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Title V Maternal and Child & Adolescent Health

Serving Iowa’s women, children, adolescents, and families

Iowa Department of Public HealthBureau of Family Health

March 14, 2018

Presenters

• Stephanie Trusty, Nurse Clinician– Bureau of Family Health, Maternal Health Program– Email: stephanie.trusty@idph.iowa.gov– Phone: (515) 418-7604

• Janet Beaman, Executive Officer 2– Bureau of Family Health, Child & Adolescent Health Program– Email: janet.beaman@idph.iowa.gov– Phone: (515) 745-2728

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Title V of the Social Security Act

• Title V funding: Key source of support for promoting and improving the health and well-being of the nation’s mothers, children, including children with special needs, and their families.

• Vision: An America where all children and families are healthy and thriving and have a fair shot at reaching their fullest potential.

History of Title V• The federal Maternal and Child Health (MCH) Program

was authorized in 1935 under Title V of the Social Security Act. Its roots, however, go back nearly a century - to the 1912 creation of the Children's Bureau.

• MCH Block Grant is a federal-state partnership that supports the development of community-based solutions to health threats facing women, children, and families.

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Title V MCH Goals• Access to quality health care for mothers and children, especially for

people with low incomes and/or limited availability of care

• Health promotion efforts that seek to reduce infant mortality, reduce the incidence of preventable diseases, and increase the number of children appropriately immunized against disease

• Access to comprehensive prenatal and postnatal care for women, especially low-income and/or at-risk pregnant women

• An increase in health assessments and follow-up diagnostic and treatment services, especially for low-income children

• Access to preventive health care services for children as well as rehabilitative services for those in need of specialized medical care

• Family-centered, community-based systems of coordinated care for children with special healthcare needs

• Toll-free hotlines and assistance in applying for services for pregnant women with infants and children who are eligible for Medicaid

Federal Structure for MCH

Public Health Service

Department of Health and Human Services(DHHS)

Health Resources Services Administration(HRSA)

Maternal and Child Health Bureau

(MCHB)

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Federal Maternal and Child Health Bureau (MCHB)• MCHB promotes

– maternal/women’s health– perinatal and infant health– child health– adolescent and young adult health– children and youth with special health care needs

• MCH provides special focus on– families with low income levels– those with diverse racial and ethnic heritages – those living in rural and isolated areas with limited access to

care

Title V Block Grant in Iowa

• Granted to state health departments through a formula-based block grant.

– In Iowa, funds come to the Iowa Department of Public Health.

• It is a $3 billion federal-state partnership.– Matching requirement: States must match at least $3 for

every $4 in federal funds received.

• 37% of Iowa’s Title V funding goes for children and youth with special health care needs.

– In Iowa, this goes to Child Health Specialty Clinics at the University of Iowa

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Iowa’s Title V Block Grant• Promotes the health of pregnant women, children, and

youth by facilitating access to preventive health services, especially for low-income families and families with limited access.

• Promotes the development of community-based systems of medical and oral health care for pregnant women, children, youth, and young adults.

• Places an increased emphasis on serving adolescents:MCAH

Iowa’s Structure for MCAH

Iowa Department of Public Health (IDPH)

Division of Health Promotion and Chronic Disease Prevention (HPCDP)

Bureau of Family Health and Oral Health Center

(BFH) (OHC)

Child Health Specialty Clinics (CHSC)

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National and State Performance Measures

(NPM and SPM)

Iowa’s Title V National Performance MeasuresNPM # Data Source Performance Measure MCH Population Domain

PM 1 BRFSS Percent of women with a past year preventative visit Women/Maternal

PM 4 National Immunization Survey A) Percent of infants ever breastfedB) Percent of infants breastfed exclusively through 6 months

Perinatal/Infant

PM 6 NSCH – revised Percent of children, ages 9-71 months, receiving a developmental screening using a parent-completed screening tool

Child Health

PM 9 YRBSS & NSCH Percent of adolescents, ages 12-17 years, who are bullied Adolescent Health

PM 10 NSCH – revised Percent of adolescents with a preventive services visit in the last year Adolescent Health

PM 11 NSCH – revised Percent of children with and without special health care needs having a medical home CSHCN

