Chapter Five
State Title V / Title XIX Interagency
Agreements
To establish roles and responsibilities
between the parties for the purpose of providing
coordination of services to promote prompt access
to high quality prenatal, intrapartum, postpartum,
postnatal, and child health services for women
and children eligible for benefits under Title
V and XIX of the Social Security Act.
-- Stated objective from Maryland’s 2004
IAA
A. Overview of Data and Tables
B. State-by-State Summary Tables
A.
Overview of Data and Tables
Explanation of
the Tables
Each of the IAAs reviewed for this publication
is summarized in the following tables. From
the 36 States that submitted IAAs or other material,
a total of 47 documents were analyzed; a number
of States have multiple agreements to cover
separate topics.
Each chart is divided into four sections:
- A description of the document itself, including:
- Title and author.
- Date of publication (year only).
- Number of pages.
- Link to the full-text of the document.
- A summary of contractual details, including:
- Effective date.
- Duration.
- Type of agreement.
- Agencies involved.
- Authority cited for the agreement.
- A summary of the agreement sections that
relate to CMS requirements outlined in 42
CFR 431.615(d), including:
- Objectives of the agreement.
- Responsibilities of the agencies involved.
- Services provided by each State agency.
- Cooperative relationships at the State
level.
- Services provided by local agencies.
- Identification and outreach activities.
- Reciprocal referrals.
- Plans for coordination of services for
beneficiaries.
- Methods for reimbursement.
- Plans for reporting and sharing of data.
- Plans for periodic review of the agreement.
- System of continuous liaison between agencies.
- Plans for joint evaluation of the agreement
and other policies.
- A listing of general contract provisions
(item 19) listing whether the document covers:
- Amendment/modification of agreement.
- Audit.
- Confidentiality of records/HIPAA compliance.
- Default.
- Dispute resolution mechanisms.
- Drug-free workplace provisions.
- Failure to satisfy scope of work (SOW).
- Indemnification/liability clauses.
- Provisions for lack of funds.
- Lobbying statements.
- Systems for maintenance of records/recordkeeping.
- Nondiscrimination clauses.
- Methods for payment.
- Regulations regarding subcontracts.
- Tobacco policies (smoke-free workplace
environment).
- Grounds and methods for termination
of agreement.
When information is gathered from different
sections of the agreement or other supporting
documentation (e.g., the cover letter sent by
the State agency with the IAA) but is not clearly
spelled out in the text, straight brackets []
are used to highlight this data.
Wherever possible, text in the summary tables
is taken directly from the IAAs. While this
practice has a tendency of making various tables
lengthy, it more accurately preserves the tone
and intent of the document than a simple summary
paragraph could do. Modifications to the text
(most often ellipses or other omissions) have
been made for clarity and brevity. Large omissions
have been noted in the summary tables with links
back to the full-text agreements. The full-text
of each IAA summarized along with a database
of the components of the summary tables are
accessible at http://www.mchlibrary.info/IAA.
States Summarized
in the Tables
B.
State-by-State Summary Tables
State: Alabama
(Region 4)
Document: Provider Contract
between the Alabama Medicaid Agency and the
Alabama Department of Public Health [Amendment
to Original Contract]
Author: Alabama Medicaid Agency
Date: 2004 Pages: 3 pp.
Document URL: http://www.mchlibrary.info/iaa/states/AL_1_1.pdf
Contractual Details:
1. Effective Date: March 1,
2004 [amendment date].
2. Duration: N/A
3. Type of Agreement: Provider
Contract.
4. Agencies Involved: A. The
Alabama Medicaid Agency (“Medicaid”)
[Title XIX].B. The Alabama Department of Public
Health (ADPH) [Title V].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
To amend the original T5/T19 provider contract
regarding EPSDT services (care coordination).
7. Responsibilities: N/A
8. Services Provided by Agency:
A. Amendment: Care Coordination.
- ADPH shall develop and maintain a care
coordination system which shall ensure Medicaid-eligible
children receive appropriate services.
- ADPH shall utilize reports provided by
Medicaid monthly to identify children who
have not received screenings.
- ADPH shall follow-up on positive findings
for sickle cell and metabolic screenings,
newborn hearing screens, and immunization
status.
- ADPH shall receive referrals from physicians
and dentists regarding medically-at-risk clients.
- ADPH shall arrange for necessary transportation.
- ADPH shall utilize the appropriate diagnosis
codes to identify high-risk children.
- ADPH shall provide a monthly summary of
EPSDT Care Coordination to the Agency’s
EPSDT staff.
B. Original Agreement.
Original agreement consists of the “respective
responsibilities of Title V and Title XIX agencies
in the provision of services by perinatal coordinators.
Title V is responsible for ensuring that
perinatal coordinators meet professional standards.
Perinatal coordinators provide following
services: increasing awareness of and utilization
of tertiary care centers and preventive health
care; evaluation of resources; identification
of areas of need; and development of new resources;
research and development of more effective mechanism
for the transfer of high risk mothers and
babies. Title V will review compliance of each
perinatal coordinator annually. Title X may
seek
replacement of any non-complying coordinator.”
(From 1st edition of
State MCH-Medicaid Coordination nation: A Review
of Title V and Title XIX Interagency Agreements).
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service A2, A6.
12. Reciprocal Referrals: See
Section 8, Service A4.
13. Coordinating Plans: N/A
14. Reimbursement:
Medicaid will reimburse ADPH for care coordination
services based on Medicaid’s current reimbursement
rates. ADPH agrees to reimburse Medicaid the
state share of costs associated with providing
care coordination services.
15. Reporting Data: See Section
8, Service A2, A7.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:N/A
State: Arizona
(Region 9)
Document: [Arizona] Data-Sharing
Request/Agreement
Author: Arizona Department
of Economic Security
Date: n.d. Pages: 10 pp.
Document URL: http://www.mchlibrary.info/iaa/states/AZ_1_1.pdf
Contractual Details:
1. Effective Date: N/A
2. Duration: N/A
3. Type of Agreement: Standard
Business Agreement.
4. Agencies Involved: A. Arizona
Department of Economic Security.B. Arizona Department
of Health Services, Public Health Prevention
Services, Division of Public Health, Office
of Women’s and Children’s Health
[Title V].
5. Authority Cited: Field in
agreement form left blank.
Summary Related
to CMS Requirements:
6. Objectives:
To establish access to information used by the
Pregnancy and Breast Feeding Hotline; the Newborn
Intensive Care Program; and the Newborn Screening
Program.
7. Responsibilities: N/A
8. Services Provided by Agency:
AzTECs access will be used to determine enrollment
status with any/all DES-FAA programs. This includes
but is not limited to: Baby Arizona; food stamps;
health care plans; and cash assistance. This
information is used to facilitate enrollment
and/or answer enrollees’ questions.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8.
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: N/A
15. Reporting Data:
There are many contractual provisions regarding
provision and security of data. Please see original
document.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
maintenance of records/recordkeeping
State: California
(Region 9)
Document: Interagency
Agreement between California Department of Health
Services, Title XIX Medicaid Agency and the
Title V Maternal and Child Health Agency
Author: California Department
of Health Services
Date: 1997 Pages: 15 pp.
Document URL: http://www.mchlibrary.info/iaa/states/CA_1_1.pdf
Contractual Details:
1. Effective Date: Immediately
(signed January 15, 1997).
2. Duration: Will continue
in effect unless revised or canceled.
3. Type of Agreement: Interagency
Agreement.
4. Agencies Involved: A. California
Department of Health Services (DHS), Medical
Assistance Program (Medi-Cal) [Title XIX].B.
Maternal and Child Health Branch (MCH) [Title
V].C. Children’s Medical Services Branch
(CMS).
5. Authority Cited: A. Public
Health Law 89-97.B. SSA §1902(a)(11), et
al.C. 42 CRF §431.615(b) and §431.615(c)(4).
Summary Related
to CMS Requirements:
6. Objectives:
A. To enable CHS and its Title V and Title XIX
programs to carry out the mandate of cooperation.
B. To protect and improve the health of California’s
women, pregnant women, infants, children
and adolescents, particularly those who are
low-income, by developing and implementing
initiatives that systematically attack the underlying
causes of preventable diseases and
conditions; strengthening relationships with
local health agencies and expanding partnerships
with multi-cultural and ethnic organizations;
working to close the gaps in health status and
access to care among the State’s maternal
and child health population; and, developing
and
implementing standards of care, program choices,
data collection and surveillance processes,
and contracting and reimbursement systems that
promote outcome-oriented and business-like
approaches to the administration of Title V
and Title XIX programs.
7. Responsibilities:
A. Title V and XIX agencies are charged with
direct responsibility to achieve the Year 2000
Objectives in California as they relate to women
and children.
B. Programs within the Department that impact
women and children have the responsibility of
making resources available to achieve the goals
and objectives of this Agreement.
C. Medi-Cal is responsible for the conduct of
the Title XIX program.
D. MCH Branch is responsible for the conduct
of the MCH program.
E. CMS Branch is responsible for the Child Health
and Disability Prevention (CHDP) and California
Children’s Services (CCS) programs.
8. Services Provided by Agency:
A. Objective 1: Ensure and support the provision
of a comprehensive, coordinated, and
accountable health services delivery system
for all eligible pregnant women, infants, children,
and adolescents.
1. Medi-Cal Services
.
a. Develop reimbursement methodologies for the
payment of MCH care services.
b. Support the retention of culturally and linguistically
competent, and geographically strategic,
safety net and traditional providers of MCH
services who have a positive track record of
serving
the Medi-Cal population.
c. Develop, in cooperation with MCH and CMS,
provider manuals, billing instructions, and
provider training.
d. Develop, in cooperation, health care standards,
etc.
2. MCH and CMS Services
.
a. Participate in joint development and implementation
of pilot projects.
b. Maintain a specialty provider network.
c. Develop, in cooperation with Medi-Cal, provider
manuals, billing instructions, and provider
training.
d. Develop in cooperation health care standards.
B. Objective 2: Ensure the provision of high
quality health care by organizations and providers
who meet professional practice standards.
1. Medi-Cal Services
.
a. Collaborate in developing standards.
b. Participate and collaborate in the development
of program policies, etc.
c. Establish quality improvement standards.
d. Collaborate in setting standards for services.
e. Participate with MCH and CMS in the oversight
and monitoring of services.
2. MCH and CMS Services
.
a. Collaborate in developing standards.
b. Provide case management.
c. Participate with Medi-Cal in the oversight
and monitoring of services.
C. Objective 3: Improve access to perinatal
and preventive health care services for low-income
women, particularly adolescents and children,
respectively, and services to CSHCN.
1. Medi-Cal Services
.
a. Refer potentially eligible Medi-Cal beneficiaries
to the CCS program.
b. Develop eligibility procedures.
c. Develop and produce outreach materials and
oversee the implementation of outreach
campaigns.
d. Develop and implement Medi-Cal provider recruitment.
e. Maintain a MCH provider resource directory
and database.
2. MCH and CMS Services
.
a. Identify and fund local health departments
and other contractors to provide the infrastructure
for health care programs which may be utilized
to provide services to the Medi-Cal program’s
beneficiaries and other low income women and
children.
b. Support provider outreach.
c. Develop regulations that define CSHCN.
d. Provide health education and MCH expertise
in the development of outreach materials.
e. Certify perinatal providers.
f. Conduct prenatal guidance and other outreach
programs.
D. Objective 4: Ensure maximum utilization of
Title XIX funds by Title V contractors and
providers, including reimbursement by Medi-Cal
for all medically necessary services within
the
Medi-Cal scope of benefits.
1. Medi-Cal Services
.
a. Seek input from Title V staff into the development
of Medi-Cal fee-for-service and managed
care rates and reimbursement mechanisms.
b. Reimburse Title V contractors and providers,
etc. with current Medi-Cal rates and fees for
all
services within the scope of Medi-Cal benefits.
c. Reimburse authorized providers for services
delivered to Medi-Cal beneficiaries with CCS-
eligible conditions.
2. MCH and CMS Services
.
a. Require all Title V providers to be Medi-Cal
providers.
b. Ensure that Title V funded contractors/providers
bill for services.
(For the following objective, the respective
agency services have been omitted for brevity.
See
the full-text document for a complete listing
of these services).
E. Objective 5: Plan and support the delivery
of training and education programs for health
professionals and the community, including beneficiaries
of Title V and XIX services.
F. Objective 6: Develop and implement data collection
and reporting systems that support
assessment, surveillance, and evaluation with
respect to health status indicators and health
outcomes among the populations served by both
programs.
G. Objective 7: Improve ongoing intra departmental
communication between staff of the two
programs for information sharing, problem solving,
and policy setting (this includes sharing of
information and maintaining regular, formal
communications).
H. Objective 8: Maintain adequate Title XIX
and Title V program staff with the necessary
expertise necessary to carry out the specific
functions and responsibilities of providing
direct
support in administering the Title XIX program.
I. Objective 9: Maximize utilization of third
party resources available to Title XIX recipients.
9. Cooperative Relationships:
See Section 13. Cooperative relationship building
is stressed throughout Section 8.
10. Services Provided by Local Agencies:
Identify and fund local health departments and
other contractors to provide the infrastructure
for health care programs which may be utilized
to provide services to the Medi-Cal program’s
beneficiaries and other low income women and
children (Section 8, Service C2a).
11. Identification and Outreach:
Title V will identify infants, children, adolescents,
and women who are potentially eligible for Medi-Cal
and, once identified, aid them in applying.
Title V in collaboration with Title XIX is
responsible for outreaching and informing all
EPSDT eligible individuals about the program.See
also Section 8, Service C1c.
12. Reciprocal Referrals:
See Section 8, Service C1a.
13. Coordinating Plans:
To ensure high quality, coordinated services
there will be joint development of policies
and
regulations between the Title V and XIX programs
on services.
There will be coordination and collaboration
in the development and implementation of managed
care programs.
VIII. Cooperative and Collaborative Methods
and Arrangements.
A. Arrangements for Resolving Operational Issues.
B. Arrangements for Reciprocal Referrals.
C. Arrangements for Payments of Reimbursement.
D. Arrangements for Exchange of Reports of Services
Provided to Recipients of Title XIX.
E. Arrangements for Periodic Review of the Agreement
and Joint Planning for Changes.
14. Reimbursement:
The Medi-Cal program is responsible for paying
for those medically necessary program benefits
to eligible Medi-Cal beneficiaries delivered
by Title V programs.See also Section 8, Service
A1a, I.
15. Reporting Data:
Title V will maintain confidentiality of the
medical records and release such information
to a third party only with written consent.There
will be sharing of data and participation in
joint planning efforts in order to identify
service delivery gaps and to improve the delivery
of services.
See also Section 8, Service F.
16. Review:
Arrangements for Periodic Review of the Agreement
and Joint Planning for Changes: Meetings will
be held at least once a year, and more frequently
if necessary, among the Branch Chiefs, or their
representatives, of the programs part to this
Agreement for the purpose of reviewing the need
for any changes or clarifications to the Agreement,
carrying out the agreements specified herein,
evaluating activities and policies set out and
providing coordinated input to the required
plans of the respective programs.
17. Liaison:
All parties will keep each other apprised of
those services and scope of benefits available.Each
party will designate form their respective staff
appropriate liaisons whose responsibilities
shall include regular and periodic communication
about the programs.Continuous liaison among
the parties will be the responsibility of the
Chief of each of the programs and those staff
designated as lead persons in their respective
Branches.See also Section 8, Service G.
18. Evaluation:
At the request of any party to the Agreement,
a formal review may be scheduled to modify,
enlarge, or clarify this Agreement. Any changes
in this Agreement will be subject to full discussion
and concurrence in writing prior to incorporation
into this document.
19. General Contract Provisions:
confidentiality of records/HIPAAamendment/modification
of agreementtermination of agreement
State: Colorado
(Region 8), document 1 of 2
Document: [Colorado] Interagency
Agreement
Author: Colorado Department
of Health Care Policy and Financing
Date: n. d. Pages: 18 pp.
Document URL: http://www.mchlibrary.info/iaa/states/CO_1_2.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 -
June 30, 2005.
3. Type of Agreement: Interagency
Agreement.
4. Agencies Involved: A. Colorado
Department of Health Care Policy and Financing
(“the Department” or HPCF) [Title
XIX].B. Colorado Department of Public Health
and the Environment (CDPHE) [Title V].
5. Authority Cited: Encumbrance
Number PO UHA 2105-2007 in Fund Number 100,
Appropriation Accounts 450 and 460 and Organization
Number 4111.
Summary Related
to CMS Requirements:
6. Objectives: N/A
7. Responsibilities: A. The
Department is responsible for the administration
of the Colorado Medical Assistance Program (Medicaid).B.
CDPHE is responsible for the administration
of the Health Care Program for Children with
Special Needs in Colorado.
8. Services Provided by Agency:
The following are the topics under which services
are provided. See the original Agreement for
a complete list of services.
A. Family Planning.
B. Prenatal Plus.
C. Health Care Program for Children with Special
Needs (HCP).
D. Developmental Evaluation Clinic Services.
E. Immunization Program.
F. Lead Poisoning Prevention Program.
G. Breast and Cervical Cancer Program.
H. Nurse Home Visitor Program.
9. Cooperative Relationships:
The Department and CDPHE shall work together
to provide program implementation and administration
for all programs listed in this IAA. This program
coordination includes, but is not limited to:
joint meetings when necessary, telephone conference
calls, review of printed materials, assistance
with billing concerns, assistance with provider
questions, and joint participation in program
trainings.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
A. HPC Medical Home Initiative shall promote
use of EPSDT outreach activities to Primary
Care Physicians for Medicaid-enrolled families.
B. CDPHE shall work with Department EPSDT Program
Outreach Coordinators to develop and maintain
a mechanism whereby Medicaid-enrolled clients
shall be informed of the availability of Title
V funded services, and referred for these services
as appropriate.
12. Reciprocal Referrals:
See Section 11, Service B.
13. Coordinating Plans: The
Department shall collaborate via mutually agreed
upon activities/conferences.
14. Reimbursement: A. The
Department shall intervene with the Department’s
Designated Entity to ensure payment of the correct
rate for Medicaid covered services.B. The Department
shall bill the State match for Medicaid expenditures
to CMS.C. CDPHE shall bill the Department no
less than quarterly.D. CDPHE shall submit a
request for reimbursement within 45 working
days after the final State fiscal year.E. Family
planning client claims are paid directly out
of MMIS.F. Payments shall be made from state
funds not to exceed $102,346 for the administrative
costs of the Medicaid Prenatal Plus Program.G.
HCP specialty clinic providers are paid out
of MMIS.H. HCP Developmental and Evaluation
Clinic services are billed directly by Medicaid
providers and paid through the Department Designated
Entity.I. Immunizations and vaccines are paid
out of the MMIS.J. Medicaid covered Lead Poisoning
Prevention Program benefits are paid out of
MMIS.K. Benefits to BCCP clients are paid directly
out of MMIS.L. Payment shall be made to the
NHVP providers as earned.
15. Reporting Data: A. CDPHE
shall provide an annual report to the Department
on the program reporting the progress made.B.
The Department shall provide CDPHE with Internet
access for materials that are relevant to the
programs identified in this IAA.
16. Review: N/A
17. Liaison: CDPHE and the
Department shall each designate a primary contact
for each activity under this IAA.
18. Evaluation: N/A
19. General Contract Provisions:
lack of fundsdispute resolution mechanismconfidentiality
of records/HIPAAmaintenance of records/recordkeepingfailure
to satisfy SOWamendment/modification of agreementtermination
of agreement
State: Colorado
(Region 8), document 2 of 2
Document: [Colorado] HIPAA
Business Associate Interagency Memorandum of
Understanding
Author: Colorado Department
of Health Care Policy and Financing
Date: n. d. Pages: 9 pp.
Document URL: http://www.mchlibrary.info/iaa/states/CO_2_2.pdf
Contractual Details:
1. Effective Date: July 1,
2001.
2. Duration: July 1, 2004 -
[April 21, 2005].
3. Type of Agreement: Interagency
Memorandum of Understanding.
4. Agencies Involved: A. Colorado
Department of Health Care Policy and Financing
(HCPF) [Title XIX].B. Colorado Department of
Public Health and the Environment (CDPHE).
5. Authority Cited: A. Interagency
Agreement Number 2105-2007.B. Health Insurance
Portability and Accountability Act of 1996,
42 U.S.C. 1302d-3120d-8 (HIPPA).C. HIPAA Privacy
Rule at 45 CFR Parts 160 and 164.
Summary Related
to CMS Requirements:
6. Objectives:
A. To disclose certain information to Associate
[CDPHE] pursuant to the terms for the contract,
some of which may include protected health information.
B. To protect the privacy and provide for the
security of protected health information disclosed.
C. To enter into a contract containing specific
requirements with CDPHE prior to the disclosure
of protected health information.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. CDPHE
.
1.
Permitted Uses:
CDPHE shall not use Protected Information except
for the purpose of
performing CDPHE’s obligations under and
permitted by the terms of the MOU.
2.
Permitted Disclosures:
CDPHE shall not disclose Protected Information
in any manner that
would constitute a violation of the Privacy
Rule if disclosed by HCPF.
3.
Appropriate Safeguards:
CDPHE shall implement appropriate safeguards
as are necessary to
prevent the use or disclosure of Protected Information.
4.
Reporting of Improper Use or Disclosure:
CHPHE shall report to HCPF in writing any use
or
disclosure of Protected Information other than
as provided for by this MOU.
5.
CDPHE’s Agents:
If CDPHE uses one or more subcontractors or
agents to provide services
under this MOU who have access to Protected
Information, each subcontractor or agent shall
sign an agreement containing the same provisions
as this MOU.
6.
Access to Protected Information:
CHPHE shall make Protected Information maintained
by
CDPHE or its agents or subcontractors available
to HCPF for inspection.
7.
Amendment of PHI:
CDPHE shall make Protected Information available
to HCPF for
amendment and incorporate any such amendment
within 20 business days.
8.
Accounting Rights:
within 20 business days CDPHE shall make available
to HCPF the
information required to provide to HCPF.
9.
Governmental Access to Records:
CDPHE shall make its internal practices, books,
and
records available to the Secretary of the U.S.
Department of Health and Human Services.
10.
Minimum Necessary:
CDPHE shall only request, use, and disclose
the minimum amount of
Protected Information necessary to accomplish
the purpose of the request.
11.
Data Ownership:
CHPHE acknowledges that it has no ownership
rights with respect to
Protected Information.
12.
Retention of Protected Information:
CHPHE shall retain all Protected Information
through
the term of this MOU.
13.
Notification of Breach:
CHPHE shall notify HCPF within 2 business days
of any breach of
security.
14.
Audits, Inspection, and Enforcement:
Within 10 business days of a written request,
CDPHE
shall allow HCPF to conduct a resalable inspection.
15.
Safeguards During Transmission:
CDPHE shall be responsible for using appropriate
safeguards to maintain and ensure confidentiality
of Protected Information transmissions.
B. HCPF
.
1.
Safeguards During Transmission:
HCPF shall be responsible for using appropriate
safeguards to maintain and ensure confidentiality
of Protected Information transmissions.
2.
Notice of Changes:
HCPF shall provide CDPHE with a copy of its
notice of privacy practices
as well as any subsequent changes.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: N/A
15. Reporting Data: See Section
8 for security measures while reporting data
as well as transmission of Protected Information.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementfailure to satisfy SOWindemnification/liabilitysubcontractslack
of funds
State: Connecticut
(Region 1), document 1 of 2
Document:
State of Connecticut: Memorandum of Understanding
between the Department of Public Health and
the Department of Social Services Regarding
Data Exchanges
Author: State of Connecticut
Department of Public Health
Date: 2005 Pages: 10 pp.
Document URL: http://www.mchlibrary.info/iaa/states/CT_1_2.pdf
Contractual Details:
1. Effective Date: Amended
May 20, 2005.
2. Duration: This MOU shall
be in effect until canceled by mutual agreement
of the parties or “suspended” with
60 days advance notice by one party to the other
party.
3. Type of Agreement: Memorandum
of Understanding.
4. Agencies Involved: A. Connecticut
Department of Public Health (DPH).B. Connecticut
Department of Social Services (DSS).
5. Authority Cited: Section
19a-45a of the Connecticut General Statutes.
Summary Related
to CMS Requirements:
6. Objectives:
To improve public health service delivery and
public health outcomes for low-income populations
through the sharing of available Medicaid, HUSKY
Plan Part B, HUSKY Plus and Title V data.More
specifically, through the implementation of
the addenda to this MOU pertaining to specific
data exchanges, the purposes are as follows:1.
To increase coordination between DPH and DSS
for programs funded by the MCH Block Grant.2.
To increase coordination in the administration
of programs that are designed to improve the
health of children and adults in Connecticut.3.
To increase cooperation in reviewing and implementing
fiscal policies that affect populations served
by DPH and DSS and providers of services.4.
To implement a process that allows for joint
access to critical Medicaid and public health
data without duplication of effort.5. To promote
long-range planning as it relates to data sharing.
