Children’s Special Health Services (CSHS) Committee<br />Meeting minutes from June 25, 2010<br />Montana School for the Deaf and Blind, Great Falls<br />Council members present:<br />Chairperson Laura Nicholson MD; Krystal Tweet RN; Terry Hall RN; Stacy Smith RN; Angela Haddick parent; Mary Anne Guggenheim MD; Roger Holt, PLUK; Steve Gettel, MSDB; John Johnson MD by video conference.<br />Council members unable to attend:<br />Marian Kummer MD; Cyndi Leaphart RN; Joline Hartze RN; Nicole Trahan parent; Michelle Holton parent; Sylvia Danforth DEAP; Peggy Schlesinger MD; Thomas Randall MD; Caitlin Hall MD<br />Guests:<br />Shauna Peek RN, GFC; Jan Donaldson Family Outreach; Sam Yang, MD, Shodair; Carroll King MD, St Vincent’s and MT Pediatric Project; and Denise Higgins, Montana Public State Lab.<br />CSHS Staff members present:<br />Denise Brunett, CSHS Supervisor; MaryLynn Donnelly RN; Corliss Scott.<br />Meeting was called to order by Laura Nicholson, Chairperson. Previous minutes were reviewed; no changes necessary.<br />Introductions - Welcome was extended to Angela Haddick, new CSHS parent representative. She gave an overview of her family’s experience with a new baby with special needs.<br /> <br />Discussion of CSHS Charter – Denise Brunett- <br />Ideas included:<br />Increasing nurse coordinators from three (3) to six (6). <br />Add PLUK and MSDB.<br />Add Jan Donaldson as Part C representative.<br />Added Mary Ann Guggenheim, MD as SSI representative. <br /> Laura Nicholson will ask each specialty clinic’s medical directors to participate on the Committee.<br />Denise Brunett will draft agreed upon amendments to the charter and send to the Committee.<br />Regional Reports: Great Falls – Krystal Tweet RN –<br />Shauna Peek introduced as new nurse coordinator.<br />Experiencing challenges with layoffs at all levels and increasing regional clinic counts. <br />Kerry Ford MD, pediatric orthopedist, from Helena has been sent a contract from Benefis and they are negotiating an orthopeadic clinic. <br />Difficulty replacing Dr. Messick on the cleft/craniofacial team. At this time, Chris Burk MD will plan to cover this clinic.<br />Seeking connection with new pediatric neurologist, Tarif Bakdash MD.<br />Pursuing clinics with Peggy Schlesinger MD.<br />Accepting Browning Cleft Clinic next year.<br />Discussion regarding adding adult pulmonologist to cystic fibrosis interdisciplinary clinics.<br />Billings – Stacy Smith RN –<br />Tarif Bakdash MD, pediatric neurologist, started seeing patients the first of June 2010. At this time there are 200 on the wait list, physician referrals accepted; children on the wait list are being prioritized. At this time the plan is to have 3 clinic days a week at St Vincent’s and 2 days a week outreach clinics. <br />Denver will finish up in July 2010 so able to assist with the backlog of neurology patients. Denver and Seattle are willing to come be of assistance as needed. It is yet to be determined how Denver and Seattle outreach clinics in Billings will be impacted by Dr. Bakdash’s practice. Billings nurse coordinators go to Bozeman for endocrine clinic and will add cleft/craniofacial clinics next year.<br />PET still in progress. It has gone to IRB for approval. There are not as many patients who would be appropriate for the grant as was initially anticipated. Patients need to be seen first by the doctor in clinic and are only eligible for teleconference as a follow-up. As neurologists in Seattle have changed and with Dr. Backdash now available, there are very few patients who would be served by teleconferencing. Progress has also slowed recently on the grant due to increased clinic load<br />GI Dr. Narkewicz currently comes from Denver every other month and provides GI videoteleconference every month that he doesn’t have clinic in Billings. This is allowing patients to do their follow-up closer to home as there are many locations available throughout the state. Dr. Narkewicz will video teleconference with Miles City in June and we are planning for the Great Falls area this summer. This has been especially helpful for newly diagnosed ciliac patients who get their biopsies done while he is in Billings and within a week are getting their dietary education. <br />Nephrology- Dr. Ruth McDonald from Seattle will no longer be doing outreach in Billings. However, another Seattle Nephrologist, Dr. Symons, will be replacing her and will start in October at our upcoming Nephrology clinic. <br />There is discussion about adding Cathy Stevens MD of the Billings Clinic, to the CF clinics to see the patients over age 18. This age group is reported to be 40% of the CF population.