DC: Bridging the Data Divide E S T A B L I S H I N G A D A T A S H A R I N G A G R E E M E N T B E T W E E N T H E S C H O O L S, H E A L T H D E P A R T M E N T, A N D M E D I C A I D T O I M P R O V E C O O R D I N A T I O N A N D T A R G E T E D O U T R E A C H A N D S E R V I C E D E L I V E R Y
Presenter Disclosures C h a r l i s s a Q u i c k, M S A, B S N, R N D O H S c h o o l H e a l t h D i v i s i o n C h i e f C o l l e e n S o n o s k y, J D D H C F A s s o c i a t e D i r e c t o r f o r C h i l d r e n s H e a l t h S e r v i c e s D I S C L O S U R E : N o r e l a t i o n s h i p s t o d i s c l o s e.
Objectives O b j e c t i v e 1 : I d e n t i f y t h e t w o l a w s t h a t i m p a c t p r i v a c y o f s c h o o l h e a l t h d a t a ( F E R P A a n d H I P A A ) a n d u n d e r s t a n d t h e k e y r e q u i r e m e n t s o f e a c h. O b j e c t i v e 2 : U n d e r s t a n d h o w m e e t i n g t h e j u r i s d i c t i o n a l r e q u i r e m e n t f o r s c h o o l s t o c o l l e c t s t u d e n t h e a l t h i n f o r m a t i o n p r o v i d e s t h e f r a m e w o r k t o s h a r e n e e d e d d a t a, w h i l e m e e t i n g t h e n e e d s a n d o b l i g a t i o n s o f m u l t i p l e a g e n c i e s t o i m p r o v e c h i l d a n d a d o l e s c e n t h e a l t h. O b j e c t i v e 3 : I d e n t i f y a c t i o n s t e p s r e q u i r e d t o i n i t i a t e a s i m i l a r a g r e e m e n t i n y o u r h o m e j u r i s d i c t i o n, i n c l u d i n g i d e n t i f y i n g a p p l i c a b l e s t a k e h o l d e r s, p o t e n t i a l h u r d l e s, a n d s o l u t i o n s.
Setting the Stage: Who We Are and Why We Work Together
Who We Are: District of Columbia Non-DCPS, 37855 DCPS, 47548 Non Medicaid 47% Medicaid 53% 85,403 School-Aged Children in DC Of 47,548 students enrolled in DCPS in SY15-16, 53% were also enrolled in Medicaid
Who We Are DOH DCPS Meet Health Needs of DC Children DHCF
Medicaid Children in DCPS - Feb 2016 25,289 DCPS children enrolled in Medicaid 17% visited their PCP and dentist, and submitted a valid universal health certificate and oral health assessment form to their school
Medicaid Children in DCPS In 2015: 57% of DCPS Medicaid children visited their PCP Less than half have a valid universal health certificate on file. 55% of DCPS Medicaid children visited their dentist 38% have a valid oral health assessment form on file.
Medicaid Children in DCPS - February 2016 27% The percentage of DCPS Medicaid children between the ages of 11 and 20 who attend a school with a school-based health center
Step 1: Identify the Problem
What s the Problem? D C P S a n d D H C F e a c h h a v e i n s t i t u t i o n a l r e q u i r e m e n t s t o m o n i t o r a n d m e e t t h e h e a l t h n e e d s o f D i s t r i c t o f C o l u m b i a c h i l d r e n. D O H, a s t h e p u b l i c h e a l t h a g e n c y, s u p p o r t s m e e t i n g t h e s e r e q u i r e m e n t s t h r o u g h v a r i o u s p r o g r a m s. L a c k o f d a t a s h a r i n g a n d c o l l a b o r a t i o n r e s u l t e d i n d u p l i c a t i o n o f e f f o r t s a n d i n a c c u r a t e d a t a r e g a r d i n g r e c e i p t o f b a s i c h e a l t h s e r v i c e s b y D C c h i l d r e n.
Documentation Collection Challenges W E L O V E P A P E R!!! UHC/OHA
So this happens W H A T I S T H I S I N Y O U R B A C K P A C K?!?! I V E B E E N D R I V I N G A R O U N D W I T H T H E S E P A P E R S I N T H E C A R F O R W E E K S!