7. Responsibilities:
The addenda specify that DPH and DSS are responsible
for (note: no addendum 4 was
submitted):
A. Identification of Medicaid births (Addendum
1).
B. Information regarding children receiving
lead screenings (Addendum 2).
C. Children receiving Title V services (Addendum
3).
D. Children with asthma (Addendum 5).
8. Services Provided by Agency:
Addendum 1: DPH will send core demographics
to DSS; DSS will complete a match of the birth
records with HUSKY A enrollment data.Addendum
2: DSS will provide DPH with a list of selected
children enrolled in the Medicaid program; DPH
will use the linking data to abstract data elements;
DPH will analyze and report this data.Addendum
3: DPH will provide DSS a list of children who
received Title V services; DSS will determine
which children enrolled in HUSKY A received
Title V services and provide a file with these
names to DPH.Addendum 5: DSS will prove DPH
with a file of children enrolled in HUSKY A
who have had had any services related to asthma
diagnosis or treatment along with total number
of children enrolled in HUSKY A.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: N/A
15. Reporting Data: A. Use
of Data for Specified Purposes: DPH and DSS
agree that the data they receive from each other
will be used only for the purposes set forth
in this MOU.B. Confidentiality of Data: DPH
and DSS will not further disclose the information
they receive from each other.C. Task-Specific
Addenda: This MOU included addenda that specifies
the data to be shared between DPH and DSS.D.
Disposition of Data: DPH and DSS will destroy
all confidential individually identifiable health
information as soon as the purposes for which
they received the information have been accomplished.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
paymentamendment/modification of agreementtermination
of agreement
State: Connecticut
(Region 1), document 2 of 2
Document:
[State of Connecticut:] Memorandum of Understanding
between Department of Public Health and (Name
of Managed Care Organization)
Author: State of Connecticut
Department of Public Health
Date: n.d. Pages: 4 pp.
Document URL: http://www.mchlibrary.info/iaa/states/CT_2_2.pdf
Contractual Details:
1. Effective Date: N/A
2. Duration: N/A
3. Type of Agreement: Memorandum
of Understanding.
4. Agencies Involved: A. State
of Connecticut Department of Public Health (DPH).B.
CYSHCN Regional Medical Home Support Centers
(CT has contracted with 5 MCOs).
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
To recognize shared goals and to establish methods
of coordination and cooperation to ensure that
children and youth served by the Regional Medical
Home Support Centers who are enrolled in Connecticut’s
HUSKY, Part A managed care program receive timely
and comprehensive health care services under
the EPSDT program.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. CYSHCN Regional Medical Home Support Centers
.
1. Support CYSHCN and their families by assisting
them with coordination of multiple systems
of care.
2. Provide training and support to the Pediatric
Primary Care providers by addressing family
needs.
3. Assist the Pediatric Primary Care Providers
with care coordination of CYSHCN who have
high severity needs.
4. Assist with the coordination between the
Pediatric Primary Care Providers and specialists.
5. Promote the establishment of a “Medical
Home.”
6. Contract with Parents Networ4k across the
State to support families with CYSHCN.
7. Provide respite services to underinsured
and uninsured families of CYSHCN.
B. MCOs
.
1. Inform families about EPSDT.
2. Conduct outreach to ensure children receive
EPSDT services.
3. Link children to primary care providers and
dental providers.
4. Schedule EPSDT appointments for children.
5. Remind families when EPSDT exams are due.
6. Ensure that primary care providers participating
in HUSKY A are knowledgeable about
EPSDT.
9. Cooperative Relationships:
See Section 8, Service A1, A3.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service B1, B2.
12. Reciprocal Referrals:
See Section 8, Service B3.
13. Coordinating Plans: See
Section 8, Service A4, A6, B6.
14. Reimbursement: N/A
15. Reporting Data: The Regional
Medical Home Support Centers (RMHSC) shall provide
a copy of the RMHSC health information form
to the MCOs.
16. Review: N/A
17. Liaison: Each MCO shall
provide DPH with the name of a liaison who shall
serve as a consistent point of contact for the
Regional Medical Home Support Centers (RMHSC).
The liaison shall be responsible for providing
assistance to the RMHSC to resolve any problems
that arise.
18. Evaluation: N/A
19. General Contract Provisions:
N/A
State: Florida
(Region 4)
Document:
[Florida] Cooperative Agreement for the
Health Start Coordinated Care System for Pregnant
Women and Infants between the Agency for Health
Care Administration and the Department of Health
Author: Florida Agency for
Health Care Administration
Date: 2001 Pages: 4 pp.
Document URL: http://www.mchlibrary.info/iaa/states/FL_1_1.pdf
Contractual Details:
1. Effective Date: N/A
2. Duration: The expiration
date of the interagency agreement shall coincide
with the expiration date of the Medipass waiver,
including extensions, or until otherwise canceled.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. Florida
Agency for Health Care Administration (“the
Agency”) [Title XIX].B. Florida Department
of Health (“the Department”) [Title
V].
5. Authority Cited: Medipass
waiver under 1915(b) of the Social Security
Act.
Summary Related
to CMS Requirements:
6. Objectives:
To better serve the needs of Florida’s
pregnancy women and children at risk for poor
birth and health outcomes.
7. Responsibilities: A. The
Agency is responsible for the administration
of the State’s Medipass waiver.B. The
Department is responsible for being the Title
V agency.
8. Services Provided by Agency:
A. Agency for Health Care Administration
.
1. Provide TA to the Department.
2. Arrange for an independent assessment of
waiver cost-effectiveness.
3. Provide Medicaid data.
4. Delegate administrative oversight of the
waiver to the Department.
5. Be responsible for the submission of all
Medipass Healthy Start Coordinated Care System
waiver applications to CMS.
6. Form a staff and statewide advisory group
with the Department to oversee the implementation
of care coordination.
B. Department of Health
.
1. Fund Healthy Start services.
2. Develop and implement Healthy Start’s
Standards and Guidelines.
3. Develop and implement Healthy Start’s
quality improvement activities.
4. Be responsible for contract management.
5. Provide programmatic TA.
6. Adhere to Title V requirements.
7. Assist the Agency in the development of waiver
applications to CMS.
8. Invite communities to participate in the
Healthy Start program.
9. Establish regional advisory groups.
10. Develop brochures and other materials for
informing recipients about the program.
11. Bill the Agency monthly.
12. Certify the State match.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service B8, B10.
12. Reciprocal Referrals:
Exchange of information between the agencies
will be affected through an established referral
process, joint consultation, and regular meetings.
13. Coordinating Plans: N/A
14. Reimbursement: See Section
8, Service B1, B11, B12.
15. Reporting Data: See Section
8, Service A3.
16. Review: N/A
17. Liaison: See Section 8,
Service A6. Also see Section 12.
18. Evaluation: N/A
19. General Contract Provisions:
confidentiality of records/HIPAAamendment/modification
of agreementtermination of agreement
State: Georgia
(Region 4)
Document:
Interagency Master Agreement between the Georgia
Department of Community Health and the Georgia
Department of Human Resources for Services in
Support of the Medicaid Program for the State
of Georgia
Author: Georgia Department
of Community Health
Date: n.d. Pages: 34 pp.
Document URL: http://www.mchlibrary.info/iaa/states/GA_1_1.pdf
Contractual Details:
1. Effective Date: From the
day of issuance.
2. Duration: From the date
of issuance until the close of the current State
fiscal year (June 30th) unless renewed in writing.
3. Type of Agreement: Interagency
Master Agreement.
4. Agencies Involved: A. Georgia
Department of Human Resources (DHR).B. Georgia
Department of Community Health (DCH).
5. Authority Cited: 42 CFR
431.615.
Summary Related
to CMS Requirements:
6. Objectives:
To provide the various support services described
in this Agreement and found at Supplements to
this Agreement.
7. Responsibilities: A. DCH
is responsible for all health planning issues
in the state and for providing a broad range
of governmental services aimed at improving
the lives of Georgia’s citizens.B. DHR
is responsible for administering numerous programs
of which some are directly related to the Georgia
Medical Assistance Program.
8. Services Provided by Agency:
A. DCH Services
.
1. Provide a single point of contact for coordination
with DCH.
2. Provide copies of federal and state regulations
pertinent to services provided.
3. Send DHR copies of all materials prepared.
4. Work with DHR related to any service delivery
Agreement to be entered into with an outside
vendor.
5. Review all deliverables submitted to DHR
for approval to pay invoices and ensure
compliance with this Agreement.
6. Reimburse DHR in accordance with this Agreement.
B. DHR Services
.
1. Perform all services specified in the Supplements.
2. Provide Federal and State regulations, etc.
to DCH.
3. Provide an annual report detailing all projects
to DCH.
9. Cooperative Relationships:
See Section 8, Service A4.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: See
Section 8, Service A4.
14. Reimbursement: DCH agrees
to provide to DHR the FFP payments received
by DCH that are attributable to the administrative
cost of these services on a quarterly basis.
For specified services DHR agrees to pay DCH
the appropriate non-federal share of the benefit
cost on a regular basis.DHR and DCH agree that
this is a cost reimbursement Agreement. DHR
agrees to provide the State portion of matching
funds necessary to receive FFP for all applicable
supplements. DHR agrees that reimbursable costs
will be determined in accordance with 45 CFR
Part 74. This includes reimbursement for administration
cost and reimbursement for benefit cost.
15. Reporting Data: DHR agrees
to maintain and provide information descriptive
of the services required under this Agreement
necessary for DCH to meet the reporting requirements
imposed by HHS. See also Section 8, Service
A2, A3, B3.
16. Review: N/A
17. Liaison: DHR and DCH have
established a coordinating committee consisting
of the Commissioner or his or her designee form
DCH, the commissioner or his or her designee
from DHR, and a representative of each appropriate
program division of DHR and DCH. Said committee
shall meet no less than once per quarter to
review and evaluate the services, to explore
other avenues of interaction, and to meet the
requirements of the Agreement. See also Section
8, Service A1
18. Evaluation: N/A
19. General Contract Provisions:
drug-free workplaceamendment/modification of
agreementtermination of agreementconfidentiality
of records/HIPAA
State: Hawaii
(Region 9)
Document: [Hawaii] Memorandum
of Agreement between Department of Human Services
and Department of Health
Author:
State of Hawaii Department of Human Services,
Med-QUEST Division, Health Coverage Management
Branch
Date: 2004 Pages: 16 pp.
Document URL: http://www.mchlibrary.info/iaa/states/hi_1_1.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 -
June 30, 2005.
3. Type of Agreement: Memorandum
of Agreement.
4. Agencies Involved: A. Department
of Human Services (DHS), Med-QUEST Division
(MQD). B. Department of Health (DOH), Family
Health Services Division (FHSD).
5. Authority Cited:
Title XIX of the SSA; Part C of the Individuals
with Disabilities Education Act (IDEA); Hawaii
Revised Statutes Section 321.357 - the Part
C Early Intervention State Plan approved by
the U.S. Department of Education under Part
C of IDEA.
Summary Related
to CMS Requirements:
6. Objectives:
To provide Early Intervention Services to QUEST-eligible
infants and toddlers.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. FHSD
.
1. Provide services to Hawaii QUEST clients
between birth and age three who meet the
eligibility requirements for developmentally
delayed, biologically at risk and environmentally
at
risk.
2. Provide Early Intervention Services excluded
from the medical QUEST plan contracts.
3. Determine the level, intensity, frequency,
appropriateness, and service modality of Early
Intervention Services to be provided.
4. Implement a process for notification upon
a denied authorization for services.
5. Ensure that all families are informed regarding
their rights when they disagree about services.
6. Implement a process for notification of the
recipient’s right to file for a State
Fair Hearing.
7. Ensure that policies and procedures are in
place to support the Quality Assurance Plan
(QAP).
8. Ensure that early intervention providers
meet appropriate qualifications.
9. Establish monitoring schedules and criteria
and monitor early intervention providers.
10. Maintain records of covered services furnished
to eligible children.
11. Ensure that medical and financial records
are available for review by DHS or CMS.
12. Process electronic transmissions of daily
and monthly rosters for QUEST eligible enrollees.
13. Provide monthly submissions of provider
network and encounter data to the MQD.
14. Assume financial responsibility for payment
of mandated IDEA Part C services.
15. Provide information to inform recipients
and their families covered under this MOA of
their
benefits.
16. Comply with Federal and State rules and
regulations.
17. Pay 100 percent of the State share for the
services.
18. Reimburse DHS any amount disallowed by CMS.
B. Med-QUEST Division of DHS
.
1. Pay DOH/FHSD according to the appropriate
reimbursement rates.
2. Review the monthly rate on an annual basis.
3. Review the operations and policies of early
intervention services.
4. Monitor DOH/FHSD to ensure its written QAP
is implemented.
5. Ensure clients meet eligibility and enrollment
criteria for Medicaid.
6. Ensure that enrollments and disenrollments
are done accurately and in an efficient and
timely
manner.
7. Provide the DOH/FHSD staff with access to
a mutually agreed-upon telephone or electronic
system to ensure continuing eligibility of each
client on a monthly basis.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service A2, A5, A6, B5, B6, B7.
12. Reciprocal Referrals:
A. The DOH will make training available on an
annual basis to all PCPs on the screening tools
available for identifying infants and toddlers
with developmental delays.B. The DHS will inform
all PCPs of the existence of this agreement
and encourage them to take advantage of the
training.C. As a result of the developmental
screening, or other obvious need for services,
any PCP or QUEST plan can refer an infant or
toddler to H-KISS for the assignment of an interim
care coordinator and the initiation of services.D.
The care coordinator will identify the PCP for
each QUEST-eligible infant or toddler. If the
PCP did not refer the infant or toddler, the
care coordinator will inform the PCP of the
services being received by the child.E. The
care coordinator will invite the PCP to participate
in the IFSP meetings and will provide each PCP
with a copy of the child’s IFSP.
13. Coordinating Plans: N/A
14. Reimbursement: The DOH
shall submit a monthly invoice to DHS for Early
Intervention Services provided to Medicaid infants
and toddlers receiving services.A. The DHS shall
pay the DOH for the Federal share at the Hawaii
Federal Medical Assistance Percentage (FMAP)
in place for the month for which reimbursement
is made. The DOH is responsible for the State
share of the expenditures.B. All Federal reimbursement
funds received under this agreement will be
deposited into the Early Intervention Special
Fund.C. The total amount of the MOA shall not
exceed $2,500,000 in Federal funds per State
fiscal year.D. DOH/FHSD shall reimburse DHS
any amount disallowed by CMS for services provided
under this MOA.E. If State and/or Federal regulations
and/or QAP standards are not met, the MQD will
provide DOH/FHSD with notice and such other
due process protections as the State may provide.
DOH/FHSD and DHS will collaborate to develop
a Correction Action Plan that will include clearly
stated objectives and time frames for completion.
15. Reporting Data: See Section
8, Service A10, A11, A12, A13.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
termination of agreementamendment/modification
of agreement
State: Idaho
(Region 10)
Document:
Cooperative Agreement Between [the] Division
of Health and Division of Welfare, Idaho Department
of Health and Welfare
Author: Idaho Department of
Health and Welfare
Date: 1993 Pages: 7 pp.
Document URL: http://www.mchlibrary.info/iaa/states/id_1_1.pdf
Contractual Details:
1. Effective Date: January
6, 1994.
2. Duration: N/A [remains in
effect as of 07/29/04].
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: (1) Idaho
Department of Health and Welfare, Division of
Health, Bureau of Maternal and Child Health
(BMCH) [Title V].(2) Idaho Department of Health
and Welfare, Division of Welfare, Bureau of
Medicaid Policy and Reimbursement (BMPR) [Title
XIX].
5. Authority Cited: The Social
Security Act (no title specified).
Summary Related
to CMS Requirements:
6. Objectives:
A. To establish a cooperative and coordinative
relationship between the Divisions and Bureaus
in carrying out their mutual responsibilities
in facilitating the provision of medical services
to Idaho citizens.B. To meet the requirements
of the Social Security Act.
7. Responsibilities: A. BMPR
is often in the position of developing and implementing
health policy which requires the knowledge and
expertise of a variety of health professionals.
It has a health professional staff who have
special knowledge and expertise in rules and
regulations concerning Medicaid programs and
can provide consultation to the Bureau of MCH
concerning Medicaid reimbursement for Title
V and Title X MCH services.B. The Division of
Health has professionals on staff with knowledge
and expertise in the area of MCH, health policy,
etc. It can provide valuable consultation in
drafting, developing, implementing, and monitoring
certain aspects of some programs supported by
the Bureau of Medicaid Policy and Reimbursement.
8. Services Provided by Agency:
A. Mutual Responsibilities
.
1. Promote health services for all families
in need of services.
2. Enhance and monitor perinatal care statewide.
3. Provide financial support/reimbursement to
local health agencies, volunteer health agencies,
and other groups and individuals engaged in
the delivery of health services to mothers and
children.
B. Division of Health, BMCH
.
1. Needs assessment: collect and analyze health
data. Identify needs.
2. Program planning: Serve as a focal point
for statewide planning of health education,
disease
prevention, diagnosis, treatment, and rehabilitative
services for mothers and children (including
provide technical assistance in developing referral
forms).
3. Program services implementation: monitor
implementation of the statewide perinatal care
improvement plan.
4. Program quality assurance: provide input
into the development of standards and guidelines
and provide training to MCH health care providers.
5. Program evaluation: plan, collect, analyze,
interpret, and report data demonstrating the
effectiveness of MCH services and the impact
on the health status of mothers and children.
6. Assist Medicaid in provider relations with
physicians and other health care providers.
7. Conduct outreach with potential clients.
8. Promote “one stop shopping” program
services.
9. Use Medicaid funding to contract for development,
implementation, and direction of an
EPSDT Provider Training Program for registered
nurses.
C. BMPR
.
1. Medicaid utilization control and review:
collect and analyze expenditure data for Medicaid-
covered services; develop, implement, and monitor
Medicaid provider and contract agreements;
and investigate inappropriate billing/utilization
of Medicaid reimbursement.
2. Coordinate with other bureaus within the
Division of Welfare to facilitate referrals
to WIC
and other MCH Programs.
3. New or revised service coverage or program
changes: develop and promulgate regulations
governing new/revised Medicaid-covered services;
coordinate with BMCH regarding changes;
inform BMCH and providers of changes; and inform
Regional Welfare program Managers of
changes.
4. Financial arrangements: activities requested
and performed are outlined in Appendix A.
9. Cooperative Relationships:
BMPR and BMCH will jointly participate in implementation
of collaborative services, such as an outreach
campaign and a toll-free information line and
referral service.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
A client whose eligibility has been established
in the Medicaid program is ensured income eligibility
for the WIC program. See Section 8, Service
B7 and Section 13 for outreach.
12. Reciprocal Referrals:
Intake staff for each program shall inform clients
about the availability of the other program’s
services. Also see Section 8, Service B2 and
C2 and Section 13.
13. Coordinating Plans: See
Section 8, Service B9 for coordination of EPSDT.
14. Reimbursement: See Section
8, Service C1, C4, and Appendix A.
15. Reporting Data: Each bureau
will maintain records required and provide summary
reports and program procedural manuals to the
other agency. Also see Section 8, Service C1.
16. Review: N/A
17. Liaison:
Meetings between program managers and bureau
chiefs will take place at least semiannually
to
review progress toward meeting mutual objectives.
Central office bureau chiefs of the respective
programs shall promote liaison between the regional
directors and the district health department
directors.
18. Evaluation: Evaluation
of policies that affect the agreement shall
be accomplished during special meetings. Also
see Section 8, Service B5.
19. General Contract Provisions:
N/A
State: Illinois
(Region 5), document 1 of 2
Document:
Agreement Between Illinois Department of
Public Aid and Illinois Department of Human
Services - Office of Family Health Regarding
the Maternal and Child Health Program
Author: Illinois Department
of Public Aid
Date: 2000 Pages: 10 pp.
Document URL: http://www.mchlibrary.info/iaa/states/IL_1_2.pdf
Contractual Details:
1. Effective Date: May 14,
2000.
2. Duration: Either party may
terminate at midnight on June 30 of any year
with 360 days written notice to the other.
3. Type of Agreement: Interagency
Agreement.
4. Agencies Involved: A. Illinois
Department of Public Aid (DPA) [Title XIX].B.
Illinois Department of Human Services - Office
of Family Health (DHS-OFH) [Title V].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
A. To delineate respective roles, responsibilities,
and financial obligations associated with the
administration of the Medical Programs.B. To
provide mutually agreed upon support functions
to the Medical Programs.C. To maintain clear
communication between the agencies in the interest
of the mutual clients.D. To relate specifically
to (a) the outreach and case management services
of the MCH population and (b) the facilitation
of the claim for Federal matching funds for
the efficient and effective administration of
the State Plan.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. Mutual Services.1. Develop interagency procedures
to facilitate the necessary implementation of
the Program Agreement and to include the procedures
in their respective policy manuals.2. Designate
a liaison person from the central administrative
offices for regular interagency communications.B.
DHS-OFH.1. Request and obtain the necessary
appropriation for outreach and case management
activities.2. Submit to DPA quarterly estimates
of the claims to be submitted in the next quarter.3.
Ensure that the MCH program adheres to requirement
for participation.4. Direct the use and distribution
of the funds appropriated to it.5. Be responsible
for the certification that the claims for FFP
submitted are for expenses that have been paid
prior to submittal as well as that the claims
are the actual costs.6. Provide to DPA all documents
and other necessary information to allow DPA
to submit the claim for payment.7. Provide payment
to agencies performing outreach activities.8.
Provide payment to agencies performing case
management activities.9. Perform quality assurance
activities.10. Provide DPA with a fiscal year
summary report.11. Provide to each MCO a monthly
report.12. Submit to DPA a draft of the next
fiscal year Family Case Management Contract
Attachment.C. DPA.1. Maintain a hotline to address
case management client concerns.2. Provide to
DHS-OFH a data information exchange.3. Provide
to the local health departments data relative
to children enrolled in the Medical Programs
within their jurisdiction to increase EPSDT
participation, including immunizations and lead
screening.4. Inform DHS-OFH of pending termination
proceedings against certified providers.5. Draw
the eligible amounts of Federal monies for the
applicable services.6. Monitor the operation
of services reimbursed.7. Maintain responsibility
for the coordination and implementation of State
and Federal audit requirements relative to the
Medical Programs.8. Furnish DHS-OFJ data, reports,
and information as may be required to ensure
satisfying State and federal fiscal responsibility
requirements.9. Furnish DHS-OFH appropriate
claims and eligibility information.10. Provide
DHS-OFH electronic access to client identifying
information.
9. Cooperative Relationships:
See Section 8, Service A1.
10. Services Provided by Local Agencies:
See Section 8, Service C3.
11. Identification and Outreach:
The covered services for this Agreement are
(a) outreach to persons who are potentially
eligible for services under the Medical Programs
and (b) case management to identified MCH
populations and chronically ill adults who are
eligible for services under the Medical Programs.
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: See
Section 8, Service A1.
14. Reimbursement: See Section
8, Service B2, B4, B5, B6, B7, B8, C5.
15. Reporting Data: See Section
8, Service B10, B11, B12, C2, C3, C4, C8, C9,
C10.
16. Review: This Program Agreement
shall be periodically reviewed as follows:A.
Annual Basis: At least once a year the entire
Program Agreement shall be reviewed. Such review
shall be for the purpose of continuing the Program
Agreement, maintenance of the Medical Programs
Guide, and/or including clarifications as may
be necessary.B. Periodic Review: At the request
of either agency, a formal review may be scheduled
to modify, amend, or terminate this Program
Agreement, and/or modify or amend the Programs
Guide.
17. Liaison: See Section 8,
Service A2.
18. Evaluation: Any changes
to this Program Agreement shall be subject to
interagency discussion and concurrence in writing,
thereafter to be reduced to writing and incorporating
this document by reference.
19. General Contract Provisions:
auditamendment/modification of agreementtermination
of agreement
State: Illinois
(Region 5), document 2 of 2
Document:
Intergovernmental Agreement between the
Illinois Department of Public Aid and the Board
of Trustees of the University of Illinois Regarding
the Division of Specialized Care for Children
Author: Illinois Department
of Public Aid
Date: 2004 Pages: 9 pp.
Document URL: http://www.mchlibrary.info/iaa/states/IL_2_2.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 -
June 30, 2005.
3. Type of Agreement: Intergovernmental
Agreement.
4. Agencies Involved: A. Illinois
Department of Public Aid (DPA) [Title XIX].B.
Board of Trustees of the University of Illinois
on behalf of the University of Illinois at Chicago
(UIC) Office of the Vice Chancellor Health Affairs,
Division of Specialized Care for Children (OVCHA/DSCC)
[Title V].
5. Authority Cited: Article
7, Section 10(a) of the Constitution of the
State of Illinois and the Illinois Intergovernmental
Cooperation Act (5 ILCS 220/1 et seq.).
