Transcript High Risk Infant Follow-Up (HRIF) Quality of Care

2013 Data Training Sessions
Training for CCS HRIF Program Web-Based Reporting System
Erika Gray, BA
HRIF-QCI Project Manager
CPQCC


1979 CCS Standards for “Tertiary” NICUs were developed
addressed CCS HRIF examinations. “CCS may pay for follow-up
examination of high risk NICU graduates even though a CCS
eligible condition does not exist“.
July 1, 2006 restructured CCS HRIF Program went into effect
Core Diagnostic Services
Comprehensive History & Physical Exam with Neurologic
Assessment
Developmental Assessment
Family Psychosocial Assessment
Hearing Assessment
Ophthalmologic Assessment
Coordinator Services

CCS & CPQCC designed the High Risk Infant Follow-up Quality
Care Initiative (HRIF-QCI) Reporting System to:
 Identify quality improvement opportunities for NICUs in the
reduction of long term morbidity
 Allow HRIF programs to compare their activities with all sites
throughout the state
 Allow the state to assess site-specific successes
 Support real-time case management
Reference: CCS Program Letter (PL): 01-0611

CCS-approved HRIF Programs are required to complete and
submit reports to CPQCC using the web-based HRIF-QCI
Reporting System for infants and children enrolled in a CCSapproved HRIF Program as of January 1, 2009, and thereafter.

CCS-approved NICUs are responsible for ensuring that all highrisk eligible infants discharge from the NICU are referred to their
CCS-approved HRIF Program or have a written agreement for the
provision of these services by another CCS-approved HRIF
Program.
https://www.ccshrif.org/download.html
CCS HRIF PROGRAM MEDICAL ELIGIBILITY CRITERIA
Data should be collected on infants/children under three years of age who meet California Children’s Services (CCS) HRIF medical eligibility criteria
and who met CCS medical eligibility criteria for Neonatal Intensive Care Unit (NICU) care OR had a CCS eligible medical condition at some time during
their stay in a CCS-approved NICU, even if they were never a CCS client. Infants are medically eligible for the HRIF Program when the infant:
Met CCS medical eligible criteria for NICU care, in a CCS-approved
NICU, regardless of length of stay, (as per Number Letter 05-0502, Medical
Had a CCS eligible medical condition in a CCS-approved NICU,
regardless of length of stay, (as per California Code of Regulations, Title 22,
OR
Section 41800 through 41872, CCS Medical Eligibility Regulations).
Eligibility in a CCS-approved NICU).
AND MET ONE OF THE FOLLOWING
Birth weight ≤ 1500 grams or the gestational age at
birth < 32 weeks.
OR
Birth weight > 1500 grams and the gestational age at birth ≥ 32
weeks and one of the following criteria was met during the
NICU stay:
A.
Cardiorespiratory depression at birth (defined as pH less than 7.0 on an
umbilical blood sample or a blood gas obtained within one hour of life) or an
Apgar score of less than or equal to three at five minutes.
B.
A persistently and severely unstable infant manifested by prolonged hypoxia,
acidemia, hypoglycemia and/or hypotension requiring pressor support.
C.
Persistent apnea which required medication (e.g. caffeine) for the treatment of
apnea at discharge.
D.
Required oxygen for more than 28 days of hospital stay and had radiographic
finding consistent with chronic lung disease (CLD).
1.The discharging/referring NICU/Hospital or HRIF Program will submit a
Service Authorization Request (SAR) to local CCS Office. (Service Code
Group [SCG] 06, should be requested). http://www.dhcs.ca.gov/
services/ccs/cmsnet/Pages/SARTools.aspx
E.
Infants placed on extracorporeal membrane oxygenation (ECMO).
F.
Infants who received inhaled nitric oxide greater than four hours for persistent
pulmonary hypertension of the newborn (PPHN).
2.The discharging/referring NICU/Hospital will send a copy of the
Discharge Summary to the HRIF Program.
H.
