Advisory Sub Committee
Archived Minutes
Meeting Minutes - May 13, 2005
Participating: Ellen Carey, RN; Marion Kummer, MD; Peggy Egan, Parent; Laura Nicholson, MD; MaryAnn Guggenheim, MD; BJ Archambault, RN; Jackie Forba, Acting Bureau Chief; MaryLynn Donnelly, RN; Michelle Thibodeau, DDB Chief; Corliss Scott, Outreach Coordinator; Michele O'Donnell, Clinic Administrator; Mary Noel, Planning and Prevention Bureau; Nancy Gass, Parent, Gerald Eichner, MD; Sylvia Danforth, DEAP Director; Lori Byron, MD; Teri Web, Parent
Approval of 10-08-04 minutes-"Correction re Website in Yellowstone County-"There is not a website currently, but they want one. The sentence in question was on page 4 of the minutes and should say: Compared to Helena and Havre, his pulmonary clinics are better organized because Great Falls Clinic has a dedicated place for the clinic to occur.
Program updates:
Personnel Changes (Jackie Forba)-"BJ Archambault has been the acting Section Supervisor since the end of December 2004. Jackie Forba is the acting Bureau Chief of the HRB since the end of December 2004. The vacancies are due to budget constraints. Discussion: It was suggested that Dr. Nicholson contact Chuck Hunter regarding CSHS budget.
Update on CSHS billing for specialty clinics (Mary Noel)-"Although I am no longer part of the Health Care Resources Bureau, I took this billing project with me to my new position because it fits in with the mission of the Office of Planning, Coordination, and Analysis. I am helping the bureau set up the billing system and then the bureau will assume responsibility.
Background-"Traditionally, the Children's Special Health Services program has provided specialty clinic services to children in Montana free of charge. Because the federal government established goals directed toward more infrastructure building and less direct service provision, and because the federal Maternal and Child Health Block Grant amount is shrinking each year, CSHS will begin submitting claims to payment sources for children who attend cleft/craniofacial clinics and metabolic clinics. Process-"Michele has been preparing for this process for a couple of years. She attended training on billing procedures and researched systems and procedures. More recently, Michele completed and submitted an application to ACS Provider Relations for CSHS to become a Medicaid provider. She worked with ACS to establish a new provider type and set the fee schedule and the fund code. We are awaiting word on the acceptance of the provider application. Michele is also evaluating billing software. Some programming changes are needed to the Medicaid claims payment system. The MMIS user group gave the project priority number 1 but we do not anticipate completion of the programming changes before the next month or two. The Division's fiscal staff developed a flow chart of the process, revenue, and accounting functions, which is now in the process of being revised. Billing codes-"T1024, multidisciplinary team services, per encounter, $75 per specialist (some children will come to clinic and see only part of the team; usually this is a second visit in one year where a specific issue needs to be addressed). T1025, multidisciplinary team services, per day, $600 per day (annual full team evaluation of 10-12 specialists for cleft, or 4-5 specialists for metabolic). Regarding other payment sources, Michele will begin contacting insurance plans soon. Jackie Forba talked with Blue Cross Blue Shield of Montana about CSHS billing for specialty clinic services for children who have CHIP. BCBS had some questions about numbers of CHIP children who attend clinics, when CSHS plans to begin billing, and the time periods for which CSHS will bill. CSHS has draft amendments to the contracts with St. Vincent"s and Community Medical Center to allow CSHS to bill for their specialty clinics.
Other tasks on the project timeline include identifying and scheduling changes to CHRIS, developing policies and procedures, educating providers and families of the changes, and evaluating staffing and technical assistance needs. For children who have no payment source (Medicaid, CHIP, other insurance), CSHS will continue to be the payment source for them.
Discussion: Handout #1 was reviewed with a discussion of potential income of $200,000. Dr. Kummer questioned how facilities would be reimbursed. Mary explained that billing for cleft and metabolic clinics is a stepping-stone for other types of clinics to bill. It was decided the advisory council did not need to take an active role in this process at this time.
Legislative Update (Jackie Forba)-"Department and Bureau had good outcomes. CSHS now has fiscal authority to bill for clinics; Funding from new tobacco tax to establish a GF Clinic site was approved; CSHS is to be involved in development of Genetics RFP. CHIP-" will now be using a shortened application which will be on their website. CHIP is projecting to enroll 3000 more kids as of July 2005 as a result of I149, I146, and state funding. There will be additional "wrap-around" funding for some mental health services for kids with severe emotional disturbance (SED). CHIP was directed to evaluate the Nurse First program that is currently being used by Medicaid. A bill was introduced passed to allow DPHHS to investigate a self-insured plan for CHIP. DPHHS plans to continue purchasing insurance from BCBS for FFY 2006 and during FFY 2006 will determine the feasibility of a self-insured plan for the future. An administrative cap of 12% was established for the purchase of a fully insured plan and the reserve fund was defined HB 552 increases the Medicaid assets test so now more CHIP kids maybe eligible for Medicaid beginning July 2006. For additional information regarding Department legislative outcomes, please contact Jackie at jforba@mt.gov or 444-5288.
Discussion: Dr. Guggenheim questioned where we are going to get an additional 3000 kids (minus the wait list). CHIP staff will be conducting outreach to potentially eligible families, providers, advocates and community agencies.
Genetic program update re SB275 (BJ Archambault)-"General discussion of RFP process; also, we'll explore the possibility of Shodair taking over metabolic follow-up.
