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Federal Financial Participation for Comprehensive Perinatal Services Program (CPSP) Perinatal Service Coordinators (PS

Federal Financial Participation for Comprehensive Perinatal Services Program (CPSP) Perinatal Service Coordinators (PSC). CPSP….. .

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Federal Financial Participation for Comprehensive Perinatal Services Program (CPSP) Perinatal Service Coordinators (PS

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  1. Federal Financial Participationfor Comprehensive Perinatal Services Program (CPSP)Perinatal Service Coordinators (PSC)

  2. CPSP….. • A special MediCal program provides comprehensive services, including prenatal care, health education, nutrition, and psychological support to and for MediCal eligible and MediCal beneficiaries up to 60 days post partum through CPSP providers. • CPSP provides services and care beyond the normal approved MediCal providers to give every baby a healthy start in life, improve pregnancy outcomes, reduce the incidence of low birth weight infants, and prevent catastrophic illness in low/no income women,infants and children

  3. FFP – What is it? • Federal Title XIX Program Medicaid or MediCal $$ funds • Purpose Identify low or no income women and children that had no means or access to health care and Link women and children of need to care, providers and/or services to ensure safe and healthy pregnancy, birth and growth. • Two Program Objectives #1 To assist individuals eligible for MediCal to enroll in the MediCal program and/or #2 To assist individuals on MediCal to access MediCal providers and services. • Bonus $$$ for qualified staff performing specific activities. • Requirements

  4. FFP Requirements Qualified Perinatal Services Coordinator must meet: #1 Skilled Professional Medical Personnel – SPMP *Must meet Federal SPMP qualifications not State or County. #2 MCAH Policy & Procedure *Position requirements *SPMP Questionnaire

  5. FFP Requirements con’t • MediCal Factor *CPSP is a MediCal program serving MediCal providers and clients only. *95% is the maximum MediCal Factor for PSC to matchable. *Almost 100% of your activities on behalf of the CPSP are matchable activities. *Many activities in the CPSP can only be matched by staff in the program.

  6. FFP Requirements • Time Study -At least once a quarter for an entire month. -Must be for 100% of your time and activities for all programs & activities assigned and worked. • Secondary Documentation -Supports the information on the Time Study. -Provides sufficient information to distinguish different activities and programs. -Documentation should support the Function Code chosen. -Maintained for three (3) years.

  7. FFP Function Codes • Outreach • SPMP Administration Case Management • SPMP Intra/Inter Agency Coordination, Collaboration & Administration • Non-SPMP Intra/Inter Agency Coordination, Collaboration & Administration • Program Specific Administration • SPMP Training • Non-SPMP Training • SPMP Program Planning & Policy Development • Quality Management by SPMP • Non-Program Specific General Administration • Other Activities - Exceptions • Paid Time-Off

  8. Function Code #1OutreachNon-Enhanced Activity This function is to be used by all staff when performing activities that inform MediCal eligible or potentially eligible individuals, as well as other clients, about health services covered by MediCal and how to access the health programs. Activities include a combination of oral and written informing methods which describe the range of services available through the MediCal program and the benefits of preventive or remedial health care offered by the MediCal program.

  9. Function Code #1OutreachExamples • Visit and presentation to medical providers office concerning CPSP. “10:00 AM - !2:00 Pm CPSP program presentation to Northwest Women & Children Clinic.” • Community presentation concerning CPSP. “6:00 PM – 7:00 PM Sacramento School District PTA presentation – Early Prenatal Care can make a difference” • Inform the perinatal community, including  providers, managed care plans, and other health and human service providers about local status and trends of perinatal outcomes and their relationship to the MCH yearly plan. “2:00 PM – 4:00 PM UC Davis regional OB/GYN providers association meeting – CPSP presentation.”

  10. Function #2SPMP Administrative Medical Case ManagementEnhanced Activity This function is to be used only by skilled professional medical personnel when participating in medical reviews; assessing the necessity for and types of medical care associated with medical case management and case coordination activities required by individual MediCal beneficiaries.

  11. Function #2SPMP Administrative Medical Case ManagementExample • Working with a client to find a CPSP provider. “ Provided M. Reams with a list CPSP providers in her area.”

  12. Function Code #3SPMP Intra/Interagency Coordination, Collaboration, & AdministrationEnhanced Activity This function is to be used only by skilled professional medical personnel when performing collaborative activities that involve planning and resource development with other agencies which will improve the cost effectiveness of the health care delivery system and improve availability of medical services.

  13. Function Code #3SPMP Intra/Interagency Coordination, Collaboration, & AdministrationExamples • Participate in local planning to address unmet needs to provide access to first trimester care for all pregnant women. “2:00 PM – 5:00 PM Access to Care Collaborative”. • Work with the perinatal community including provider, managed care plans and human service providers to reduce barriers to care, avoid duplication of services and improve communications. “10:00 AM - !2:00 PM Meeting the Transportation needs in our community – Collaborative”.

  14. Function Code #5Program Specific AdministrationNon-Enhanced Activity This function is to be used by all staff when performing activities that are related to program specific administration which are identifiable and direct charged to the program. Office related general task.

  15. Function Code #5Program Specific AdministrationExamples • Reading and responding to e-mails, phone calls and mail. “8:00 AM – 8:30AM Responding to E-Mails, returned 2 calls.” • Photocopying “ 2:30 PM – 3:30 PM Preparing forms for new CPSP provider packets.” • MCAH Program meetings “1:30 PM – 2:30 PM MCAH staff meeting”. • Time Study documentation “4:30 PM – 5:00 PM Complete weekly Time Study”.