Evidence of intracranial pathology, including but not limited to, intracranial
hemorrhage (grade II or worse), periventricular leukomalacia (PVL), cerebral
thrombosis, cerebral infarction, developmental central nervous system (CNS)
abnormality or “other CNS problems associated with adverse neurologic
outcome”.
I.
Other problems that could result in neurologic abnormalities (e.g., history of
CNS infection, documented sepsis, bilirubin in excess of usual exchange
transfusion level, cardiovascular in stability, hypoxic ischemic encephalopathy,
et cetera.
HRIF Program Referral Process:
Communication is between the CCS-approved NICU and HRIF Program.
1.The discharging/referring NICU/Hospital will refer eligible infants to the
HRIF Program at the time of discharge to home, and complete the
“Referral/Registration Form” via the web-based HRIF-QCI Reporting
System.
Medical eligibility for the HRIF Program is determined by the County CCS
Program or Regional Office staff. The CCS Program is also required to
determine residential eligibility. As the HRIF Program is a diagnostic service,
there is no financial eligibility determination performed at the time of referral
to CCS. However, insurance information shall be obtained by CCS. An infant
or child is eligible for the HRIF Program from birth up to 3 years of age.
G. History of documented seizure activity.
Revised 9/1/2011
This web-based Reporting System
was developed for CCS HRIF Program
medically eligible infants, regardless of
insurance status or CPQCC eligibility.
1.
Executive Committee – meets quarterly and provides expertise
and guidance
2.
Data Advisory Abstractor Work Group – meets annual to review
data collection and provides recommendations
3.
Steering Committee – ad hoc group that provides specific
expertise
4.
Ad hoc Work Groups - NICU Report; Quality Improvement;
Medical Eligibility Criteria and Cerebral Palsy
1.
Standardize California HRIF Programs
2.
Identify Quality Improvement Issues for NICUs
3.
Early Identification: Infants Who Would Benefit From HRIF
Program Services
4.
Serve as a Surveillance Tool: Monitor NICU Medical Risk
Factors
5.
Case Management Profile: Manage Patient Resources and
Monitor Infant’s Actual Service Profile

69/115 (57%) CCS NICUs have a HRIF Program

67/69 (97%) HRIF Programs reporting online
◦ 19/20 Regional
◦ 43/44 Community
◦ 2/2 Intermediate

17/46 (37%) referring CCS NICUs reporting online
◦ 14/31 Community
◦ 3/15 Intermediate
BIRTH YEAR
2009
2010
2011
TOTAL
N
N
N
Ref/Registration
6497
6983
7001
20,481
Standard #1
4559
4713
4397
13,669
Standard #2
3431
3157
1422
8,010
Standard #3
2135
1299
38
3,472
Referral/Registration Form
It is the responsibility of the discharging to home California Children’s
Services (CCS) Neonatal Intensive Care Unit (NICU)/Hospital OR the last
CCS NICU/Hospital providing care to make the referral to the High Risk
Infant Follow-up (HRIF) Program.
Upon referring an infant to the High Risk Infant Follow-up (HRIF)
Program, a “Referral/Registration Form” is completed (except HRIF I.D.
Number) by the discharge/referring NICU/Hospital at time of discharge
to home.
HRIF Program Referral Process:
Communication is between the CCS-approved NICU and HRIF Program.
1.The
discharging/referring NICU / Hospital will refer eligible infants to
the HRIF Program at time of discharge to home, and complete the
“Referral/Registration Form” via the web-based HRIF-QCI Reporting
System.
2.The
discharging/referring NICU / Hospital or HRIF Program will submit
a Service Authorization Request (SAR) to the Local CCS Office for HRIF
services. (Service Code Group [SCG] 06, should be requested).
http://www.dhcs.ca.gov/services/ccs/cmsnet/Pages/SARTools.aspx
3.The
discharging/referring NICU / Hospital will send a copy of the
Discharge Summary to the HRIF Program.
4.The
HRIF Program will accept the infant’s case and all applicable
information will be carried forward to the “Standard Visit Form” as
appropriate in order to decrease entering data that is already in the
system.
