Table 4 provides descriptive
data on the socioeconomic status of health center patients. The table is
included in both the Universal Report and the Grant Reports.
For the Universal
Report, include as patients all patients receiving at least one
face-to-face encounter for services within the scope of any of the programs
covered by UDS. The Grant Reports include only patients who
received at least one face-to-face encounter that was within the scope of the
program in question. Note that no cell in a Grant Report may contain a number
larger than the corresponding cell in the Universal Report. Patients are to
be reported only once per section in each report filed.
NOTE: The sum of Table 3A, Line39, Column A + B (total
patients by age and gender) must equal Table 4, Line 6 (patients by income) and
Line 12, Column A + B (patients by insurance status.) The sum of Table 3A,
Lines 1-20, Columns A + B must equal Table 4, Line 12, Column A. Similarly,
total patients reported on the Grant Reports on Tables 3A, 3B and 4 must be
equal.
Income as Percent of Poverty Level, Lines 1 - 6
Grantees are expected to
collect income data on all patients, but are not required to collect this
information more frequently than once during the year. If income information
is updated during the year, report the most current information available.
Patients for whom the information was not collected within the last year must
be reported on line 5 as unknown. Do not attempt to allocate patients with
unknown income. Knowing that a patient is homeless or a migrant or on Medicaid
is not adequate to classify that patient as having an income below the poverty
level.
Income is defined in ranges
relative to the Federal poverty guidelines (e.g., < 100 percentage of the
federal poverty level). In determining a patient’s income relative to the
poverty level, grantees should use official poverty line guidelines defined and
revised annually. The official Poverty Guidelines are published in the Federal
Register in February or March of each year. (Available at http://aspe.hhs.gov/poverty/08poverty.shtml)
Every patient reported on
Table 3A must be reported once (and only once) on lines 1 through 5. The sum
of Table 3A, Line39, Column A + B (total patients by age and gender) must equal
Table 4, Line 6 (patients by income). The same is true for Grant Reports.
Principal Third Party Insurance Source, Lines 7 - 12
This portion of the
table provides data on patients by principal source of insurance for primary
medical care services. (Other forms of insurance, such as dental or vision
coverage, are not reported.) Patients are divided into 2 age groups (Column A)
0 - 19 and (Column B) age 20+. Primary patient medical insurance is divided
into seven types as follows:
·
S-CHIP (Line 8b or 10b) – The State Child Health Insurance
Program (also known as S-CHIP) provides primary health care coverage for
children and, on a state by state basis, others – especially parents of these
children. S-CHIP coverage can be provided through the state’s Medicaid program
and/or through contracts with private insurance plans. In some states that make
use of Medicaid, it is difficult or even impossible to distinguish between
regular Medicaid and S-CHIP-Medicaid. In other states the distinction is
readily apparent (e.g., they may have different cards). Where it is not
obvious, S-CHIP may often still be identifiable from a “plan” code or some
other embedded code in the membership number. This may also vary from county
to county within a state. Obtain information from the state and/or county on
their coding practice. If there is no way to distinguish between regular
Medicaid and S-CHIP Medicaid, classify all covered patients as “regular”
Medicaid. In those states where S-CHIP is contracted through a private
third party payor, participants are to be classified as “other public-CHIP”
(Line 10b) not as private.
·
Medicaid (Line 8a, 8b and 8) – State-run programs
operating under the guidelines of Titles XIX (and XXI as appropriate) of the
Social Security Act. Medicaid includes programs called by State-specific names
(e.g., California’s Medi-Cal program). In some states, the State Children’s
Health Insurance Program (S-CHIP) is also included in the Medicaid program –
see above. While Medicaid coverage is generally funded by Federal and State
funds, some states also have “State-only” programs covering individuals
ineligible for Federal matching funds (e.g., general assistance recipients) and
these individuals are also included on Lines 8a, 8b and 8. NOTE: Individuals
who are enrolled in Medicaid but receive services through a private managed
care plan that contracts with the State Medicaid agency should be reported as
“Medicaid", not as privately insured.