Summary Related
to CMS Requirements:
6. Objectives:
To provide for effective and efficient administration
of the respective programs by coordinating certain
duties.
7. Responsibilities: A. DPA
is responsible for administering the Medical
assistance (Medicaid) program.B. OVCHA/DSCC
is responsible for administering the CSHCN program.
8. Services Provided by Agency:
A. Mutual Services
.
1. Assign responsibilities to staff related
to the operation and evaluation of this Agreement.
2. Coordinate internal and intergovernmental
procedures to facilitate implementation of this
Agreement.
3. Ensure confidentiality.
B. OVCHA/DSCC
.
1. Accept referrals for development an application
for waiver services.
2. Provide an appropriate professional case
administrator for every referral accepted.
3. Gather all reports and information to prepare
a comprehensive individual waiver application.
4. Develop an individual service plan as agreed
to by the child’s community physician.
5. Submit to DPA the completed application and
Medical Plan of Care (MCP).
6. Clarify any components of the application
questioned by DPA.
7. Implement and case administer the prescribed
individual service plan.
8. Notify DPA of any change in the status of
the child.
9. Follow all State and Federal rules.
10. Advise DPA prior to implementing any change
in policy.
11. Notify DPA and all waiver participants 6
months in advance if it intends to discontinue
participation.
12. Forward all necessary documentation to process
payments to all nursing agencies providing
services to participants in the waiver.
13. Provide to DPA all information to allow
DPA to claim FFP for those services.
14. Update each MPC and submit revised information,
etc.
C. DPA
.
1. Provide consultation and TA to OVCHA/DSCC.
2. Process all applications for the waiver.
3. Notify OVCHA/DSCC and the child’s guardians
of its decision.
4. Withdraw approval when notified by OVCHA/DSCC
that case administration has been
withdrawn.
5. Provide access to fair hearings for any waiver
participant wishing to contest.
6. Provide to OVCHA/DSCC all necessary information
to provide program and case
administrative services for the waiver.
7. Provide OVCHA/DSCC with necessary computer
access.
8. Assist OVCHA/DSCC in preparing the cost allocation
plan.
9. Submit expenditures for FFP and deposit the
resulting federal reimbursement into the General
Revenue Fund. Determine the amount to be credited
to OVCHA/DSCC. Directly reimburse
DSCC the appropriate costs.
10. Submit all necessary documentation in order
that claims submitted will be paid, etc.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service B3.
12. Reciprocal Referrals:
See Section 8, Service B2.
13. Coordinating Plans: N/A
14. Reimbursement: A. OVCHA/DSCC
shall submit to the Comptroller of the State
claims for nursing care provided to children
in the waiver program.B. DPA shall designate
OVCHA/DSCC as its fiscal agent for said purpose
and grants OVCHA/DSCC’s designees the
authority to pay claims for nursing services.C.
OVCHA/DSCC shall provide DPA records of all
payments made.D. OVCHA/DSCC shall monitor signature
authority, etc.
15. Reporting Data: See Section
8, Service B12, B13.
16. Review: This Agreement
may be reviewed periodically and, if necessary,
amended upon mutual agreement of the parties.
Any amendments shall be in writing and signed
by the authorized representative of each party.
17. Liaison: N/A
18. Evaluation: See Section
16.
19. General Contract Provisions:
amendment/modification of agreementfailure to
satisfy SOWmaintenance of records/recordkeepingtermination
of agreement
State: Indiana
(Region 5)
Document:
Memorandum of Understanding between Indiana
State Department of Health and Indiana Office
of Medicaid Policy and Planning for Data Sharing
Author: Indiana State Department
of Health
Date: 2003 Pages: 28 pp.
Document URL: http://www.mchlibrary.info/iaa/states/in_1_1.pdf
Contractual Details:
1. Effective Date: August
15, 2003.
2. Duration:
Shall remain in effect until terminated or modified.
Either party may terminate this Agreement through
written notice to the other, at least 30 days
prior to the effective date of such termination.
3. Type of Agreement: Memorandum
of Understanding.
4. Agencies Involved: A. Indiana
State Department of Health (ISDH) [Title V].B.
Indiana Office of Medicaid Policy and Planning
for Data Sharing (OMPP) [Title XIX].
5. Authority Cited: 42 CRF
431.615 and with current federal policy regarding
Title XIX and Title XXI coordination and IAAs.
Summary Related
to CMS Requirements:
6. Objectives:
A. To promote high quality heath care and services
for program members.
B. To comply with applicable State and Federal
statutes, regulations, and guidelines, including
the Health Insurance Portability and Accountability
Act of 1996 (HIPAA).
C. To specify the reimbursement and financial
arrangements applicable in carrying out agreed
upon administrative activities.
D. To assist local communities in developing
cooperative relationships among local agencies
and local providers.
E. To minimize service delivery duplication
and fragmentation.
F. To promote timely sharing of programmatic
data to support the business needs of the agencies
and to support the evolving role of the State
government in assuring appropriate, accessible,
cost-
effective care for vulnerable populations.
G. To improve the health status of Indiana residents
by ensuring early intervention and the
provision of preventative services, health examinations,
and necessary treatment and follow-
through care.
7. Responsibilities: N/A
8. Services Provided by Agency:
I. Coordination.
A. Mutual Services
.
1. Work collaboratively to improve the health
of Indiana residents.
2. Work collaboratively to improve the availability
and quality of comprehensive health care and
nutritional services.
3. Ensure that Title V, Title XIX, Title XXI,
and WIC services are consistent with the needs
of
the participants and the programs’ objectives
and requirements.
4. Coordinate program initiatives to avoid duplication
of efforts among agency programs.
5. Assign staff for coordination and planning
activities and maintain representation on
committees to ensure coordination of collection
of data.
6. Work collaboratively in the development of
mutually acceptable member and population
objectives and outcome measures to be tracked
on a routine basis.
7. Share and review results of any study or
analysis based on shared participant data in
accordance with HIPAA regulations.
8. Consult regarding the integration of public
health services into the managed care programs
and disease management programs for members
covered by OMPP programs.
9. Collaborate to maximize State resources in
maintaining compliance to HIPAA.
10. Coordinate administrative reimbursement
for blood-lead testing and related supplies
for
Medicaid enrollees.
B. ISDH
.
1. Develop and monitor ISDH services, policies,
and quality of care assessment activities
that include establishing professionally recognized
protocols and standards of care, personnel
standards, and tracking systems for programs
receiving reimbursement from OMPP.
2. Review and provide comment to proposed managed
care contract elements, disease
management programs, vendor selection, and negotiations,
and participate in ongoing monitoring
of compliance upon request by OMPP.
3. Inform local MCH, WIC, and CSHCS offices
and local health departments of the Agreement
and of the responsibilities of the local program
staff affected by this Agreement.
C. OMPP
.
1. Furnish the ISDH with updated listings of
enrolled IHCP providers.
2. Consult, as needed, with the ISDH to receive
input on public health care issues relevant
to
managed care program and disease management
services.
3. Inform the county DFC office of the establishment
of this Agreement and of the
responsibilities of the county department personnel
as affected by this Agreement.
4. Inform the contracted providers of the establishment
of this Agreement of the responsibilities
of the providers as affected by this agreement.
II. Confidentiality.
A. Mutual Services
.
1. Comply with all applicable State and Federal
laws, regulations, and rules regarding
confidentiality of participant information,
ensuring that information is disclosed only
for
purposed of activities necessary for administration
of the respective program(s) and for audit and
examination authorized by law.
2. Establish administrative, technical, and
physical safeguards to protect the confidentiality
of
the data and to prevent unauthorized use or
access to it.
III. Data Sharing.
A. Mutual Services
.
1. Work together to improve the State’s
capacity to integrate data, link data files,
and to utilize
program data to improve program administration
and outcomes.
2. Work collaboratively in the development of
performance measures that rely on linked data
as
a means of better understanding the needs of
vulnerable populations and targeting resources
to
them more effectively.
3. Collaborate among programs to guide the permissible
sharing and dissemination of data for
program administration, policy development,
and to carry out the responsibilities listed
in this
Agreement.
4. Implement processes to ensure data sharing
requests are in compliance with HIPAA and
applicable State and Federal statutes, regulations,
and guidelines.
5. Assign specific program designees to accept
and coordinate all data request from each
respective agency in accordance with individual
program procedures and protocols.
6. Provide specific agreed upon program data
necessary for program monitoring and evaluation.
B. ISDH
.
1. Work collaboratively by providing, in compliance
with HIPAA regulations, the necessary
client data files and vital records data to
facilitate client care administration and to
permit
matching of population-based and other programmatic
data files for evaluation purposes.
2. Cross-match computerized participant files
to generate lists of newly enrolled members
who
are not participating in all potential services
to increase service coordination efforts.
3. Provide data through standard reports about
population-based health care assessments.
4. Collaborate with IHCP to determine joint
outcome indicators and objectives to be evaluated
regularly.
C. OMPP
.
1. Work collaboratively by providing, in compliance
with HIPAA regulations, the necessary
client data files and vital records data to
facilitate client care administration and to
permit
matching of population-based and other programmatic
data files for evaluation purposes.
2. Provide specified demographic data summaries
regarding populations served by Title V
programs needed to fulfill Title V Federal reporting
requirements and to track MCH-related
Healthy People 2010 Objectives.
3. Make available each month to the WIC-contracted
computer firm the names of newly certified
IHCP beneficiaries to be used for eligibility
determination.
I
V. Reimbursement.
A. Mutual Services
.
1. Establish a mutually agreeable methodology
and protocols for receiving Federal financial
participation for approved costs incurred by
the ISDH in sharing data.
2. Maintain and/or provide documentation of
financial data and monitoring of records required
to support program reimbursement.
3. Implement procedures to track, collect, or
disseminate payments.
4. Provide assistance and information to resolve
issues relating to billing and reimbursement
for
the cost of sharing data.
B. ISDH
.
1. Provide required financial and statistical
data to document costs of data sharing activities.
2. Maintain and furnish upon request appropriate
records and data as necessary or required by
OMPP to document requested reimbursement for
data sharing activities to ensure that OMPP
will
be able to collect Federal match dollars.
3. Conduct internal auditing to ensure accurate
submission of claims for data sharing activities.
4. Contribute the State match for Federal reimbursements
for ISDH-operated programs claimed
under this Agreement for administrative activities.
C. OMPP
.
1. Provide timely reimbursement for costs of
agreed upon data sharing activities allowable
under
Federal regulations.
9. Cooperative Relationships:
Coordination is woven through Section 8 by listing
activities for collaboration between agencies
under each main task.
10. Services Provided by Local Agencies:
See Section 8, Service IB3, IC3.
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: Coordination
is woven through Section 8 by listing activities
for collaboration between agencies under each
main task.
14. Reimbursement: See Section
8, Service IV.
15. Reporting Data: See Section
8, Service III.
16. Review: See Section 17.
17. Liaison: The State Health
Commissioner and the Director of the OMPP shall
designate contact persons for purposes of regular
communication or inquiries between the agencies
regarding each agency’s responsibilities
under this Agreement.
The liaison persons shall oversee the investigation
of any problem that arises from the operation
of this Agreement. They shall mutually conduct
an annual review of the effectiveness and shall
initiate jointly any amendments to the Agreement.
18. Evaluation: See Section
17.
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementconfidentiality of records/HIPAAdispute
resolution mechanism
State: Iowa
(Region 7), document 1 of 4
Document: Cooperative
Agreement Between the Iowa Department of Human
Services and the University of Iowa On Behalf
of Child Health Specialty Clinics
Author: Iowa Department of
Human Services
Date: 2004 Pages: 14 pp.
Document URL: http://www.mchlibrary.info/iaa/states/IA_1_4.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 -
June 30, 2005.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. The
State of Iowa Department of Human Services (DHS)
[Title XIX].B. Child Health Specialty Clinics
(CHSC) [Title V].
5. Authority Cited: A. DHS:
Iowa Code Chapter 217, 249A.4.B. CHSC: Iowa
Administrative Code, Chapter 76, Section 641
(76.1 - 76.17).C. 42 U.S.C., Section 1396d(r).
Summary Related
to CMS Requirements:
6. Objectives:
To define the responsibilities of the parties
in assessment, planning, and care coordination
activities related to the recipients of EPSDT
and the HCBS-IH programs of the Iowa T19 program.
7. Responsibilities: CHSC
is responsible for providing services in accordance
with defined performance expectations and employing
staff that can provide DHS with technical assistance
and consultation regarding children, under the
age of 21, with complex special health care
needs.
8. Services Provided by Agency:
Each service below contains multiple sub-tasks
in the original Agreement, which have been omitted
for clarity. See Agreement for full-text.A.
CHSC.1. Provide needed services to recipients
of the Title XIX programs who are children with
complex special health care needs.2. Assist
DHS as needed or requested, for administration
and quality assurance purposes.3. Provide DHS
with reports on MCH performance measures.4.
Assist in eligibility determination and service
provision.
9. Cooperative Relationships:
CHSC shall work in collaboration with agencies
that participate in the HCBS-IH Waiver program
or who serve as EPSDT providers.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
CHSC shall explain to interested families the
HCBS-IH Waiver program and /or the EPSDT program
and/or other DHS programs.
12. Reciprocal Referrals:
CHSC shall provide resource and referral information,
i.e., refer the child and family to appropriate
services.
13. Coordinating Plans: CHSC
shall consult with DHS staff to determine if
the HCBS-IH Waiver and EPSDT provider qualifications
and conditions of the program, including services,
are being met.
14. Reimbursement: CHSC will
be paid for services provided a fee not to exceed
$853,1044 for the Agreement period of 07/01/04
- 06/30/05. The agreement will allow reimbursement
of travel expenses. Expenses for meetings, including
meals, will be reimbursed at cost.
15. Reporting Data: CHSC shall
submit detailed invoices on a quarterly basis
for services rendered. The supporting documentation
will be available for audit purposes. The invoices
shall be reviewed by the Department for accuracy
and adequacy of documentation.
16. Review: N/A
17. Liaison: CHSC shall serve
on the EPSDT/Care for Kids Advisory and the
HCBS-IH Waiver Advisory Committees of DHS and
related committees.
18. Evaluation: N/A
19. General Contract Provisions:
defaultlack of fundsnondiscriminationtobaccotermination
of agreementfailure to satisfy SOWconfidentiality
of records/HIPAAmaintenance of records/recordkeeping
State: Iowa
(Region 7), document 2 of 4
Document: Iowa Department
of Human Services and Iowa Department of Public
Health Cooperative Agreement
Author: Iowa Department of
Human Services
Date: 2004 Pages: 11 pp.
Document URL:
http://www.mchlibrary.info/iaa/states/IA_2_4.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 -
June 30, 2005.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. The
State of Iowa Department of Human Services (the
“Department” or DHS) [Title XIX].B.
The State of Iowa Department of Public Health
(IDPH) [Title V].
5. Authority Cited: A. DHS:
42 CFR 431.615; CFR 441.61.B. IDPH: SSA 1902(a)(11);
1902(1)(1)(A) or (B).
Summary Related
to CMS Requirements:
6. Objectives:
A. To ensure the availability of comprehensive,
cost-effective, and quality medical care for
the mutual beneficiaries.B. To ensure the following:1.
A mutually agreed-upon goal and set of objectives.2.
A definition of the scope of services provided
by State and local agencies and the criteria
each party utilizes in determining eligibility
for benefits.3. The development of a cooperative
and collaborative relationship at the State
level.4. A delineation of the mutual and individual
responsibilities of the parties to eligible
beneficiaries.
7. Responsibilities:
A.
Title XIX is responsible for the following services:
physician; dentist; dental hygienist;
prescription drugs; chiropractors; rural health
clinics; federally qualified health centers;
optometrists/opticians; ambulance; medical transportation;
ambulatory surgical centers;
podiatrists; orthopedic shoes; occupational
therapy and speech therapy; physical therapy;
hearing
aids; home health agencies; medical equipment;
family planning clinics; maternal health centers;
psychologists; community mental health centers;
independent laboratories; EPSDT; birth centers;
nurse midwives; family and pediatric nurse practitioners;
area education agencies; infant and
toddler program; local education agencies; rehabilitation
services for people with chronic mental
illness; rehabilitative treatment services;
lead investigation services; hospitals; nursing
facilities;
home and community based services.
B. Title V is responsible for the following
services: child health services; hawk-i outreach
program; maternal health services; Iowa Barriers
to Prenatal Care project ; family planning
services; dental health genetic services; WIC
services; public health nursing and home care
aides.
8. Services Provided by Agency:
A. Objective I: To increase the utilization
of Title XIX, Title X, WIC, Title V, and Title
XXI
programs by mutual efforts of both state agencies.
1. DHS Shall
:
a. Inform DHS applicants who are women ages
15 - 44 and children ages 0 - 21 of Title V
programs in their community.
b. Notify individuals in the State who are determined
t be eligible for medical assistance and
who are pregnant women, breastfeeding or postpartum
women or children below the age of 5 of
the availability of WIC services.
c. Furnish local Title V programs with DHS application
forms and brochures explaining
application, eligibility, and services.
d. Furnish financial support for transportation
of Title XIX clients to local family and child
health services.
e. Administer the Title XXI program.
2. IDPH shall
:
a. Refer all patients potentially in need of
social services to local DHS offices for assistance
and
require Title V funded maternal health centers
to participate in presumptive eligibility.
b. Provide potentially eligible patients with
DHS application and brochures.
c. Furnish local DHS offices with brochures
and other information explaining eligibility
for Title
V and WIC services locally available.
d. Furnish written information that the Medicaid
program can send to recipients concerning the
availability of family and child health services.
B. Objective II: To maximize resources and expertise
of IDPH and DHS in order to increase the
quality and continuity of care of eligible clients.
1. DHS shall
:
a. Furnish IDPH with Title XIX provider manuals
as requested.
b. Issue Title XIX vendor numbers to maternal
health centers, child health centers, and lead
investigation agencies that meet family and
child health standards.
c. Provide training and TA to family and child
health staff on federal laws and regulations
governing Medicaid coverage and eligibility.
d. Coordinate and collaborate with family and
child health and other state level entities
involved
in providing services to mothers and children
around planning, financing, implementing, and
evaluating of Medicaid services utilized by
this population group.
2. IDPH shall
:
a. Request Title XIX provider manuals as needed.
b. Develop standards and implement an accreditation
process for maternal health centers, child
health centers, and lead investigation agencies
to ensure consistency and quality care throughout
Iowa.
c. Provide training and TA to DHS staff on federal
laws and regulations governing IDPH
programs.
d. Coordinate and collaborate with DHS and other
state level entities involved in providing
services to mothers and children around the
planning, financing, implementing, and evaluating
health services utilized by this population
group.
9. Cooperative Relationships:
Policy decisions necessary for the implementation
of this Agreement shall be developed through
a communicative relationship between the parties
to this Agreement. The appropriate division
directors must approve in writing all mutually
agreed-upon decisions.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
The parties to this agreement ensure that their
staff or agencies they contract with for direct
services will inform and refer Medicaid eligible
persons under 21 for screening, diagnostic,
and treatment services.
12. Reciprocal Referrals:
Each party will specify the referral mechanisms
utilized to refer to each of the parties respective
programs.
13. Coordinating Plans: Ongoing
communication between state level staff responsible
for planning, financing, implementing, and evaluating
health care services will occur so that a coordinated
system can be ensured.
14. Reimbursement: Each of
the parties to this agreement shall continue
to cooperated in their usual and customary fiscal
relationship to ensure federal dollars will
be used more productively. It is intended that
WIC funds will be the first and primary source
of payment for nutritional products and services
for persons eligible for WIC services. Title
XIX will be the primary source of payment for
Title XIX medical services provided to mutual
beneficiaries through Title V providers.
15. Reporting Data: IDPH shall
maintain records (both billing and service)
which sufficiently and properly document all
charges billed to the Department.
16. Review: See Section 18.
17. Liaison: Specific mechanism
not addressed, although collaboration and coordination
are woven throughout Section 8.
18. Evaluation: This Agreement
may be amended in writing from time to time
by mutual consent of the parties. All amendments
to this Agreement must be fully executed by
both parties.
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementtobacconondiscriminationconfidentiality
of records/HIPAAmaintenance of records/recordkeepinglobbying
State: Iowa
(Region 7), document 3 of 4
Document: Iowa Department
of Human Services and Iowa Department of Public
Health EPSDT Program
Author: Iowa Department of
Human Services
Date: 2004 Pages: 7 pp.
Document URL: http://www.mchlibrary.info/iaa/states/IA_3_4.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 -
June 30, 2005.
3. Type of Agreement: Agreement.
4. Agencies Involved: A. The
State of Iowa Department of Human Services (DHS)
[Title XIX].B. The State of Iowa Department
of Public Health (IDPH) [Title V].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
To retain IDPH to coordinate administration of
the EPSDT program in order to:A. Develop and maintain
local capability for conducting screening examinations
required under the EPSDT program.B. Increase program
efficiency and effectiveness by ensuring that
needed services are provided timely and efficiently.C.
Develop and maintain local capacity for MCH Services
and to provide Medicaid information and care coordination
to EPSDT clients.D. Develop a cooperative and
collaborative relationship at all levels to prevent
duplication of services.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. IDPH.1. Determine if local agencies requesting
to be screening centers meet the recommended
standards of medical practice established by
the program, etc.2. Provide consultation and
TA in communities in assessing local needs for
EPSDT services.3. Implement the EPSDT program
through contracts established with Title V agencies.4.
Provide consultation and TA to schools and Area
Education Agencies in investigating participation
in EPSDT activities.5. Provide continued TA
to MCH Centers conducting cost analyses to determine
the cost of providing services in order to promote
more cost efficient services.6. Provide consultation
and TA to communities in assessing local needs
for Administrative Medicaid Claiming.7. Coordinate
meetings with DHS for Prevention for Disability
Policy Council and other health care providers
to facilitate coordinated efforts.8. Provide
TA for targeted issues such as immunization,
lead screening, developmental screening, and
newborn hearing screening.9. Assist the editor
of the EPSDT Care for Kids newsletter.10. Participate
in planning and implementing the Medicaid Enterprise
Activities.11. Provide an annual report which
identifies the activities provided in the previous
year.B. DHS.1. Reimburse EPSDT screening centers
for the full cost of providing screening, outreach,
and care coordination.2. Provide to IDPH a daily
list of Medicaid clients who are eligible for
EPSDT outreach and care coordination services.3.
Maintain a vendor number for IDPH and provide
a vendor number to screening centers.4. Submit
this Agreement to CMS.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
See Section 8, Service A1.
11. Identification and Outreach:
See Section 8, Service A2, A4, A5, A6.
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: IDPH will
be paid for the services described in Section
8 a fee not to exceed $310,175 for the Agreement
period. Claims shall be submitted quarterly.
15. Reporting Data: See Section
8, Service A11, B2.
16. Review: N/A
17. Liaison: See Section 8,
Service A10.
18. Evaluation: N/A
19. General Contract Provisions:
lack of fundstobaccolobbyingtermination of agreementfailure
to satisfy SOWconfidentiality of records/HIPAA
State: Iowa
(Region 7), document 4 of 4
Document: Iowa Department
of Human Services and Iowa Department of Public
Health Outreach
Author: Iowa Department of
Human Services
Date: 2004 Pages: 5 pp.
Document URL: http://www.mchlibrary.info/iaa/states/IA_4_4.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 -
June 30, 2005.
3. Type of Agreement: Agreement.
4. Agencies Involved: A. The
State of Iowa Department of Human Services (DHS)
[Title XIX].B. The State of Iowa Department
of Public Health (IDPH) [Title V].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
To provide outreach services to women and children
who are or may be Medicaid eligible.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. IDPH
.
1. Maintain a toll-free number that women and
families can contact and receive information
from appropriately trained personnel who provide
information and referrals for prenatal care,
family planning, and well-child services.
2. Assess the adequacy of the medical care and
other services the woman or child utilizing
the
line is receiving and distribute health information
concerning medical services that would meet
the woman’s or child’s individualized
needs.
3. Conduct a minimum of 4 health education activities
that link the target population with
available health services. Health education
activities will be mutually agreed upon by the
Title V
director and the EPSDT program specialist.
4. Submit an annual report combined with the
EPSDT program report which identifies the
activities provided in the previous year. This
report will contain information on the outreach
activities that occurred, the number of toll-free
calls received, and other activities provided.
B. DHS
.
1. Claim a Federal match for the funds expended
and remit this match to IDPH.
2. Submit this agreement to CMS. Expenditures
for outreach activities will be eligible for
a 50
percent Federal match through the Medicaid program
if approved by CMS.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
The focus of this document is outreach; thus,
outreach activities comprise the bulk of Section
8.
12. Reciprocal Referrals:
See Section 8, Service A1.
13. Coordinating Plans: See
Section 8, Service A3.
14. Reimbursement: IDPH will
be paid for the services described in Section
8 a fee not to exceed $124,066 for the Agreement
period. IDPH shall submit detailed invoices
on a quarterly basis for services rendered.