Standard Visit Form
The HRIF Program has three core visits that take place during the
following time periods: Visit #1 (4-8 months), Visit #2 (12-16 months)
and Visit #3 (18-36 months).
During the third and final core visit (18-36 months) a developmental
test, such as a Bayley III Scales of Infant and Toddler Development, must
be performed and reported. It is highly recommended that an Autism
Spectrum Screening tool such as the MCHAT be performed between 1630 months of age.
Incomplete Standard Visits
If you cannot obtain a neurologic or developmental assessment during
the core visit, schedule a return visit for the infant to complete the
assessment(s) and indicate the reason why the assessment was not
performed. When the infant returns the missing neurologic or
developmental assessment data can be entered on the incomplete
“Standard Visit Form.” The date of the return visit should be entered into
the “Date Performed” field(s).
Additional Visit Form
If an infant requires additional visits for further assessment, an
“Additional Visit Form” must be completed. Additional visits may occur
before, between and/or after the recommended time frames for
Standard Visits.
This form only captures the date, reason (Social Risk, Case Management,
Concerns with Neuro/Developmental Course or Other) and disposition
for the additional visit.
Client Not Seen/Discharge Form
Used for the following 5 case scenarios:
1.
2.
3.
4.
5.
Infant referred to your HRIF Program, but your staff was unable to
contact the infant’s parent (primary caregiver) to establish an initial
core visit.
No Show: parent (primary caregiver) rescheduled (less than 24 hours)
of a scheduled appointment or did not come to a scheduled core visit
appointment.
Infant eligible for HRIF Program, but parent (primary caregiver)
declines service.
Infant expired prior to core visit, family relocated, insurance denial,
etc.
Infant transferred/referred to another HRIF Program for follow-up
services.
This form captures only the date, category, reason and disposition
for the client not seen visit.
REFERRAL REGISTRATION FORM
“Unable to Complete Form” check box – online only
Should ONLY be used for the following (3) case scenarios:
1. Infant expired prior initial core visit - disposition: Closed
2. Parents refused follow-up services – disposition: Closed
3. Lost to follow (unable to contact the family after multiple attempts)
– disposition: Closed
NOTE: Complete a “Client Not Seen/Discharge Form” to capture the
reason why the Referral/Registration Form will be incomplete.
REFERRAL REGISTRATION FORM
1. CPQCC Reference Number
NOTE: Enter “00000” as the CPQCC Network Patient ID Number, if your not sure
if the infant met the CPQCC NICU Eligibility Criteria or the CPQCC data contact
person is backlogged and, therefore has not assigned a CPQCC Network Patient
ID Number for the infant. Use the “CPQCC Reference Number Report” to replace
assigned CPQCC Network Patient ID Numbers.
2. Date of Discharge to Home (*Required Field)
Enter the date when the infant/child was discharged home (Foster Care or
Medical Foster Care) from your hospital without ever transferring to another
hospital using MM/DD/YYYY.
NOTE: Discharge to home occurs when an infant goes home from your
hospital, not the NICU.
STANDARD VISIT FORM
3. Core Visit (*Required Field)
The HRIF Program has three core visits that take place during the following
recommended time periods: Visit #1 (4-8 months), Visit #2 (12-16 months)
and Visit #3 (18-36 months).
Enter the appropriate Core Visit by selecting “1”, “2”, or “3”.
NOTE: Core Visit #1 is the initial first visit to the follow-up program, even if
the patient is older than 8 months corrected age.
4. Hospitalizations Since Last Visit
If this is the infant/child’s first core visit, indicate if the infant/child was
hospitalized since NICU discharge and prior to the first HRIF core visit. If this
is the second or third Core visit, indicate if the infant/child was hospitalized
between HRIF Core assessment visits.
NOTE: A hospitalization is defined as admission and at least an overnight
stay in the hospital. This should be distinguished from a long emergency
room visit or urgent care outpatient clinic visit that may or may not have
been over night during interviews with the family.
STANDARD VISIT FORM
5. Medications Since Last Visit
New item “Oral Steroids”
NOTE: The purpose of this question is to capture the significant and/or
consistent medications that the child is taking or has taken during the
intervals described. Occasional use of acetaminophen, ibuprofen, or over
the counter cough or cold medications should not be captured.
