Instructions for Form 325 "Primary Health Care Annual Reporting Form" - Texas

This document contains official instructions for Form 325, Primary Health Care Annual Reporting Form - a form released and collected by the Texas Health and Human Services.

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Download Instructions for Form 325 "Primary Health Care Annual Reporting Form" - Texas

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1
Primary Health Care Program
Annual Report
Form 325 Instructions
INTRODUCTION
Purpose
The Health and Human Services Commission (HHSC) is required by legislative mandate to report
on the performance of Primary Health Care Services. The Form PHC 325 Annual Report is
used to describe the demographic characteristics of Primary Health Care (PHC) clients,
monitor access to program services provided to diverse populations, and assess the way the
PHC programs interact with other funding sources.
Procedure
Form PHC 325 must be completed and submitted to HHSC within 60 days of the end of
the state fiscal year (SFY), unless otherwise instructed.
Agencies should email the completed Form 325 to PHCReports@hhsc.state.tx.us and
HDS.ADS@hhsc.state.tx.us.
TERMS AND DEFINITIONS
PHC Contract
HHSC contracts with providers to facilitate the efficient and economical provision of PHC
Services. HHSC reimburses contractor for expenses incurred through a cost reimbursement
method.
PHC Client
An individual who has been screened, determined to be eligible for services, and has received
one or more PHC services at a HHSC PHC clinic is considered a PHC client. The same PHC
client may be counted only once during the program’s fiscal year, regardless of the number of
visits, encounters, or services they receive (e.g., one client seen four times during the year is
counted as one unduplicated client.)
PHC Clinic
A site where agency staff provides PHC services to PHC clients.
PHC Service
Any client encounter at a PHC clinic that results in the PHC client having a medical or health-
related need met. Unless otherwise specified, report only services provided to PHC clients using
PHC funding, and do not report services funded through another source of coverage. Per the
Primary Health Care Services Act, PHC services include:
(A) diagnosis and treatment;
(B) emergency services;
(C) family planning services;
(D) preventive health services, including immunizations;
(E) health education;
(F) laboratory, X-ray, nuclear medicine, or other appropriate diagnostic services;
(G) nutrition services;
(H) health screening;
Revised September 2018
Primary Health Care Services Program Annual Report Form 325 Instructions
1
Primary Health Care Program
Annual Report
Form 325 Instructions
INTRODUCTION
Purpose
The Health and Human Services Commission (HHSC) is required by legislative mandate to report
on the performance of Primary Health Care Services. The Form PHC 325 Annual Report is
used to describe the demographic characteristics of Primary Health Care (PHC) clients,
monitor access to program services provided to diverse populations, and assess the way the
PHC programs interact with other funding sources.
Procedure
Form PHC 325 must be completed and submitted to HHSC within 60 days of the end of
the state fiscal year (SFY), unless otherwise instructed.
Agencies should email the completed Form 325 to PHCReports@hhsc.state.tx.us and
HDS.ADS@hhsc.state.tx.us.
TERMS AND DEFINITIONS
PHC Contract
HHSC contracts with providers to facilitate the efficient and economical provision of PHC
Services. HHSC reimburses contractor for expenses incurred through a cost reimbursement
method.
PHC Client
An individual who has been screened, determined to be eligible for services, and has received
one or more PHC services at a HHSC PHC clinic is considered a PHC client. The same PHC
client may be counted only once during the program’s fiscal year, regardless of the number of
visits, encounters, or services they receive (e.g., one client seen four times during the year is
counted as one unduplicated client.)
PHC Clinic
A site where agency staff provides PHC services to PHC clients.
PHC Service
Any client encounter at a PHC clinic that results in the PHC client having a medical or health-
related need met. Unless otherwise specified, report only services provided to PHC clients using
PHC funding, and do not report services funded through another source of coverage. Per the
Primary Health Care Services Act, PHC services include:
(A) diagnosis and treatment;
(B) emergency services;
(C) family planning services;
(D) preventive health services, including immunizations;
(E) health education;
(F) laboratory, X-ray, nuclear medicine, or other appropriate diagnostic services;
(G) nutrition services;
(H) health screening;
Revised September 2018
Primary Health Care Services Program Annual Report Form 325 Instructions
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(I) home health care;
(J) dental care;
(K) transportation;
(L) prescription drugs and devices and durable supplies;
(M) environmental health services;
(N) podiatry services; and
(O) social services.