15. Reporting Data: See Section
8, Service A4.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
lack of funds
tobacco
lobbying
amendment/modification of agreement
termination of agreement
failure to satisfy SOW
confidentiality of records/HIPAA
State: Kansas
(Region 7)
Document:
Cooperative Agreement between the Kansas
Department of Health and Environment and the
Kansas Department of Social and Rehabilitation
Services
Author: Graeber, CD and Schalansky,
J
Date: 2002 Pages: 41 pp.
Document URL: http://www.mchlibrary.info/iaa/states/ks_1_1.pdf
Contractual Details:
1. Effective Date: Upon signature
by the Secretaries of both agencies (04/03/2002).
2. Duration: April 3, 2002
- June 30, 2007.
3. Type of Agreement: Interagency
Agreement.
4. Agencies Involved: A. Kansas
Department of Health and Environment (KDHE).B.
Kansas Department of Social and Rehabilitation
Services (SRS).
5. Authority Cited: A. Legislative.1.
Section 1902(a)(11)(A), (B); 1905(a)(4)(B) of
the SSA.B. Regulatory.1. 42 CFR 431.615; 34
CFR 303.321, 522, and 527; 7 CFR 246.4(a)8,
(b)1.2. The Food, Agriculture, Conservation
and Trade Act of 1990 (Farm Bill).
Summary Related
to CMS Requirements:
6. Objectives:
A. To provide an integrated system of high quality,
comprehensive health services to citizens of
Kansas, many of whom are underserved.B. To ensure
a mutually agreed upon goal and set of objectives
that delineates both the mutual and individual
responsibilities of the parties in the provision
of services.C. To ensure a definition of the
scope of services provided either on-site or
by referral.D. To ensure the development of
a cooperative relationship at the state level.E.
To ensure a joint plan to establish a fiscal
protocol that will maximize utilization of funds
in providing services to consumers.
The potential benefits from cooperation between
KDHE and SRS include the following:
1. Promotion of continuity of care.
2. Sharing of medical, social, and technical
expertise through staff consultations.
3. Reduction of duplication of effort.
4. Efficient allocation of resources based on
need.
5. Utilization of Title V overmatch to provide
Title XIX services.
6. Achievement of greater accountability in
regard to outcome.
7. Responsibilities: KDHE
and SRS have authority and responsibility for
the administration of health programs including
Title V and Title XIX as well as programs such
as Food Stamp, Farmworker, Refugee, family planning,
WIC, Kansas Infant-Toddler services, and immunization.
8. Services Provided by Agency:
KDHE and SRS agree to very detailed services
under each of the following areas:
A. General MCH Services
.
1. Health Care Services.
2. Program Information and Service.
3. Collaboration, Consultation, and Continuing
Education.
4. Fees and Reimbursement.
B. The Kan-Be-Healthy (EPSDT) Program
.
1. General Services.
2. Expanded Nutrition Services for High Risk
Consumers.
C. Services for CSHCN
.
1. General Services.
2. Medicaid Managed Care Services.
3. Supplemental Security Income (SSI) Services.
4. Rehabilitation Services.
D. Prenatal Health Promotion/Risk Reduction
.
1. General Services.
2. Expanded Nutrition Services for High Risk
Pregnant Women.
E. Newborn/Postpartum Home Visit
.
F. Special Supplemental Nutrition Program for
Women, Infants, and Children (WIC)
.
G. Commodity Supplemental Food Program (CSFP)
.
H. Family Planning
.
I. Farmworker Health
.
J. Refugee Health
.
K. Services for Tuberculosis
.
L. Immunizations
.
M. Substance Abuse Services
.
1. Consultation and Continuing Education.
2. Treatment Services.
3. Fees and Reimbursement.
N. Toll-Free Telephone Number
.
O. Teen Pregnancy Case Management Project
.
P. HIV/STD Programs ad Services
.
1. Program Information and Services.
2. Consultation and Continuing Education.
3. Counseling, Testing, and Treatment Services.
4. Feed and Reimbursements.
Q. Quality Assurance
.
R. Kansas Infant-Toddler Services
.
S. Breast and Cervical Cancer
.
Outcome measures are provided for each of these
areas.
9. Cooperative Relationships:
A committee shall be appointed to ensure coordination
between the State Title V Assurance Statement
and the Title XIX State Plan. Appointment, by
the Secretaries, of at least one (1) representative
shall constitute the membership of this committee.
The committee shall meet at the request of either
agency Secretary or designee, or at least annually,
to permit the parties to this Agreement to provide
input, to resolve any problems/issues which
may arise, to review, evaluate, and make recommendations
to the Secretaries regarding the conditions
outlined in other sections of this Agreement.
10. Services Provided by Local Agencies:
KDHE must encourage local health departments
and agencies to provide follow-up and outreach
activities for Medicaid consumers. SRS must
work with KDHE and local providers to resolve
barriers to health care services.
11. Identification and Outreach:
KDHE must promote early identification and referral
of individuals to SRS who may be eligible for
Medicaid benefits and must provide state and
local SRS offices with MCH program brochures
for distribution to Medicaid consumers.
12. Reciprocal Referrals:
Each party to this Agreement will establish
a system of referrals for those services not
directly rendered by the agency, but which are
essential to meet the individual’s need.
To the degree possible, these referrals will
be made at the time of client contact. Programs
such as the supplemental nutrition program for
WIC, Food Stamps, and Healthy Start will fall
into this category.
13. Coordinating Plans: KDHE
and SRS must participate in cooperative program
planning and monitoring of MCH services covered
by XIX.
14. Reimbursement: Unless
there are other third party resources, SRS shall
reimburse eligible providers for any service
covered under the State Medicaid Plan for eligible
Medicaid consumers. Services provided to consumers
covered under managed care programs will be
paid in accordance with managed care guidelines.
Title XIX funds shall be the first and primary
source of payment for medical services provided
to mutual beneficiaries of the Title V and Medicaid
Programs.
15. Reporting Data: KDHE will
provide SRS with documentation of Title V overmatch
and will report documented concerns relating
to health services availability an barriers
for Medicaid consumers.
16. Review: See Section 9
for a detailed description of the review and
evaluation process.
17. Liaison: Continuous liaison
among the parties to the Agreement shall be
the responsibility of the Secretaries or their
appointed staff designees.
18. Evaluation: See Section
9 for a detailed description of the review and
evaluation process.
19. General Contract Provisions:
dispute resolution mechanismconfidentiality
of records/HIPAAsubcontractspaymenttermination
of agreement
State: Kentucky
(Region 4)
Document: The Commonwealth
of Kentucky Master Agreement
Author: Commonwealth of Kentucky
Department for Community Based Services
Date: 2003 Pages: 19 pp.
Document URL:
http://www.mchlibrary.info/iaa/states/KY_1_1.pdf
Contractual Details:
1. Effective Date: July 1,
2003.
2. Duration: July 1, 2003 -
June 30, 2004.
3. Type of Agreement: Master
Agreement.
4. Agencies Involved: A. Department
for Community Based Services (DCBS).B. Department
for Medicaid Services (DMS) [Title XIX].C. Department
for Public Health (DPH) [Title V].
5. Authority Cited: 1996 Kentucky
Acts Chapter 380.
Summary Related
to CMS Requirements:
6. Objectives:
To provide Medicaid reimbursement for targeted
case management services for Medicaid eligible
recipients including children in custody of
or under the supervision of, or at risk of being
in the custody of the state and, adults who
may require protective services from the state,
and for rehabilitative services for children
in the custody of or under the supervision of,
or at risk of being in the custody of, the state,
as a component of the Title V MCH Program.
7. Responsibilities: A. DCBS
is responsible for providing protective services,
such as targeted case management and rehabilitative
services.B. DMS is responsible for the administration
of the Medical Assistance Program in Kentucky.C.
DPH is responsible for administering the Title
V Program.
8. Services Provided by Agency:
A. DCBS
.
1. Provide targeted case management services
which assist an individual in accessing needed
medical, social, educational, and other support
services.
2. Provide rehabilitative treatment services,
including treatment planning and support activities;
living skills development activities; and counseling,
therapy, consultation, and psychological
assessments.
3. Ensure staff and subcontractors providing
services meet DCBS standards.
4. Comply with the policy and procedures required
in the Medicaid Services Provider Manual.
5. Comply with appropriate provisions of the
SSA.
6. Encourage referrals between various programs.
7. Submit bills to all third party payers before
billing the Title XIX Agency.
8. Submit services claims.
9. Prevent duplication of case management services.
10. Ensure access to any subcontractor’s
financial and program records by the Title XIX
Agency.
11. Provide targeted case management and rehabilitative
services data as requested.
12. Maintain records of all Medicaid targeted
case management and rehabilitative services.
13. Provide to the Title XIX Agency required
state match for claimed expenditures.
14. Provide to the Title XIX Agency TA with
regard to DCBS targeted case management and
rehabilitative services programs.
15. Participate in the Title V MCH Program as
the provider responsible for the administration
of
the DCBS targeted case management and rehabilitative
services program.
16. Be responsible for the Title XIX audit disallowances.
17. Participate with the Title V and the Title
XIX Agencies in the development of policies
and
procedures.
B. DPH
.
1. Include targeted case management services
for Medicaid eligible recipients.
2. Ensure to the Title XIX Agency that the provider
of services is a Title V service provider.
3. Comply with the policy and procedures as
required in the Title XIX Agency Provider Manual.
4. Comply with appropriate provisions of the
SSA.
5. Encourage referrals between various programs.
6. Ensure the provision of data for services.
7. Participate with DCBS and the Title XIX Agency
in the development of policies and
procedures.
C. DMS
.
1. Certify and enroll qualified Title V providers.
2. Reimburse for the following services: targeted
case management services; rehabilitative
treatment services.
3. Reimburse DCBS as rates not to exceed cost
for eligible services.
4. Provide payment and claims data to DCBS.
5. Provide other reports to DCBS and/or the
Title V Agency.
6. Pay claims in a timely manner.
7. Provide TA to DCBS and the Title V Agency.
8. Participate with DCBS and the Title XIX Agency
in the development of policies and
procedures.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
See Section 8, Service A6, B5.
13. Coordinating Plans: See
Section 8, Service A17, B7, C8.
14. Reimbursement: A. DCBS
shall bill the Title XIX Agency for services
as per this agreement.B. The Title XIX Agency
shall pay for services under this agreement
up to a specified amount in State and Federal
matching funds. Any additional expenditures
in excess of that amount will be reimbursed
only if the necessary state match is provide
to the Title XIX Agency.C. The Title XIX Agency
shall reimburse the certified and enrolled provider
at payment levels that shall not exceed the
cost of providing the service.Specific services
regarding reimbursement are also included in
Section 8.
15. Reporting Data: See Section
8, Service A12, B6, C5.
16. Review: See Section 17
and 18.
17. Liaison: All parties shall
designate staff responsible for representing
their agencies at annual meetings, or more frequently
as necessary, for the purpose of reviewing and
evaluating the policies that affect the cooperative
work of the parties and the need for changes
in the agreement.
18. Evaluation: The agreement
will be evaluated and reviewed annually in joint
meetings among DCBS, the State Agency for Title
V, and the State Agency for Title XIX.
19. General Contract Provisions:
amendment/modification of agreementindemnification/liabilityconfidentiality
of records/HIPAAtermination of agreementsubcontractspaymentnondiscrimination
State: Louisiana
(Region 6)
Document:
Department of Health and Hospitals Intra-Departmental
Agreement between Office of Public Health (Title
V) and Bureau of Health Services Financing (Title
XIX)
Author: [Louisiana] Department
of Health and Hospitals
Date: 1990 Pages: 4 pp.
Document URL: http://www.mchlibrary.info/iaa/states/la_1_1.pdf
Contractual Details:
1. Effective Date: July 1,
1990.
2. Duration: N/A
3. Type of Agreement: Intra-Departmental
Agreement.
4. Agencies Involved: A. Office
of Public Health (OPH or Public Health) [Title
V] .B. Bureau of Health Services Financing (BHSF
or Medicaid) [Title XIX].
5. Authority Cited: A. 42 CFR
431.615.B. Section 1902(a)11 of the SSA.C. Section
513(c) of the SSA.
Summary Related
to CMS Requirements:
6. Objectives:
A. To improve the health status of children
by ensuring the provision of preventive services,
health examinations, and the necessary treatment,
and follow-through care, preferably in the context
of an on-going provider-patient relationship
and from comprehensive, continuing care providers.B.
To ensure that the State MCH agency under Title
V of the SSA and the State Medicaid Agency have
in effect a functional relationship via an IAA
which provides for the maximum utilization of
the care and services available under the MCH
programs, and utilizes the MCH programs to develop
a more effective use of Medicaid resources in
financing services to Medicaid-eligibles provided
by Title V programs.
7. Responsibilities: A. The
Louisiana Department of Health and Hospitals
is responsible for administering both the BHSF
and the OPH.B. The BHSF (Medicaid) is responsible
for policies, planning, and management of the
Medicaid Program.C. OPH (Public Health) is responsible
for program planning, policies, and operational
management of the Title V programs and has organizational
responsibility for the health units in all parishes
of the State except Orleans and Plaquemines
parishes.
8. Services Provided by Agency:
In this agreement, objectives and services are
combined together under each agency:A. MCH Objectives/Services.1.
To ensure mothers and children have access to
quality MCH services.2. To reduce infant mortality
and the incidence of preventable diseases and
handicapping conditions.3. To reduce the need
for inpatient and long-term care services.4.
To increase the number of children appropriately
immunized; to promote the health of mothers
and children.5. To provide rehabilitation services
under Title XVI.6. To provide services for identifying,
and for medical, surgical, corrective, and other
services.7. To identify Medicaid-eligible children
and to refer these children for EPSDT services.8.
To provide EPSDT services.9. To ensure that
EPSDT patients receive the full range of services.10.
To assess quality of care provided by the Office
of Public Health.11. To have a major role in
establishing standards, policies, and procedures
for health care services.12. To provide pertinent
data for program evaluation.B. Medicaid Objectives/Services.1.
To provide medical assistance to low-income
persons who are age 65 or over, blind, disabled
or members of families with dependent children
or qualified pregnant women or children.2. To
provide EPSDT services.
9. Cooperative Relationships:
Public Health will establish, jointly with Medicaid,
a Medicaid/Title V advisory committee to monitor
implementation of this Agreement, to coordinate
services offered, and to review and update its
provisions as necessary.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: Public Health
will be reimbursed on a fee-for-service basis.
15. Reporting Data:
Method of Exchange of Information.
A. Both parties shall maintain strict confidentiality
of patient medical records and other similar
records in accordance with the law and established
ethical standards.
B. Both parties agree to establish accounting
procedures, fiscal reporting, and other records
to
ensure proper accountability for fiscal transactions
and for documentation of Title V services
delivered to Medicaid-eligibles.
C. The books, records, and documentation of
Public Health, insofar as they relate to work
performed or money received under this Agreement
shall be maintained in conformity with
generally accepted accounting principals for
a period of 3 full years from the date of the
final
payment, and shall be subject to audit, at any
reasonable time and upon reasonable notice by
Medicaid or their duly appointed representative.
D. All services delivered by Title V agencies/clients
to Medicaid-eligibles shall be documented
in the patient’s medical record in accordance
with current accepted and approved standards
and
practices.
16. Review: Method for Periodic
Review and Joint Planning for Changes in the
Agreement.A. Public Health will establish, jointly
with Medicaid, a Medicaid/Title V advisory committee
to monitor implementation of this Agreement,
to coordinate services offered, and to review
and update its provisions as necessary.B. The
Advisory Committee will meet at least every
6 months when either party requests that a formal
meeting be conducted.C. The Advisory Committee,
at a minimum, will be comprised of: (1) MCH
Director; (2) MCH Medical Director; (3) WIC
Director; and (4) Medicaid representative.
17. Liaison: See Section 16.
18. Evaluation: Joint Evaluation
of Policies.It will be the function of the joint
Medicaid/Title V Advisory Committee to review
periodically the tenants of this Agreement with
the aim of ensuring:1. That all Medicaid-eligible
in need of Title V services receive them.2.
That appropriate fiscal documentation is ongoing.3.
That information flows freely between both parties.
19. General Contract Provisions:
N/A
State: Maryland
(Region 3)
Document: Cooperative
Agreement between Maryland State Department
of Health and Mental Hygiene (Title XIX) Medicaid
Agency, (Title V) Maternal and Child Health
Agency, and the Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC)
Author: Maryland State Department
of Health and Mental Hygiene
Date: n. d. Pages: 14 pp.
Document URL: http://www.mchlibrary.info/iaa/states/MD_1_1.pdf
Contractual Details:
1. Effective Date: Effective
upon the signatures of the authorized of the
Family Health Administration and the Maryland
Medical Assistance Program (signed July 2004).
2. Duration: Five years from
the date the cooperative agreement is signed,
or until either party provides written notification
of termination.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. Maryland
State Department of Health and Mental Hygiene
[Title XIX] Medicaid Agency.B. Maternal and
Child Health Agency, Family Health Administration
(FHA) [Title V].C. Special Supplemental Nutrition
Program for Women, Infants, and Children (WIC).
5. Authority Cited: A. Social
Security Act, 42 U.S.C. 1397-aa-1397jj.B. Maryland
General Code Annotated, Title 15, Subtitle 301.C.
Title V Maternal and Child Health Block Grant
of the Social Security Act-General Code Annotated,
18-107.
Summary Related
to CMS Requirements:
6. Objectives:
To establish roles and responsibilities between
the parties for the purpose of providing coordination
of services to promote prompt access to high quality
prenatal, intrapartum, postpartum, postnatal,
and child health services for women and children
eligible for benefits under Title V and XIX of
the Social Security Act, and section 17 of the
Child Nutrition Act of 1996, as amended.
7. Responsibilities: A. The
Medicaid Program is responsible for operating
the Maryland Children’s Health Program
as a Medicaid expansion with the full benefit
package.B. FHA is responsible for the utilization
of funds provided for by Title V MCH Block Grant
and the Maryland Health -- §18-107, in
the provision of MCH services and services for
CSHCN and for administering the Title X/Family
Planning Program.C. WIC is responsible for providing
supplemental foods and nutrition education to
pregnant and postpartum women, infants, and
young children from families with low incomes
who are at risk by reason of inadequate nutrition
or health care or both.
8. Services Provided by Agency:
A. Administration and Policy.1. Medicaid Program.a.
Establish eligibility policy, regulations, and
procedures.b. Perform outreach to encourage
low income maternal and child populations to
apply for Medicaid and to utilize preventive
and primary care services.,2. FHA.a. Provide
services.b. Provide Medicaid with expertise
and TA related to programs and policies for
CSHCN.c. Refer clients who are eligible for
Medicaid benefits and assist them in receiving
services from providers who participate in the
Maryland Medical Assistance Program.3. Mutual
Services.a. All parties will coordinate activities
to enhance customer service and work to resolve
problems with impact on timely access to services.b.
All parties will coordinate strategic planning
efforts to ensure coordination in the design,
implementation, and evaluation of program services
for women, infants, and children.c. All parties
will keep each other apprised of those services
which are available to eligible individuals
pursuant to Federal law and State regulations
and guidelines.d. All parties will collaborate
when implementing significant changes to program
policies that may impact the other.e. All parties
will develop program policies and regulations
that address standards of quality care.f. All
parties will promote family planning and prenatal
care.g. All parties will promote the importance
of a medical home.h. FHA and Medicaid will collaborate
on the development of tools and processes for
identifying high-risk women and will jointly
provide support for the Maryland Prenatal Risk
Assessment system.i. FHA and Medicaid will develop
training and education programs for medical
professionals and consumers.j. WIC and Medicaid
will notify each other of policy changes that
may have an affect on access to services and
will coordinate with FHA on initiatives to improve
MCH.k. FHA will coordinate with Medicaid regarding
activities and programs regarding childhood
health promotion and prevention programs.B.
Reimbursement and Contract Monitoring (see Section
14).C. Confidentiality and Data Exchange (see
Section 15).D. Recipient Outreach and Referral
(see Section 11).E. Training and Technical Assistance.F.
Provider Capacity.G. System Integration (see
Section 13).H. Quality Assurance Activities.
9. Cooperative Relationships:
See Section 13.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
D. Recipient Outreach and Referral.1. Primary
and Preventive Care for Children.a. FHA.(1).
Assist Medicaid with distribution of MA/MCHP
applications.(2). Verify Medicaid eligibility
prior to providing services and will refer potential
eligible Medicaid/MCHP families for eligibility
determination.(3). FHA/Oral Health will refer
children.b. Medicaid.(1). Conduct outreach to
Medicaid recipients.c. Mutual Services.(1).
Medicaid and FHA will coordinate hotline activities.(2).
FHA/Oral Health and Medicaid will work collaboratively
to update the resource guide of dental providers.2.
CSHCN (similar activities as above; for full
list of activities, see original document).3.
Pregnant Women and Infants (similar activities
as above; for full list of activities, see original
document).4. Family Planning (similar activities
as above; for full list of activities, see original
document).5. WIC (similar activities as above;
for full list of activities, see original document).
12. Reciprocal Referrals:
See Section 11.
13. Coordinating Plans: G.
System Integration.1. Primary and Preventive
Care for Children: FHA and Medicaid will:a.
Collaborate to establish and maintain relationships
with providers who serve low-income and Medicaid/MCHP
enrolled children and to help facilitate problem
resolution.b. Collaborate to ensure that there
are public forums for exchange of information
such as the Medicaid Advisory Committee, Oral
Health Advisory Committee, and other ad hoc
advisory groups.2. CSHCN (similar activities
as above; for full list of activities, see original
document).3. Pregnant Women and Infants (similar
activities as above; for full list of activities,
see original document).4. Family Planning (similar
activities as above; for full list of activities,
see original document).5. WIC (similar activities
as above; for full list of activities, see original
document).
14. Reimbursement:
B. Reimbursement and Contract Monitoring.
1. FHA and Local Health Departments.
a. Ensure that clinical services are furnished.
b. Maintain adequate medical and financial records.
c. Refrain from knowingly employing or contracting
with entities that have been disqualified
from the Medicaid program.
d. Will not require additional payment from
an individual after Medicaid makes payment to
the
Title V designee for a covered service. If Medicaid
denies payment or request repayment on the
basis that an otherwise covered service was
not medically necessary or preauthorized, the
Title V
Agency will not seek payment for that service
from the recipient.
e. Title XIX funds will be used to reimburse
providers for services covered by that Program
if
the individual is eligible for services covered
by both Title XIX and Title V programs.
f. Collaborate with Medicaid regarding oral
health initiatives.
g. Provide specialty services that are not covered
by Medicaid.
2. Mutual Services.
a. All parties will ensure that services provided
by its grantees are not duplicative.
b. All parties will maintain a system to ensure
coverage for special infant formulas.
15. Reporting Data: C. Confidentiality
and Data Exchange.1. FHA and Medicaid.a. Safeguard
and maintain confidentiality.b. Participate
in the exchange of data necessary for the Title
V and Title X reapplication.c. Coordinate and
participate in the exchange of data related
to: births to women enrolled in Medicaid and
utilization of Family planning services; maternal,
fetal, infant, and child death reviews; prenatal
risk assessment data; PRAMS; and treatment of
children exposed to lead.d. Exchange data necessary
to conduct quality assurance and utilization
studies.2. FHA and WIC.a. Maintain confidentiality
of records.3. Medicaid.a. Provide FHA with access
to select Medicaid files.4. Medicaid and WIC.a.
Ensure that any sharing of client data is in
accordance with appropriate regulations.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreement
State: Michigan
(Region 5)
Document: [Michigan Title
V / Title XIX Interagency Agreement]
Author: [Michigan Department
of Public Health]
Date: 1995 Pages: 10 pp.
Document URL: http://www.mchlibrary.info/iaa/states/MI_1_1.pdf
Contractual Details:
1. Effective Date: Original
agreement: January 1, 1981, with addenda approved
September 28, 1987 and October 1, 1995.
2. Duration: This contract
supersedes and prior agreement between the parties
and shall continue in effect for a period of
one year from the date hereof. It shall remain
effective for successive periods of 1 year each
thereafter unless during any such period, this
contract shall be canceled in accordance with
the terms contained herein. This contract may
be terminated, when either party requests termination,
by giving 90 days written notice to the other
party of its intention to terminate.
3. Type of Agreement: [Interagency
Agreement].
4. Agencies Involved: A. Michigan
Department of Public Health [Title V].B. Michigan
Department of Social Services [Title XIX].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
To reduce infant mortality and morbidity and to
reduce the incidence of mental retardation and
other handicapping conditions.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. Public Health Services
.
1. Promote cooperative program planning and
monitoring efforts.
2. Identify individuals in need of preventive,
diagnostic, treatment, and medical care and
services.
3. Identify and refer to Social Services individuals
who may be eligible of Medical Assistance
Program benefits.
4. Provide or arrange for health care and services.
5. Request from Social Services reimbursement
for the cost of covered Medical Assistance care
and services provided by Title V projects to
individuals eligible for Medical Assistance.
