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Appendix 12 - CCS Administrator SurveyCalifornia Children’s Services (CCS) is an important program serving some of our state’s mostvulnerable children. Federal requirements stipulate that every 5 years, State Title V (Maternal andChild Health Services Block Grant) Programs must conduct a needs assessment to identify prioritiesfor improving services for children and youth with special health care needs (CYSHCN). Since CCSreceives a portion of California’s Title V allocation, this needs assessment includes the CCS Program.As part of the needs assessment process, the Family Health Outcomes Project at the University ofCalifornia, San Francisco is conducting this online provider survey. We expect the survey to takeabout 20-25 minutes. You may skip questions if they do not apply, and we strongly encourage you toanswer the questions at the end regarding program priorities for the next five years. If you have anyquestions about the survey, you can call the Family Health Outcomes Project at (415) 476-5283. Thankyou for your valuable input!1. Please indicate which of these best describes your role in the CCS Program. (Select all that apply amily Medicine geonNurseNurse PractitionerOphthalmologistOrthodontistOrthopedic SurgeonOtolaryngologistOral-Maxillofacial SurgeonPediatricianPediatric Allergist ImmunologistPediatric CardiologistPediatric Critical Care PhysicianPediatric EndocrinologistPediatric Gastroenterologist
Pediatric HematologistPediatric Infectious Disease PhysicianPediatric NephrologistPediatric NeurologistPediatric NeurosurgeonPediatric OncologistPediatric PulmonologistPediatric SurgeonPerinatologistPhysician Assistant (PA)Physical, Occupational or Speech TherapistPsychiatristPsychologistSocial WorkerOther (please specify)2. Are you currently CCS-paneled?YesNoNot now, but I have been in the pastDon’t know/Not sure3. Please select the setting in which you practice (check all that apply):Tertiary Medical Center (Non-Kaiser)Children’s HospitalKaiser Tertiary Medical CenterStand-alone specialty clinicPrimary care practice (private)Primary care practice (public)Federally Qualified Health Center (FQHC)Other (please specify)
4. Please select the county(s) in which you practice (please select all that apply, if more than three, pleaseindicate in the "other" field):County NameCounty 1County 2County 3Other (please specify)5. When seeing CCS clients, what percentage of your time is spent providing primary care (if any), and whatpercentage of your time is spent providing specialty care (if any)?0-25%26-50%51-75%Don't Know/NotSure76-100%Primary CareSpecialty Care6. Approximately what percentage of your patients are CCS clients?0-25%26-50%51-75%76-100%Don’t know/Not sure7. Please rate the significance of the following potential barriers to providing high quality care to CCS clients(with 0 as not a barrier, and 5 as a very significant barrier):0-Not a BarrierMedi-Cal reimbursementrates for care ofconditions NOT coveredby CCSCCS reimbursementrates for care of CCScovered conditionsDelay in payments forservices provided toCCS children12345-SignificantBarrier
0-Not a BarrierAmount and difficulty ofpaperwork to completefor Medi-CalreimbursementAmount and difficulty ofpaperwork to completefor CCS reimbursementComplexity of care andamount of time neededto care for CCS childrenAmount of resourcesneeded to coordinateservices for CCSchildrenAmount of accessibleand available resources(e.g. social services,mental and behavioralhealth, respite care) forCCS children andfamiliesPrimary care physician’sability to accesselectronic informationfrom the specialty careproviders serving thesame CCS childrenWorking with Medi-CalManaged Care HealthPlans (MCPs), e.g.,approval forservices/special tests orprocedures,reimbursement processState capacity to enforceCCS regulationsState capacity toconduct facilityassessmentsState capacity topromptly processapplications forbecoming a CCSpaneled providerDelay in authorizationsfrom CCS12345-SignificantBarrier