Step 2: Identify With Whom You Want to Collaborate W h o h a s t h e i n f o r m a t i o n y o u n e e d? W h o s h o u l d b e c o r e p a r t n e r s? W h o a r e t h e s t a k e h o l d e r s t h a t n e e d t o b e c o n s u l t e d?
Why Work Together? S t u d e n t s b e n e f i t f r o m t h e c o l l a b o r a t i o n. A c h i e v e o u r g o a l s : Healthy students who are successful in school and develop healthy habits. Students with the greatest needs have the services that meet those needs.
Step 3: Identify the Goal W h a t d a t a / r e s o u r c e s d o e s e a c h p a r t n e r h a v e a v a i l a b l e? W h a t d a t a / r e s o u r c e s d o y o u w a n t t o e x c h a n g e? H o w w o u l d y o u w a n t t o u s e t h a t d a t a / r e s o u r c e s?
Step 4: Identify the Barriers
Family Educational Rights and Privacy Act (FERPA) P r o t e c t s p r i v a c y o f s t u d e n t s e d u c a t i o n a l r e c o r d s E d u c a t i o n a l r e c o r d s i n c l u d e : Student information, including immunization records, school health records, etc. Information about what school a student attends Attendance data Academic data
Health Insurance Portability and Accountability Act (HIPAA) R e q u i r e s c o v e r e d e n t i t i e s t o p r o t e c t i n d i v i d u a l h e a l t h r e c o r d s a n d i d e n t i f i a b l e h e a l t h i n f o r m a t i o n I n c l u d e s c o n d i t i o n s o n u s e s a n d d i s c l o s u r e s t h a t m a y b e m a d e w i t h o u t c o n s e n t, i n c l u d i n g : public health activities, legal obligations and institutional requirements, and care coordination
Step 5: Develop an Agreement that Addresses the Barriers I d e n t i f y t h e i n s t i t u t i o n a l r e q u i r e m e n t s o f e a c h p a r t n e r, w i t h a p p r o p r i a t e j u r i s d i c t i o n a l l a w s, r e g u l a t i o n s, e t c., i f a p p l i c a b l e C o n v e n e s t a k e h o l d e r s e a r l y a n d o f t e n! T h i n k t h r o u g h a n y t h i n g a n d e v e r y t h i n g t h a t y o u m i g h t w a n t t o d o, s h a r e, c o l l a b o r a t e o n C u l l d o w n t o t h e k e y p a r t s e v e r y o n e c a n a g r e e t o S e e k a p p r o v a l f r o m a l l r e s p e c t i v e a g e n c i e s
Applicable Law D C O F F I C I A L C O D E 31-2402 S T U D E N T H E A L T H C A R E A C T O F 1 9 8 5 R e q u i r e s d o c u m e n t a t i o n o f p e r i o d i c p h y s i c a l e x a m i n a t i o n, d e n t a l e x a m i n a t i o n s, i m m u n i z a t i o n s, a n d b l o o d l e a d s c r e e n i n g D C O F F I C I A L C O D E 18-0209 H E A L T H Y S C H O O L S A C T O F 2 0 1 0 A m e n d e d t h e S t u d e n t H e a l t h c a r e A c t o f 1 9 8 5 t o r e q u i r e a n n u a l p h y s i c a l e x a m i n a t i o n
Applicable Law D C O F F I C I A L C O D E 38-6 2 1 P U B L I C S C H O O L N U R S E A S S I G N M E N T A C T R e q u i r e s a m i n i m u m o f 2 0 h o u r s p e r w e e k o f r e g i s t e r e d n u r s i n g ( R N ) c o v e r a g e i n p u b l i c s c h o o l s. L i c e n s e d p r a c t i c a l / v o c a t i o n a l n u r s e ( L P N / L V N ) s t a f f m a y s u p p l e m e n t t h i s c o v e r a g e t o m e e t t h e r e q u i r e m e n t, b u t t h e y m u s t w o r k u n d e r t h e s u p e r v i s i o n o f a n d c o l l a b o r a t e w i t h t h e r e g i s t e r e d n u r s e