6. Establish and maintain standards and guidelines.
7. Certify to Social Services public providers
of family planning services.
8. Designate hospitals, physicians, and transportation
providers.
9. Designate appropriate personnel to work on
a Public Health/Social Services task force to
examine issues of coordination, policy development,
quality assurance, and reporting and
evaluation.
B. Services Provided by Social Services
.
1. Promote cooperative planning.
2. Determine the financial eligibility of individuals
for whom application has been made.
3. Identify and refer individuals in need of
health care and services available by and through
Title V projects to Public Health.
4. Establish the scope of services and reimbursement
levels available.
5. Reimburse, as first payer, the cost of care
and services furnished by or through the Title
V
grantee in individuals eligible for Medical
Assistance.
6. Designate appropriate personnel to work on
a Public Health/Social Services task force to
examine issues of coordination, policy development,
quality assurance, and reporting and
evaluation.
9. Cooperative Relationships:
See Section 8, Service A1, B1.
10. Services Provided by Local Agencies:
Provide accurate lists of clients due for screening
to local health departments or other organizations.
11. Identification and Outreach:
See Section 8, Service A2, A3, B2, B3.
12. Reciprocal Referrals:
See Section 8, Service A3.
13. Coordinating Plans: See
Section 8, Service A1, B1.
14. Reimbursement: See Section
8, Service A5, B4, B5.
15. Reporting Data: See Section
8, Service A7.
16. Review: N/A
17. Liaison: Title XIX to
Designate a staff member to serve as EPSDT coordinator
and liaison with Title V.
See also Section 8, Service A9, B6.
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreement
State: Minnesota
(Region 5)
Document: State of Minnesota
Interagency Memorandum of Understanding
Author: [Minnesota Department
of Health]
Date: 2003 Pages: 4 pp.
Document URL: http://www.mchlibrary.info/iaa/states/mn_1_1.pdf
Contractual Details:
1. Effective Date: July 1,
2003 or upon the date that the final required
signature is obtained, whichever occurs later;
or until a revised agreement is signed. (Signed
on August 11, 2003).
2. Duration: The agreement
may be canceled by either department at any
time, with or without cause, upon 30 days written
notice to the other party.
3. Type of Agreement: Memorandum
of Understanding
4. Agencies Involved: A. Minnesota
Department of Health (DOH) [Title V].B. Minnesota
Department of Human Services (DHS) [Title XIX].
5. Authority Cited: A. Minnesota
Statutes, Section 145.88.B. Minnesota Statutes,
Section 256.01, Subdivision 2, Paragraph (1),
and 256B.04, Subdiv. 1.
Summary Related
to CMS Requirements:
6. Objectives:
A. To promote quality health care services for
low-income children, pregnant women, and CSHCN,
including primary and preventive health services.B.
To coordinate and enhance efforts, streamline
application processes, reduce duplicative efforts,
and ensure compliance with federal and state
laws and regulations and the appropriate use
of public funds.
7. Responsibilities: A. The
DOH is responsible for administrating the Title
V program.B. The DHS is responsible for administrating
the Medicaid program.
8. Services Provided by Agency:
A. DHS
.
1. Participate in advisory or work groups related
to MCH and child health issues including
CSHCN.
2. Participate in quarterly joint meetings.
3. Enter into separate IAAs for those duties
that require a transfer of personally identifying
data
and funds.
4. Accept referrals from the DOH for the Medical
Assistance and Minnesota Care program.
B. DOH
.
1. Participate in advisory or work groups related
to MCH and child health issues including
CSHCN.
2. Participate in quarterly joint meetings.
3. Enter into separate IAAs for those duties
that require a transfer of personally identifying
data
and funds.
4. Accept referrals from the DHS and provide
follow-up services to CSHCN and their families.
9. Cooperative Relationships:
Quarterly joint meeting are to cover, among
other issues, coordination of departmental policies/procedures
that impact health care services or the delivery
of health care services to the MCH populations;
identification how the departments can work
together to identify individuals under 21 in
need of services.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
The Department contracts with counties to perform
outreach and follow-up EPSDT services for eligible
children. In order to identify children under
21 in need of medical or remedial services,
the Department receives screening and referral
information from managed care health plans that
is fed into the Department’s “CATCH
3” tracking system.
12. Reciprocal Referrals:
See Section 11.
13. Coordinating Plans: See
Section 9.
14. Reimbursement: N/A
15. Reporting Data: Information
from the CATCH 3 tracking system (see Section
11) is downloaded to the counties for use in
performing outreach activities. It is also used
for referral follow-up activities. Also, the
quarterly joint meeting are to cover, among
other issues, sharing of appropriate and relevant
aggregate data affecting health status or the
delivery of health care services.
16. Review: Quarterly joint
meetings are to cover, among other issues, the
review at least annually of this Memorandum
of Understanding to determine if any changes
are required.
17. Liaison: Authorized representatives
and members of quarterly joint meetings are
named.
18. Evaluation: See Section
16.
19. General Contract Provisions:
termination of agreementamendment/modification
of agreementindemnification/liability
State: Mississippi
(Region 4)
Document: Cooperative
Agreement between Mississippi State Department
of Health and the Division of Medicaid in the
Office of the Governor State of Mississippi
(Perinatal High Risk Management Services)
Author: Mississippi State Department
of Health
Date: 2004 Pages: 29 pp.
Document URL: http://www.mchlibrary.info/iaa/states/ms_1_1.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 -
June 30, 2005.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. Division
of Medicaid, Office of the Governor (Division)
[Title XIX].B. State of Mississippi Department
of Health (Department) [Title V].
5. Authority Cited: Miss. Code
Ann. §43-13-117(19)(a); 43-13-117(5); 43-13-115.
Summary Related
to CMS Requirements:
6. Objectives:
To provide case management and extended services
through approved case management agencies over
the state to those pregnant/postpartum women
and infant Medicaid beneficiaries.
7. Responsibilities: A. The
Department is the State agency responsible for
the general supervision of the health interests
of the people of that State and is authorized
to enter into contracts and agreements with
other State or Federal agencies in effecting
an efficient delivery of public health services.B.
The Division is responsible for providing case
management and extended services for high risk
pregnant/postpartum women through approved case
management agencies and EPSDT.
8. Services Provided by Agency:
Exhibit A lists the criteria for case management
and the enhanced services to be provided for
various target groups.
A. High risk infants, age birth to one (1) year
old
.
1. Case management.
2. Medical risk assessment.
3. Enhanced EPSDT services for high risk infants.
B. High risk pregnant women
(services to be provided during pregnancy and
through the end of
the month in which a 60-day postpartum period
ends).
1. Case management.
2. Medical risk assessment.
3. Nutritional assessment/counseling.
4. Psychosocial assessment/counseling.
5. Health education.
6. Home visit.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
Any infants who are developmentally delayed
and who meet early intervention criteria should
be enrolled in early intervention.
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: The
Department shall coordinate with the Division
in the purchase of case management and extended
services for those individual Medicaid beneficiaries
who are pregnant/postpartum and at high risk
and for infants, birth to 1 year of age, who
are at high risk for mortality and morbidity.
14. Reimbursement: The case
management agencies shall be reimbursed as a
provider of medical services through the Division’s
Fiscal Agent on the basis of the service cost
as set out in appropriate regulations. The case
management agencies shall bill the Division
through its fiscal agent for their services
within 60 days from the date of service or within
30 days of the recipient’s receipt of
the Medicaid card. The Department will be responsible
for providing state matching funds only for
case management and extended services actually
provided by the Department to those individuals
determined to be eligible. Reimbursement shall
be made from monthly billings. The reimbursement
fees will be at a flat rate per month.
15. Reporting Data: The Department
shall submit a monthly report to the EPSDT Division
and/or the PHRM Unit of the division, for Medicaid
enrolled pregnant women and/or Medicaid enrolled
infants receiving services. The Department shall
report detailed information to the Division
annually. The CMS1500 claim form information
submitted by the Department to Medicaid’s
fiscal agent must show all Medicaid procedure
codes for all services.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementindemnification/liabilitynondiscriminationconfidentiality
of records/HIPAA
State: Missouri
(Region 7), document 1 of 6
Document: Cooperative
Agreement between the [Missouri] Department
of Social Services, Division of Medical Services
and the Department of Health, Division of Maternal,
Child and Family Health, Bureau of Family Health:
Prenatal Case Management and/or Service Coordination
for Pregnant Women
Author: Missouri Department
of Social Services
Date: 2000 Pages: 7 pp.
Document URL: http://www.mchlibrary.info/iaa/states/mo_1_6.pdf
Contractual Details:
1. Effective Date: April 1,
2000.
2. Duration: Shall remain in
effect until canceled by one or both parties.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. Department
of Social Services (DSS), Division of Medical
Services [Title XIX].B. Department of Health
(DOH), Division of Maternal, Child and Family
Health, Bureau of Family Health [Title V].
5. Authority Cited: 42 CFR
431 Subpart M.
Summary Related to CMS Requirements:
6. Objectives:
To provide the most efficient, effective, and
cost effective administration of Title XIX case
management services.
7. Responsibilities: Mutual
Responsibilities.A . Provide a plan for the
coordination of services.B. Improve and expand
prenatal and preventive health services to Medicaid
eligible recipients through education, cooperative
planning, reducing barriers to access to health
care, and follow-up activities.C. Reduce the
incidence of inadequate prenatal care.D. Reduce
the incidence of perinatal substance use of
alcohol, tobacco, and drugs.
8. Services Provided by Agency:
A. DSS.1. Reimburse DOH the Title XIX Federal
share of actual and reasonable costs for service
coordination.2. Provide DOH access to the information
necessary to properly administer the Prenatal
Case Management Service Program and service
coordination for the Perinatal Substance Abuse
Program.3. Meet and consult on a regular basis,
at least quarterly, with DOH on issues related
to this agreement.4. Provide notification to
DOH as soon as any changes are defined in the
billing process and billing requirements affecting
any local agencies included in this agreement.B.
DOH.1. Employ administrative staff to provide
TA to the Medicaid Case Management providers.2.
Ensure service coordination staffing for the
Perinatal Substance Abuse Program.3. Employ
necessary staff to provide quality assurance
activities and act as liaison with multiple
disciplines on the medical aspects of the program.4.
Account for the activities of the staff employed.5.
Provide as requested by the State Medicaid Agency
the information necessary to request Federal
funds available under the State Medicaid match
rate.6. Return to DSS any Federal funds which
are deferred and/or ultimately disallowed.7.
Maintain the confidentiality of client records
and eligibility information.8. Meet and consult
on a regular basis, at least quarterly, with
DSS.9. Conduct all activities recognizing the
authority of the single State Medicaid agency.
9. Cooperative Relationships:
DSS enters into the cooperative agreement with
DOH for provider relations and quality assurance,
including establishing standards, TA, coordination,
and data management of the case management services,
and service coordination for women enrolled
in the Perinatal Substance Abuse Program.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
Case closure, referral, and realignment of service
plan will be coordinated by DSS and DOH.
13. Coordinating Plans: Service
coordination will be conducted for perinatal
substance abuse in the following:1. Assistance
to the clients/families in establishing a medical
care home.2. [Missing].3. Service identification.4.
Service monitoring.5. Case closure, referral,
and realignment of service plan.
14. Reimbursement: See Section
8, Service A1.
15. Reporting Data: See Section
8, Service A2 and B5.
16. Review: A task force consisting
of the Directors of the respective departments
or their designees and an equal number of other
persons from their respective divisions chosen
by the Directors shall meet at least quarterly,
for the purpose of program development, review,
and evaluation to discuss problems, and to develop
recommendations to improve programs for better
and expanded services to individuals. These
activities shall include consideration of:1.
The evaluation of policies, duties, and responsibilities
of each agency.2. Arrangement for periodic review
of the agreements and for joint planning for
changes in the agreements.3. Arrangements for
continuous liaison between the divisions and
departments and designated staff responsibility
for liaison activities at both the state and
local levels.
17. Liaison: See Section 8,
Service A3 and B8.
18. Evaluation: See Section
16.
19. General Contract Provisions:
termination of agreementamendment/modification
of agreementconfidentiality of records/HIPAA
State: Missouri
(Region 7), document 2 of 6
Document: Interagency Agreement
between the Missouri Department of Health and
the Missouri Department of Social Services:
Well Child Outreach
Author: Missouri Department
of Social Services
Date: 1997 Pages: 3 pp.
Document URL: http://www.mchlibrary.info/iaa/states/mo_2_6.pdf
Contractual Details:
1. Effective Date: July 1,
1997
2. Duration: Until canceled
by one or both parties.
3. Type of Agreement: Interagency
Agreement.
4. Agencies Involved: A. The
Missouri Department of Health (DOH), Division
of Maternal, Child and Family Health (DMCFH)
[Title V].B. The Missouri Department of Social
Services, Division of Medical Services [Title
XIX].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
A. To continue to implement a statewide program
[the Well Child Outreach Project] designed to
promote the health of children, adolescents, and
pregnant women.B. DOH’s goal is to reduce
the inadequate prenatal care rate to no more than
10 percent by year 2000.C. DSS’s goal is
to screen 80 percent of all Medicaid-eligible
children each year.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. DSS.1. Designate one or more persons who
will serve as a contact for DOH.2. Reimburse
DOH 100 percent of the Title XIX Federal share
for staff responsible for implementing the Well
Child Project.3. Reimburse DOH 100 percent of
the Title XIX Federal share for expense and
equipment costs.4. Provide DOH with Year to
Date EPSDT participation rates.B. DOH.1. Employ
staff and incur necessary expenses to carry
out the Project; account for the activities
of the staff.2. Involve DSS in program process.3.
Keep records and provide written reports to
DSS on relevant program data related to print
material distribution, outreach activities,
etc.4. Evaluate the Project and share the results
with DSS.5. Return to DSS any Federal funds
which are deferred and/or ultimately disallowed.6.
Provide the billing information necessary to
obtain Federal financial participation.Maintain
the confidentiality of client records.7. Conduct
all activities recognizing the authority of
the single State Medicaid agency.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: See
Section 8, Activity B2.
14. Reimbursement: See Section
8, Activity A2, A3, and B5.
15. Reporting Data: See Section
8 Activity A4, B1, B3, and B6.
16. Review: N/A
17. Liaison: See Section 8,
Activity A1.
18. Evaluation: See Section
8, Activity B4.
19. General Contract Provisions:
termination of agreementconfidentiality of records/HIPAA
State: Missouri
(Region 7), document 3 of 6
Document:
Cooperative Agreement between the [Missouri]
Department of Social Services, Division of Medical
Services and the Department of Health, Division
of Maternal Child and Family Health, Bureau
of Special Health Care Needs: Head Injury Program
Author: Missouri Department
of Social Services
Date: 2001 Pages: 9 pp.
Document URL: http://www.mchlibrary.info/iaa/states/mo_3_6.pdf
Contractual Details:
1. Effective Date: July 1,
2001.
2. Duration: Until canceled
by one or both parties.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. The
Missouri Department of Health (DOH), Division
of Maternal, Child and Family Health (DMCFH)
[Title V].B. The Missouri Department of Social
Services (DSS), Division of Medical Services
(DMS), Head Injury Program [Title XIX].
5. Authority Cited: 42 CFR
431 Subpart M.
Summary Related
to CMS Requirements:
6. Objectives:
To provide the most efficient, effective administration
of Head Injury Services.
7. Responsibilities: Mutual
Responsibilities.A. To ensure early and appropriate
response to a referral so that diagnosis, assessment,
and treatment/intervention occur within the
timelines established by DOH policy and procedure.B.
To ensure that services are of sufficient amount,
duration, and scope to responsibly achieve the
stated purpose of this agreement.C. To establish
a health care home for those Medicaid eligible
individuals receiving Head Injury service coordination
activities.
8. Services Provided by Agency:
A. DSS.1. Reimburse DOH the Title XIX Federal
share of actual and reasonable costs for Head
Injury Administration activities.2. Define the
rates of reimbursement as per 42 CFR 433.15,
432.50,and 433.15(7).3. Reimburse DOH the Title
XIX Federal share of actual and reasonable costs
for data research services.4. Reimburse DOH
the Title XIX Federal share of actual and reasonable
costs incurred by Electronic Data Processing.5.
Provide DOH access to the information necessary
to properly provide Head Injury Service Administration.6.
Meet and consult on a regular basis, at least
quarterly, with DOH.B. DOH.1. Maintain direct
employment of those staff necessary to provide
the programmatic and operation oversight, management,
and monitoring of the Head Injury Program.2.
Ensure that contracted service coordination
staff furnish service coordination for the medical
services available.3. Provide linkage of data
system for coordination, identification, and
effective case planning.4. Provide Head Injury
Administration to assess the necessity for and
adequacy of medical care and services provided,
which include outreach; service coordination;
program service case planning; service monitoring;
and case closure, referral, and realignment
of service plan.5. Account for the activities
of the DOH staff and contractual staff.6. Provide
the information necessary to request Federal
funds.7. Return to DSS any Federal funds which
are deferred and/or ultimately disallowed.8.
Maintain the confidentiality of client records
and eligibility information.9. Seek General
Revenue appropriations to provide the State
match for the Federal matching share.10. Meet
and consult on a regular basis, at least quarterly,
with DSS.11. Conduct all activities recognizing
the authority of the single State Medicaid agency.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
DOH will assist in identifying possible Medicaid
eligibles and referring them to the DFS for
eligibility determination [this activity is
highlighted in Section 8]
12. Reciprocal Referrals:
DOH will establish a health care home, provide
referrals to Medicaid covered services, and
make appointments for appropriate primary care
and appropriate Medicaid services.
13. Coordinating Plans:
See Section 8, Service B2. DOH will also make
plans for coordinating rehabilitation services
identified in the Program Service Plan.
14. Reimbursement: See Section
8, Service A1-A5.
15. Reporting Data: See Section
8, Service A6, B3
16. Review: DOH will review
the Program Service Plan, ensuring the plan
relates to services the individual is receiving
and documents the client’s progress. DOH
staff will also monitor contracted staff’s
performance of the SOW.
17. Liaison: See Section 8,
Service B4.
18. Evaluation: A task force
consisting of the Directors of the respective
departments or their designees and an equal
number of other persons from their respective
divisions chosen by the Directors shall meet
at least quarterly, for the purpose of program
development, review, and evaluation to discuss
problems, and to develop recommendations to
improve programs for better and expanded services
to individuals. These activities shall include
consideration of:1. The evaluation of policies,
duties, and responsibilities of each agency.2.
Arrangement for periodic review of the agreements
and for joint planning for changes in the agreements.3.
Arrangements for continuous liaison between
the divisions and departments and designated
staff responsibility for liaison activities
at both the State and local levels.
19. General Contract Provisions:
termination of agreementconfidentiality of records/HIPAA
State: Missouri
(Region 7), document 4 of 6
Document: Cooperative
Agreement between the [Missouri] Department
of Social Services and the Department of Health
relating to Administration of the Medicaid Home
ad Community-Based Services Waiver for Targeted
Individuals with Physical Disabilities
Author: Missouri Department
of Social Services
Date: 2001 Pages: 10 pp.
Document URL: http://www.mchlibrary.info/iaa/states/mo_4_6.pdf
Contractual Details:
1. Effective Date: July 1,
2001.
2. Duration: Until canceled
by one or both parties.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. The
Missouri Department of Health (DOH) [Title V].B.
The Missouri Department of Social Services,
Division of Medical Services (DSS-DMS) [Title
XIX].
5. Authority Cited: 42 CFR
431 Subpart M.
Summary Related
to CMS Requirements:
6. Objectives:
To provide the most efficient, effective administration
of the Physical Disabilities Waiver (PDW).
7. Responsibilities: Mutual
Responsibilities.A. To provide for cost-effective
home and community-based services for individuals
as cost effective alternative to Intermediate
Care Facility for Mentally Retarded (ICF/MR).B.
To ensure necessary safeguards have been taken
to protect the health and welfare of persons
receiving services under the Physical Disabilities
Waiver.
8. Services Provided by Agency:
A. DSS
.
1. Reimburse DOH the Title XIX Federal share
of actual and reasonable costs for the waiver
program.
2. Provide DOH access to the information necessary
to properly administer the PDW Program.
3. Meet and consult on a regular basis with
DOH.
4. Provide the administration of Physical Disabilities
Waiver and Personal Care Guidelines.
5. Provide training for DOH staff.
6. Determine recipients’ eligibility for
Medicaid.
7. Review on a yearly basis the most recent
assessment and plan of care to ensure the need
for
services was documented in the plan of care
and all services needs in the plan were properly
authorized prior to delivery.
8. Prepare the annual report on the impact of
the PDW program.
9. Exchange data with DOH to compile periodic
reports on the number of clients served, their
costs, and the savings generated.
10. Review reports of a provider non-compliance
submitted from DOH and pursue any action
necessary to remedy.
11. Prepare, print, mail, and publish online
material regarding Medicaid services.
12. Review materials to be published by DOH
regarding Medicaid services.
13. Review and comment on policy and procedure
for the internal operations of staff regarding
Medicaid services.
14. Maintain the confidentiality of client records.
15. Conduct hearings for persons who have appealed
denial or termination of services by DOH.
16. Designate an employee of DSS-DMS to serve
as a liaison with DOH.
17. Assist DOH in the transitioning of eligible
individuals to the adult Medicaid services.
18. Provide support as needed to DOH in developing
plans of care.
B. DOH
.
1. Directly employ qualified professional and
support staff necessary to provide the
administration and case management of services.
2. Maintain recipient to allow for coordination,
identification, effective care planning, etc.
3. Collaborate with other State agencies in
the client’s assessment.
4. Collaborate with other State agencies in
developing plans for care.
5. Provide PDW case management.
6. Prior authorize medically necessary PDW and
Personal Care Program services.
7. Conduct, at a minimum, quarterly home visits.
8. Monitor provision of service.
9. Act as a liaison in the due process for the
recipient and family in the event of a case
closure,
referral, and/or realignment of plan of care.
10. Account for the activities of the staff
employed.
11. Provide the information necessary to request
Federal funds.
12. Return to DSS any Federal funds which are
deferred and/or ultimately disallowed.
13. Maintain the confidentiality of client records.
14. Meet and consult on a regular basis with
DSS-DMS.
15. Conduct all activities recognizing the authority
of the single State Medicaid agency.
16. Assume the financial responsibility for
the development of print materials.
17. Follow the guidelines accepted by DSS and
DOH.
18. Prepare policy and procedures for internal
operations of DOH staff.
19. Ensure DOH staff participation in Medicaid
related training.
20. Provide training as needed.
21. Participate in hearings in regard to DOH
administration.
22. Report suspected provider abuse or non-compliance.
9. Cooperative Relationships:
See Section 8, Service B3, B4
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service A6, B2.
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: See
Section 8, Service A3. Coordination language
is integrated throughout Section 8.
14. Reimbursement: See Section
8, Service A1, B12.
15. Reporting Data: See Section
8, Service A2, A8, A9.
16. Review: See Section 8,
Service A7; Section 18.
17. Liaison: See Section 8,
Service A16, B14.
18. Evaluation: A task force
consisting of the Directors of the respective
departments or their designees and representatives
from each division shall meet annually, for
the purpose of program development, review,
and evaluation to discuss problems, and to develop
recommendations to improve programs for better
and expanded services to eligible individuals.
These activities shall include consideration
of:1. The evaluation of policies, duties, and
responsibilities of each agency.2. Feasibility
of cost effectiveness.3. Arrangements for periodic
review of the agreements and for joint planning
for changes in the agreements.4. Review of liaison
activities.
19. General Contract Provisions:
termination of agreementconfidentiality of records/HIPAA
State: Missouri
(Region 7), document 5 of 6
Document:
Cooperative Agreement between the Missouri
Department of Social Services, Division of Medical
Services and the Missouri Department of Health,
Bureau of Special Health Care Needs, Head Injury
Program: Non-Emergency Medical Transportation
Author: Missouri Department
of Social Services
Date: 2000 Pages: 5 pp.
Document URL: http://www.mchlibrary.info/iaa/states/mo_5_6.pdf
Contractual Details:
1. Effective Date: January
1, 2000.
2. Duration: Until canceled
by one or both parties.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. The
Missouri Department of Health, Bureau of Special
Health Care Needs, Head Injury Program (DOH/BSHCN)
[Title V].B. The Missouri Department of Social
Services (DSS), Division of Medical Services
(DMS) [Title XIX].
5. Authority Cited: 42 CFR
431 Subpart M.
Summary Related
to CMS Requirements:
6. Objectives:
To provide the most efficient and cost effective
Non-Emergency Medical Transportation (NEMT)
services.
7. Responsibilities: Mutual
Responsibilities.To ensure transportation services
to and from covered Missouri Medicaid services
for head injured Medicaid eligible recipients
age 21 or over.
8. Services Provided by Agency:
A. DSS
.
1. Reimburse DOH/BSHCN the Title XIX Federal
share for NEMT services.
2. Provide DOH/BSHCN access to the information
necessary to properly provide NEMT
services.