<br />Missoula – Terry Halls RN –<br />The specialty clinics are under Pediatrics at Community Medical Center (CMC) and receive lots of support. <br />Dr. Koyle, pediatric urologist, comes to Missoula 3-4 times a year. There’s a back log of 50 patients. Dr. Koyle works with two (2) urologists in Missoula (Dr. Kronner and Dr. Westenfelder). Dr. Manktelow will also be assisting him with some of the surgery cases. <br />Hoping to start a pediatric gastroenterology clinic in the fall as there are a large number of pediatric patients needing this care. <br />Synagis clinic – numbers are down, this is attributed to the new recommendations and coverage policies. Joline and Terry did not attend all of the Synagis clinics due to clinic schedules, and double clinics. There were 61 visits to Synagis clinics attended by Terry or Joline. <br />Since October, there have been 960 patient visits through the Western Region clinics.<br />CMC is working on marketing the pediatric specialty clinics.<br />Paul Smith MD, pulmonologist, from CMC does see patients at the regional pediatric specialty clinic.<br />Contracting Update – Denise Brunett-<br />
Effective April of 2010, CSHS sent contracts to all providers that receive payment for services rendered at CSHS interdisciplinary clinics (cleft/craniofacial, metabolic and cystic fibrosis). Most the contracts are signed and returned. This did cause the loss of some team members, which have since been replaced.
Effective June of 2010, all CSHS team members are required to have a contract in place in order to be paid for their services at CSHS interdisciplinary clinics.
Handout demonstrates the billing revenue has increased to $250k+ for the most recent state fiscal year. In total, $1,511,200 has been billed and $840,000 has been paid. Michele’s efforts have also decreased the amount of revenue lost to claim denials.
Effective July 2010, CSHS contracted with HeathEWeb as a claim submitter. This service allows for enhanced technology to bill for CSHS interdisciplinary clinics.
The Committee applauded Michele’s efforts to get appropriate billing technology. Way to go, Michele!
Shannon Koenig in our bureau is being trained to be data support for the CHRIS system. She will assist MaryLynn with CHRIS development, design and testing. Glad to have your help, Shannon!
Newborn screening follow-up and genetics services John Johnson MD– Shodair:
Please see the attachment “Genetics Update – CSHS meeting 6/25/2010
Samuel Yang MD was introduced to the group. Dr. Yang has joined the genetics team at Shodair and will be taking over Janet Thomas’ MD duties at the metabolic clinic. He will be overlapping coverage with Dr. Thomas on the existing patients this fall. Dr Yang will shadow Dr. Thomas at the metabolic clinics this fall. After the fall of 2010 he will be the metabolic clinic physician. Back-up for Joan Reichert (nutrition services) will probably continue via Denver.
Shodair has subspecialist contracts for hematology, pulmonology, and endocrine.
Shodair is hosting the second annual Metabolic day August 14th in Helena.
Dr. Johnson announced Shodair has the ability to do microarray testing.
Denise Higgins of the Montana Public State Lab clarified ACT sheets are not being sent. The team encouraged them to keep working on the ACT sheets so they can be included with the abnormal results to medical providers.
Denise Higgins will send information to Denise Brunett to share with the CSHS Committee regarding billing and use of PKU results for NBS.
Update: The Montana Public Health Laboratory (MTPHL) in the Department of Public Health and Human Services has waived the fee for Phenylalanine monitoring through June 2011. Healthcare providers submitting the phenylalanine monitors will see the tests listed on their monthly MTPHL invoices as ‘fee waived’.
