AMCHP 2006 ANNUAL CONFERENCE
EARLY CHILDHOOD: BUILDING THE FOUNDATION FOR LIFELONG HEALTH
March 4-8, 2006
FCASSIE LAUVER: I thought I was just feverish. So I’m glad to hear that it’s actually warm in here. Maybe we can get it cooled off over break.
There are a couple of revisions or pieces that we want to make sure and note, and one of them has to do with the--one of the new performance measures. And Michelle--originally, when we had these posted, the changes posted, the detail sheet that was online was not correct. Since then, it’s been corrected, but we just want to make sure and point this out. And Michelle, why don’t you share that information?
MICHELLE LAWLER: Well, just to make a point, too, that the--we know the guidance isn’t out yet. It has been submitted to the Office Management and Budget for clearance, but the proposed changes are posted on the Maternal and Child Health Bureau Web site, which I think all of you know, but it’s: www.mchb.hrsa.gov. And when you go there, you’ll see a section that says, 'Of Interest.' And you go down to that, and it’ll say 'Proposed Changes to the Title V Block Grant.' So it does outline what Chris went through very well, and it will show you what we call detail sheets for the Performance Measures, the National Performance Measures. With National Performance Measure 11, which is the one where it’s been changed from number of infants being breastfed at hospital discharge to the new Performance Measure is at 6 months. We updated the detail sheet. Somewhere in the process, and I really can’t tell you where it happened or how it happened, somewhere in that lengthy process in the addition that at least ended up being posted on our Web site, the detail sheet was partially revised, but the bottom half was the detail sheet from the last Performance Measure. Utah? Anyone here from Utah? Utah brought that to our attention, and we’re very grateful they did, because it was not the updated detail sheet. So if you have not gone in in the last few weeks to look at those changes and to maybe run them off, I would suggest you go back in and make a fresh copy.
The detail sheet for National Performance Measure--the current one, the correct one, the revised one is posted now. Where you will notice the difference is really when you get to, first of all, the Healthy People 2010 objective. It’s B and not C. But most importantly is the data sources and data issues. The CDC’s National Immunization Survey is a very good data source for this particular Performance Measure, and we strongly considered throughout the process of whether to revise it or not. So we do see that as a very good data source for you. Unfortunately, what was originally posted did not include that update. So what you will see there now does have the CDC’s National Immunization Survey, as well as National Survey of Children’s Heath. So just be aware of that change, and if you ran your copy a couple months ago, when we first went out with our Federal Register notice, go back into the site and run a fresh copy. Any questions on that? Okay. Yes?
UNKNOWN SPEAKER: You said there’s some new instructions for what narrative you want for the Health System Capacity Indicators (inaudible) guidance. Are those new instructions on that Web site that you just mentioned?
MICHELLE LAWLER: I’m not sure if the total new instructions are. Cassie, do you or Scott--Scott, would you like to address that? How detailed are the--well, actually, I have it here. It just says the directions for the Health Systems Capacity Indicator were expanded to enhance clarifications and that they will be reported annually. I’m not sure the detailed instructions are there, but if you want to see those, you can submit a request to the HRSA OMB, is that the correct title, Jack, Clearance Officer, and, you know, upon request we can provide those instructions for you.
UNKNOWN SPEAKER: And, so when the guidance is finalized--at what point do we expect to get them in guidance and how do we get them?
MICHELLE LAWLER: Do you want me to address it, or do you want to take over?
CASSIE LAUVER: The process for getting a guidance cleared through OMB generally takes 60 days. Or OMB has 60 days to clear a particular set of guidances, although if they have questions, they can stop the clock at any time for us to be able to respond. The guidance was submitted on February 7th, so we’re hoping, hoping, knock on wood, that we have the final guidance to release just about the same time that the TVIS will be open for release. I don’t want to jinx myself there and have it be delayed. We’re hoping that we don’t have an issue, and it doesn’t appear that we do, but I can never second-guess OMB. So we’re looking at the target date is April 7th, and we will notify--we will send out--we have a listserv of all the directors. And so we will send it out to the MCH and Children with Special Needs directors that the new guidance is available and it’s, you know, where they can find it online. We will just be making minimal copies, hard copies of the guidance this time, as we did the last time. So the guidance itself will be available online, and we’ll let you know when that is. If that becomes an issue for you, in terms of responding to the Health System Capacity Indicators, as Michelle said, you can make that request to the--and Jack, do you have the exact title of where that is--or we can provide that for you if it might be more helpful to have--make sure that we have it. But you can make that request to the OMB Clearance person in our agency, and we can get the exact language out. And we’re already thinking about what strategies should we not have a complete guidance by the first--around the first of April. How we can share, because there are a lot of restrictions, and what it is that we can share before OMB clears it. Whether we can give the whole document out in draft, or how exactly we would do it. But at this point, we’re hoping that what we do have is a clear guidance at the first part of April.