6. Equipment Since Last Visit
New item “Helmet”
7. Does the Child Have Visual Impairment / Hearing Loss? - sections
Added “per specialized clinical exam or parent report” to definition.
STANDARD VISIT FORM
8. Neurologic Assessment
New item “C. Is There Scissoring of the Leg on Vertical Suspension?
If “Abnormal” or “Suspect” was checked for neurologic assessment exam, indicate if there
is persistent “scissoring” (crossing of the legs) when the infant/child is vertically
suspended (supported under arms).
Select “No”, if there is no scissoring of the legs on vertical suspension present.
Select “Yes”, if there is scissoring of the legs on vertical suspension present.
9. Medical Therapy Unit (MTU) – New Section
The Medical Therapy Program (MTP) is a special program withinCalifornia
Children's Services that provides physical therapy (PT), occupational therapy
(OT) and medical therapy conference (MTC) services for children who have
handicapping conditions, generally due to neurological or musculoskeletal
disorders. Website: http://www.dhcs.ca.gov/services/ccs/Pages/MTP.aspx
Is the Child Receiving Services Through CCS Medical Therapy Program (MTP)?
Check all instances (options) that apply at the time of core visit. Valid options
are “No”, “Yes”, “Referred”, “Referral Failure”, “Parent Refused Service”,
“Determined Ineligible by MTP” or “Unknown”.
STANDARD VISIT FORM
10. Child Protective Services (CPS)
Added: “Is a Child Protective Services (CPS) Case Currently Opened?”
Select one option that applies at the time of core visit.
Select “No”
Select “Yes”, if CPS referral is pending or currently opened
Select “Referred at Time of Visit”
STANDARD VISIT FORM
11. Disposition (*Required Field) – Redefined
Select only one option that applies at the time of core visit.
Select
“Scheduled to Return”, the infant/child will be scheduled for another
follow-up core visit at the HRIF Program.
Select
“Will Be Followed by Another CCS HRIF Program” when the infant/child
is transferred and receiving follow-up care from another CCS HRIF Program.
Select
“Discharged Graduated”, the infant/child has completed the three HRIF
Program follow-up core visits and has reached the 3-year age limit. No
further data will be submitted to CMS/CCS.
Select
“Discharged, Will Be Followed Elsewhere”, when the infant/child will be
receiving follow-up care from a NON CCS HRIF Program or from out of state.
No further data will be submitted to CMS/CCS
STANDARD VISIT FORM
11. Disposition (*Required Field) – Redefined
continue
Select
“Discharged, Closed Out of Program”, the HRIF Program has
determined that the infant/child is no longer needs to be followed within a
CCS HRIF Program. No further data will be submitted to CMS/CCS.
Select
“Discharged, Family Withdrew Prior To Completion”, the infant/child’s
primary caregiver(s) decides not to return or continue follow-up core visits at
the CCS HRIF Program, before the final (3rd) visit or the child’s third birthday.
No further data will be submitted to CMS/CCS.
Select
“Discharged, Completed HRIF Core Visits, Referred for Additional
Resources”, the child has completed the three HRIF Program follow-up core
visits, has reached the 3-year age limit and referred for additional resources.
No further data will be submitted to CMS/CCS.
ADDITIONAL VISIT FORM
13. Disposition (*Required Field) – Redefined
Select only one option that applies at the time of core visit.
Select
“Scheduled to Return”, the infant/child will be scheduled for another
follow-up core visit at the HRIF Program.
Select
“Will Be Followed by Another CCS HRIF Program” when the infant/child
is transferred and receiving follow-up care from another CCS HRIF Program.
Select
“Discharged Graduated”, the infant/child has completed the three HRIF
Program follow-up core visits and has reached the 3-year age limit. No
further data will be submitted to CMS/CCS.
Select
“Discharged, Will Be Followed Elsewhere”, when the infant/child will be
receiving follow-up care from a NON CCS HRIF Program or from out of state.
