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HomeMy WebLinkAboutAgenda - 03-06-1996 - IX-B t Board of Commissioners `+ 1 Action Agenda Item No. —$ Action Agenda Item Abstract Meeting Date: March 6, 1996 Subject: Maternity Care Coordination Grant Department: Health Public Hearing Yes_ No X Budget Amendment Needed Yes X No Attachments(s) Information Contact Health Director's Office X2411 1. Notice of Award of$12,500 grant from DEHNR. 2. Local Health Department Budget Telephone Number 3. Contract Addendum 4. Two letters from the Department of Family Hillsborough 732-8181 Medicine, UNC School of Medicine Chapel Hill 968-4501 5. Maternity Care Coordinator Revenue Mebane 227-2031 and Expense Analysis Durham 688-7331 Purpose: To approve acceptance of a grant from DEHNR awarded in the amount of$12,500.00 to increase the number of pregnant women covered by Medicaid who receive Maternity Care Coordination and establish a permanent, time-limited Social Work position to provide the services at the UNC School of Medicine Department of Family Medicine. Background: The Orange County Health Department has been providing a case management service called Maternity Care Coordination(MCC) since 1989. The service was designed by the State Health Department and the State Division of Medical Assistance to reduce the infant mortality rate and other poor pregnancy outcomes experienced by pregnant women who are covered by Medicaid. A study by the State Center for Health and Environmental Statistics demonstrated that pregnant women who receive MCC have significantly better birth outcomes than women who do not receive MCC. Reducing poor birth outcomes has been a high priority in the health department for several years. Currently, the department provides MCC at the OCHD clinic in Hillsborough and off-site at UNC Hospital Clinics. The two positions are self-supporting through Medicaid fees charged for the services. Recently, DEHNR determined that approximately 60 pregnant women covered by Medicaid last year did not receive MCC and recommended that the health department expand the service. Concurrently, the department received a request to outstation a maternity care coordinator at the Family Practice Center which has seen an increase in the number of Medicaid eligible prenatal patients it has enrolled as a Carolina Access provider. In their letter of January 29, 1996, Family Medicine said that the lack of MCC resulted in missed appointments, poor follow-up and lack of support for psychosocial problems. 1 2 The attached letter of February 19, 1996, commits the Department of Family Medicine to cover the ' daily operating expenses for the position including telephone, office space, basic supplies and computer support without a claim on the revenue unless a year end review shows a surplus of revenue over health department expenses. It is appropriate for the OCHD to provide this service for the following reasons: 1. The service fits within the priorities we have set for reducing poor pregnancy outcomes such as low birth weight, prenatal and infant mortality. This has been the number one or two priority in our last three community diagnoses. 2. We have developed expertise in the area of case management and outreach services. 3. We have a similar arrangement with UNC Hospitals prenatal clinic through which we have outstationed a maternity care coordinator to provide MCC services. The grant from DEHNR provides up front funding of$12,500 to allow an MCC to be paid while the caseload builds up and the Medicaid reimbursement begins to flow. The attached revenue and expense analysis demonstrates that the projected monthly Medicaid revenue is expected to cover the cost of a social worker at grade 67, step 3B. The up front funding will give us time to generate revenue at a level sufficient to support the position. Therefore, no county funds are requested to supplement the grant and the revenues. The Department of Family Medicine has asked for a one year commitment to test the feasibility of this arrangement. Therefore, we are requesting a permanent time-limited position for one year, the continuation of which will be contingent upon the Medicaid revenue projections being realized and the Department of Family Medicine being willing to continue the partnership. Recommendation: The Manager recommends: 1. That the grant of$12,500 be accepted and the contract amendment with DEHNR be authorized for signature. 