3. Meet and consult on a regular basis, at least
annually, with DOH/BSHCN.
4. Develop and conduct periodic utilization
reviews to ensure payments do not duplicate.
5. Refer recipients who meet certain criteria
to the DMS NEMT broker.
6. Maintain the confidentiality of client records.
B. DOH/BSHCN
.
1. Identify Medicaid eligible head injury recipients.
2. Arrange/schedule the most cost-effective
NEMT services appropriate.
3. Certify to DSS the provisions of the non-Federal
share for transportation services.
4. Provide the information necessary to request
Federal funds.
5. Accept responsibility for disallowances.
6. Meet and consult on a regular basis, at least
annually, with DSS.
7. Conduct all activities recognizing the authority
of the single State Medicaid agency.
8. Maintain all necessary information to support
the claims and provide [CMS] any necessary
data for auditing.
9. Maintain confidentiality of client records.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service B1.
12. Reciprocal Referrals:
See Section 8, Service A5.
13. Coordinating Plans: N/A
14. Reimbursement: See Section
8, Service A1.
15. Reporting Data: See Section
8, Service A2, B4, B8.
16. Review: See Section 8,
Service A4.
17. Liaison: See Section 8,
Service A3,B6.
18. Evaluation: A task force
consisting of the Directors of the respective
departments or their designees and representatives
from each division shall meet annually, for
the purpose of program development, review,
and evaluation to discuss problems, and to develop
recommendations to improve programs for better
and expanded services to eligible individuals.
These activities shall include consideration
of:1. The evaluation of policies, duties, and
responsibilities of each agency.2. Feasibility
of cost effectiveness.3. Arrangements for periodic
review of the agreements and for joint planning
for changes in the agreements.4. Review of liaison
activities.
19. General Contract Provisions:
termination of agreementconfidentiality of records/HIPAA
State: Missouri
(Region 7), document 6 of 6
Document:
Cooperative Agreement between the [Missouri]
Department of Social Services, Division of Medical
Services and the [Missouri] Department of Health,
Division of Maternal, Child and Family Health,
Bureau of Family Health: Administrative Case
Management, Healthy Children and Youth Program
(HCY)
Author: Missouri Department
of Social Services
Date: 2000 Pages: 5 pp.
Document URL: http://www.mchlibrary.info/iaa/states/mo_6_6.pdf
Contractual Details:
1. Effective Date: July 1,
1997.
2. Duration: Until canceled
by one or both parties.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. The
Missouri Department of Health, Division of Maternal,
Child and Family Health, Bureau of Family Health
(DOH) [Title V].B. The Missouri Department of
Social Services (DSS), Division of Medical Services
(DMS) [Title XIX].
5. Authority Cited: 42 CFR
431 Subpart M.
Summary Related
to CMS Requirements:
6. Objectives:
To provide the most efficient and cost efficient,
effective administration of Title XIX EPSDT aka
in the state as Healthy Children and Youth (HCY).
7. Responsibilities: Mutual
Responsibilities.A. To ensure early and appropriate
intervention and screening so that diagnosis
and treatment occur in a timely manner.B. To
ensure that services are of sufficient amount,
duration, and scope.C. To establish a medical
care home for those Medicaid eligible children
receiving HCY services.D. To ensure that services
are provided by appropriate Medicaid enrolled
providers.E. To ensure that all children requiring
technical and/or nursing services are provided
service coordination.F. To ensure that service
coordination is available for all clients requiring
service coordination as a result of substance
abuse.
8. Services Provided by Agency:
A. DSS
.
1. Reimburse DOH the Title XIX Federal share
for HCY services.
2. Reimburse DOH the Title XIX Federal share
for research services.
3. Reimburse DOH the Title XIX Federal share
of costs incurred from EDP for their provision
of data.
4. Provide DOH access to the information necessary
to properly provide HCY services.
5. Provide DOH access to the information necessary
to properly provide HCY administration.
6. Meet and consult on a regular basis, at least
quarterly, with DOH.
B. DOH
.
1. Employ all necessary professional staff.
2. Employ administrative staff.
3. Provide linkage of data systems for coordination,
identification, and effective case planning.
4. Aid ad assist in the development of screening
tools.
5. Provide HCY administration and act as liaison.
6. Account for activities of the staff employed.
7. Provide the information necessary to request
Federal funds.
8. Return to DSS any Federal funds which are
deferred and/or ultimately disallowed.
9. Maintain the confidentiality of client records.
10. Seek General Review appropriations to provide
the Federal matching share for HCY
services.
11. Meet and consult on a regular basis with
DSS.
12. Conduct all activities recognizing the authority
of the single State Medicaid agency.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
DOH will assist in identifying possible Medicaid
eligibles. DOH will identify the kind, amount,
intensity, and duration of services required.
12. Reciprocal Referrals:
DOH will assist in referring Medicaid eligibles
to the Division of Family Services.
13. Coordinating Plans: N/A
14. Reimbursement: N/A
15. Reporting Data: N/A
16. Review: N/A
17. Liaison: N/A
18. Evaluation:
A task force consisting of the Directors of
the respective departments or their designees
and
representatives from each division shall meet
at least quarterly, for the purpose of program
development, review, and evaluation to discuss
problems, and to develop recommendations to
improve programs for better and expanded services
to eligible individuals. These activities shall
include consideration of:
1. The evaluation of policies, duties, and responsibilities
of each agency.
2 Arrangements for periodic review of the agreements
and for joint planning for changes in the
agreements.
3. Arrangements for continuous liaison.
19. General Contract Provisions:
termination of agreementconfidentiality of records/HIPAA
State: Nebraska
(Region 7)
Document:
Interagency Agreement between the Nebraska
Department of Health and Human Services, Family
Health Division and the Nebraska Department
of Health and Human Services, Finance and Support,
Medicaid (Title XIX)
Author: Nebraska Department
of Health and Human Services
Date: 1998 Pages: 10 pp.
Document URL: http://www.mchlibrary.info/iaa/states/ne_1_1.pdf
Contractual Details:
1. Effective Date: November
13, 1998
2. Duration: In perpetuity
(although original agreement continued through
June 30, 1999 and has been renewed annually).
3. Type of Agreement: Interagency
Agreement.
4. Agencies Involved: A. Nebraska
Department of Health and Human Services, Family
Health Division (FHD) [Title V].B. Nebraska
Department of Health and Human Services Finance
and Support, Medicaid (Title XIX Agency) [Title
XIX].
5. Authority Cited: A. Title
V of the (Public Health) Social Security Services
Act.B. Child Nutrition Act of 1989, Section
17(e)(4)(b).C. Title XIX of the Social Security
Act (Medicaid), Section 1902(a)(11)(A).
Summary Related
to CMS Requirements:
6. Objectives:
A. To promote continuity of care, sharing of
scarce expertise, reduction of unnecessary
duplication of effort, efficient allocation
of resources, and the achievement of greater
accountability to produce an enhanced and expanded
health care services system to mutual
clients and improve the health of the families
of the State of Nebraska.
B. To ensure maximum utilization of Title XIX
resources by those served by the programs of
the
Family Heath Division and their providers.
7. Responsibilities: The Nebraska
Department of Health and Human Services is responsible
for the conduct of the Family Health Division
Programs and the Department of Health and Human
Services Finance and Support is responsible
for the conduct of the Title XIX Program.
FHD is broadly responsible for core public health
functions as they specifically address the following
population groups: pregnant women and all women
of reproductive age, infants, children, adolescents,
and their families
8. Services Provided by Agency:
FHD and the Title XIX Agency shall (each agency
has multiple subtasks under each major activity):A.
Promote continuity of care, share expertise,
reduce duplication of effort, etc.B. Ensure
maximum utilization of Title XIX resources.C.
Maximize the potential for delegation of tasks
by the Title XIX agency to the FHD to ensure
that Medicaid-eligible children have access
to and receive the full range of assessment,
diagnostic, and treatment services.D. Encourage
comprehensive and continuous care to mutual
clients by encouraging or requiring providers
in each program enjoined by this agreement,
to identify and refer potentially eligible individuals
through the use of reciprocal referrals.E. Increase
access to and improve delivery of family planning,
prenatal, and obstetric care to low income women,
particularly teenagers.F. Develop a system that
ensures early identification of Title XIX eligible
individuals, including pregnant women, in need
of preventive health, medical, or remedial care
and services, and assist and support such individuals
in obtaining needed services.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
The Title XIX Agency shall inform and educate
all Title XIX State and local health and human
services to make them knowledgeable of the services
offered by FHD programs.
11. Identification and Outreach:
The FHD shall promote preventive health care
and encourage eligible children to receive EPSDT
screening examinations.
12. Reciprocal Referrals:
See Section 8, Service D. Also, the Title XIX
Agency shall provide FHD grantees referrals,
data, reports, and other material needed to
support outreach activities.
13. Coordinating Plans: N/A
14. Reimbursement: A. Title
XIX Agency.1. Reimburse FHD program providers
who are also Medicaid providers.2. Establish
a formal method of communication, collaboration,
and cooperation with FHD regarding procedures,
periodicity, and content standards for EPSDT,
rates and reimbursement methods by regularly
scheduled meetings.3. Encourage and support
the FHD policy to recover third party reimbursement
and other revenues. It is the intent to make
Medicaid funds the first and primary source
of payment for medical services provided to
Medicaid clients through the FHD programs.4.
Plan, in conjunction with FHD, to address billing
concerns.5. Identify overall services and provide
the maximum allowable rate information for procedures.B.
FHD.1. Ensure that FHD providers shall bill
the Title XIX agency.2. Respond to and attend
annual meetings regarding rates and reimbursement
methods.3. Ensure that all third-party revenues
shall be retained by the FHD provider.4. Cooperate
and participate in the planning process.
15. Reporting Data: Program
reports will be developed to support financial
claims for Federal Medicaid financial match
funding. The FHD or its grantees will maintain
a method of readily identifying Medicaid eligible
children benefiting from the activities within
the scope of this Agreement.The FHD shall provide
documentation of Title V match and submit the
required fiscal and program reports of Title
V activities on a quarterly basis. The Title
XIX Agency will provide financial reimbursement
directly to the grantee based upon the grantee’s
invoice and narrative and on FHD’s quarterly
documentation.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementpayment
State: New
Mexico (Region 6)
Document: State of New
Mexico Human Services Department Medical Assistance
Division Provider Participation Agreement
Author: State of New Mexico
Human Services Department Medical Assistance
Division
Date: 2003 Pages: 6 pp.
Document URL: http://www.mchlibrary.info/iaa/states/nm_1_1.pdf
Contractual Details:
1. Effective Date: March 18,
2003.
2. Duration: Shall remain in
effect until terminated.
3. Type of Agreement: Provider
Participation Agreement.
4. Agencies Involved: A. Human
Services Department [Title XIX].B. Children’s
Medical Services [Title V].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
To specify the terms and conditions for the provision
of medical services to Medicaid clients.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. Children’s Medical Services
.
1. Abide by all Federal, State, and local laws
under Title XIX and Title XXI.
2. Furnish services, bill for services, and
receive payment for services upon approval of
this
agreement.
3. Comply with all billing instructions, reimbursement,
audit, recoupment, and withholding
provisions.
4. Maintain and keep updated program policies,
instructions on billing and utilization review,
and other material.
5. Furnish and update complete information on
provider address, licensing, certification,
etc.
6. Comply with all laws regarding the provider’s
authority to operate a business.
7. Assume sole responsibility for all costs
of doing business.
8. Verify that an individual is eligible for
a specified medical program administered by
HSD.
9. Maintain the confidentiality of client information.
10. Render covered services to eligible clients.
11. Assume responsibility for any and all claims
submitted on behalf of the provider.
12. Retain any and all original medical or business
records as are necessary to verify the
treatment of clients.
13. Upon closure of office, notify HSD where
records will be located.
14. Furnish to Medicaid at no cost access to
records requested.
15. Accept as payment in full the amount paid
by HSD for services furnished to clients in
accord
with the reimbursement structure.
16. Not collect payments from the client for
services, except as allowed by HSD.
17. Seek payment from any other payer or insurer
before seeking payment from HSD.
18. Not refuse to furnish services to an eligible
client because of a third party’s potential
liability
for payment.
19. Inform HSD when an attorney or other party
requests information related to the services
rendered to a client.
20. Agree to HSD regulations when furnishing
services to clients who sustained injury in
an
accident or action that may be subject to a
legal proceeding.
B. Human Services Department
.
1. Distribute information necessary to participate
in medical programs administered by HSD.
2. Process payments in a manner delineated by
federal guidelines.
3. Reimburse providers for furnishing covered
services or procedures to eligible clients.
4. Conduct administrative investigations and
proceedings to ensure that providers comply
with
the terms of this agreement.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service A8
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: See Section
8, Service A2, A4, A7, A15, A15, A17, A18, B2,
B3.
15. Reporting Data: See Section
8, Service A5, A12, A13, A14, A19, B1.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
termination of agreementdispute resolution mechanismfailure
to satisfy SOWindemnification/liabilityconfidentiality
of records/HIPAAdefault
State: New
York (Region 2)
Document: Medicaid/EPSDT
- Title V Action Plan: New York State Department
of Health
Author: New York State Department
of Health
Date: n.d. Pages: 3 pp.
Document URL: http://www.mchlibrary.info/iaa/states/NY_1_1.pdf
Contractual Details:
1. Effective Date: N/A
2. Duration: N/A
3. Type of Agreement: Action
Plan.
4. Agencies Involved: A. New
York State Department of Health [Title V].B.
New York Office of Medicaid Management [Title
XIX].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives:
To provide:A. Access to health insurance for
every New Yorker.B. Comprehensive, high quality
and accessible medical services for every New
Yorker.C. A medical home for every New Yorker.D.
Non-discriminatory provision of assistance,
and of medical services, to Medicaid applicants
and recipients.E. Delivery of all services to
Medicaid applicants and recipients in a culturally
and language appropriate manner.F. An increase
in the public’s awareness of Title V and
Title XIX services available to them.G. Coordination
of services delivery, to ensure services will
be provided without duplication of effort, or
fragmentation.
7. Responsibilities: Shared
responsibilities include:A. Definitions and
clarifications of the respective functions and
responsibilities of each party.B. Adherence
by medical care and health services providers
to Federal and State regulations and standards
of medical care.C. Education of Medicaid recipients
relative to services available.D. Share de-identified
data.E. Observing and requiring adherence to
Federal and State laws.F. Observing the Civil
Rights Act of 1964.G. Designating personnel
for continuous liaison.
8. Services Provided by Agency:
A. Title V Services.1. Maintain the Growing
Up Healthy Hotline.2. Review utilization, quality,
etc. of care and services furnished by Medicaid.3.
Provide to Title XIX lists of institutions approved
to provide care.4. Provide consultation to Medicaid.5.
Provide advice and assistance in the design
of data capture instruments.6. Provide documentation
instructions to Title V contractors.7. Assist
Title V contractors in qualifying for payment
under Title XIX.8. Make referrals to Medicaid;
assist in identifying Title V clients of potential
eligibility; and refer those clients to the
appropriate agency.B. Title XIX Services.1.
Access to lists of health care providers eligible
to receive Title XIX reimbursement.2. Access
to lists of health care providers ineligible
to receive Title XIX reimbursement.3. Provide
oversight/monitoring, guidance, support, and
necessary assistance to the State’s local
Departments of Social Services (LDSS) in matters
of Medicaid eligibility, enrollment, and maintenance
of client records.4. Arrange and promote partnerships,
communication, and cooperation between Title
XIX and LDSS Medicaid operations by mutual coordination,
an attendance at meetings.
9. Cooperative Relationships:
See Section 8, Service B4.
10. Services Provided by Local Agencies:
Provide oversight/monitoring, guidance, support,
and necessary assistance to the State’s
local Departments of Social Services (LDSS)
in matters of Medicaid eligibility, enrollment,
and maintenance of client records (Section 8,
Service B3).
11. Identification and Outreach:
See Section 8, Service A1.
12. Reciprocal Referrals:
See Section 8, Service A8.
13. Coordinating Plans: See
Section 8, Service B4.
14. Reimbursement: See Section
8, Service A7, B1.
15. Reporting Data: Title V
and Title XIX share de-identified data relative
to health outcomes, gaps in services, concerns
for placement and proficiency of providers,
and the utilization of the EPSDT program. See
also Section 8, Service A3, A6, B1, B2.
16. Review: N/A
17. Liaison:
There is shared responsibility to designate
specific personnel from Title V and Title XIX
to be
responsible for continuous liaison activities.
Designated personnel from relevant divisions
will
meet on a regular basis, with a minimum of 4
meetings a year, to discuss all areas of mutual
and
singular responsibility for respective programs,
to update each other on new developments, and
to maintain and enhance communication and cooperation
between the entities.
18. Evaluation: N/A
19. General Contract Provisions:
N/A
State: North
Carolina (Region 4)
Document: Memorandum of
Understanding between the Division of Medical
Assistance and the Division of Public Health,
[North Carolina] Department of Health and Human
Services
Author: North Carolina Department
of Health and Human Services
Date: [2001] Pages: 52 pp.
Document URL: http://www.mchlibrary.info/iaa/states/nc_1_1.pdf
Contractual Details:
1. Effective Date: April 1,
2001.
2. Duration: Will remain in
effect until terminated by one or both parties.
3. Type of Agreement: Memorandum
of Understanding.
4. Agencies Involved: A. Division
of Medical Assistance (DMA) [Title XIX].B. Division
of Public Health (DPH) [Title V].
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives: To improve
the health of Medicaid eligible clients.
7. Responsibilities: N/A
8. Services Provided by Agency:
Mutual Services
.
1. Collaborate in (a) planning, (b) consultation
and TA to providers, (c) development of
agreements with other State agencies.
2. Consult with appropriate groups and develop
health services policies.
3. Administer the Baby Love Program.
4. Promote appropriate access to comprehensive
care.
5. Take part in joint initiatives.
6. Coordinate activities between health programs.
7. Ensure allowable cost reimbursement for services
provided to eligible Medicaid clients.
8. Provide public health specific program guidance
as needed.
9. Update and develop program manuals and guidance.
10. Develop a system of local service providers
to refer pregnant women and EPSDT children
under age 5 to WIC and MCC programs.
11. Determine when changes are needed to the
list of covered services.
The MOU also includes a detailed list of DPH
and DMA responsibilities; local health department
information; arrangements for immunizations;
arrangements for purchase of medical care
services for CSHCN; arrangements for HealthCheck/EPSDT;
arrangements for fostered child
health nurse screeners; arrangements for school-based
health centers; arrangements for HIV case
management and AIDS home and community-based
services; and details on data exchange.
9. Cooperative Relationships:
DMA and DPH will cooperate in providing consultation,
technical assistance, policy and program guidance
to local service providers.
10. Services Provided by Local Agencies:
A local entity may enter into agreements with
physicians and dentists for the provision of
services that are to be reimbursed to the agency
in accordance with the Medicaid Fee Schedules.
When the local entity enters into an agreement,
a supplemental provider agreement must be executed
between the local health department and physician.
11. Identification and Outreach:
DMA and DPH shall provide outreach and marketing
activities that promote appropriate health services
utilization.
12. Reciprocal Referrals:
See Section 8, Service 10.
13. Coordinating Plans: See
Section 8, Service 1, 5, 6.
14. Reimbursement: See Section
8, Service 7.
15. Reporting Data: A. DMA
will:1. Authorize access to Medicaid eligibility
files.2. Authorize access to Medicaid paid claims
datasets.3. Review reports, articles, data tables,
and other products of analysis of Medicaid data.4.
Approve or disapprove written requests from
CHIS for use of data.5. Approve or disapprove
written requests from CHIS to publish/release
data.B. CHIS will:1. Use DMA datasets only for
aggregate analysis of data.2. Provide a copy
of reports requiring linkages of vital records
and Medicaid program files.3. Obtain approval
of DMA prior to release of information.4. Obtain
approval of DMA for any use of data.
16. Review: The parties to
the agreement will review its contents at least
once annually.
17. Liaison: The Assistant
Director of Medical Policy in DMA and the Deputy
Division Director in DPH shall serve as agency
liaisons for the purposes of implementing this
MOU.
18. Evaluation: See Section
8, Service 11.
19. General Contract Provisions:
lack of fundsamendment/modification of agreementtermination
of agreement
State: North
Dakota (Region 8)
Document:
Cooperative Agreement between North Dakota
Department of Human Services and North Dakota
Department of Health and Primary Care Office/Primary
Care Association
Author: North Dakota Department
of Human Services
Date: 2003 Pages: 9 pp.
Document URL: http://www.mchlibrary.info/iaa/states/ND_1_1.pdf
Contractual Details:
1. Effective Date: July 1,
2003.
2. Duration: Until further
review required.
3. Type of Agreement: Cooperative
Agreement.
4. Agencies Involved: A. The
North Dakota Department of Health (Health) [Title
XIX].B. The North Dakota Department of Human
Services (DHS) [Title V].C. The Primary Care
Office (PCO).D. The Primary Care Association
(PCA).
5. Authority Cited: 42 CFR
431.615 and Chapter 50-24.1 North Dakota Century
Code (NDCC).
Summary Related
to CMS Requirements:
6. Objectives:
A. To define the responsibilities of the parties
with respect to persons receiving Title XIX,
TV,
Title X, WIC, North Dakota Head Start-State
Collaboration Office, Diabetes Prevention and
Control Program, Right Track Program, Immunizations
Program, and Birth Review Program
services.
B. To ensure quality and accessible care to
improve the health status of CSHCN, pregnant
women, mothers, infants and children, especially
those who are disadvantaged. Achievement of
this goal will be facilitated by formalizing
and strengthening relationships between programs,
reducing duplication, increasing accessibility,
and providing mechanisms for enhanced program
coordination.
7. Responsibilities: A. DHS
is the State agency responsible for administering
Medicaid.B. DHS is responsible for administering
Children’s Special Health Services (CSHS).C.
DHS is responsible for administering early intervention
services.D. Health is the State agency responsible
for administering the MCH Program, WIC, the
Title X Family Planning Program, the Immunization
Program, and the Diabetes Prevention and Control
Program.E. Health is responsible for planning
and implementing MCH and nutrition services.
8. Services Provided by Agency:
A. DHS/Title XIX.
1. Payment
: DHS shall reimburse Title V and Title X Programs
that have entered into provider
agreements with DHS at the rates established.
DHS will monitor and ensure that duplication
of
payment is avoided.
2. Local Coordination
: County social service departments shall make
Title XIX eligibility
determinations for potentially eligible individuals
referred by MCH, SCHS, Title X,
Immunization, WIC, and other programs; promote
and refer Title XIX eligible persons in need
of services to the various programs listed in
this agreement; inform Title XIX eligible recipients
about the North Dakota Health Tracks Program
and refer all eligibles for scheduling of screening
appointments and any necessary follow-up; and
inform and refer families who do not qualify
for
Title XIX to the Healthy Steps Program (SCHIP).
B. DHS/Title V.
1. Title V CSHS Service Programs
: DHS shall conduct, coordinate, and fund, in
part, local Title
V CSHS Programs which provide health services
to eligible CSHCN and their families; provide
care coordination; and monitor and ensure that
duplication of payment is avoided.
2. Local Coordination
: CSHS shall refer CSHCN and their families
to county social services to
determine eligibility for Medicaid and other
social service programs and to local WIC agencies;
promote and refer to other programs for provision
of health services to potentially eligible
children and their families.
C. DHS/Developmental Disabilities (DD) Unit.
1. The DD Unit shall utilize Federal Part C
funds to cover printing and postage costs of
the Birth
Review Program.
2. The DD Unit will print letters received by
e-format from the HEALTH and mail them to
families to inform them of available services.
3. The DD Unit will forward requests the CSHS
has received for developmental screenings to
regional HSC for Right Track screenings.
D. DHS/North Dakota Head Start and Early Head
Start Programs (NDHS/EHS).
1. NDHS/DHS will work with other programs to
promote an exchange of information.
2. Local Coordination: NDHS/DHS will refer children
and their families to county social
services to determine eligibility for Medicaid
and WIC eligibility; promote and refer children
and
their families to other local public health
programs as deemed appropriate.
E. Health/Title V.
1. Title V Service Projects
: Health shall monitor, assess, and fund, in
part, local Title V MCH
Projects which provide public health services
to eligible women, infants, and children in
selected
sites throughout the State; encourage eligible
local Title V MCH Projects to apply for provider
status and to apply for direct reimbursement;
monitor and ensure that duplication of payment
is
avoided.
2. Local Coordination
: Health shall refer potentially eligible women,
infants, children, and their
families to designated personnel to determine
program eligibility; promote the use of appropriate
programs for eligibles.
F. Health/Optimal Pregnancy Outcome Program
(OPOP).
1. Title V OPOP Services Projects
: OPOP shall monitor, assess, and fund, in part
local OPOP
agencies which provide direct health services
and education.
2. Local Coordination
: OPOP shall refer potentially eligible women,
infants, children, and their
families to designated personnel to determine
program eligibility; promote the use of appropriate
programs for eligibles.