Website development status (Michele O'Donnell)-"CSHS website has been launched on the test site. Michele will email the advisory committee the address when it is available for use. Discussion: Dr. Guggenheim recommended publicizing information about the site. Links to Mountain States Genetics Network Regional Collaboration Center (MSGNRCC) and Parents Let's Unite with Kids (PLUK) were suggested. Dr. Nicholson reported grant possibilities through MSGP (Mountain State Genetic Program) to improve linked services. Dr Kummer expressed concern about duplication in websites and reported Medicaid is now developing their website.
Regional clinic updates (Ellen Carey) The Missoula clinic continues to grow from 250 clinic visits in a year to 850. Stable leadership at the hospital has been helpful. PLUK is now renting office space from Community Medical Center and is co-located with the clinic site. One of the benefits of co-location is that much of PLUK's activity is done from a home office. Marylynn reported Marcie McGill, the nutritionist for the Great Falls cleft-craniofacial clinic, has left the position and a replacement would be needed. Carolyn Wendell was suggested as a possibility.
(Marian Kummer for Cyndi Leaphart) Billings is working on NICU follow-up and feeding clinic development. GI clinic, Dr Narkowicz, did one follow-up clinic per telemedicine. The first NICU clinic will be in December 2005. The clinic site lost $300,000 last year and of course want to lose less in future. Discussion: Dr. Guggenheim recommended the hospital credit the tests, etc., done as a result of clinic visits to the income side. Courtney Hartwell, RD, is working out well as part of the metabolic team. She has had training in Missoula, but will not be able to train with Dr. Thomas' staff at this time. Other sites (BJ Archambault, MaryLynn Donnelly, Dr. Eichner)-"CSHS is waiting for tobacco tax $'s to establish clinic site, but will start preliminary work this fall. Interest from the Great Falls Clinic and Benefis Hospital in establishing a site in Great Falls has been gratifying. The hospital and clinic will be asked to provide joint input for prospective clinic coordinator candidates and medical director/advisor. CSHS staff previously met with Julie Wall, RN Director of Nursing and Julie Hickethier, Vice-president of Benefis Healthcare. Dr. Eichner confirmed the GF Clinic does have space available for the Clinic site.
CSHS financial update (BJ Archambault)-"Financial budget for dates 07-01-04 through 04-30-05 was reviewed. Attachment A Discussion: It was clarified that CSHS can shift funds from one area of the budget to another area. AC wanted to know why budget is still short-"Explanation: Theresa Gruby is working full-time, rather than part-time for CSHS, and staff received a 25cent an hour raise. Comp time is minimal in CSHS. Dr. Guggenheim anticipates that as the GF clinic site is developed and there is a responsibility shift, CSHS would see a change in personnel costs.
CATCH GRANT/CSHCN needs assessment survey (Dr. Kummer)-"A cshcn needs assessment survey is being conducted jointly with Diana Fricke of the MCH Bureau. The survey will be conducted at Part C organizations and the regional clinics. The survey queries parents about what services they're having trouble with, asks where they get information, and what could primary care providers do to help. Five-dollar phone cards are being provided as survey incentives for specialty clinic participants. Sylvia Danforth offered to survey youth with special health care needs also. The goal is to get the survey out soon and survey ~3000-4000 families. Results will be used in MCH BG reporting and used to get grants for a website. Diana Fricke will collate the results.
PSP providers-"Policy has been established and effectively finalized. CSHS has received a formal application from Dr. Gunville and he has started providing clinics.
Specialty Clinic Booklet errors-"There are some errors in the specialty clinic booklet which need to be corrected in the next version. CSHS will make specialty clinic information available on the website but will also continue to do a mailing or at least mail out an index card with website information.
MSDB update-"CSHS links with Hi Track and MSDB are moving along and are on target. In future, CSHS would like to make "live" hearing screening results available at specialty clinic sites. The NBHS council teleconferenced earlier this week. A $150,000 NBHS grant each year for 3 years was awarded the NBHS Program. Frustration was expressed regarding the kids who are lost to follow up. Process not routed through MSDB. The NBHS program is making information available to council members. MSDB would like to combine funding for an Audiology position to have ½ of a position and ½ funding from OPI to combine activities of hearing conservation program and NBHS follow up. If CSHS receives Champion"s grant funding, parent project is going to focus on payment for hearing aides. There was discussion regarding the question of follow-up. CSHS is not currently doing follow-up on kids who do not return for 2nd screen.
Follow-up programs-"Champions for Progress incentive award request was submitted. Funding will be used to increase parent participation and satisfaction with CSHCN program activities. CSHS is participating in re-vamping of TCM billing program for cshcn. The School Nurse Guidance manual for CSHCN has been updated. Information was 10 years old. New manual is available in CD and hard copy and contains multiple forms for school use. Copies are being provided to Cyndi and Ellen.
Old Business-"Data on where children are served-"Conditions information is not accurate and partial data is not useful. Frustrating process. MaryLynn will work with requester in future to clarify specifics.
New Business-CSHS Medical Advisor-"Dr. Laura Nicholson in now the CSHS medical advisor. She is also now the Chair of the CSHS Advisory Committee.
Blaze Favara, M.D., resigned from the AC.
The advisory committee meeting was cut short due to technical difficulties. Date options will provided to the advisory committee for a fall face-to-face meeting.