No further data will be submitted to CMS/CCS
ADDITIONAL VISIT FORM
13. Disposition (*Required Field) – Redefined
continue
Select
“Discharged, Closed Out of Program”, the HRIF Program has
determined that the infant/child is no longer needs to be followed within a
CCS HRIF Program. No further data will be submitted to CMS/CCS.
Select
“Discharged, Family Withdrew Prior To Completion”, the infant/child’s
primary caregiver(s) decides not to return or continue follow-up core visits at
the CCS HRIF Program, before the final (3rd) visit or the child’s third birthday.
No further data will be submitted to CMS/CCS.
Select
“Discharged, Completed HRIF Core Visits, Referred for Additional
Resources”, the child has completed the three HRIF Program follow-up core
visits, has reached the 3-year age limit and referred for additional resources.
No further data will be submitted to CMS/CCS.
CLIENT NOT SEEN/DISCHARGE FORM
14. Category (*Required Field) – Redefined
Select “Discharged”, if the infant/child will be referred to another CCS HRIF
Program or other program (Non-CCS HRIF Program) for follow-up services.
15. Disposition (*Required Field) – Redefined
Select
“Scheduled Appointment”, if the infant/child has been scheduled for a
return follow-up core visit.
Select
“Will Schedule Appointment”, if the infant/child will be scheduled for a
return follow-up core visit.
Select
“Will Be Followed by Another CCS HRIF Program” when the infant/child
is transferred and receiving follow-up care from another CCS HRIF Program.
CLIENT NOT SEEN/DISCHARGE FORM
15. Disposition (*Required Field) – Redefined
continue
Select
“Discharged, Will Be Followed Elsewhere”, when the infant/child will be
receiving follow-up care from a NON CCS HRIF Program or from out of state.
No further data will be submitted to CMS/CCS
Select
“Discharged, Closed Out of Program”, the HRIF Program has
determined that the infant/child is no longer needs to be followed within a
CCS HRIF Program. No further data will be submitted to CMS/CCS.
• PART 1 – Referral/Registration Missing Data (RMD)
• PART 2 – Duplicate Records
• PART 3 – Patient Case History (RCH)



PART 1 - "Referral/Registration Missing Data (RMD) Report", this
report only identifies records (infants born in 2009 and 2010) with
missing data items in the HRIF Program dataset (birth mother's
DOB, caregiver information, missing CPQCC ID numbers, language,
race and ethnicity).
PART 2 - "Duplicate Records", an email was sent to all HRIF Program
Coordinators October 2nd - 8th, identifying duplicate records found
in the Reporting System. Deadline to removal duplicate records is
November 5, 2012.
PART 3 - "Record Case History (RCH) Report", this report displays
the dates and dispositions for infants born in 2009 and 2010,
including attached forms (Standard Visits, Client Not
Seen/Discharges and Additional Visits) submitted in the HRIF
Program. The purpose of this report is to help HRIF Programs track
and close case records.
*Use these reports as a tool. Please login the
web-based HRIF-QCI Reporting System to
update any records by January 13, 2013.
• Duplicate records across programs
• Programs registering infants who expired in the NICU
• Programs registering infants who haven’t been discharge
to home (transfer date is entered as discharge to home
date)
• Missing CPQCC ID #’s (difficult to obtain from CPQCC
Contacts)
• Incorrect OSHPD codes used for CPQCC Reference Number
• Mother’s identified as primary caregiver, but Mother’s DOB
is unknown
• NON CCS hospitals are be selected as “Referring CCS
NICUs”
• No communication between NICU CPQCC Data Contacts
and Discharge Planner/HRIF Program with CPQCC Network
Patient ID#’s
• CCS NICUs not referring eligible infants via the web-based
Reporting System
• Transferring data in a timely manner (NICU to HRIF
Program)
• Referral/Registration Forms not submitted at the time of
discharge to home
• HRIF Programs ONLY enrolling infants who show at the
initial core visit (missing infants who may have qualified at
time of discharge)
•
Universal Duplicate Record Feature
•
•
•
Patient Data Self Audit Instrument Report
HRIF Summary Report
NICU Summary Report
•
•
•
CPQCC Reference Number Tool
Parent Questionnaire Tool
Tracker Tool – available Feb 2013
Complete the Reporting System User Contact Form and fax to 650721-5751, Attention: HRIF-QCI Support Staff. Available on the
www.ccshrif.org Homepage.