2. That the Health Department be authorized to enter into an agreement with the UNC Department of Family Medicine to provide MCC services to their prenatal clients for a trial period of one year the continuation of which is contingent upon a review of the first year's experience. In concurrence with the request of Family Medicine in their letter of January 29, 1996. 3. In concurrence with the request of Family Medicine in their letter of January 29, 1996, that a permanent, time-limited position be approved for a period of 12 months commencing with the date of hire which is projected to be on or about May 1, 1996, to be reviewed as to outcome effectiveness financial feasibility before it is renewed. t ® 3 THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILT. The School of Medicine The University of North Carolina at Chapel Hill Department of Family Medicine Department of Family Medicine 919-966-3889(phone) Manning Drive,Campus Box 7595 919-966-6125 (fax) Chapel Hill,NC 27599-7595 January 29, 1996 Eileen Kugler Director, Personal Health Division Orange County Health Department P.O. Box 8181, 300 W. Tryon Street Hillsborough, NC 27278 Dear Ms. Kugler, We are writing to request your assistance in developing a Maternity Care Coordination pilot project for our UNC Family Practice Center Patients. We would like to negotiate a one year contract with Orange County Health Department to provide a full time position for an MSW prepared maternity care coordinator based at the Family Practice Center. This would allow us to provide maternity care coordination for women receiving prenatal care in our setting. We have spoken with Lynda Dixon and Dennis Williams have received support from the Division of Medical Assistance. Bruce Nelson,a social work graduate student,has worked with us in identifying barriers to care for our prenatal patients. We anticipate 175 births within our practice during the present academic year and have documented that anywhere from 25-35% of our patients are on Medicaid at any given time.Our lowest estimate would then be from 42-60 patients on Medicaid during a given year. However, we do not know how many more women are eligible for Medicaid(either full coverage or for coverage of expenses not reimbursed by private insurance). It became quickly apparent to us that the lack of maternity care coordination often resulted in missed appointments,poor follow up,and lack of support for psychosocial problems. It is becoming more and more evident that our clients need an onsite Maternity Care Coordinator because we do not have the resources necessary to provide the same services. We have utilized the services of the MCC's in all of the surrounding counties (Orange, Durham, Alamance, Chatham) as well as Piedmont Health Services. It is impossible to refer everyone so we find ourselves calling for assistance after a crisis has occurred rather than being able to anticipate problems. We would like for the person in this position to provide case management services during prenatal clinic visits and home visits according to state MCC guidelines. Since our projected numbers would not support a full time position,we would like to utilize the MSW to provide intensive psychosocial counseling also according to state guidelines. 4 We have explored the options available to us (i.e. developing a position within our department or contracting with the health department) and think the most effective approach would be to seek the support of the health department. We understand this is a new approach to MCC outside the health department or tertiary care setting. This may seem somewhat analogous to the position at UNC OB filled by Donna Daniels. Our model of care however, is more like a private practice than a high risk clinic. Our patients have primary providers who also provide prenatal,delivery,and newborn care. We attract women from several counties and would hope to provide maternity care coordination irregardless of the county of origin. (i.e. Orange, Durham, Chatham, Alamance) We look forward to participating in the state's efforts to develop a community/private practice based maternity care coordination program. As a professional member of our prenatal team we would certainly hope to include a Maternity Care Coordinator in team