0-Not a Barrier12345-SignificantBarrierDelay in authorizationsfrom Medi-Cal ManagedCare Health PlansDelay in authorizationsfrom Private HealthPlansTransportation issues,e.g., families getting toappointments on timeLack of electronicrecordsHealth Planrequirements to useoutside labs/diagnosticimagingCommunicationchallenges with sharinginformation betweenCCS and Health PlansOther, rate here anddescribe belowOther (please specify)8. What do you, as a provider, need from the system (CCS and/or Medi-Cal) in order to provide the bestquality care to CCS clients? Please write your answer:
9. Please indicate how much you agree or disagree with the following statements:Strongly isagreeDon’t Know/NotSureIncreasing access toprimary care for childrenwith CCS conditions willhelp decreaseemergency room visitsand hospitalizations.Increasing access tospecialty care forchildren with CCSconditions will helpdecrease emergencyroom visits andhospitalizations.The Medi-Cal providernetwork presentschallenges in terms ofthe availability andcapacity of primary andspecialty care providers.10. Please indicate how much you agree or disagree with the follow statements about monitoring CCSstandards as communicated by regulations and/or Numbered Letters:Strongly AgreeRegular facility site visitsare an important part ofmonitoring and enforcingregulations/NumberedLetters.The state CCS programhas adequate capacity(i.e. staff, clinicalexpertise, funding) toconduct periodic facilitysite visits to monitor andenforceregulations/NumberedLetters.Facility site visits areconducted by amultidisciplinary team ofstate staff andconsultants who areexperts in their yDisagreeDon’t Know/NotSure
11. Please indicate how much you agree or disagree with the follow statements:Strongly isagreeDon’t Know/NotSureDedicated funding forcounty parent liaisons tohelp CCS children andtheir families navigatethe health care systemshould be a CCSprogram priority.Families would benefitfrom County CCSprograms being requiredto convene familyadvisory committees12. How often do you (or your practice) communicate with other providers who are also serving your CCSclients?RegularlyCommunicatePrimary Care ProvidersOther Specialty CareProviders, includingSpecial Care CentersRegional CentersSchoolsCCS Medical TherapyProgram (MTP)Mental Health unicateBased on NeedsRarelyCommunicateNever CommunicateDon’t Know/NotSure
13. How often do you experience the following barriers in communicating with other providers?AlwaysUsuallySometimesDon't Know/NotSureNeverTime ConstraintsLack of SharedElectronic MedicalRecords (EMR)Health InsurancePortability andAccountability Act(HIPAA) Concerns[Consent Forms]Other (please specify)14. Please tell us how helpful the following strategies are (or could be) for improving communication with otherproviders (when 0 not helpful at all, and 5 very helpful):0-Not Helpful123One-time use HIPAAform for provider-toprovider communicationabout CYSHCNRegularly scheduledmeetings or conferencecalls to discuss complexcasesAutomatic emails toother providersindicating that patientwas seenPlease share any suggestions you may have related to using the EMR to improve communication here:45-Very Helpful
15. Medical Home Definition, American Academy of Pediatrics (AAP): "The medical care of infants, children,and adolescents ideally should be accessible, continuous, comprehensive, family-centered, coordinated,compassionate, and culturally effective. It should be delivered or directed by well-trained physicians whoprovide primary care and help to manage and facilitate essentially all aspects of pediatric care. The physicianshould be known to the child and family and should be able to develop a partnership of mutual responsibilityand trust with them.”Please indicate how much you agree that it would be helpful if Medi-Cal Managed Care Health Plansfunded pediatric practices that care for CYSHCN to become certified medical homes, and providedadditional reimbursements to cover the costs of the additional staff and services required to be amedical home:Strongly AgreeSomewhat AgreeNeutralSomewhat DisagreeStrongly DisagreeDon't Know/Not Sure16. Based on the AAP definition in the previous question, do you consider your practice to be a medical homefor your CCS and non-CCS CYSHCN clients?YesNoDon’t Know/Not Sure17. What would your practice need to become a medical home for CCS clients?Additional resources (e.g. financial reimbursements, more staff)Nothing, I have everything I need to be a medical home for CCS clientsNothing, there are other reasons for my not providing a medical home for CCS clientsDon't know/Not sureOther (please specify)