·
Medicare (Line 9) – Federal insurance program for the
aged, blind and disabled (Title XVIII of the Social Security Act).
·
Other Public Insurance (Line 10a) –State and/or local
government programs, such as Washington’s Basic Health Plan or Massachusetts’
Commonwealth plan, providing a broad set of benefits for eligible individuals.
Include public paid or subsidized private insurance not listed elsewhere. Do
not include any S-CHIP, Medicaid or Medicare patients on this line. Do not
include uninsured individuals whose visit may be covered by a public source
with limited benefits such as the Early Prevention, Screening, Detection and
Treatment (EPSDT) program or the Breast and Cervical Cancer Control Program,
(BCCCP), etc. ALSO DO NOT INCLUDE persons covered by workers' compensation, as
this is not health insurance for the patient, it is liability insurance for the
employer.
·
Other Public (S-CHIP) (Line 10-b) – S-CHIP programs which
are run through the private sector, often through HMOs, where the coverage
appears to be a private insurance plan (such as Blue Cross / Blue Shield) but
is funded through S-CHIP.
·
Private Insurance (Line 11) – Health insurance
provided by commercial and non-profit companies. Individuals may obtain
insurance through employers or on their own. Private insurance includes
insurance purchased for public employees or retirees such as Tricare, Trigon,
Veterans Administration, the Federal Employees Benefits Program, etc.
One additional
categories are included on Table 4 for patients who are uninsured (line 7).
Every patient reported on
Table 3A must be reported once (and only once) on lines 7 through 11. The sum
of Table 3A, Line39, Column A + B (total patients by age and gender) must equal
Table 4, Line 12 Column A + B (total patients by insurance status.) The same
is true for Grant Reports.
Specific
Instructions for Reporting Patients by Source of Insurance
Grantees should report the
patient’s primary health insurance covering medical care,
if any, as of the last visit during the reporting period. Principal
insurance is defined as the insurance plan/program that the grantee
would bill first for services rendered. NOTE: Patients who have
both Medicare and Medicaid, would be reported as Medicare patients because
Medicare is billed before Medicaid. The exception to the Medicare first rule
is the Medicare-enrolled patient who is still working and insured by both an
employer-based plan and Medicare. In this case, the principal health insurance
is the employer-based plan, which is billed first.
Patients for whom no
other information is available, whose services are paid for by grant
programs, including family planning, BCEDP, immunizations, TB control, as well
as patients served in correctional facilities, may be classified as uninsured.
Similarly, patients whose
services are subsidized through State/local government “indigent care programs”
are considered to be uninsured.
Examples of state government “indigent care programs” include New Jersey
Uncompensated Care Program, NY Public Goods Pool Funding, California’s Expanded
Assistance for Primary Care, and Colorado Indigent Care Program.
For both Medicaid and
Other Public Insurance, the table distinguishes between “regular” enrollees and
enrollees in S-CHIP.
Medicaid
= Line 8b includes Medicaid-S-CHIP
enrollees only; Line 8a includes all other enrollees; and Line 8 is the sum of
8a + 8b.
Other Public = Line 10b includes S-CHIP
enrollees who are covered by a plan other than Medicaid; Line 10a includes all
other persons with other public insurance (Grantees are asked to describe the
programs so the UDS editor can make sure that the classification of the program
as other public is appropriate.); and Line 10 is the sum of 10a + 10b.
MANAGED CARE
UTILIZATION - Lines 13a – 13c
This section on “Managed Care Utilization” ask for a report
of the patient Member Months in managed care.
Member
Months: A member month is defined as 1
member being enrolled for 1 month. An individual who is a member of a plan for
a full year generates 12 member months; a family of 5 enrolled for 6 months
generates (5 X 6) 30 member months. Member month information can often be
obtained from monthly enrollment lists generally supplied by managed care
companies to their providers.
Member Months for Managed Care (capitated) (Line 13a) – Enter the total capitated member months
by source of payment. This is derived by adding the total enrollment reported by
the plan for each month.