G. Health/Title X Family Planning.
1. Title X Service Programs
: Title X Family Planning shall monitor, assess,
and fund Local
Family Planning Programs to ensure the quality,
cost, accessibility, acceptability, reporting
and
performance of delegate agencies.
2. Local Coordination
: The Family Planning Program shall accept any
Title XIX recipient for
family planning services. Proper referrals shall
be made and confidentiality maintained.
H. Health/WIC Program.
1. WIC Services
: The state WIC Program shall fund, provide
policies and procedures, and
evaluate services of local WIC agencies.
2. Local Coordination
: Information provided by applicants and participants
may be provided
to designated representatives of other programs
for the purpose of establishing the eligibility
of applicants. Local WIC Programs will promote
and refer persons in need to the appropriate
programs.
I. Health/Immunization Program.
1. Immunization Program
: The State Immunization Program shall provide
the following:
vaccines to administer to eligible children;
assessment of State/county provider immunization
coverage levels; TA on immunization administration
protocols and vaccine storage and handling;
vaccine administration forms, information statement,
etc.; quality assurance reviews of public
and private vaccine providers; and laboratory
testing of pregnant women for hepatitis B surface
antigen.
2. Local Coordination
: Aggregate and individual immunization data
will be shared with various
stakeholders (e.g., WIC, North Dakota Health
Tracks, MCH CSHS, Title X, and the Medicaid
Vaccine for Children Program).
J. Health/Diabetes Prevention and Control Program.1.
Diabetes Prevention and Control Program: The
State Diabetes Prevention and Control Program
will provide the following: collection, analysis,
and distribution of surveillance data; implementation
of clinical practice guidelines, quality management
indicators, and quality improvement projects;
development and implementation of educational
campaigns; development of community-based interventions;
sponsorship of patient and professional education
programs; advocacy for reimbursement; and establishing
improved access to care.2. Local Coordination:
The Diabetes Prevention and Control Program
will provide assistance with local diabetes
systems.
9. Cooperative Relationships:
Language is integrated throughout Section 8.
10. Services Provided by Local Agencies:
Local Coordination is typically addressed as
the second service under each of the program
areas. See Section 8, Service A2, B2, D2, E2,
F2, G2, H2, I2, J2.
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
Referrals are treated in local coordination
under each of the program areas in Section 8.
13. Coordinating Plans: In
addition to services outlined in Section 8,
coordination is to occur at a state level and
will include continuous liaison (see Section
17), the administration of the State Systems
Development Initiative (SSDI) grant (see Section
15), periodic review (see Section 16), and evaluation
of policies (see Section 18).
14. Reimbursement: Funding
and reimbursement is typically address in the
first service under each of the program areas
in Section 8.
15. Reporting Data: DHS and
Health, through administration of the State
Systems Development Initiative (SSDI) grant,
will work cooperatively to improve the data
collection and analysis capacity in the Title
V program. Data will be used to carry out needs
assessment activities, including identification
of health priority needs for the MCH population,
and program planning and evaluation. Cooperation
will include support in linking of data sets,
research methodology, and statistical analysis
from appropriate DHS and Health Department personnel.
16. Review: The designated
DHS and Health representatives shall meet as
needed, but at least biannually, to evaluate
and assess the joint efforts outlined in this
agreement.
17. Liaison: DHS and Health
will identify staff that will serve as liaisons
between state programs. These persons shall
have the authority to represent their respective
agencies in the development and implementation
of work plans and in the resolution of any programmatic
or procedural problems.
18. Evaluation: Each agency
will ensure an opportunity for the liaison staff
and other affected staff to review and comment
on proposed policy changes or initiatives.
19. General Contract Provisions:
indemnification/liabilitytermination of agreementamendment/modification
of agreementconfidentiality of records/HIPAA
State: Ohio
(Region 5)
Document:
Interagency Agreement between the Ohio Department
of Job and Family Services and the Ohio Department
of Health
Author: Ohio Department of
Health
Date: 2003 Pages: 11 pp.
Document URL: http://www.mchlibrary.info/iaa/states/oh_1_1.pdf
Contractual Details:
1. Effective Date: Upon execution
(signed 10/23/2003).
2. Duration: October 23, 2003
- June 30, 2005.
3. Type of Agreement: Interagency
Agreement .
4. Agencies Involved: A. The
Ohio Department of Job and Family Services (ODJFS)
[T19 and 21].B. The Ohio Department of Health
(ODH) [T5].
5. Authority Cited: A. 42 U.S.C.
Section 701, et. seq.B. 7 CFR, Part 246.C. 42
U.S.C. Section 705(a)(5)(F).
Summary Related
to CMS Requirements:
6. Objectives:
A. To coordinate health services and to conduct
outreach, program eligibility, and payment for
services for Ohio mothers and children.
B. To support the State MCH Services Block Grant,
the Early Childhood Comprehensive
Services (ECCS) Plan, and the Healthy Child
Care Ohio grant program.
C. To clarify issues, define problems, and propose
alternatives related to promoting a statewide
system of coordinated health services to eligible
women and children.
D. To increase public awareness of the need
for health care coverage and services for women
and children.
E. To conduct outreach to ensure that eligible
women and children receive access to health
care coverage and receive needed health services
and to ensure that the agencies signing this
Agreement serve their common population.
F. To make available health services statewide
that meet the requirements of the MCH Services
Block Grant, WIC, etc. and the Title XIX Medicaid
programs.
G. To coordinate the exchange of information
and referrals between programs for the purposes
of outreach, eligibility determination, and
verification of outcome of referral.
H. To maximize the efficient use of Federal
and State funds.
I. To participate actively in the planning and
implementation of services.
J. To share the goal of interdepartmental cooperation
in coordinating and implementing
interagency systems.
K. To improve, expand, and maximize the efficiency
and effectiveness of existing resources and
services.
L. To increase public awareness of the need
for health care coverage and a range of
developmental screenings.
M. To coordinate the exchange of information
between the parties.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. ODJFS
.
1. Require CDJFS staff to identify participants
potentially eligible for the WIC and MCH
Programs and to refer them to the appropriate
program.
2. Make available to the DFCHS the Ohio Medicaid
Management Information System.
3. Provide ODH’s DFCHS with current information
about Medicaid eligibility, services, and
policies.
4. Include with Medicaid eligible consumers’
medical card a message regarding medical services
provided by other programs.
5. Provide ODH with information on ODJFS programs
for use by HMG Helpline employees.
6. Provide ODH with current lists of Managed
Care Plans contracting with Medicaid.
7. Provide ODH with the Combined Program Application.
8. Provide ODH with updated lists of local DCJFS
contact information.
B. ODH
.
1. Require various programs to identify and
refer to CDJFS those people who are potentially
eligible for services and assist them in applying
for Medicaid.
2. Keep all consultants informed of Medicaid
eligibility guidelines and promote increased
use
of Medicaid by local health departments, public
health agencies, and other agencies serving
mothers and children.
3. Provide ODJFS with updated lists of MCH programs.
4. Require the local programs to have information
regarding MCH programs available for
clients.
5. Operate the HMG Helpline.
6. Require that CFHS and CMH program providers
are Title XIX and Title XXI providers.
7. Provide ODJFS’s Bureau of Consumer
and Program Support with information about policies
governing the DFCHS programs.
8. Ensure that the CMH program shall not be
the payer for services eligible for payments
by
ODJFS programs.
9. Notify ODJFS of any significant reimbursement
policy and program changes.
10. Not make any changes to the CPA form.
C. Mutual Responsibilities
.
1. Assist their respective local agencies in
carrying out the provisions of this agreement
by
providing training and TA promoting improved
health services for women and children.
2. Coordinate outreach, education, and program
promotion.
3. Explore common issues and participate in
meetings for joint planning.
4. Representatives of ODH and ODJFS shall meet
upon request of either of the parties to review
implementation of this Agreement.
5. Maintain representatives on committees, task
forces or ad hoc work groups of the respective
departments for the purpose of ensuring coordination
of services, eliminating duplication, and
maximizing resources.
9. Cooperative Relationships:
See Section 8, Service C3.
10. Services Provided by Local Agencies:
See Section 8, Service B4, C1.
11. Identification and Outreach:
See Section 8, Service A1, C2 (further requires
developing joint outreach or public relations
programs and/or materials for the purpose of
promoting programs administered by ODH and/or
ODJFS), B1, C2.
12. Reciprocal Referrals:
See Section 8, Service B1.
13. Coordinating Plans: N/A
14. Reimbursement: See Section
8, Service B8, B9.
15. Reporting Data: See Section
8, Service A2, A3, A5, B7.
16. Review: See Section 8,
Service C4.
17. Liaison: See Section 8,
Service C5.
18. Evaluation: See Section
8, Service C4.
19. General Contract Provisions:
failure to satisfy SOWamendment/modification
of agreementnondiscriminationconfidentiality
of records/HIPAAauditdispute resolution mechanismmaintenance
of records/record keeping
State: Oklahoma
(Region 6)
Document: [Oklahoma] Memorandum
of Agreement
Author: Oklahoma State Department
of Health
Date: 2004 Pages: 4 pp.
Document URL: http://www.mchlibrary.info/iaa/states/ok_1_1.pdf
Contractual Details:
1. Effective Date: October
1, 2004.
2. Duration: October 1, 2004
- September 30, 2005.
3. Type of Agreement: Memorandum
of Agreement.
4. Agencies Involved: A. Oklahoma
State Department of Health (OSDH) [Title V].B.
Oklahoma Department of Human Services (OKDHS)
[Title XIX].
5. Authority Cited: Title 74,
O.S. 1991, section 581.
Summary Related
to CMS Requirements:
6. Objectives:
To jointly seek to provide services to the CSHCN
population of the State of Oklahoma.
7. Responsibilities: A. The
OSDH and the OKDHS are the agencies responsible
for administering the MCH Block Grant in Oklahoma.B.
The OKDHS is responsible for administering the
CSHCN Program, which is a portion of the Federal
MCH Block Grant.
8. Services Provided by Agency:
A. OKDHS
.
1. Develop and carry out a program for CSHCN
in accordance with all Federal and State
requirements, including capturing existing data
or developing/identifying systems to capture
data
for reporting on national and State specific
performance measures.
2. Participate in monthly coordination meetings
with MCH Service and other meetings as are
necessary to ensure collaboration between Title
V services for CSHCN and Title V services
for pregnant women, mothers, infants, and children;
and to ensure collaboration on the Title V
Annual Report and Application process.
3. Designate the Division Director of Family
Support Services Division (FSSD) as the Title
V CSHCN Director; provide sufficient support
and staff to ensure operation of the CSHCN
Program to meet performance measures.
4. Commit to use all available resources of
OKDHS to ensure systems development and to
provide access to comprehensive community-based
systems of care by offering fully integrated
and comprehensive services.
5. Identify clear lines of responsibility and
supervision for the CSHCN Program to improve
coordination of CSHCN administered programs
with all other OKDHS services; increase the
infrastructure building activities of the CSHCN
Program.
6. Be responsible for the development of the
CSHCN portion of the annual block grant
application and report; OKDHS will designate
a contact person with whom MCH will
coordinate.
7. Ensure compliance with State matching and
maintenance of effort requirements applicable
to
the OKDHS share of block grant funds.
8. Ensure strict adherence to contracting procedures
that include monitoring activities and
claims auditing activities by the OKDHS staff.
B. OSDH
.
1. Coordinate with the OKDHS in the development
of the CSHCN portion of the annual block
grant application and report; designate a contact
person to whom OKDHS will provide all
requested information.
2. Participate in monthly coordination meetings
with CSHCN Program and other meetings as
are necessary to ensure collaboration between
the Title V services for pregnant women, mothers,
infants, and children with the Title V services
for CSHCN and to ensure collaboration on the
Title V Annual Report and Application process.
3. Make CSHCN funds directly available to the
OKDHS for program activities and
administrative costs with payments to be made
monthly or quarterly. Funding amount is based
on appropriation information provided by HHS
and is contingent upon the actual Block Grant
Fund Award.
9. Cooperative Relationships:
See Section 8, Service A6, B2.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. See Section 8, Service A2, A5, B2.
14. Reimbursement: See Section
8, Service A7, B3.
15. Reporting Data: See Section
8, Service A1.
16. Review: N/A
17. Liaison: See Section 8,
Service A6, B1.
18. Evaluation: N/A
19. General Contract Provisions:
termination of agreementauditindemnification/liabilityamendment/modification
of agreement
State: Oregon
(Region 10)
Document: [Oregon] Intergovernmental
Agreement [and Amendment]
Author: Oregon Department of
Human Services
Date: 1995, 2000 Pages: 10
pp.
Document URL: http://www.mchlibrary.info/iaa/states/or_1_1.pdf
Contractual Details:
1. Effective Date: July 1,
1995, amended July 1, 2000 (changes to agreement
are underlined).
2. Duration: This Agreement
shall become effective on July 1, 1995, and
shall expire unless otherwise terminated or
extended, on June 30, 2005.
3. Type of Agreement: Intergovernmental
Agreement.
4. Agencies Involved: A. Department
of Human Services, Office of Medical Assistance
Programs (OMAP) [Title XIX].B. Oregon Health
Sciences University, Child Development and Rehabilitation
Center (CDRC) [Title V].
5. Authority Cited: A. Original
Oregon Intergovernmental Agreement number 51290.B.
42 CFR 431.615.
Summary Related
to CMS Requirements:
6. Objectives:
To encourage appropriate and maximum utilization
of the services of the CDRC by OMAP clients who
are eligible for medical assistance under Title
XIX (Medicaid) and Title XXI (Children’s
Health Insurance Program).
7. Responsibilities: A. CDRC
is responsible for providing services for CSHCN
under Title V and other highly specialized services,
including services to adults with hemophilia.B.
OMAP is responsible for reimbursing CDRC at
cost for services provided by CDRC to OMAP clients
eligible for medical assistance under Title
XIX.
8. Services Provided by Agency:
A. CDRC shall provide the following services
to Medicaid recipients:1. Multidisciplinary
evaluation.2. Case management and medical services
such as physicians services, nursing services,
laboratory and other diagnostic testing, physical
and occupational therapy, evaluations and treatment,
psychological/psychiatric evaluations, speech
and audiological evaluations and treatment,
hearing aids, dental services, amniocentesis
and genetic counseling for parents of children
with disabling conditions, prosthetic, orthotic,
and other medical supplies and equipment, and
EPSDT screenings.3. Specialized treatment services
through outpatient clinics at CDRC centers
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: Billings
will be done on the UB-92 in accordance with
billing instructions and requirements in OMAP’s
Hospital Services Guide. CDRC agrees that it
is not a direct provider of augmentative communicative
devices or other large items of durable medical
equipment. CDRC is not required to obtain prior
authorization before billing for covered services,
except CDRC agrees to conform to all limitation
on services in the provision of hearing aids.
(Additional details are given for overpayment,
interim payment, third part billing, and the
maximum compensation to be billed).
15. Reporting Data: N/A
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementconfidentiality of records/HIPAAindemnification/liabilityfailure
to satisfy SOW
State: Rhode
Island (Region 1), document 1 of 2
Document:
Rhode Island Department of Health, Division
of Family Health: Medicaid/EPSDT Administrative
Activities
Author: Rhode Island Department
of Health, Division of Family Health
Date: 1995 Pages: 12 pp.
Document URL: http://www.mchlibrary.info/iaa/states/ri_1_2.pdf
Contractual Details:
1. Effective Date: February
16, 1995.
2. Duration: N/A
3. Type of Agreement: N/A
4. Agencies Involved: This
document lists only the Department of Human
Services (DHS), Division of Family Health’s
[Title V] administrative activities as they
relate to Medicaid/EPSDT.
5. Authority Cited: Generally
cites the SSA, but does not give specific reference.
Summary Related
to CMS Requirements:
6. Objectives:
To specify the administrative activities related
to the Medicaid/EPSDT programs that include all
activities designed to ensure the availability,
accessibility, and coordination of required health
care resources.
7. Responsibilities: The Department
of Human Services (DHS), Division of Family
Health is responsible for coordinating and care
planning to assist individuals to enroll in
a program; arranging for and providing a support
plan of care; program planning and development
to establish strategies and model projects to
ensure system capacity; conducting activities
that ensure needed services; and billing for
activities that will not include costs for activities
currently being provided in accordance with
the Head Start, Early Intervention, and Adolescent
Pregnancy Medicaid agreements.
8. Services Provided by Agency:
The Department of Human Services (DHS), Division
of Family Health will provide the
following services (multiple examples of each
type of service are provided in the document):
A. Outreach and Intensive Informing
: using a combination of oral and written information
methods that describe the range of services
available through the programs and the benefits
of
preventive or remedial care offered by these
programs.
B. Facilitating Medicaid Applications
: assisting in determining eligibility.
C. Care Planning and Coordination Activities
: coordinating screenings, assessments,
examination, and evaluations, assisting individuals
access services, etc.
D. Interagency Coordination
: performing collaborative activities with other
agencies to improve
the cost effectiveness of the health care delivery
system, improve the availability of services,
focus services on specific population groups
or geographic areas in need of special attention,
or
define the scope of each agency’s programs.
E. Other Training
: conducting or participating in training.
F. Program Planning and Development
: performing activities that support the planning
and
development of programs.
G. Quality Management
: performing activities such as program monitoring
and auditing that
are necessary for proper and efficient Medicaid
administration.
9. Cooperative Relationships:
See Section 8, Service D (developing IAAs to
maximize effectiveness of service delivery and
accessibility to services, and to minimize duplication).
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service A, B.
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: See
Section 8, Service C.
14. Reimbursement: N/A
15. Reporting Data: N/A
16. Review: Reviewing program
policies, procedures, standards protocols, and
health related educational materials.
17. Liaison: N/A
18. Evaluation: Working with
other agencies to evaluate the effectiveness
of service delivery systems and needed improvements.
19. General Contract Provisions:
N/A
State: Rhode Island (Region 1), document
2 of 2
Document:
Memorandum of Agreement between the Department
of Human Services, RI Department of Health,
and RI Health Center Association Regarding the:
Rhode Island Family Resource Counselor Program
Author: Rhode Island Department
of Health, Division of Family Health
Date: 2004 Pages: 12 pp.
Document URL: http://www.mchlibrary.info/iaa/states/ri_2_2.pdf
Contractual Details:
1. Effective Date: June 14,
2004.
2. Duration: N/A
3. Type of Agreement: Memorandum
of Agreement.
4. Agencies Involved: A. Department
of Health (DOH) [Title V].B. Department of Human
Services (DHS), Division of Family Health [Title
XIX].C. Rhode Island Health Center Association
(RIHCA).
5. Authority Cited: N/A
Summary Related
to CMS Requirements:
6. Objectives: N/A
7. Responsibilities: The Family
Resource Counselor Program is designed to screen
and refer pregnant women, children and families
for RIte Care/RIte Share, Family Independence
Program (FIP), Child Care Subsidy, Food Stamps
and Women, Infants and Children (WIC) and to
help them apply for RIte Care/RIte Share.
8. Services Provided by Agency:
A. DOH
.
1. Explore ongoing funding sources in collaboration
with DHS and RIHCA.
2. Analyze data provided by RIHCA and DHS for
the purpose of program evaluation.
3. Conduct overall program evaluations.
4. Provide annual training on WIC eligibility
and referrals.
5. Participate jointly with DHS and RIHCA in
overall program oversight and policy
development for the FRC program.
6. Participate in quarterly FRC planning meetings.
7. Participate in quarterly FRC trainings.
8. Participate in the monthly Covering Kids
and Families FRC Network meetings.
B. CHS, Center for Child and Family Health (CCFH)
.
1. Explore ongoing funding sources.
2. Have a liaison or designee participate in
quarterly FRC planning meetings.
3. Have a liaison or designee participate in
quarterly FRC trainings.
4. Enter into a data sharing agreement with
RIHCA.
C. DHS
.
1. Assign a Field Operations Liaison to be responsible
for ensuring that RIHCA is given timely
updates and information.
2. Assign a Field Operations Liaison to participate
in quarterly Field/FRC Issue meetings.
3. Assign a Field Operations Liaison to participate
in quarterly FRC planning meetings.
4. Assign a Field Operations Liaison to participate
in quarterly FRC trainings.
5. Have regional managers or their designees
participate in semiannual meetings.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: See Section
8, Service A1.
15. Reporting Data: RIHCA
agrees to the following:1. To collect data from
the FRCs on a monthly basis.2. To compile data
from the FRC reports on the number of individuals
screened for FIP, Food Stamps, WIC, and RIte
Care, the number of RIte Care/RIte Share applications
completed, and provide written reports to Health,
DHS, Covering Kids and Families RI and FRC sites.3.
To track on a monthly basis systemic barriers
to enrollment and application assistance.
16. Review: N/A
17. Liaison: RIHCA agrees
to the following:1. To advocate on behalf of
all FRCs to resolve barriers to application
assistance and enrollment.2. To act as a liaison
between DHS, Health, and the FRCs.3. To participate
in quarterly Field/FRC Issue meetings with the
DHS Field Operations Liaison to discuss specific
issues and obtain policy and procedure updates.4.
To coordinate semiannual meetings at each field
office with the Regional Manager, local DHS
eligibility staff, and the FRCs to ensure continued
positive working relationships and reduce barriers
to enrollment and renewal.
18. Evaluation: See Section
8, Service A3 for overall program evaluation.
19. General Contract Provisions:
N/A
State: South
Carolina (Region 4)
Document:
Memorandum of Agreement between South Carolina
Department of Health and Environmental Control
and State Budget and Control Board, Office of
Research and Assistance to Link Maternal and
Child Health Data Files for Public Health Research,
Evaluation, and Surveillance
Author: South Carolina Department
of Health and Environmental Control
Date: 2004 Pages: 12 pp.
Document URL: http://www.mchlibrary.info/iaa/states/SC_1_1.pdf
Contractual Details:
1. Effective Date: July 1,
2004.
2. Duration: July 1, 2004 –
June 30, 2006.
3. Type of Agreement: Memorandum
of Agreement.
4. Agencies Involved: A. South
Carolina Department of Health, Environmental
Control (DHEC) [Title V].B. State Budget and
Control Board, Office of Research and Statistics
(ORS).
5. Authority Cited: A. HIPAA
45 CFR, Parts 160 and 164.B. Family Privacy
Protection Act, South Carolina Procurement Code,
Section 11-35-10, et. Seg.
Summary Related
to CMS Requirements:
6. Objectives:
A. To cooperate in creating linked, de-identified
data files that will be used for public health
and health care research, program evaluation,
and surveillance.B. To establish the parameters
for the linking and analysis of MCH data files
with other State agency and hospital utilization
data sets for public health and health care
research, evaluation, and surveillance purposes.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. SC DHEC
.
1. Provide client specific data from appropriate
program specific information systems.
2. Provide ORS with documentation and code structure
for each data set.
3. Ensure that DHEC and DHEC funding agencies
have the authority to audit, confirm, and
test that adequate procedural controls are in
place to protect the confidentiality and use
of data
shared.
4. Geocode DHEC Public Health Information and
Statistics (PHSIS) all linked address data
using Census geography levels.
B. ORS
.
1. Establish and maintain procedures and controls
to maintain confidentiality.
2. Hold in strictest confidence the identity
of all DHEC clients.
3. Perform the link between the DHEC datasets
and other State agency and health care
utilization data sets to create de-identified
data sets for public health and health care
research,
evaluation, and surveillance.
4. Coordinate all requests for access to the
linked data files.
9. Cooperative Relationships:
N/A
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
N/A
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: N/A
14. Reimbursement: N/A
15. Reporting Data: This Agreement
deals exclusively with maintenance and transfer
of data files. See Section 8 for details.
16. Review: N/A
17. Liaison: N/A
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementconfidentiality of records/HIPAAindemnification/liabilitynondiscrimination
State: South
Dakota (Region 8)
Document:
Joint Powers Agreement between South Dakota
Department of Social Services, Office of Medical
Services and South Dakota Department of Health,
Division of Health and Medical Services
Author: South Dakota Department
of Social Services
Date: n.d. Pages: 3 pp.
Document URL: http://www.mchlibrary.info/iaa/states/SD_1_1.pdf
Contractual Details:
1. Effective Date: N/A
2. Duration: A period of 1
year from the date both parties sign this agreement.
3. Type of Agreement: Joint
Powers Agreement.
4. Agencies Involved: A. South
Dakota Department of Social Services (DSS),
Office of Medical Services [Title XIX].B. South
Dakota Department of Health (DOH), Division
of Health and Medical Services [Title V].
5. Authority Cited: SDCL 1-24-2
though 1-24-9.
Summary Related
to CMS Requirements:
6. Objectives:
A. To promote high-quality health care and services
for Medical Assistance program recipients.B. Whereas,
DSS and DOH:1. Intend to promote high quality
health care and services for recipients under
the Medical Assistance Program.2. Intend to comply
with State and Federal statues, etc.3. Intend
to ensure services provided under Title XIX and
Title V are consistent with the needs of recipients
and DSS and DOH objectives and requirements.4.