meetings and as a resource in our residency training program. Ron Lingley, our departmental administrator, would be responsible for negotiating a contract, with approval by Ken Reeb, M.D. Department Chairman. In return for administrative support provided by the Department of Family Medicine in the form of office space,phone,and computer access, we would anticipate some form of reimbursement for those services from the 20%medicaid typically reimburses for "overhead.". We are also hopeful that state grant monies will be available to you for start up costs for this project.Both Trish Payne CNM,MPH and Dale Alexander, PhD (Director of the Behavioral Science) would be interested in participating with you in interviewing applicants as well as providing on site state supervisory support for the MCC working here. The Department of Family Medicine and the BABY LOVE Program are very enthusiastic about the innovative potential of this collaborative effort. It would be a challenging and rewarding experience for an MCC to work with our department.We are committed to providing a supportive collegial environment for MCC and would consider them as an integral part of our clinical and educational program.. Please let us know when we could meet to discuss this project in more detail. Please feel free to call us should you need further information before we meet. Sincerely, Margaret Helton, M.D. Trish Payne CNM,MPH cc: D. Alexander R. Lingley W. Newton K. Reeb, M.D. K. Ryan D. Williams State of North Carolina 5 Department of Environment, Health and Natural Resources • Division of Maternal and Child Health A&Jt)�A James.B. Hunt,Jr.,Governor p E H N R Jonathan B. Howes,Secretary Ann F. Wolfe, M.D., M.P.H., Director February 8, 1996 MEMORANDUM TO: Mr. Daniel Reimer, Health Director Orange County Health Department FROM: Wayne Raynor Head, Maternal Health Branch SUBJECT: Maternity Care Coordination Grant Request We are pleased to inform you that your application for maternity care coordination grant funds has been approved. The amount awarded is $12,500. Enclosed for your completion and signature are the following documents: 1. CONSOLIDATED CONTRACT AMENDMENT (DEHNR 2946A) 2. CONTRACT ACTIVITY BUDGET (DEHNR 2948) 3. CONTRACT ADDENDUM,(DEHNR 3300) Make sure all required local contractor signatures are placed on the CONTRACT AMENDMENT and CONTRACT ACTIVITY BUDGET pages. Enter February 1. 1996 to June 30 1996 as the effective dates on both documents. The health director's initials in the lower right hand corner are all that is rewired on the CONTRACT ADDENDUM page. Since funds are being allocated late in the Fiscal Year, we do not expect local providers to serve the additional numbers of Medicaid recipients projected by June 30, 1996. Therefore, the CONTRACT ADDENDUM calls for attainment of the projected increase in MCC caseload by the end of Fiscal Year 1996-97. Medicaid data like that included in Attachment III of the MCC grant application package will be used by the Division of Maternal and Child Health to monitor local performance. Return your CONTRACT AMENDMENT, ACTIVITY BUDGET and CONTRACT ADDENDUM as soon as possible to: P.O. Box 27687, Raleigh, North Carolina 27611-7687 State Courier 52-01-00 ,u r ma orpwUwq/A enu*"we2kw[./lyw 50%rw7dern0%pft*cM ..e.Mpee 6 February 8, 1996 Page 2 Department of Environment, Health and Natural Resources Division of General Services Purchase and Contracts Section P. O. Box 27687 Raleigh, North Carolina 27611-7687 Please remember that you only have to June 30, 1996 to expend these funds. Do not delay in beginning your recruitment efforts. You will be notified when the next Basic Training for New Maternity Care Coordinators is to be held. Should you have any questions or need assistance, please contact your Regional Social Work Consultant. WR/mf Enclosure cc: Regional Social Work Consultants Dr. Kevin Ryan Tom Vitaglione Johnsie Robinson i AMENDMENT NUMBER 7 to CONSOLIDATED CONTRACT between THE STATE and THE ORANGE COUNTY HEALTH DEPARTMENT This Contract covering the period from 02 01 96 to 06 30 96 (Month) (Day) (Year) (Month) (Day) (Year) is hereby amended to add the following activities: ACTIVITIES Maternity Care Coordination (medicaid) All provisions and clauses set forth in the Contract are hereby incorporated in this Amendment and constitute the terms and conditions applicable for