Reporting Period
The reporting period is the SFY, September 1– August 31.
DETAILED INSTRUCTIONS
Header Information
Instructions
Report the following information from the agency’s PHC contracts:
Report Type – Select whether this report is an initial or revised submission.
Vendor ID (VID) – Enter the 11-digit Vendor Identification Number assigned by the State
Comptroller’s Office. The VID is an 11-digit number composed of a one-digit prefix number
(1, 2 or 3) that indicates whether the VID is based on a Social Security Number (SSN),
Employer Identification Number (EIN), or a Comptroller-assigned number; a nine-digit SSN,
EIN or Comptroller-assigned number; and a self-check digit, calculated from the preceding
digits.
Contract numbers by contract type – Enter the number assigned to each contract.
Purchase order numbers by contract type – Enter the 10-digit purchase order number as
stated in each PHC contract.
Contractor Name – Enter the agency’s legal name.
City – Enter the city of the agency’s physical address.
Name of Contact and Phone– Enter the name and phone number for the agency
representative with primary responsibility for preparing the PHC 325 Annual Report.
Table 1 – Clients by Race/Ethnicity
Definitions
Race/Ethnicity – The race/ethnicity categories conform to the methodology determined by the
Texas State Data Center. These are a Non-Hispanic White (Anglo), Non-Hispanic Black, Hispanic
(of all races), and a Non-Hispanic Other population group. These consist of the census
categories: Non-Hispanic White alone, Non-Hispanic Black or African American alone, Hispanics
of all races, and persons in all other non-Hispanic racial groups referred to as the Other
population group. This latter (Other population) group also includes all persons listing two or more
races.
Instructions
This Table Must Be Completed.
Report the unduplicated number of PHC clients provided a PHC service in the fiscal year by
race/ethnicity.
Table 2 – Clients by Income Level
Revised September 2018
Primary Health Care Services Program Annual Report Form 325 Instructions
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Definitions
Income Level as a Percentage of the HHS Poverty Guidelines – The set minimum amount of
income that a family needs for food, clothing, transportation, shelter and other necessities. In the
United States this level is determined by the Department of Health and Human Services. The
percent of the Federal Poverty Level (FPL) varies according to family size. The number is
adjusted for inflation and reported annually in the form of poverty guidelines. Public assistance
programs, such as Medicaid in the U.S., define eligibility income limits as some percentage of
FPL.
Instructions
This Table Must Be Completed.
Report the unduplicated number of PHC clients provided a PHC service in the fiscal year by
income level as a percentage of the HHS poverty guidelines.
Note: The total number of clients in Table 1 should equal the total number of
clients in Table 2.
Table 3 – Clients by Other Source of Coverage
Definitions
Source of Coverage – Public or private health insurance plans that provide primary medical care
benefits to enrolled individuals. Report a source of coverage if it was available to the PHC client
while they received PHC services, even if they did not use that source of coverage to pay for
services at that time.
Supplemental Service – A PHC service provided to a HHSC PHC client while they were eligible
for another source of coverage. A PHC client may only receive a supplemental PHC service if
their other source of coverage would not pay for all or part of the service. For example, a PHC
client had coverage under CHIP Perinatal, but CHIP
Perinatal would not cover treatment of her asthma. If PHC funds are used to cover this PHC
client’s asthma treatment, then the asthma treatment would be considered a supplemental
PHC service.
Instructions
Report the following information on PHC clients with another source of coverage:
Unduplicated number of PHC clients who received a supplemental PHC service
while they had coverage under Medicaid.
Unduplicated number of PHC clients who received a supplemental PHC service
while they had coverage under CHIP Perinatal.