USER ACCESS ACCOUNTS (contacts can have multiple accounts):
Data
User: CCS-approved HRIF Program staff submits all data forms
(Referral/Registration, Standard Visit, Additional Visit and Client Not
Seen/Discharge) for infants/children receiving follow-up services from their
own HRIF Program. Data Users can generate HRIF Program and Patient
Summary reports.
Referral
User: CCS-approved NICU and/or HRIF Program staff refers HRIF
eligible infants to a CCS HRIF Program and only has access to submit the
“Referral/Registration Form”. Currently no access to generate/view reports.
NICU
User: CCS-approved NICU staff (read-only access) generate/view NICU
reports.
*User Interface Access Accounts Overview – available
for download: https://www.ccshrif.org/download.html
Universal Duplicate Record Feature
Identifies existing records across the entire HRIF-QCI
database that have the same “Date of Birth”, “Gender”,
“Singleton/Multiple” status, “Birth Hospital”, and “Mother’s
Date of Birth”.
1. Click the HRIF ID # to review record
2. Contact the HRIF Program who registered the patient
1. Email [email protected] request to transfer the record
HRIF Summary Reports
Allows HRIF Programs to view HRIF follow-up outcome data and compare to
all HRIF Programs. Users are able to view their own HRIF Program or “All”, and
filter based on “Discharge NICU”, “Infant’s Birth Year”, “Infant’s Birth Weight”,
“Report Name: Referral/Registration, Standard Visits (1, 2, or 3) or by age
range” and “Report Section Name”. Located under the “Report” tab
NICU Summary Reports
Allows CCS NICUs to view HRIF follow-up outcome data for infants cared for
in their NICU and compare to all CCS NICUs. Users are able to view their own
NICU hospital or “All”, and filter based on “Infant’s Birth Year”, “Infant’s Birth
Weight”, “Inborn/Outborn”, and “Standard Visit (1, 2, or 3) or Adjusted Age
Range” at follow up. NOTE: In order to view this report, you must have “NICU
User” access. Located under the “Report” tab
CPQCC Reference Number Report
Purpose to update/enter multiple CPQCC ID Numbers and verify data entry.
Parent Questionnaire Form
To collect social-demographic information about High Risk Infant Follow-up
(HRIF) patients and their families to determine the specific needs of this patient
population and develop better standards of care for California HRIF Programs.
HRIF Tracker
Help programs schedule and track patient records.
Coming Soon Early 2013
•
•
•
•
•
•
Transfer Patient Records Process
Website: Homepage
Website: Download Page
HRIF-QCI Manual: Web-based Reporting System
Review
CPQCC & HRIF-QCI Directory
CPQCC Newsletter
1.
1.
Contact the CCS HRIF Program Coordinator where the patient will
be transferred for follow-up care, to inform them of the patient.
Submit a “Client Not Seen/Discharge Form”, before requesting to
transfer the patient’s record:
Category: "Discharged”
Reason: "Infant Referred to Another HRIF Program"
Disposition: "Will be Followed Elsewhere"
2.
Email HRIF-QCI Reporting System Support ([email protected]) to
request the record transfer to another CCS HRIF Program. Include
in the email request the patient’s “HRIF ID Number”, “Date of Birth”
and the “HRIF Program, where the patient will be transferred”.
NOTE: Records are transferred every Friday; request received on Friday
will be transferred the following week.
“Homepage”
“Homepage”
“Download Page”
• Located on the CPQCC and
HRIF-QCI Websites:
www.cpqcc.org
www.ccshrif.org
• Password to open
directory: datacontact
• Contact the CPQCC/HRIFQCI Office, if any of the
information is inaccurate
or needs to be updated:
[email protected]
• Biannual update (new
version available in January
and July)
BEST PRACTICE PROCESS
Data should be submitted using the web-based “HRIF QCI Reporting System” for infants/children under three years of age
who meet California Children’s Services (CCS) HRIF medical eligibility criteria, even if they were never a CCS client.