18. You selected "Nothing, there are other reasons for my not providing a medical home for CCS clients,"please tell us why:
19. Are you currently part of a Health Plan that is supporting your practice to become a medical home?YesNoNot sure/Don’t know20. Please rate the importance of the following resources that could enable your practice to be a primarymedical home for CCS clients:0 - Not ImportantElectronic medicalrecord system that linksprimary care withpediatric subspecialtyprovidersAbility to make informalconsults and contactswith subspecialtyproviders (email, phoneconsultation, and/ortelemedicine)Reimbursement forlonger office visitsSupport staff for nt for carecoordination and casemanagement servicesReadily availabletreatment guidelines forpatients with specificdiagnoses/conditions(e.g., neurofibromatosis,seizure disorders)Readily availablecommunity levelresources (e.g.,Regional Center, FamilyVoices) for my patientsand their families tomeet their social,psychosocial, and homehealth needs12345 - VeryImportant
0 - Not Important12345 - VeryImportantAvailability ofsubspecialty pediatricproviders in my networkDirect mechanism forcommunication andinteracting with thechild’s schoolOther, please rate hereand then specify belowOther (please specify)21. Please tell us what differences, if any, there are in the coordination of health care for CCS versus non-CCSCYSHCN:22. How important is it for you (or your practice) to provide care coordination for CCS and non-CCS CYSHCNpatients?Very ImportantImportantSomewhat ImportantNot ImportantDon't Know/Not Sure
23. If your practice provides care coordination for CYSHCN, which of the following entities pays for this?(Check all that apply)Not applicable - my practice does not do care coordinationCCSMedi-Cal Managed Care Health PlanPrivate insurancePhilanthropyNo one pays for it, we just do it because it is neededDon’t know/Not SureOther (please specify)
24. Please tell us how often, if ever, the following issues related to durable medical equipment (DME) [e.g.,wheelchairs and walkers] present problems for your patients:Frequently aProblemOccasionally aProblemRarely a ProblemNever a ProblemDon't Know/NotSureToo few DME providerswilling to work with MediCal due to lowreimbursement ratesToo few DME providerswilling to work with MediCal due to delays inpaymentDME providers refusingto provide certain kindsof equipment due to lowreimbursement rates forthat equipmentClient discharges beingdelayed due to issues inobtaining DMEHospitals or familieshaving to purchase DMEso that clients can bedischarged in a timelymannerClients missingschool/parents missingwork due to delays ingetting or repairingneeded DMEDME providers refusingto repair or maintainequipment that theywere not authorized toprovideOther (please specify)25. Were you aware that, even if your Medi-Cal Managed Care Health Plan assigns the youth to an adultprovider, CCS can continue to authorize pediatric primary and specialty care when medically necessary untilage 21?YesNo
26. Please indicate how much you agree with the following statements about transition. Youth who have agedout of CCS and have Medi-Cal would benefit from having:Strongly AgreeSomewhat AgreeSomewhat DisagreeStrongly DisagreeDon't Know/NotSureA multidisciplinarytransition team includinga Licensed ClinicalSocial Worker, Nurse,Case Manager, SpecialtyCare Provider, PrimaryCare Physician, MedicalTherapy Programprovider, etc.Assistance in finding anew primary careproviderAssistance in finding anew specialty careproviderOther (please specify)27. Should eligibility for certain CCS conditions (e.g. hemophilia or cystic fibrosis) be extended to 65 years old,at which time Medicare would be available?YesNoDon’t Know/Not Sure28. If yes, please tell us which CCS conditions should be extended to 65 years old:29. Telehealth is increasingly being used as a tool to provide care for CCS clients in both urban and ruralsettings.Do you currently provide telehealth services or would you be willing to provide telehealth services to CCSclients?Yes, I do provide telehealth servicesYes, I would be willing to provide telehealth services, but I don't currently provide themNo, I don't provide telehealth services and I will not be able to do soDon’t Know/Not Sure