Member Months for Managed care (fee-for-service) (Line 13b) – Enter the total fee-for-service member
months by source of payment. A fee-for-service member month is defined as one
patient being assigned to a service delivery location for one month during
which time the patient may use only that center’s services, but for whom
the services are paid on a fee-for-service basis. NOTE: Do not include
individuals who receive “carved-out” services under a fee-for-service
arrangement if those individuals have already been counted for the same month
as a capitated member month.
Total Member Months. (Line 13c) – Enter the total of lines 13a + 13b
CHARACTERISTICS OF TARGET POPULATIONS,
LINES 14 - 26
This section on “selected
patient characteristics” ask for a count of persons who are enrolled in one or
more of the Bureau’s “special population” programs (migrant and seasonal
agricultural workers, persons who are homeless. patients served by school-based
health centers, or who are veterans.
Migrant or Seasonal Agricultural Workers and their
Dependents, Lines 14 - 16
All grantees are
required to report on Line 16 the combined total number of patients seen during
the reporting period who were either migrant or seasonal agricultural workers
or their dependents. Section 330(g) grantees (only!) are asked to provide
separate totals for migrant and for seasonal agricultural workers on Lines 13
and 14. For Section 330(g) grantees, Lines 14 + 15 = 16
Definitions of migrant and seasonal agricultural workers
Migrant Agricultural Workers – Defined by Section 330(g) of the Public Health Service
Act, a migrant agricultural worker is an individual whose principal
employment is in agriculture on a seasonal basis (as opposed to year-round
employment) and who establishes a temporary home for the purposes of such
employment. Migrant agricultural workers are usually hired laborers who
are paid piecework, hourly or daily wages. The definition includes those
individuals who have had such work as their principle source of income within
the past 24 months as well as their dependent family members who have also used
the center. The dependent family members may or may not move with the worker
or establish a temporary home. Note that agricultural workers who leave
a community to work elsewhere are just as eligible to be classified as migrants
in their home community as are those who migrate to a community to work
there.
Seasonal Agricultural Workers – Seasonal agricultural workers are individuals whose
principal employment is in agriculture on a seasonal basis (as opposed to
year-round employment) and who do not establish a temporary home for
purposes of employment. Seasonal agricultural workers are usually hired
laborers who are paid piecework, hourly, or daily wages. The definition
includes those individuals who have been so employed within the past 24 months
and their dependent family members who have also used the center.
For
both categories of workers, agriculture is defined as farming of the land in
all its branches, including cultivation, tillage, growing, harvesting,
preparation, and on-site processing for market or storage. Persons
employed in aquaculture, lumbering, poultry processing, cattle
ranching, tourism and all other non-farm-related seasonal work are not
included.
Homeless Patients, Lines 17 - 23
All grantees are to report
the total number of patients, known to have been homeless at the time of any
service provided during the reporting period, on Line 23. Only section 330(h)
Homeless Program grantees will provide separate totals for homeless program
patients by type of shelter arrangement.
·
The shelter arrangement reported
is their arrangement as of the first visit during the reporting period.
·
“Street” includes living outdoors,
in a car, in an encampment, in makeshift housing/shelter or in other places
generally not deemed safe or fit for human occupancy.
·
Persons who spent the prior night
incarcerated or in a hospital should be reported based on where they intend to
spend the night after their encounter. If they do not know, code as “street”.
·
Section 330(h) Homeless Program
grantees should report previously homeless patients now housed but still
eligible for the program on Line 21, “other”.
Homeless
patients – Are defined as patients
who lack housing (without regard to whether the individual is a member of a
family), including individuals whose primary residence during the night is a
supervised public or private facility that provides temporary living
accommodations, and individuals who reside in transitional housing.
School
Based Health Center Patients, Line 24
All grantees that identified
a school based health center as a service delivery site on the UDS Cover Sheet
are to report the total number of patients who received primary health care
services at the school service delivery sites(s) listed. A school based
health center is a health center located on or near school grounds, including
pre-school, kindergarten, and primary through secondary schools, that provides
on-site comprehensive preventive and primary health services.