NICU
Responsible for ensuring that ALL high-risk
infant’s discharged home from a CCS NICU are
referred to a HRIF Program.
1.Identify infant’s that meet the CCS HRIF
Program medical eligibility criteria. (Request the
CPQCC Network ID number from the CPQCC Data
Contact, ONLY if the infant met the CPQCC
eligibility criteria. NOTE: Non-CPQCC eligible
infants are coded as “99999”.)
2.Complete and submit the “HRIF-QCI
Referral/Registration Form” online at
https://www.ccshrif.org/
HRIF PROGAM
As part of HRIF Program evaluation, quality
improvement activities and program monitoring,
HRIF Programs will be required to report outcome
and service data to the CMS Branch.
HRIF Program will complete and submit the
following forms to CPQCC online at
https://www.ccshrif.org/
1. Referral/Registration Form (completed
by the CCS NICU)
2. Standard Visit Form
Recommended time periods:
3.Provide a copy of the infant’s discharge
summary to the referred HRIF Program
•
Core Visit #1 (4 - 8 months)
•
Core Visit #2 (12 - 16 months)
4.The discharging/referring NICU or HRIF Program
will submit a Service Authorization Request (SAR)
to the Local CCS Office for HRIF Services.
•
Core Visit #3 (18 – 36 months)
3. Additional Visit Form
4. Client Not Seen/Dsicharge Form
Referring CCS NICU/Hospitals:
◦ Staff identifies CCS HRIF Program eligible infants
◦ Staff completes the “Referral/Registration Form” at time
of discharge to home
 Contact the CPQCC Data Contact to identify CPQCC
eligible infants. If eligible, obtain the CPQCC Network ID
Number and include on the “Referral/Registration Form”
as the CPQCC Reference Number. If NOT eligible, code
infant as “99999”
◦ Submit the “Referral/Registration Form” to the HRIF
Program via the web-based Reporting System
◦ Fax a copy of the discharge summary to the HRIF Program
HRIF Programs
– Enroll CCS HRIF Program eligible infants, if they were not
previously identified and referred by the discharging to
home CCS NICU/Hospital
• Contact the discharge or birth CCS-approved NICU
CPQCC Data Contact to identify CPQCC eligible infants.
If eligible, obtain the CPQCC Network ID Number and
include on the “Referral/Registration Form” as the
CPQCC Reference Number. If NOT eligible, code infant
as “99999”
– The discharging/referring NICU/Hospital or HRIF Program
will submit a Service Authorization Request (SAR) to the
Local CCS Office for HRIF Services. (Service Code Group
[SCG] 06, should be requested).
http://www.dhcs.ca.gov/services/ccs/cmsnet/Pages/SAR
Tools.aspx
HRIF Programs – continue
– Complete a “Standard Visit Form” for each infant/child
during the following core visit time frames:
• Visit #1 (4 – 8 months)
• Visit #2 (12 – 16 months)
• Visit #3 (18 – 36 months)
– Standard Visit #3
• Developmental Test MUST be performed, not a Screener
• Autism Optional Section is highly recommended
– Complete an “Additional Visit Form” for an infant/child who
requires additional visits between the recommended core
visit time frames
HRIF Programs – continue
– Complete a “Client Not Seen/Discharge Form” for an
infant/child who:
1.Infant referred to your HRIF Program, but your staff was
unable to contact the infant’s parent (primary caregiver)
to establish an initial core visit.
2.No Show: parent (primary caregiver) rescheduled (less
than 24 hours) of a scheduled appointment or did not
come to a scheduled core visit appointment.
3.Infant eligible for HRIF Program, but parent (primary
caregiver) declines service.
4.Infant expired prior to core visit, family relocated,
insurance denial, etc.
5.Infant transferred/referred to another HRIF Program for
follow-up services.