30. What, if any, barriers are there to providing telehealth services for CCS patients?31. What steps should be taken to reduce barriers to providing telehealth services?32. What additional information and/or data should be available to improve the CCS Program anddemonstrate program outcomes?33. Research using CCS claims data indicates that for CCS clients with chronic, complex conditions, spendingon home care makes up a significant portion of expenditures. How can access to home care services beimproved? Please briefly describe:34. Please tell us how much you agree with the following statements:Strongly AgreeMedi-Cal will cover thecost of transportation toand from appointmentsfor your CCS and MediCal patients.CCS children haveadequate access tomental and behavioralhealth care.Non-CCS CYSHCN withprivate insurance haveadequate access tomental and behavioralhealth care.CYSHCN with Medi-CalManaged Care HealthPlans have adequateaccess to mental andbehavioral health care.Somewhat AgreeSomewhat DisagreeStrongly DisagreeDon't Know/NotSure
35. Please answer the following questions on some of your screening practices:AlwaysHow often do you (orsomeone in yourpractice) use ascreening tool to identifyneeds related to thesocial determinants ofhealth (e.g. housingproblems, foodinsecurity, etc.) for yourCCS patients?How often do you (orsomeone in yourpractice) use ascreening tool to identifyneeds related to mentaland behavioral health foryour CCS patients?How often do you (orsomeone in yourpractice) use ascreening tool to identifyneeds related to thesocial determinants ofhealth (e.g. housingproblems, foodinsecurity, etc.) for yournon-CCS CYSHCNpatients?How often do you (orsomeone in yourpractice) use ascreening tool to identifyneeds related to mentaland behavioral health foryour non-CCS CYSHCNpatients?UsuallySometimesNeverDon't Know/NotSure
36. If you (or someone in your practice) do not routinely screen your CYSHCN for mental and behavioralhealth, please indicate why (choose all that apply):Not applicable - CYSHCN are routinely screened for mental and behavioral healthNot aware of referral sources to be able to address these needsNot enough time to do screeningNot enough staff to do screeningNo reimbursementNot familiar with screening toolsScreening tool not built into EMRNot my role/jobOther (please specify)37. Please describe additional barriers (if any) to screening and referral for mental and behavioral health forCYSHCN AND for their families:For CCS CYSHCN:For non-CCS CYSHCN:38. If you (or someone in your practice) do not routinely screen your CYSHCN for social determinants ofhealth, please indicate why (choose all that apply):Not applicable - CYSHCN are routinely screened for social determinants of healthNot aware of referral sources to be able to address these needsNot enough time to do screeningNot enough staff to do screeningNo reimbursementNot familiar with screening toolsScreening tool not built into EMRNot my role/jobOther (please specify)
39. Please describe additional barriers (if any) to screening and referral for the social determinants of healthfor CYSHCN AND their families:For CCS CYSHCNFor non-CCS CYSHCN40. How important is the annual well-child visit for CCS children and other CYSHCN?Very importantImportantSomewhat importantNot important41. Are the CYSHCN that you care for receiving yearly well-child visits?Yes, most appear to be having these visitsYes, but only some appear to be having these visitsNo, it appears that most are not having these visitsI don’t know whether they are having these visits42. Do you know who is conducting the well-child visits?YesNoDon’t know/Not sure43. If yes, who is conducting the well-child visits?44. What do you think should be the top three priorities for CCS over the next five years?Priority 1Priority 2Priority 345. Please use this space to share any other comments you want to make about the CCS Program:
Primary care physician's ability to access electronic information from the specialty care providers serving the same CCS children Working with Medi-Cal Managed Care Health Plans (MCPs), e.g., approval for services/special tests or procedures, reimbursement process State capacity to enforce CCS regulations State capacity to conduct facility .