The MT cleft teams now have provisional CAT approval with the American Cleft Palate Association (ACPA). Additional information requested by the CAT has been completed and submitted to the ACPA.
The NICU rack cards are about ready to go to print. These will be sent to the hospital NICUs to be handed out to families to inform them of the services through CSHS.
Cleft fact sheet/pamphlet has been reviewed by Angela and regional nurses. Once finalized it will go to print and be distributed.
Handout “Prevalence and Identification of Cleft Lip and Palate in Montana” – DRAFT from.
Dr. King noted the MT Hospital Association may be interested in the above noted paper as the hospitals are required to enter the birth certificate data, which was one of the sources of data for the report.
Maureen Leo’s, parent representative, resignation presented and accepted.
CSHS has 46 children enrolled in the financial assistance program to date. Each child received $2,000.00 for eligible expenses for the Federal Fiscal Year 2010.
In May, CSHS was able to offer an additional $750.00 per child. Out of the 26 families who received letters, 11 families requested $750.00, 1 family requested $400.00 and 1 family requested $154.00
Insurance break down – 23 children are covered by commercial insurance, 1 child self pay, 16 children covered by Healthy Montana Kids (HMK, formerly CHIP), and 6 children covered by Healthy Montana Kids Plus (HMK+, formerly Medicaid).
The decline in number of children requesting CSHS financial assistance was discussed. There was discussion regarding if CSHS should review looking to other avenues to be of assistance to families.
Research information presented regarding assisting families possibly with COBRA or the high cost of their insurance. State policies in looked at Arizona, Michigan, New Mexico, Texas and Montana were examined. All of these states have insurance programs that are state funded. In each state each case is evaluated to see if it would be more cost effective to pay the insurance premium or to pay for the cost of the service the child needs.
Is it feasible for CSHS to assist with insurance premium payments with such a low amount of children and funds available with the amount of work it would take to set up and administer? Decided that this was not a need we should address due to rarity of the need.
It was decided CSHS could potentially use about $45,000.00 of the $90,000.00 for other allocations. Unless needs change, funds could be better used elsewhere.
Discussion regarding the ability to assist families with transportation costs. Is there some way monies could be put into the regional contracts and used to assist families?
Clinics to do an informal assessment with families over the next six (6) months to see if need travel funds; work on how one might organize disbursement.
CSHS to explore allotting funds similar to a scholarship basis to contracted regions. Update: CSHS has assessed this idea and would prefer regions request additional funding individually when needing additional funds or materials. All requests received by September 27, 2010, will be reviewed and if approved, funding will be added to the contract amendment effective October 1, 2010.
ARM draft: – Denise Brunett-<br />A draft of the Administrative Rule Amendment was shared. The majority of the amendment is clean-up, updating terminology and following the CHIP federal poverty guidelines. The amendment was reviewed by Committee. The Committee had no concerns, but requested Denise to resend the clinical portion to the physicians on the Committee for further review and clean-up. <br />Needs Assessment – Laura Nicholson:<br />Discussion regarding what can be done with the concerns parents have for their special needs children and services: The top concerns listed in the Maternal and Child Health Needs Assessment, Parents of Children with Special Health Care Needs* were reported as<br /> 1. Scarcity of local competent providers;<br /> 2. Insufficient Access to local providers;<br />3. Lack of Specialists in Montana; and <br />4. The manner in which providers treat parents.<br />Conversation – how can professionals be educated? How can CSHS committed physicians assist providers in being comfortable with this population?<br />Workgroup formed that will use a template of a book used in Texas for empowering parents to communicate and educate providers about the care of their child with special health care needs. The workgroup is: Dr. Laura Nicholson, Dr. Carroll King, and Angela Haddick and Denise Brunett.<br />*http://www.dphhs.mt.gov/PHSD/family-health/mchc/phsd-mch-assessment.shtml<br />Thanks to all for their contributions, feedback and participation! Thanks to MT School for the Deaf and Blind for hosting the CSHS Committee!<br />The next CSHS Council meeting is to be held December 3, 2010. Details will be sent to Committee members after clinic schedules have been reviewed for Committee member availability. <br />