Veterans, Line 25
All
grantees report the total number of patients served who have been discharged
from the military. It is expected that this element will be added to the
patient information / intake form at each center. Report only those who
affirmatively indicate they are veterans. Persons who do not respond or who
have no information are not counted, regardless of other indicators.
Questions and Answers for
Table 4
1.
Are there any changes to this
table?
Yes. THIS YEAR three new lines have
been added. One section – lines 13a, 13b and 13c, is to be completed only
by agencies with managed care contracts. It requests information on managed
care member months. It is the same as lines 10a, 10b, and 10 which were
formerly collected on Table 9C which has been deleted this year.
2.
If we do not receive a
Health Care for the Homeless, or Migrant grant, do we need to report the total
number of special population patients served?
Yes. All grantees, regardless of
whether they receive targeted grant funding for special populations, are
required to complete Lines 23 (total number of patients known to have been
homeless at the time of service), 16 (the total number of patients seen during
the reporting period who were either migrant or seasonal agricultural workers
or their dependents), Line 24 (Users of a school based clinic – regardless of
whether or not special funding was ever obtained for that clinic) and 25
(Veterans.) Grantees who did not receive special population funding are not
required to complete Lines 14-15 and 17-22.
3.
Must the number of patients by
income and insurance source equal the total number of unduplicated patients
reported on Tables 3A and 3B?
Yes.
4.
We have never collected
information on whether or not a patient is a veteran. Do we have to do this
now for reporting?
Yes. As of January 1, you must ask every patient who comes into your health
center whether or not they are a veteran and add this to their profile so you
can report it.
TABLE 4 – SELECTED PATIENT CHARACTERISTICS
Characteristic
|
Number Of Patients
( a )
|
Income
As Percent of Poverty Level
|
1.
|
|
|
2.
|
101 –
150%
|
|
3.
|
151 –
200%
|
|
4.
|
Over 200%
|
|
5.
|
|
|
6.
|
Total (Sum Lines 1 – 5)
|
|
Principal
Third Party Medical Insurance Source
|
0-19 years
old ( a )
|
20 and older ( b )
|
7.
|
None/ Uninsured
|
|
|
8a.
|
|
|
|
8b.
|
CHIP
Medicaid
|
|
|
8.
|
Total
Medicaid (Line 8a + 8b)
|
|
|
9.
|
Medicare (Title
XVIII)
|
|
|
10a.
|
|
|
|
10b.
|
Other
Public Insurance CHIP
|
|
|
10.
|
Total
Public Insurance (Line 10a + 10b)
|
|
|
11.
|
Private
Insurance
|
|
|
12.
|
Total
(Sum Lines 7 + 8 + 9 +10 +11+12)
|
|
|
|
|
|
Payor Category
|
Medicaid
( a )
|
Medicare
( b )
|
Other Public Including
Non-Medicaid S-CHIP
( c )
|
Private
( d )
|
Total
( e )
|
|
13a
|
Capitated
Member months
|
|
|
|
|
|
|
13b
|
Fee-for-service
Member months
|
|
|
|
|
|
|
13c
|
Total Member months ( 13a + 13b)
|
|
|
|
|
|
Characteristics
– Special Populations
|
Number Of Patients -- (a)
|
14
|
Migrant (330g grantees Only)
|
|
15
|
Seasonal (330g grantees Only)
|
|
16.
|
Total Migrant/Seasonal
Agricultural Worker or Dependent (All Grantees Report This Line)
|
|
17.
|
Homeless
Shelter (330h grantees only)
|
|
18.
|
Transitional
(330h grantees only)
|
|
19.
|
Doubling
Up (330h grantees only)
|
|
20.
|
Street
(330h grantees only)
|
|
21.
|
Other
(330h grantees only)
|
|
22.
|
Unknown (330h
grantees only)
|
|
23.
|
Total Homeless (All
Grantees Report This Line)
|
|
24
|
|
|
|
TOTAL Veterans (All grantees report this line)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|