Applicable Law S E C T I O N 1 9 0 5 ( A ) ( 4 ) ( B ) A N D 1 9 0 5 ( R ) O F S O C I A L S E C U R I T Y A C T : E A R L Y A N D P E R I O D I C S C R E E N I N G, D I A G N O S T I C, A N D T R E A T M E N T ( E P S D T ) S E R V I C E S B E N E F I T R E Q U I R E M E N T S P e d i a t r i c c o m p o n e n t o f t h e M e d i c a i d b e n e f i t E P S D T h a s t h r e e m a j o r e l e m e n t s : Access Well-Child Visit Screenings and Education Diagnosis and Treatment
Applicable Law 4 2 C F R 4 4 1. 6 1 ( U T I L I Z A T I O N O F P R O V I D E R S A N D C O O R D I N A T I O N W I T H R E L A T E D P R O G R A M S ), 42 C F R 4 4 1. 3 0 5 ( C O O P E R A T I V E A G R E E M E N T S W I T H M C H P R O G R A M, A N D / O R S E C 5 2 3 0 O F T H E S T A T E M E D I C A I D M A N U A L ( C O O R D I N A T I O N W I T H R E L A T E D A G E N C I E S A N D P R O G R A M S )
Developing the Agreement Memorandum of Agreement (MOA) developed between three agencies to share data to promote outreach for health services and target resources in schools Programmatic Staff from each agency worked to develop language, shepherd through Agency approval processes District Privacy Officers and General Counsels were included to ensure HIPAA/FERPA compliance
Step 6: Approval Process
Step 7: Implementation
Implementation: Data Sharing DCPS: -enrollment list - records of health form submission DHCF: - Medicaid status - Date of last WCV and dental visit - MCO assignment DOH: - Immunization Compliance Data Data sources are combined to identify the schools with the greatest gaps in service utilization and highest Medicaid enrollment.
Implementation: Collaborating on Outreach
Implementation: Collaboration on Services B e t w e e n S e p t e m b e r a n d F e b r u a r y i n S Y 1 5-1 6, t h e D O H O r a l H e a l t h P r o g r a m p r o v i d e d s e r v i c e s t o 1, 6 3 5 s t u d e n t s i n 4 2 D C P S s c h o o l s S c h o o l s w e r e p r i o r i t i z e d b a s e d o n s h a r e d d a t a
Success so Far: Data-Driven Decision Making
Sample: School Health Snapshot
Success So Far: Managed Care Collaboration D H C F d e v e l o p e d M C O s p e c i f i c s n a p s h o t s M C O s r e c e i v e s c h o o l e n r o l l m e n t i n f o r m a t i o n f o r t h e i r m e m b e r s T a r g e t o u t r e a c h t o s t u d e n t s a t s c h o o l s w i t h s c h o o l - b a s e d h e a l t h c e n t e r s a n d t h o s e e n r o l l e d i n H e a d S t a r t p r o g r a m s P l a n h e a l t h e v e n t s a n d e d u c a t i o n e f f o r t s, u s i n g m e m b e r s c h o o l e n r o l l m e n t d a t a
Still more to do! I n c r e a s e d a t a d i s s e m i n a t i o n t o k e y s t a k e h o l d e r s I m p r o v e t r a c k i n g o f i m p a c t Increased service utilization and form submission Student level impact on academic indicators I n c r e a s e s t u d e n t l e v e l c o o r d i n a t i o n
Questions?
We re Here to Help! Diana K. Bruce DC Public Schools Director of Health and Wellness Diana.bruce@dc.gov 202.442.5103 Charlissa Quick DC Department of Health School Health Division Chief Charlissa.quick@dc.gov 202.442.9123 Valentine Breitbarth DC Public Schools Manager of Health Services Valentine.breitbarth@dc.gov 202.719.6555 Colleen Sonosky DC Department of Health Care Finance Associate Director, Children s Health Services Colleen.sonosky@dc.gov 202.442.5913