 2067 100%

Location/Site

2017 Totals

HCHP Qualified Medical Encounter report for CY 2017 by RM O'Brien Data source: NextGen EPM 08/01/17 @ 7:45 AM

New: 99201-99205

Established: 99211-99215

Total of New &

Established: 99201-99215

Percentage of Total New

and Established

Pinellas Hope 60 335 395 9%Bayside 472 2382 2854 62%Salvation Army ARC 81 340 421 9%Salvation Army 1-Stop (St. Petersburg) 74 266 340 7%St. Vincent DePaul (Clearwater) 25 113 138 3%St. Vincent DePaul (St. Petersburg) 75 260 335 7%Homeless Emergency Project (HEP) 22 53 75 2%TS Shepherd Center 10 4 14 0%Totals (4572) 819 3753 4572 100%

2017 Totals: Qualified Medical Encounters

Location/Site

HCHP No Show Rate July 2017

Location/Site Scheduled Keep Appointments Cancelled/Rescheduled

Number of No Shows Rate

Bayside 774 454 25 283 36.6%Homeless Emergency Project (HEP) 24 17 4 2 8.3%Pinellas Hope 85 63 8 14 16.5%Salvation Army (ARC) 81 63 8 10 12.3%Salvation Army 1-Stop (St. Petersburg) 83 54 14 15 18.1%St. Vincent DePaul (Clearwater) 43 21 11 10 23.3%St. Vincent DePaul (St. Petersburg) 60 45 3 12 20.0%TS Shepherd Center 5 3 0 2 40.0%

Totals 1155 720 73 348 30.1%

HCHP No Show Rate January 2017 to June 2017

Location/Site Scheduled Keep AppointmentsCancelled/

RescheduledNumber of No Shows

Percentage

Bayside 5,111 3,188 116 1,796 35.14Homeless Emergency Project (HEP) 102 83 4 14 13.73Pinellas Hope 600 439 33 128 21.33Salvation Army (ARC) 608 483 43 83 13.65Salvation Army 1-Stop (St. Petersburg) 528 368 40 120 22.73St. Vincent DePaul (Clearwater) 290 171 26 95 32.76St. Vincent DePaul (St. Petersburg) 564 374 29 161 28.55TS Shepherd Center 17 11 0 3 17.65Totals 7820 5,117 291 2,400 30.69

Florida Department of Health in Pinellas CountyHMS Reports Pointing to Server: CHD52VSSHDW02, Namespace: HMS52 - 2017.4.01

Trend Report For MMU Dental Clients

Server Name:chd52vsdblogi01 File Name: CountyMedical.MMU.Trend_Report_For_MMU_Dental_Clients

For Date the Range of: 1/1/2017 Thru 7/31/2017

Service Site Number of Patients Service Encounters

PINELLAS PARK HEALTH CENTER 26 53

TARPON SPRINGS HEALTH CENTER 1 1

MID COUNTY HEALTH CENTER 10 15

ST PETE HEALTH CENTER-SPECIALTY CARE 31 32

BAYSIDE CLINIC-MOBILE MEDICAL UNIT 2 423 1417

ST PETERSBURG HEALTH CENTER 37 65

CLEARWATER HEALTH CENTER 16 39

All Sites 503 1622

The sum of the patients at each service site will not equal the total unduplicated number of patients any time a patient receives treatment at more than one service site.

\..

,__

Florida HEALTH

J

t

I

Florida Department of Health in Pinellas CountyHMS Reports Pointing to Server: CHD52VSSHDW02, Namespace: HMS52 - 2017.4.01

Trend Report for Bayside Dental Clinic

Server Name:chd52vsdblogi01 File Name: CountyMedical.MMU.Trend_Report_for_Bayside_Dental_Clinic

Unduplicated MMU/Safe Harbor Dental Patients at all PCMH Dental Clinics including the Bayside Dental ClinicFrom 1/1/2016 to 7/31/2017

Calendar Month PCHP MMU/BaySide NoMedHome Monthly Increase Cumulative

April 2016 28 29 3 60 60

May 2016 6 32 2 40 100

June 2016 7 47 0 54 154

July 2016 9 32 1 42 196

August 2016 9 45 5 59 255

September 2016 12 30 2 44 299

October 2016 6 33 1 40 339

November 2016 6 32 0 38 377

December 2016 4 12 0 16 393

Totals for YearPercentages

8722.14%

29274.30%

143.56% 393

Unduplicated MMU/Safe Harbor Dental Patients at all PCMH Dental Clinics including the Bayside Dental Clinic


January 2017 20 114 0 134 134

February 2017 3 60 3 66 200

March 2017 3 52 0 55 255

April 2017 5 38 1 44 299

May 2017 11 58 0 69 368

June 2017 3 63 1 67 435

July 2017 1 33 1 35 470


469.79%

41888.94%

61.28% 470

Dental EncountersFrom 1/1/2016 to 7/31/2017


April 2016 35 40 3 78 78

May 2016 44 94 8 146 224

June 2016 50 147 4 201 425

July 2016 33 103 1 137 562

August 2016 44 157 6 207 769

September 2016 35 113 4 152 921

October 2016 34 129 4 167 1088

November 2016 33 104 5 142 1230

December 2016 23 66 1 90 1320

\..

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Florida HEALTH

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33125.08%

95372.20%

362.73% 1320

Dental EncountersFrom 1/1/2016 to 7/31/2017


January 2017 33 170 0 203 203

February 2017 20 214 4 238 441

March 2017 21 220 4 245 686

April 2017 14 159 1 174 860

May 2017 30 222 0 252 1112

June 2017 30 255 1 286 1398

July 2017 14 174 1 189 1587


16210.21%

141489.10%

110.69% 1587

Copyright © 2015 Westridge Professional Services. All rights reservered. 1/1

Report Selection Range:

1 3 4 5 6 7 8 0 * # T/E Total(s)

17 0 0 0 0 0 0 0 0 0 118 135

88 231 27 85 40 638 0 261 0 0 309 2293

105 231 27 85 40 638 0 261 0 0 427

Press 1Press 2Press 3Press 4Press 5Press 6Press 7Press 8Press 9Press 0T/E

OperatorTimed Out/Error

T/E = Calls that hang up BEFORE a selection is made.

Behavioral Health ReferralsSpecialty Care ReferralsProvidersAll Other QuestionsNot in UseNot in Use

Selection Total(s) 614 0

Hours and DirectionsMedical AppointmentsDental Appointments

BAYSIDE CLINIC CLOSED MENU 0 0

Bayside Clinic Main x37866 614 0

v2.5 8/1/2017 09:07:53 AM

Menu Component Statistics [July 2017]

Menu Component Statistics [July 2017]

Menu Name 2 9

TAB 5 – OTHER UPDATES