  16. Function Code #6SPMP TrainingEnhanced Activity This function is to be used only when training is provided for or by skilled professional medical personnel and only when the training activities directly relate to the SPMP’s performance of specifically allowable SPMP administrative activities. • Meet the FFP objectives • Must be given by a SPMP • At the knowledge level of a SPMP • Be a SPMP (e.g. a Provider)in the CPSP program

  17. Function Code #6SPMP TrainingExamples • Attendance at state-sponsored PSC meeting and other required trainings and related activities such as task force committees, is essential for the coordination and operation of this program. “8:00 AM – 5:00 PM CPSP Executive Committee Meeting”. • New PSC must attend a new coordinator’s orientation. “8:00 AM – 5:00 PM New PSC training”. • Training that increases your knowledge or skills in managing pregnant women. “8:00 AM – 1:00 PM UCLA OB/GYN Department presents “Managing preterm labor”.

  18. Function Code #7Non-SPMP TrainingNon-Enhanced Activity This function is to be used by all staff when training relates to non-SPMP allowable administrative activities and to the medical care of clients. • Meet the FFP objectives • May be given by a SPMP or Non-SPMP • At a general knowledge level for SPMP & Non-SPMP staff. • For providers & staff in the CPSP program.

  19. Function Code #7Non-SPMP TrainingExamples • CPSP training for CPSP provider staff. “11:00 AM - 1:00 PM CPSP for San Andres Women and Children clinic staff”. • New MediCal procedures and forms. “ 1:30 PM – 2:30 PM Training on new MediCal forms - Dr. Rosen & staff – Diamond Bar”.

  20. Function Code #8SPMP Program Planning & Policy DevelopmentEnhanced Activity This function is to be used by onlyby skilled professional medical personnel and only when performing program planning and policy development activities. The SPMP’s tasks must officially involve program planning and policy development, and those tasks must be identified in the employee’s job description/duty statement.

  21. Function Code #8SPMP Program Planning & Policy DevelopmentExamples • Facilitate meeting the needs of providers and managed care plans for updated materials, resources and information on CPSP and the needs of the target population. “3:00 PM – 4:30 PM Meeting w Kaiser S.S.F CPSP coordinator review compliance w program requirements”. • Process applications for those eligible providers desiring to become approve CPSP providers. “2:00 PM – 3:00 PM Review & prepare Dr Shah’s CPSP application for submission.” • Under take quality assurance activities as appropriate, with CPSP providers and managed care plans and participate in regional and statewide CPSP advisory committees/workgroups. “1:30 PM – 3:30 PM Southern Regional Perinatal Committee Meeting”. • Address issues related to access and quality of perinatal care. “ 2:00 PM – 4:00 PM Review quarterly birth statistic”.

  22. Function Code #9Quality Management by SPMPEnhanced Activity This function is to be used by only by skilled professional medical personnel and only when performing quality management activities such as monitoring the authorization for medical services (utilization review) process, ongoing program assessment and evaluation, and the development of standards and protocols.

  23. Function Code #9Quality Management by SPMPExamples • Reviewing CPSP provider files. “9:00 AM – 11:00 AM Record reviews provider - Dr. Babson.” • Periodic Reviews of CPSP program protocols. “1:00 PM – 3:30 PM Reviewing and updating CPSP providers protocols.” • Provider chart review “9:00 AM - 12:30 PM – Chart review for 5 clients Dr. Gonzales Office – Provider #65-0043.”

  24. Function Code #10Non-Program Specific General AdministrationAllocated-Share of cost by all programs This function is to be used by all staff when performing non-program specific administrative activities that relate to multiple functions or to no specific, identifiable functions due to the general nature of the activities.

  25. Function Code #10Non-Program Specific General AdministrationExamples • General agency meeting – non-program issues “1:30 PM - 2:30 PM Monthly Public Health Department Mtg. • Mandated bioterrorism training “1:30 PM – 4:30 PM Bioterrorism Training”. • Safety driving training “9:00 AM – 11:00 AM CHP Safety Driving Training”. • CPR/First Aide – Agency mandated training “9:00 AM – 12:00 PM CPR Training”. • Sexual Harassment Training “2:30 PM – 3:30 PM Sexual Harassment Training”.

  26. Function Code 11 - Examples Any activity that is not part of or on behalf of the CPSP program is not matchable. For example: • Any direct clinical services. • Anticipatory Guidance/Activities • Social Activities • Childhood Safety • Job Development • School related activities • Housing need activities • Day Care • SIDs • Transportation* • Translation • Routine Developmental Testing (i.e.Denver)

  27. Function Code #12Paid Time OffAllocated - Share of cost by all programs This function is to be used by all staff to record usage of paid leave, holiday, vacation, sick leave and so on.

  28. Function Code #12Paid Time OffExamples • Vacation “8:00 AM – 5:00 PM – Vacation”. • Holidays – Thanksgiving, Lincoln’s Birthday, Christmas, New Years etc. “8:00 AM – 5:00 PM – Holiday”. • Sick leave – Doctor’s appointments, Family sick leave, etc. “3:00 PM – 5:00 PM Dentist”. • Jury Duty – Only if your agency pays your salary while on jury duty. “8:00 AM – 5:00 PM Jury Duty”. *Non-paid leave is not noted or coded on the Time Study. For example: your lunch, compensatory time off (CTO) or flex time.

  29. What can you do? • Attend a Time Study training at your local agency. • Keep up to date on all the rules & requirements. • Be prepared to Time Study. • Check your Secondary Documentation for clarity and substantiation. • Ask questions if you do not know the answer or you are unsure what to code.

  30. Need help with FFP or have FFP questions ??? • Referred to your PSC FFP training. • FFP User’s Guide. • Ask your local MCAH program manager. • Contact your MCAH Branch program consultant. • MCAH Branch CPSP staff.

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