Intend to maximize utilization of MCH Services
by DSS in the provision of medical assistance.5.
Intend to maximize utilization of the Medical
Assistance Program by DOH in the provision of
MCH Services.6. Believe it is an efficient use
of State resources to undertake this joint undertaking
demonstrating the commitment of both parties to
ongoing collaboration.
7. Responsibilities: See Section
6.
8. Services Provided by Agency:
A. DSS
.
1. Refer Title XIX eligible children under 18
to DOH’s SCHS whose physical functions
and
movements are impaired.
2. Refer all sexually active women of child
bearing age and their male partners in need
of
contraception counseling to the local Family
Planning Clinic or other family planning providers.
3. Refer all Title XIX pregnant women to the
Community Health Services Program.
4. Refer all known pregnant, postpartum, and
breastfeeding women and young children
potentially eligible to WIC for services.
5. Accept financial responsibility for reimbursement
of medically necessary preventive,
diagnostic, medical or remedial care and services
provided to any individual under 21 or any
individual who is pregnant to the extent of
that individual’s medical assistance entitlement.
6. Accept responsibility for payment of services
within the scope of the Medical Assistance
Program provided by any of the eligible individuals
in accordance with fees allowed through the
Medical Assistance Program and South Dakota
Department of Health Programs.
7. Consult with DOH in developing the standards
and periodicity and vaccination schedules for
EPSDT program with DOH.
B. DOH
.
1. Refer to DSS all those under 21 and women
of child-bearing age in need of preventive,
diagnostic, medical or remedial care and services
and who are, or may be, eligible.
2. Inform any Title XIX/CHIP eligible families
with children about the EPSDT program and
make appropriate referrals.
3. Identify pregnant women and infants who are
potentially eligible for Title XIX and assist
them in applying.
4. Identify potentially eligible children and
assist them in applying for the CHIP program.
5. Participate in the establishment of periodicity
schedules and content standards for the EPSDT
program.
6. Provide risk assessments and other services
to Title XIX eligible pregnant women potentially
in need of administrative case management services.
7. Participate in outreach efforts of the CHIP
program by providing information with health
fairs, immunization clinics, Community Health
Services Offices, and public health alliance
offices.
8. Provide a toll-free telephone number for
use by parents and consumers to access information
about physicians, practitioners, and other health
care providers in South Dakota.
C. Mutual Services
.
1. Enhance coordination between departments
by establishing procedures for the early
identification of individuals under 21 in need
of preventive, diagnostic, medical or remedial
care,
and services provided by either department.
2. Retain the sole and exclusive right to terminate
eligibility.
3. Make such reports that may be required.
4. Designate a professional staff person on
behalf of each department to act as the liaison
for the
activities contained in this agreement.
5. Enhance coordination between departments
by establishing procedures for early intervention
of pregnant women in need of medical care and
services provided by either department.
9. Cooperative Relationships:
See Section 8, Service C5.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service A6, B7, B8.
12. Reciprocal Referrals:
See Section 8, Service A1, A2, A3, A4, B1, B2,
B3, B4.
13. Coordinating Plans: See
Section 8, Service B5, C1.
14. Reimbursement: See Section
8, Service A5, A6.
15. Reporting Data: See Section
8, Service C3.
16. Review: N/A
17. Liaison: See Section 8,
Service C4.
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreement
State: Texas
(Region 6)
Document: [Explanation
on the Lack of Formal Title V/Title XIX Interagency
Agreement in the state of Texas]
Contractual Details:
“In Texas, both state MCH programs (currently
in the newly formed Texas Department of State
Health Services) and the state Medicaid program
(organizationally part of Texas Health and Human
Services Commission) are both organizationally
aligned under the Health and Human Services
Commission (HHSC), the ‘umbrella/oversight’
agency for Texas’ health and human services
system. This organizational alignment permits
the MCH and Medicaid programs to work collaboratively
and cooperatively in the absence of formal interagency
agreements, on most issues.However, there are
such instances where agreements become more
formalized. For example, certain elements of
the MCH program are formalized as part of an
RFP and/or contracts made between the State
and various contractors. For example, the RFP
found at http://www.hhsc.state.tx.us/medicaid/procure/rfp.html
relates to formalized activities related to
the CSHCN program and Texas’ Medicaid
claims administrator.” -- Maria Vega,
Title V Block Grant Coordination, Texas Department
of State Health Services.
State: Utah
(Region 8)
Document:
Memorandum of Agreement: Utah Department
of Health, Division of Health Care Financing
and Division of Community and Family Health
Services: Interagency Coordination - Title V,
Title XIX [Draft]
Author: Utah Department of
Health
Date: 2001 Pages: 17 pp.
Document URL: http://www.mchlibrary.info/iaa/states/UT_1_1.pdf
Contractual Details:
1. Effective Date: April 1,
2001.
2. Duration: Will not terminate
unless in accordance with the terms of this
agreement.
3. Type of Agreement: Memorandum
of Agreement.
4. Agencies Involved: A. Utah
Department of Health, Division of Health Care
Financing and Division of Community (DCFHS)
[Title V] .B. Utah Department of Health, Division
Family Health Services (DFH) [Title XIX].
5. Authority Cited: 42 CFR
431.615(c4).
Summary Related
to CMS Requirements:
6. Objectives:
A. To formalize and strengthen the relationship
between DCFHS and DHCF in areas of mutual interest
and concern, avoid duplication of effort, improve
access to T19 and T5 to eligible Medicaid clients.B.
To enhance the quality and T19 and T5 services.C.
To enhance program coordination and information
exchange to the extent possible.
7. Responsibilities: N/A
8. Services Provided by Agency:
A. DHCF
.
1. Assign the Director of Health Care Financing,
or designee, to be Division liaison to DCFHS.
2. Coordinate and collaborate with DCFHS in
planning and implementing Medicaid services
related to MCH populations.
3. Collaborate with DCFHS to improve access
to and quality of services for Medicaid recipients
who need MCH services.
4. Reimburse DCFHS, in accordance with 42 CFR
431.614(c4), for the cost of services
furnished Medicaid recipients by DCFHS and Title
V grantees.
5. Provide the CHEC Program Plan, which includes
sections on needs assessment, outreach, and
participation data, for use in the MCH Block
Grant Application and Annual MCH Report.
6. Coordinate CHEC outreach activities with
related programs.
7. Coordinate outreach efforts related to the
“Baby Your Baby” program.
8. Collaborate with DCFHS in efforts to improve
the immunization rates for all children.
9. Provide non-confidential and readily available
enrollment, utilization, and quality assurance
data to DCFHS.
10. Disseminate information, annually, through
Medicaid Information Bulletins or other
methods.
11. Coordinate and collaborate with DCFHS in
planning, implementing, and evaluating QA/AI
projects.
12. Coordinate and collaborate with DCFHS in
monitoring services provided by MCOs.
13. Ensure that all managed care contracts include
provisions requiring them to contract with
CDFHS for minimum screening and follow-up services.
14. Establish the Division of Community and
Family Health Services as a Medicaid provider.
15. Recognize the director of the Bureau of
CSHCN as a member of the EPSDT subcommittee.
B. DCFHS
.
1. Assign the Director, Bureau of MCH, with
the responsibility to ensure the coordination
of
services, outreach, and education provided by
the Title V programs.
2. Assign the Director, Bureau for CSHCN with
the responsibility to ensure coordination of
services, outreach, and education provided by
the Title V programs.
3. Encourage Title V-funded and other DCFHS-sponsored
programs to screen families for
possible eligibility for Medicaid benefits
4. Provide health care consultation and TA for
CHEC, CSHCN, Reproductive Health, Oral
Health, and Preventive Child Health Services.
5. Provide dental consultation and serve as
liaison with the dental provider community.
6. Designate DCFHS staff to coordinate the Child,
Adolescent, and School Health Program and
other related programs.
7. Provide to DHCF MCH data related to Medicaid
clients.
8. Bill DHCF for selected eternal products.
9. Bill Medicaid for metabolic products.
10. Bill Medicaid for selected enterable and
metabolic products for specific WIC clients.
11. Abide by this Agreement.
12. Coordinate and interface with Medicaid managed
care plans to follow the care of any person
covered through a managed care plan.
C. Mutual Services
.
1. Conduct mutual collaboration and coordination.
Each Division will designate specific
individuals for each forum to coordinate activities.
2. All information regarding recipients of services
provided shall be treated as confidential.
9. Cooperative Relationships:
See Section 8, Service A1, A2, A3, A6, A7, A8,
A11, A12, B12.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
See Section 8, Service A6, A7, B3.
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: See
Section 8, Service A8, A11, A12, B11, B12, C1.
14. Reimbursement: See Section
8, Service A4, B8, B9, B10.
15. Reporting Data: See Section
8, Service A5, A9, A10, B7.
16. Review: Both parties will
review this document annually and update as
needed.
17. Liaison: See Section 8,
Service C1.
18. Evaluation: See Section
16.
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementconfidentiality of records/HIPAAindemnification/liability
State: Virginia
(Region 3)
Document:
Interagency Agreement Between Virginia Department
of Medical Assistance Services and Virginia
Department of Health
Author: Virginia Department
of Medical Assistance Services
Date: n.d. Pages: 55 pp.
Document URL: http://www.mchlibrary.info/iaa/states/va_1_1.pdf
Contractual Details:
1. Effective Date: This agreement
shall become effective when signed.
2. Duration: This agreement
shall become effective when signed and shall
continue thereafter for a period of 3 years.
3. Type of Agreement: Interagency
Agreement.
4. Agencies Involved: A. Virginia
Department of Medical Assistance Services (DMAS)
[Title XIX].B. Virginia Department of Health
(VDH) [Title V].
5. Authority Cited:
A. 42 CFR, Subpart M, Section 431.610 (f).B.
42 CFR, Subpart M, Section 431.615 (d).
Summary Related
to CMS Requirements:
6. Objectives:
This Agreement consolidated DMAS-VDH agreements
into one document. The agreements are organized
into three discrete sections as follows:1. Long-term
Care Agreements.2. Business Associate Agreement
and Data Projects.3. Maternal and Child Health
Collaborative.
7. Responsibilities: N/A
8. Services Provided by Agency:
The IAA lists hundreds of services that each
agency is responsible for under each of its
three discrete sections. The following services
are abstracted from the overwhelming list as
representative services:A. DMAS.1. Require pre-admission
screening of all individuals who are eligible
for medical assistance.2. Require local pre-admission
screening committees to be available to render
decisions.3. Prepare documentation that describes
current program procedures and criteria.4. Provide
training.5. Authorize Medicaid reimbursement.6.
Provide TA as needed.B. VDH.1. Request the District
health Director to convene a local community
screening committee.2. Ensure that all local
health department personnel have been properly
trained.3. Refer individuals for appropriate
services.3. Determine the necessary for appropriate
care in accordance with Medicaid guidelines.4.
Authorize Medicaid reimbursement when appropriate.5.
Submit required forms.
9. Cooperative Relationships:
A section on “Planning, Coordination,
and Collaboration” or “Areas of
Collaboration” is included in each of
the programs listed in all three sections of
the IAA and details the overarching call for
cooperative relationships detailed in Section
9 above.
10. Services Provided by Local Agencies:
Engagement of local agencies is integrated in
many of the services detailed. Plans for services
to be provided are often developed locally on
conjunction with community partners.
11. Identification and Outreach:
Mechanisms for outreach are given in each of
the three sections. E.g., BABYCARE services
encompass outreach conducted through medical
clinics, physicians’ offices, and hospitals.
12. Reciprocal Referrals:
N/A
13. Coordinating Plans: The
scope of services covered under the Virginia
Medical Assistance Services Program (Medicaid)
may impact VDH’s program plans and budgets.
Similarly, actions of the VDH may affect Medicaid
provider service requirements and the cost of
services. Therefore, each agency hereby states
its intention to coordinate plans to alter current
levels of health related services that could
affect the plans or operations of the other
agency and to consider responses concerning
potential impacts before changes are adopted.
14. Reimbursement: DMAS will
reimburse VDH by one of three methods (Pass
Through Transaction; Vendor Transaction; Licensure
and Certification; Claims Processing). VDH shall
bill DMAS via Interagency Transfer (IAT) for
its monthly costs within 24 days of the close
of each month. The IAT shall reflect the total
expenditures (both direct and indirect). Specific
amounts for reimbursement are detailed for each
section: 1. Long-term Care Agreements; 2. Business
Associate Agreement and Data Projects; 3. Maternal
and Child Health Collaborative.
15. Reporting Data: This is
a summary of processes to transfer data:A. VDMSA.1.
Provide a key contact whose responsibility will
be to ensure a secure data transfer process
and establish proper data use safeguards.2.
Use data for the purpose of verification of
a recipients’ status and to check for
payments made.3. Acknowledge the receipt of
information to VDH.B. VDH.1. Provide a key contact
whose responsibility will be to ensure a secure
data transfer process and establish proper data
use safeguards.2. Provide data on a quarterly
basis.3. Data exchange will be initiated by
VDH in a confidential method.
16. Review: N/A
17. Liaison: DMAS and VDH
contacts are given for each of the programs
listed in all three sections of the IAA.
18. Evaluation: N/A
19. General Contract Provisions:
amendment/modification of agreementtermination
of agreementconfidentiality of records/HIPAAdispute
resolution mechanism
State: Washington
(Region 10)
Document:
[Washington] Statement of Work: Interlocal Agreement
[Exhibit A, B7, C, E, and F7]
Author: Washington State Department
of Health
Date: n.d. Pages: 34 pp.
Document URL: http://www.mchlibrary.info/iaa/states/WA_1_1.pdf
Contractual Details:
1. Effective Date: [January
1, 2000].
2. Duration: [January 1, 2000
- June 30,2004].
3. Type of Agreement: Interlocal
Agreement in 5 Exhibits: Exhibit A (Statement
of Work); Exhibit B7 (Agency Responsibilities);
Exhibit C (Administrative Match Reimbursable
Activities: Outreach and Linkage); Exhibit E
(Compensation and Administration); Exhibit F7
(DOH/DSHS-MAA Accounting Procedures).
4. Agencies Involved: A. The
Department of Social and Health Services (DSHS)
- Medical Assistance Administration (MAA) [Title
XIX].B. The Department of Health (DOH) [Title
V].
5. Authority Cited: Chapter
39.34 RCW and all relevant and associated statutes.
Summary Related
to CMS Requirements:
6. Objectives:
A. To provide DOH reimbursement for a portion
of the expenses incurred when performing Medicaid-related
administrative activities as described in the
Exhibits.B. To document responsibilities for
implementation of the shared DOH and MAA programs
and activities and to ensure documented accounting
procedures are adhered to and maintained.C.
To document the delegation of certain administrative
duties from the T19 Single State Agency to the
DOH and to designate responsibilities of DOH
and DSHS in their jointly operated programs
and activities.
7. Responsibilities: DOH has
responsibility for all MCH program activities,
furnishing the necessary personnel and/or services
and otherwise do all things necessary for or
incidental to the performance of work set forth
in this Agreement. Unless otherwise specified,
the DOH shall be responsible for performing
all fiscal and program responsibilities.
8. Services Provided by Agency:
Exhibit B7: Agency Responsibilities.
A. DOH
.
1. MCH Administration.
2. CSHCN: DOH shall (a) promote collaboration
with DSHS-MAA; (b) have the CSHCN-
SSI coordinator serve as liaison with the Disabilities
Determination Service Unit; (c) maintain
policies and procedures; (d) coordinate with
DSHS to maintain guidelines on reimbursement;
(e) assist MAA in facilitating access to health
care for eligible SSI children; (f) coordinate
with
MAA to provide consultation to CSHCN contractors.
3. MCH Assessment: DOH shall (a) conduct PRAMS
surveillance system; (b) reimburse MAA
for providing analyses and reports.
4. Genetics: DOH shall (a) maintain and update
prenatal genetic counseling information; (b)
provide consultation to providers; (c) ensure
availability of DOH funds for the State match
for
Title XIX reimbursement; (d) coordinate training
and monitoring activities with MAA.
5. Maternal Infant Health: DOH shall assist
with (a) Maternity Support Services (MSS) and
childbirth education; (b) Infant Case Management
(ICM); (c) First Steps training; (d) Pregnancy
Risk Assessment Monitoring System (PRAMS); (e)
Healthy Mothers, Healthy Babies (HMHB)
outreach; (f) perinatal centers; (g) consultation;
(h) home birth; (i) tobacco cessation activities.
6. Child and Adolescent Health / Child Profile:
DOH shall coordinate with MAA in developing
and implementing strategies to improve access
to Medicaid services, including EPSDT, oral
health and CHILD Profile health promotion materials.
7. Immunizations: DOH shall promote immunizations
and related services for Medicaid and S-
CHIP clients
8. MCH Programwide Activities: DOH shall contract
with HMHB for a toll-free line and
outreach activities.
9. Client Services: DOH shall coordinate with
HIV/AIDS case management.
10. Family Planning and Reproductive Health.
11. WIC Program collaboration.
12. Newborn Screening collaboration.
13. Office of Community and Rural Health collaboration.
14. Health Services Quality Assurance collaboration.
15. Office of the Secretary collaboration.
16. Tobacco Prevention and Control Program collaboration.
17. Washington Breast and Cervical Health Program
(WBCHP) Transition to Medicaid Case
Management.
18. Accounting and Audit.
19. Exchange of Information: All client-specific
and aggregate data exchanged shall be
maintained. In keeping with measures to protect
the confidentiality of records, DOH shall
utilize strict security procedures and protection
to ensure that these data are not disclosed
to
unauthorized third parties.
B. DSHS-MAA
.
1. General Responsibilities: (a) reimburse approved
providers billing for MSS, Prenatal Genetic
Counseling Services, and HIV/AIDS Case Management
through the MMIS; (b) provide updates
to DOH regarding Medicaid and S-CHIP eligibility
requirements and program changes; (c) assist
Title V contractors in obtaining Title XIX administrative
match; (d) DDDS will refer to the Title
V CSHCN program all SSI blind and disabled childhood
disability decisions who are under the
age of 16; (e) designate individuals to coordinate
with DOH staff on Medicaid related activities.
2. Immunizations collaboration.
3. Accounting collaboration.
4. First Steps Training collaboration.
5. Office of Community and Rural Health collaboration.
6. Tobacco Control and Prevention Program collaboration.
7. Washington Breast and Cervical Health Program
(WBCHP) Transition to Medicaid Case
Management.
9. Cooperative Relationships:
Cooperation and coordination of plans is integrated
throughout Exhibit B7.
10. Services Provided by Local Agencies:
N/A
11. Identification and Outreach:
Exhibit C: Administrative Match Reimbursable
Activities: Outreach and Linkage.Outreach and
linkage activities reimbursed by MAA through
the Administrative Match program are limited
to activities that provide information about
the Medicaid program, help potential Medicaid
eligibles through the application process, and
enhance the ability of Medicaid eligibles to
access Medicaid services. Activities that link
families with services other than Medicaid are
not reimbursable under the Administrative Match
program.
12. Reciprocal Referrals:
See Section 8, Service B1(d).
13. Coordinating Plans: Cooperation
and coordination of plans is integrated in Exhibit
B7.
14. Reimbursement: Exhibit
E: Compensation and Administration.A. Consideration
for the work provided in accordance with this
Agreement has been established under the terms
of RCW 39.34.130. Compensation for services
shall be based on established rates or in accordance
with establish terms.B. For all Title XIX delegated
program and administrative activities included
in this agreement, DOH is responsible for maintaining
compliance with Medicaid Federal regulations
and any overpayments requested as a result of
audit findings.
Exhibit F7: DOH/DSHS-MAA Accounting Procedures.
See also Section 8, Service B1(a, b).
15. Reporting Data: See Section
8, Service A19.
16. Review: N/A
17. Liaison: See Section 8,
Service B1(e).
18. Evaluation: N/A
19. General Contract Provisions:
audit
State: Wisconsin
(Region 5)
Document: [Wisconsin] Memorandum
of Understanding: Title V, WIC, Title XIX and
Title XXI
Author: State of Wisconsin Department
of Health and Family Services, Division of Public
Health
Date: 2000 Pages: 7 pp.
Document URL: http://www.mchlibrary.info/iaa/states/wi_1_1.pdf
Contractual Details:
1. Effective Date: March 7,
2000.
2. Duration: Until terminated
or amended.
3. Type of Agreement: Memorandum
of Understanding.
4. Agencies Involved: A. Wisconsin
Department of Health and Family Services, Division
of Public Health (DPH), including the CSHCN
Program and the WIC Program [Title V].B. Wisconsin
Department of Health and Family Services, Division
of Health Care Financing (DHCF) [Title XIX].
5. Authority Cited: No overarching
authority cited. Authority for specific programs
(e.g., EPSDT and WIC) are cited.
Summary Related
to CMS Requirements:
6. Objectives:
To improve the health status of low income women,
infants, and children including special needs
children by ensuring provision of preventive
services and of any necessary treatment and/or
follow-up care allowed under the SSA. in the
context of an ongoing provider-patient-family
relationship and from continuing care providers
who can provide quality and comprehensive care.
7. Responsibilities: A. Title
V and WIC funded agencies will be encouraged
to make available their range of services to
the recipients of Medicaid, including outreach
to ensure that all family members who may qualify
are informed about the program and how to apply.B.
Recipients of Medicaid will be encouraged to
utilize Title V and WIC services.C. Title V-funded
agencies will adhere to the precedence of Medicaid
billing principles.D. Title V program income
from Title XIX reimbursed services will be applied
as State matching resources, against requirements
stated in Federal Title V regulation.E. HealthCheck
(EPSDT) services are to be mutually agreed upon.F.
The parties agree to periodically address issues
and resolve problems, and to jointly develop
formal procedures that will carry out the spirit
and letter of the agreement. An ongoing liaison
will be developed between the DPH and DHCF to
review content standards for HealthCheck.G.
This Agreement will be reviewed annually by
both parties and updated as necessary.
8. Services Provided by Agency:
Services have been designed to address the responsibilities
in Section 7, including referring eligible clients
between participating programs; obtaining reimbursement
for services rendered; sharing of data, reports,
and other relevant information; and developing
collaborative and/or complementary service programs
in the following areas.A. Medicaid Managed Care
Expansion.B. Wisconsin’s Program for CSHCN.C.
Wisconsin WIC Program.D. Toll-Free Telephone
Numbers.E. HealthCheck (EPSDT).F. Medicaid Applicant
Identification and Assistance.G. Cooperative
and Collaborative Relationships.
9. Cooperative Relationships:
Title V, Title XIX, and the State WIC programs
agree to establish cooperative and collaborative
relationships, including work groups and periodic
meetings, with respect to the following programs
and services, including, but not limited to:
HealthCheck (EPSDT); Immunizations; CSHCN; Recipient
Access/Provider Participation including Electronic
Benefits Transfer; Medicaid Clinical Review;
Prenatal Care Coordination; Healthy Start; Birth
to Three; Children Come First; Expansion of
Medicaid Managed Care programs; Medicaid outreach
and eligibility; DadgerCare including Title
XXI; Family Planning waiver service; and Implementation
of Medicaid eligibility functions with the Department
of Workforce Development.
10. Services Provided by Local Agencies:
A. Encourage State, regional, and local health
department staff to participate in any Medicaid
managed care advisory groups.B. Provide local
health departments and WIC projects with essential
information on how the Medicaid managed care
system works, current information on Medicaid
quality of care indicators, and the current
Medicaid reimbursement.C. Provide HMOs with
information on local health departments and
WIC projects and the services they provide.D.
Promote coordination and collaboration between
local health departments WIC Projects, HMOs,
and other Title XIX managed care programs.
11. Identification and Outreach:
See Section 7, Activity A.
12. Reciprocal Referrals:
HMOs are to refer pregnant, breastfeeding, and
postpartum women, infants, and children under
age 5 years to the WIC Program. The WIC Program
will refer WIC applicants/participants to Medicaid
programs and services.
13. Coordinating Plans: Wisconsin
Title V, Title XIX, and WIC Programs agree to
collaborate on programs and services to identify
pregnant women and children who may be eligible
for Medicaid and once identified, to assist
them in applying for such assistance, including
selecting an appropriate managed care delivery
system.
14. Reimbursement: Title V-funded
agencies will adhere to the precedence of Medicaid
billing principles: Medicare and private third
party payers as first recoverable dollar, Medicaid
as second dollar, and Title V as third dollar,
in payment for services rendered. Medicaid-certified
Title V agencies must have an established fee
schedule on file and bill Medicaid according
to the schedule.
15. Reporting Data: Electronic
data exchange and other data exchange for the
administration, evaluation, and analysis of
the CSHCN Program.
16. Review: See Section 7
Activity G.
17. Liaison: See Section 7
Activity G.
18. Evaluation: See Section
7 Activity G.
19. General Contract Provisions:
termination of agreementamendment/modification
of agreementconfidentiality of records/HIPAA
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