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HomeMy WebLinkAboutResolution - 4008 - Contract - TTUHSC - Case Management Services, Health Department - 10/22/1992Resolution No. 4008 October 22, 1992 Item #36 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock BE and is hereby authorized and directed to execute for and on behalf of the City of Lubbock a contract and associated documents by and between the City of Lubbock, acting by and through the Lubbock City Health Department, and the Texas Tech University Health Sciences Center, acting by and through Office of Maternal and Infant Health, attached herewith, which shall be spread upon the minutes of the Council and as spread upon the minutes of this Council shall constitute and be a part of this Resolution as�if_ftom copied herein in detail. Passed by the City Council thin 22nd /N. ay ff�Aa EVIEWE'Er ATTEST: C S ak aw'e_ sally Still Ab4e Acting City Secretary APPRO D AS..TO TENT: R. D. Goo man, Public Health Administrator APPROVED AS TO FORM: uonaia u. vanaiver, rirst Assistan City Attorney DGV:dw/Agenda-D2/K-TTUHSC.Res October 13, 1992 ctober , 1992. Resolution No. 4008 October 22, 1992 Item #36 AGREEMENT This is a letter of agreement between the City of Lubbock acting by and through the Lubbock City Health Department (hereafter referred to as LCHD) and the Texas Tech University Health Sciences Center, acting by and through Office of Maternal and Infant Health, Lubbock (hereafter referred to as OMIH). This agreement will be carried out through the Texas Department of Health Case Management 1993 grant funding, for the purpose of providing new maternal and infant support services to residents living within Lubbock County. This agreement is based upon the Texas Department of Health Case. Management 1993 grant proposal which describes the plan for delivery of case management services in Lubbock County, Texas, through a joint effort between OMIH in Lubbock and LCHD. This agreement is, therefore, included within the revised TDH Contract, TDH document number C3000462, effective September 1, 1992, between the Texas Department of Health and TTUHSC Lubbock. ARTICLE I The following is agreed upon by LCHD and OMIH: OMIH, through TDH funding, will pay for one maternal/infant care case worker who will be stationed at the LCHD clinic at 1902 Texas Avenue, Lubbock, Texas, according to the following: a. 1.0 full-time equivalent position (40 hours per week) at a salary not to exceed $14,165 per annum. b. Funding of $5021 to cover fringe benefits commensurate with the usual and customary fringe benefit rate at LCHD for equivalent positions. c. Funding for this position is contingent upon renewal and continuance of the TDH M&CH Family Health Services Contract. This agreement is contingent upon funding being available for the term of the contract and LCHD will have no right of action against HSC in the_ event that HSC is unable to perform its obligations under this agreement as a result of suspension, termination, withdrawal, or failure of funding to HSC from Texas Department of Health. d. Funding is to be used solely for salary and fringe benefits of this 1.0 FTE position, and cannot be used to offset other LCHD expenditures. ARTICLE II The scope of work for the employee covered in this agreement will be as outlined in the attached documents entitled Outreach Worker I Job Description, and Letter of Cooperation, and will include screening and enrolling into high risk case management all prenatal women and infants using LCHD clinics. 1 ARTICLE III Payments will be made to the LCHD quarterly from TDH grant funds through the OMIH according to the following schedule. September 15: 4796.50 December 15: 4796.50 March 15: 4796.50 June 15: 4796.50 Payments for services must reflect only time periods where the employee mentioned in this agreement remains on LCHD staff. ARTICLE IV LCHD agrees to: (1) provide office and/or clinic space, clerical supplies, and telephone access which are necessary to carry out normal tasks relating to the MIHIA program; (2) be responsible for the hiring and dismissal of the employee under this agreement. ARTICLE V Nothing contained herein shall be construed as creating the relationship of employer and employee between LCHD and TTUHSC. LCHD shall be deemed at all times to be an independent contractor. In carrying out the terms of this Agreement, LCHD shall select its own employees and such employees shall be and act under the control of the employer. ARTICLE VI Regardless of the date of execution hereof, this Agreement shall become effective September 1, 1992, and continue in full force until August 31, 1993. This Agreement is automatically renewable for a period of one year. ARTICLE VII Either party may terminate this Agreement with or without cause with thirty (30) days written notice to the other party. Should this Agreement be terminated within a billing quarter, any unearned portion of that quarter's payment made by TTUHSC will be refunded on a prorated monthly basis at the rate of $1598.83. ARTICLE IX The laws of the State of Texas shall govern the validity, performance, and enforcement of this Agreement and the venue for any legal proceedings shall be in Lubbock County, Texas. The undersigned parties bind themselves to the faithful performance to this Agreement. K ATTEST:' 0� 10/22/92 Acting C y Secretary DATE Sally Still Abbe APPROVED AS TO CONTENT: C'Z'T�"" 4A--- 0/ 2 R.D. Goodman, inistrator DATE Lubbock City Health Department APPROVED AS TO FO Wald G. Vandiver, First DATE Assistant City Attorney TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER OFFICE