A couple of other points that I wanted to mention, and then we can go back and see if we have any other questions for Chris or at this point. One has to do with Form 7. And Form 7 is the form that looks at numbers by population group. And if any of you were at block grant reviews last year, you’ll know that the project officer from our division that were out there asked states to really look at this particular form. Because what we started seeing, and it became really evident to us, particularly in large states, was that we saw numbers decreasing in terms of population served. And so that was provocative to us, and we started going back to some of the big states where we saw some drastic changes in numbers served. And some of the responses that we got in one of the states, for example, where we saw that they were serving several million individuals in a particular group, and when we saw that drop by a half a million, we asked the state what was going on. And what we found out was that that state had developed a new system that looked at actual payment--reimbursement for direct services, and because lots of state had felt a little uncomfortable in terms of the numbers that they’ve served in some of the areas, and they felt like they had a new system that actually captured real numbers, they decided to use those real numbers. And that particular form doesn’t show numbers across years--you’re only reporting for that year. And they didn’t actually catch that they were showing that they were serving a much smaller population than they had even in the previous year.
And the real intent, and I would encourage you to go back and look at the instructions for Form 7, and it’s a bit misleading. And I have it here in front of me, because it says, “In Column A, enter the unduplicated count of individuals who received a direct service”. So one might think that that’s the top level of the pyramid that they are to be reporting. But really, what the intent is is to capture numbers of the first 3 levels of the pyramid. The only restriction there, or area that you may not want to include, or that you should include, is the infrastructure. You may have a Public Service Announcement out that would go to everyone in the state, and you really don’t want to be reporting everyone--I mean, that would misrepresent the numbers that you’re reporting. But we really do want more than just those that are receiving direct services for your program. Lots of states, for example, are involved with Part C of IDEA. And so they commingle dollars in terms of that program. So you certainly would want t be counting that population even though you may not be providing a direct service. But at any rate, Form 7 is a powerful tool for us at the Federal level, because we use that form with Congress, and if we show that we’re decreasing the number of individuals that we served, that could cause--or send some red flags in Congress, and I would assume that that would be true for your own legislature, if you’re showing that you’re serving fewer individuals, when in fact, that may not be the case. You may be just restricting the way that you look at the population. So it’s really critical, particularly in this day and age, when we’re looking at decreases in programs, that we make sure that we tell our story the best that we can. And be sure and capture all of those individuals that this program comes in contact with, regardless if we’re actually paying a direct service or not.
And the other had to do with Form 15. And we had a lot of requests last year to look at Form 15 to see if there was a way to directly link it to our TA Web site, where, if you were interested in having technical assistance in particular area, to try to minimize duplication of data entry. And we talked with our friends from SCIC about what we might do with that, and we really felt that when the state is first developing their application to us, that that’s really a beginning point to think about Form 15 and what technical assistance that you might have. So we really didn’t want everything that you put in there to automatically be shifted to the TA Web site, because you may prioritize that after review you may decide that other technical assistance may be more appropriate for you. So we didn’t go the route of having--once you put something in there, to directly put it someplace else. But we did build a link so if you did want to go ahead and move to the TA Web site, you could go directly from there. So that was the logic behind that change.
So, I think we’re running a little ahead of schedule, and I don’t know if there’s any more questions, first, for Chris. And he will be here, so you can save those, and catch him later at the Monday and Tuesday. And why don’t we go ahead and take a 15-minute break now and come back at 2:00 rather than 2:15. And we will try to cool the room down a little bit, and you’ll have the opportunity to hear from Dr. Acuna from CDC about an investment that they have that may be very helpful to the states relative to MCH at peak capacity. So join us back at 2:00. Thank you.