PM 12 NSCH – revised Percent of children with and with special health care needs who received services necessary to make transitions to adult health care

CSHCN

PM 13 A) PRAMS B) NSCH-revised

A) Percent of women who had a dental visit during pregnancy andB) Percent of infants and children, ages 1-17 years, who had a preventive dental visit

in the last year

Cross-cutting

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Iowa’s Title V State Performance MeasuresSPM # Performance Measure MCH Population Domain

SPM 1 Percent of children and youth with special health care needs who meet the criteria for Quality of Care

CYSHCN

SPM 2 A) Percent of Child Health clients who report a medical home

B) Percent of Maternal Health clients who report a medical home

Cross-cutting

SPM 3 Percent of children with a payment source for dental care Child Health

SPM 4 Percent of early care and education programs that receive child care nurse consultant services Child Health

SPM 5 Rate of physical activity among adolescents aged 18-24 Adolescent Health

Primary Funding Sources for Iowa MCAH Services

Federal Department of

Health and Human Services

Iowa Department of Human Services

Iowa Department of

Public Health

Interagency Agreement

Title VTitle XIX

Maternal Health Centers & Screening Centers

Contract

Title V MH and CAH Agencies

Other Local Providers

Subcontract

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The Title V MCH Pyramid of Services

Public Health Services and Systems• Community needs assessment / data analysis / strategic planning

• Developing and reviewing protocols

• Developing and maintaining community linkages – providing information on the MCAH program to local providers

• Hiring of personnel and staff training

• Establishing subcontracts and agreements

• Quality assurance and quality improvement

• Program evaluation

• Population-based services

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Enabling Services• Outreach

– Presumptive eligibility for pregnant women and children– Reaching hard-to-reach populations– Health fairs

• Informing services– For families of newly eligible Medicaid children– Provides information on Medicaid’s EPSDT benefits

• Care coordination services– Linking to maternity care or periodic well child exams and related diagnosis & treatment– Work with medical, dental, mental health, and other providers on behalf of clients– Arranging interpretation and transportation services

Direct Services• Primary and preventive services through a medical/dental home

• Gap-filling direct care services provided by MCAH agencies– Prenatal Risk Assessment– Maternal health education– Psychosocial services– Depression screening– Domestic violence screening– Drug/alcohol screening– Immunizations– Blood lead tests– Developmental and emotional/behavioral screening– Dental screens– Fluoride varnish applications

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Maternal and Child & Adolescent Health Services

Medicaid’s Maternal Health Center and Screening Center programs provide the model of services for ALL CLIENTS served through MCAH programs.

– Screening Center guidelines are based upon Bright Futures (AAP - American Academy of Pediatrics)

– Maternal Health Center guidelines are based upon Guidelines for Perinatal Care (AAP/ACOG – American Congress of Obstetricians and Gynecologists)

MCAH Electronic Record System

• TAVConnect is the official record for all MCAH services.

– Child and Adolescent Health Services must be entered into the TAV-CAH module.

– Oral Health services must be entered into the TAV-OH module.

– Maternal Health services must be entered into the TAV-MH module.

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Medicaid Member’s Designation• Medicaid Managed Care Organizations (MCOs)

– Clients either choose or are assigned to a Medicaid MCO whose role is to ‘manage the member’s care’.

– Clients access care from providers enrolled in their MCO.– Claims for direct care services provided by MCAH agencies are billed to the

MCO in which the client is enrolled.

• Medicaid Fee-for-service (FFS)– Any practitioner enrolled in Medicaid may provide health care services.– Claims for direct care services provided by MCAH agencies are billed to IME

for Medicaid fee-for-service clients. – All Medicaid covered dental direct care services provided by MCAH agencies

are billed to the IME for any Medicaid enrolled client (whether FFS or MCO designated).