OF MATERNAL AND INFANT HEALTH Elmo M. Cavin,VP, Fiscal Affairs DATE Texas Tech University Health Sciences Center REVIEWED FOR FORM: Beni Hemmeline DATE Associate General Counsel Texas Tech University Health Sciences Center 3 0t1'l'RFACH WORKER I The MIHIA case worker will serve as the primary contact with medically needy high risk obstetric patients and their infants. Responsibilities include patient case finding, financial screening, Medicaid enrollment facilitation, MIHIA enrollment, patient counseling, case tracking, home visitation, and supplying the documentation for these activities as required by the Texas Department of Health and the MIHIA Contractor. The community-based case worker will act as the MIHIA spokesperson and representative to the local community, and will maintain a positive and professional attitude in all MIHIA- related activities. The case worker will make every effort to integrate MIHIA services into local clinics and to establish good relationships with these agencies and with the local Department of Human Services Medicaid Certifiers. The case worker will be expected to travel between local health agencies in the fulfillment of his/her duties, and may, upon occasion, be required to work unusual hours, but no overtime hours. The case worker is required at all times to show a caring and respectful attitude toward MIHIA patients. SPECIFIC RESPONSIBILITIES:----- ^---------- - ---- — — A. Case Finding 25% 1. Interview prenatal patients for MIMA and Medicaid financial eligibility and historical high risk conditions using MEMA protocols. These interviews will take place at designated clinic sites, including WIC, family planning, health department clinics, and/or designated locations. 2. Explain MIHIA and Medicaid Program benefits and enrollment procedures to all potentially eligible patients. 3. Schedule all potentially eligible patients to complete MIHIA eligibility detenninat:on, a*id inform patients of ne�r�PLt rinriiri�n4atitJn 4. Inform all prenatal patients of prenatal clinic locations, and the financial requirements of the clinics. 5. Schedule all potentially eligible patients into the designated prenatal health clinic. 6. With the MIHIA case management team, develop resources to promote community awareness of the MIHIA Program. 7. Develop community awareness to the problems of teen pregnancy. 8. Communicate weekly with the WIC and Family Planning agencies in the district. B. Financial Screening and Enrollment 25% 1. Complete an integrated MHUA/Medicaid screening form for each patient with a suspected high risk condition. 2. Complete all required MEMA financial application materials and demographic information for MIHIA eligible patients. 3. Explain the MIHIA case management philosophy and obtain the patient participation commitments and signatures from MIHJA enrollees. 4. Explain Medicaid application procedures and assist the patient sin completing the Medicaid application form and in gathering necessary documentation. 5. Follow up missed Medicaid appointments and troubleshoot Medicaid problems. C. Patient Counseling and Management 25% 1. Maintain a professional and sympathetic relationship with the patient, and make patient facilitation a chief priority. 2. Develop a patient case load, and provide support and counseling for each patient from the time of enrollment through the fust year of the infant's life, as a part of a case management team, thereby promoting continuity of care. 3. Refer socially or medically very high risk patients to the MIHIA Case Manager according to established protocols. 4. Follow up all missed appointments of maternal and infant patients in the case ----—load:--- -- ----------- — -- - -- ----- - 5. Participate in patient education, under the direction and instruction of the Case Manager, on such topics as family planning, well baby care, and locations of infant care. 6. Provide local community resource information to the patients for both medical and social problems. Make interagency referrals as appropriate, under the guidance of the Case Manager. 7. LAxat:, l;;,ali::.,, ....:;e:: ;,)r I'VITH'A. i:,;ants, and make appointments as needed. 8. Patient assistance mwy include occasional home visits, but will not include patient 9. Assist patients with billing questions or problems, and facilitate problems with hospitals or providers under the direction of the MIHIA Director. 10. Follow the case management responsibilities outlined in the TDH 1991 Case Management Handout. D. Case Tracking and Documentation 25% 1. Coordinate and send on time, all necessary enrollment and tracking paperwork to the central office. ---------- 2. Document all patient contacts and follow-up activities by using a tickle -card system. 3. Be responsible for program enrollment documentation. 4. Track the progress of all Medicaid applications and approvals, and record ultimate Medicaid status. S. Communicate weekly with the MIHIA certifier and local Medicaid certifier to ensure adequate feedback. 6. With the local participating nurse, complete required postpartum information on mothers and infants by using medical records and patient interviews. 7. Follow each patient's infant until one year past birth by establishing contact according to MEHA case tracking protocols. Centrally based OW I positions will also: I Staff the 1-800 maternal and infant care line. 2. Facilitate Medicaid enrollment for all potentially eligible women using -the Department r of OB/Gyn prenatal clinics. 3. Make hospital visits under the direction of the case manager, to ensure continuity of care and tracking, as well as patient education. 