Table 4 – Behavioral Health Services
Definitions
Funding Source – Benefit that paid for all or part of the service.
Behavioral Health Service – Services used to treat a mental, emotional, or chemical
dependency disorder.
Revised September 2018
Primary Health Care Services Program Annual Report Form 325 Instructions
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Instructions
Report the following information on behavioral health services:
Unduplicated number of PHC clients who received a behavioral health service through
the PHC Program.
Unduplicated number of PHC clients who received a behavioral health service through
another funding source.
Questions
1. Question – What if a client received behavioral health services from both PHC and
another funding source during the year?
Answer – Agencies should report clients under each funding source through which they received
behavioral health services during the year. If a client received behavioral health services through
both PHC and another funding source, the agency may count the client once under the PHC
category and once under another funding source category.
Table 5 – PHC Encouraged Optional Staff
Definitions
Lactation Consultant – Health care professional who specializes in the clinical management of
breastfeeding and who is certified as an International Board Certified Lactation Consultant
(IBCLC) by the International Board of Lactation Consultant Examiners Inc. (IBLCE), under the
direction of the US National Commission for Certifying Agencies.
Community Health Worker – A person who, with or without compensation, is a liaison and
provides cultural mediation between health care and social services, and the community. A
Community Health Worker (CHW) is a trusted member of the community who: has a close
understanding of the ethnicity, language, socio-economic status, and life experiences of the
community served; assists people to gain access to needed services; and increases health
knowledge and self-sufficiency through a range of activities such as outreach, patient navigation
and follow-up to community health education and information, informal counseling, social support,
advocacy, and participation in clinical research. A Certified CHW is an individual with current
certification as a community health worker issued by the Department of State Health Services.
Instructions
Report the following staffing data:
Number of full-time equivalent (FTE) CHWs by compensation type
Number of FTE Lactation Consultants (LCs)
Unduplicated number of PHC clients who received a Lactation Consultant service through
the PHC Program
Table 6 – Cost of PHC Services
Definitions
Direct Care – PHC services provided to HHSC PHC clients. Enter costs associated with
providing services related to direct patient care (e.g., salaries of individuals providing healthcare
services, medical supplies, contractor costs) as detailed in the agency’s PHC contracts and
budgets.
Health Education – The process of educating or teaching individuals about lifestyles and daily
activities that promote physical, mental, and social well-being. This process may be provided on
an individual, one-to-one basis, or to a group of individuals. Enter costs associated with health
Revised September 2018
Primary Health Care Services Program Annual Report Form 325 Instructions
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education services, such as, educational materials and pamphlets
Other Direct Medical Service – Diagnosis & treatment, emergency services, family
planning, preventive health, laboratory and x-ray, health screening, prenatal medical
services, dental services, and all medications dispensed to clients (this includes Rx
vouchers).
Non-Medical Service – Transportation, nutrition, case management, social services, and other
optional PHC services.
Administrative – Administrative costs may include costs not associated with direct patient care.
(e.g., salaries for non-healthcare individuals, administrative supplies, screening and eligibility)
Instructions
This Table Must Be Completed.
Report the cost of PHC Program-funded services, by cost category and program type.
Questions
1. Question – Are Health Education, Other Direct Medical Services, and Non-Medical Services part
of direct care?
Answer – Yes. Reported costs for these three categories should add up to the total costs for
direct care services
Table 7 – Clinics where PHC clients were provided PHC Services
Definitions
Instructions
Report the following information on PHC clinics:
Clinic name
County of the clinic physical address
Zip code of the clinic physical address
Questions
1. Question – What if the clinic started providing PHC services to HHSC PHC clients after the
reporting period began? What if the clinic stopped providing PHC services to PHC clients before the
reporting period ended?
Answer – Report all clinics that provided PHC services to PHC clients at any point during the
reporting period. Report all clinics, even if the clinic started providing services after the reporting
period began or if the clinic stopped providing services before the reporting period ended.
Revised September 2018
Primary Health Care Services Program Annual Report Form 325 Instructions
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