Assuring Member Rights Under Medicaid• Client confidentiality

• Freedom of choice of health provider within the member’s Medicaid status

• MCO choice upon enrollment or change for Good Cause: https://dhs.iowa.gov/iahealthlink/choosing-a-health-plan/good-cause

• Right to appeal to Iowa Medicaid or MCOs– Iowa Department of Human Services

Appeals Section1305 E Walnut Street, 5th FloorDes Moines, IA 50319Phone (515) 281-3094FAX (515) 564-4044Email: appeals@dhs.state.ia.ushttps://dhs.iowa.gov/appeals/appeal-a-dhs-decision

– Contact the assigned MCO regarding their appeal process.

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Iowa’s MCAH Application Process• A Request for Proposal (RFP) process establishes the foundation

for the upcoming project period (FFY 2017 through FFY 2020).

• A Request for Application (RFA) is a continuation application submitted in each subsequent year of the project period (FFY 2018, FFY 2019, and FFY 2020).

• Upon approval, a MCAH contract is issued.– Special conditions for the MCAH Program.– General Conditions that apply to all IDPH contracts.

Go to http://idph.iowa.gov and click on ‘Funding Opportunities’.

The Local MCAH Application• Establishes the MCAH program plan for each county in the service

area. – Required activities identified in the guidance (e.g. BOH and NPM/SPM)– Program priorities based upon community needs, including CHNA & HIP– Optional activities

• Provides a program summary through Logic Models – MH, CAH, OH

• Includes:– Activity Worksheets– Service Delivery Tables– Program Budgets

• Are submitted through IowaGrants.gov.

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IowaGrants.gov Grant Site

All documentation of contract activities are captured on the agency’s grant site in IowaGrants.gov. Components include:

– Application– Contract and amendments– Correspondence– Posting of claims– Site Visits– Reports (e.g. Cost Analysis, Service Note Review,

Chart Audits, Mid-Year Report, Year End Report)

Billing of MCAH Services• Always bill your agency’s cost -- determined by the Cost Analysis completed

at the beginning of the fiscal year.

• IME, Medicaid MCOs, and IDPH reimburse your agency’s cost for the service billed – up to a maximum rate.

– Claims go to IDPH for presumptive eligibility, informing, and care coordination services.

– Claims go to IME for medical direct care services for Medicaid fee-for-service clients.

– Claims go to the Medicaid MCO for medical direct care services for clients enrolled in the MCO.

– Claims go to IME for all oral health direct care for all Medicaid clients (FFS or MCO).

• Assure that date of service on billing records matches the date of service in TAVConnect and the clinical record.

• Be sure that documentation of services is complete for any service billed.

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MCAH Project Management Portal• Designed for MCAH agencies to access relevant program

resources: http://idph.iowa.gov/family-health/mchportal

• Tools include:– Cost Analysis and Transportation Plan– Maternal Health Services Summary– Child & Adolescent Health Services Summary– Logic Models– Chart Audit Guidelines and Tools– DHS Rules for Documenting Services– Service Note Review– Consent and Release of Information Templates– On-line trainings such as CAH Informing, Care Coordination, and Direct Care

Services– And MORE!

Iowa Medicaid Enterprise (IME)• Provider Services 800-338-7909 (toll free)

515-256-4609 (Des Moines area)

• Member Services 800-338-8366 (toll free)

515-256-4606 (Des Moines area)

• Eligibility Verification System (ELVS)

800-338-7752 (toll free)

515-323-9639 (Des Moines area)

or via the web portal through EDISS at https://ime-ediss5010.noridian.com/iowaxchange5010/LogonDisplay.do.

• IA Health Link: https://dhs.iowa.gov/iahealthlink

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For More Information• The Chief of the Bureau of Family Health serves as Iowa’s Title V

Director.

• Your agency’s Regional MCAH Consultant and/or Oral Health Consultant serve as primary contacts for program information.

• For assistance from our Bureau staff, call 1-800-383-3826.

Resources• IDPH Bureau of Family Health: http://idph.iowa.gov/family-health

• HRSA Maternal and Child Health Bureau: https://mchb.hrsa.gov/

• HRSA Title V MCH Block Grant: https://mchb.hrsa.gov/maternal-child-health-initiatives/title-v-maternal-and-child-health-services-block-grant-program

• Association of Maternal and Child Health Programs (AMCHP): http://www.amchp.org/pages/default.aspx

• National Performance Measure Data: https://mchb.tvisdata.hrsa.gov/

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