4 Staff the weekly Maternity Enrollment Clinic at HSC. LETTER OF COOPERATION TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER OFFICE OF MATERNAL AND INFANT HEALTH AND LUBBOCK CITY HEALTH DEPARTMENT The purpose of this letter is to delineate the scope of case management services provided by Texas Tech University Health Sciences Center Office of Maternal and Child Health (OMIH) and Lubbock City Health Department (LCHD). This letter will describe the case management coordination plan that will serve for both the billable and unbillable case managed patients who qualify for MIHIA and/or Medicaid case management. This letter will outline the methodology by which interagency patient case management and care coordination, including the assignment of a single case manager for each patient, is provided; to define the scope of management services for each agency; and to comply with the Medicaid case management application requirement. For the purpose of clarification, the term "case manager" in this letter refers to the case worker or agency who will be eligible to bill Medicaid for case management. This letter in no way implies that either party is obligated to case manage patients only under Medicaid -billable guidelines. This letter is not a formal contract. SCOPE OF CASE MANAGEMENT RESPONSIBILITIES FOR EACH ACENCY TTUHSC Office of Maternal and Infant Lubbock City Health Department will: Health will: 1. Act as case manager for Lubbock County pre- 1. Act as case manager for prenatal patients natal patients who qualify for this service who qualify for this service and who choose and who choose to enter care at the TTUHSC to enter care at the LCHD OB clinic. Department of Obstetrics and Gynecology OB clinic. 2. Screen all new LCHD maternity patients for 2. Screen and enroll these patients in case management, and maintain documentation of the case management process in OMIH files according to TDH and Medicaid guidelines. Medicaid and MIHIA enrollment, and iden- tify those patients eligible for high risk case management services. 3. Continue to screen and enroll all eligible patients entering care at TTUHSC for the MIHIA program from the fifteen -county MIHIA contract area. 4 S. Q 7. Assist Medicaid -eligible patients to obtain eligibility and monitor the Medicaid status throughout the pregnancy. Continue to provide necessary services for MIHIA mothers and infants per the existing MIHIA contract. Assist LCHD with patient information gathering for patients being case managed by LCHD but are receiving prenatal care at TTUHSC Lubbock OB Clinic. Ensure that these patients are also enrolled in the MIHIA Program and are interviewed at each visit to assess service needs. Perform an initial OB medical record review on Lubbock county patients using the TTUHSC OB Clinic as part of the OMIH QA process in order to ensure that the medical and case management needs of each patient will be met. Refer University Medical Center Neonatal Intensive Care Unit (NICU) infants from Lubbock County to LCHD by means of a di- rect conference between the OMIH nurse practitioner and LCHD nurse. This referral will be at the discretion of the two health care agencies' health care nurses. This 3. Enroll eligible patients into the MIHIA pro- gram and Medicaid case management pro- gram, and maintain documentation of the case management process in LCHD files according to TDH and Medicaid guidelines appropriate for Medicaid and MIHIA. 4. Assist Medicaid -eligible patients to obtain eligibility and monitor the Medicaid status throughout the pregnancy. S. Continue to provide necessary services for MIHIA patients per the existing MIHIA con- tract. 6. Identify, by means of an identification card or stamp, women whom LCHD has enrolled in case management and who subsequently transfer prenatal care to the HSC OB Clinic. This card will serve to notify OMIH staff that this patient is already in care. 7. Follow up infants of LCHD case managed mothers, according to MCD/MIHIA guide- lines. Assist OMIH with MIHIA information gathering needed for completion of records, including taking the responsibility for com- pletion of the M&CH Tracking forms as needed. 8. Act as case manager for University Medical Center Neonatal Intensive Care Unit infants after their return to the community, provided that the mothers of these infants are under referral will be followed by a formal refer- ral document and pertinent medical man- agement records. OMIH will be the case manager of infants who are in the NICU. Upon acceptance of the referral by LCHD, the case management will be formally trans- ferred. Past that time, OMIH will no longer act as case manager. 9. OMIH nurse practitioner will act in a consul- tive capacity with the primary case man- ager and notify LCHD when high risk infants using the HSC Pediatrics High Risk Clinic can be discharged to a local clinic. ffi7 Meet with LCHD and other agencies per- forming maternal and child case manage- ment services on a regular basis to discuss overall community case management plan- ning, regional policy, and regional needs. n tanto i c r ffice of Maternal and Infant Health TTUHSC � lZ-� Dat9f 61 LCHD case management. This will require close communication with OMIH staff who have been working with the family during the inpatient admission. Formal acceptance of the patient by LCHD will be a part of this process. 9. Meet with OMIH and other agencies perform- ing maternal and child case management ser- vices on a regular basis to discuss overall community case management planning, regional policy, and regional needs. aj_�11 NAme /- C7c;)- Date