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
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