the above activities involving State funding. CONTRACTOR SIGNATURES NORTH CAROLINA DEPARTMENT OF ENVIRONMENT,HEALTH,AND NATURAL RESOURCES Jonathan B. Howes, Secretary Health Director Date By Finance Officer Date Department Head's Signature or Authorized Agent Chairman of County Date Commissioners DEHNR 2946A (Revised 3/93) General Services Division (Review 10/95) LOCAL HEALTH DEPARTMENT BUDGET $ N.C. Department of Environment, Health,and Natural Resources Revision Number—— Division of General Services SFY 95-96 Division of Maternal and Child Health ----- P.O.Number 2/1 / 96 6/30 / 96 9 6 5 1 0 7 0 0 68 Effective Date Termination Date Contract Number Contractor: ORANGE COUNTY HEALTH DEPARTIMT Activity: Maternal Care Coordination Project Director: Daniel B. Reiser Total Budget:$ 12,500.00 ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 12,500.00 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 E General Contracted or Purchased ServicesjAI, ` 'u School Health ;.: I BLT7:'? d` D Clinician y iwWirrw ui ui,w4uw. wiurr� itiwrw-�.� r. I 2 T, Laboratory $ ' Pharmacy Services -.7777 777 U Transfer TXIX R Subtotal State Expend. $ 12,500.00 E LOCAL EXPENDITURES: LOCAL EXP 9000 S TOTAL EXPENDITURES—equal to Total Receipts $ LOCAL FUNDS: R Appropriation APPROP 101 E TXIX TXIX 102 C Other Receipts OTHR REC 103 E Subtotal Local Funds $ 12,500.00 STATE/FEDERAL/SPECIAL FUNDS: I P 1601 536961 -1510-5107-XXXX 12,500.00 T S Subtotal State/Federal/Special $ 12,500.00 TOTAL RECEIPTS—equal to Total Expenditures $ Local Authorized Official Signature Date Division/Section Si tur Date w� ection 8� Finance Officer Signature 77- -, Fiscal Management Signature Date DEHNR 2948(Revised 2/93) General Services Division(Review 2/94) 9 N.C. Department of Environment, Health and Natural Resources Page 1 of 1 Division of General Services FY 1995-96 f CONTRACT ADDENDUM Maternal Health Branch 96 51070 068 Office, Section, or Branch Contract Number brange County Health Department Maternity Care Coordination Contractor Activity icaic The number of Medicaid recipients who will receive maternity care coordination services in FY 1996-97 will be 60 more than the number who were served in FY 1994-95. Reviewed by DEHNR 3300 (Revised 2/90) General Services Division(Review 1/95) Initials Date (D 10 1 THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL Rn.L The Meal of Modialne The Univa my of North Catolina at Chapel Hill Depattm m of Paudly Modiolne Depamum of Family Modieine 919.966.3711(phone) Manning Drive,Campus Box 7595 91"M-6115(64 Chapel Hill,NC 27599-7595 February 19, 1996 Dan Reimer, Health Director Orange County Health Department FAX 664-3007 Dear Mr. Reimer, The University of North Carolina Department of Family Medicine would like to confirm our support for a Baby Love pilot project jointly undertaken with the Orange County Health Department. This project involves establishing a maternity care coordinator at the UNC, Family Practice Center. It is understood that the Orange County Health Department will provide salary and benefits for this coordinator,to be covered by the revenue generated. The UNC Department of Family Medicine will cover the daily operating expenses for this person, including telephone, office space, basic supplies, and, if necessary, the required computer support. At the end of the pilot year, the project will be reviewed with any surplus revenue used to cover the shared expenses. We understand, though, that because this is a pilot project there is no guarantee of any reimbursement for overhead expenses and we are willing to assume this risk. We look forward to working with you in this innovative undertaking as we strive to provide quality care to women and children of North Carolina. Sincerely, Ken Reeb, M.D. Professor and Chair 1 1 11 Maternity Care Coordinator Revenue and Expense Analysis REVENUE (Annualized) We anticipate a total caseload of approximately 60 clients for the year with about 40 at any given time. Projections of services are: 5 Initial contacts/month @ $92.97 each = $ 464.85 35 Subsequent contacts/month @ $47.02 each — 1645.70 10 Home visits/month @ $50.75 each = 507.50 10 Counseling/month @ $33.25 each — 332.50 Total $2950.55/month x 12 months = $35,406 EXPENSES $28,584 salary projected at Grade 67 Step 3B 7,400 fringe benefits $35,984 Total salary and fringe 296MCC.doc/am/adm/bOcc