California Children’s Services (CCS) is an important program serving some of our state’s most vulnerable children. Federal requirements stipulate that every 5 years, State Title V (Maternal and Child Health Services Block Grant) Programs must conduct a needs assessment to identify priorities for improving services for children and youth with special health care needs (CYSHCN). Since CCS receives 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 of California, San Francisco is conducting this online provider survey. We expect the survey to take about 20-25 minutes. You may skip questions if they do not apply, and we strongly encourage you to answer the questions at the end regarding program priorities for the next five years. If you have any questions about the survey, you can call the Family Health Outcomes Project at (415) 476-5283. Thank you for your valuable input!

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* 1. Please indicate which of these best describes your role in the CCS Program. (Select all that apply if necessary):

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* 2. Are you currently CCS-paneled?

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* 3. Please select the setting in which you practice (check all that apply):

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* 5. When seeing CCS clients, what percentage of your time is spent providing primary care (if any), and what percentage of your time is spent providing specialty care (if any)?

  0-25% 26-50% 51-75% 76-100% Don't Know/Not Sure
Primary Care 
Specialty Care

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* 6. Approximately what percentage of your patients are CCS clients?

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* 7. 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 Barrier 1 2 3 4 5-Significant Barrier
Medi-Cal reimbursement rates for care of conditions NOT covered by CCS
CCS reimbursement rates for care of CCS-covered conditions
Delay in payments for services provided to CCS children
Amount and difficulty of paperwork to complete for Medi-Cal reimbursement
Amount and difficulty of paperwork to complete for CCS reimbursement
Complexity of care and amount of time needed to care for CCS children
Amount of resources needed to coordinate services for CCS children
Amount of accessible and available resources (e.g. social services, mental and behavioral health, respite care) for CCS children and families
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 assessments
State capacity to promptly process applications for becoming a CCS-paneled provider
Delay in authorizations from CCS
Delay in authorizations from Medi-Cal Managed Care Health Plans
Delay in authorizations from Private Health Plans
Transportation issues, e.g., families getting to appointments on time
Lack of electronic records
Health Plan requirements to use outside labs/diagnostic imaging
Communication challenges with sharing information between CCS and Health Plans
Other, rate here and describe below

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* 8. What do you, as a provider, need from the system (CCS and/or Medi-Cal) in order to provide the best quality care to CCS clients? Please write your answer:

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* 9. Please indicate how much you agree or disagree with the following statements:

  Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree Don’t Know/Not Sure
Increasing access to primary care for children with CCS conditions will help decrease emergency room visits and hospitalizations.
Increasing access to specialty care for children with CCS conditions will help decrease emergency room visits and hospitalizations.
The Medi-Cal provider network presents challenges in terms of the availability and capacity of primary and specialty care providers.

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* 10. Please indicate how much you agree or disagree with the follow statements about monitoring CCS standards as communicated by regulations and/or Numbered Letters:

  Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree Don’t Know/Not Sure
Regular facility site visits are an important part of monitoring and enforcing regulations/Numbered Letters.
The state CCS program has adequate capacity (i.e. staff, clinical expertise, funding) to conduct periodic facility site visits to monitor and enforce regulations/Numbered Letters.
Facility site visits are conducted by a multidisciplinary team of state staff and consultants who are experts in their fields.

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* 11. Please indicate how much you agree or disagree with the follow statements:

  Strongly Agree Somewhat Agree Neutral Somewhat Disagree Strongly Disagree Don’t Know/Not Sure
Dedicated funding for county parent liaisons to help CCS children and their families navigate the health care system should be a CCS program priority.
Families would benefit from County CCS programs being required to convene family advisory committees

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* 12. How often do you (or your practice) communicate with other providers who are also serving your CCS clients?

  Regularly Communicate Sometimes Communicate Based on Needs Rarely Communicate Never Communicate Don’t Know/Not Sure
Primary Care Providers
Other Specialty Care Providers, including Special Care Centers
Regional Centers
Schools
CCS Medical Therapy Program (MTP)
Mental Health Providers
Community-Based Organizations

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* 13. How often do you experience the following barriers in communicating with other providers?

  Always Usually Sometimes Never Don't Know/Not Sure
Time Constraints
Lack of Shared Electronic Medical Records (EMR)
Health Insurance Portability and Accountability Act (HIPAA) Concerns [Consent Forms]

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* 14. Please tell us how helpful the following strategies are (or could be) for improving communication with other providers (when 0 = not helpful at all, and 5 = very helpful):

  0-Not Helpful 1 2 3 4 5-Very Helpful
One-time use HIPAA form for provider-to-provider communication about CYSHCN
Regularly scheduled meetings or conference calls to discuss complex cases
Automatic emails to other providers indicating that patient was seen

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* 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 who provide primary care and help to manage and facilitate essentially all aspects of pediatric care. The physician should be known to the child and family and should be able to develop a partnership of mutual responsibility and trust with them.”

Please indicate how much you agree that it would be helpful if Medi-Cal Managed Care Health Plans funded pediatric practices that care for CYSHCN to become certified medical homes, and provided additional reimbursements to cover the costs of the additional staff and services required to be a medical home:

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* 16. Based on the AAP definition in the previous question, do you consider your practice to be a medical home for your CCS and non-CCS CYSHCN clients?

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* 17. What would your practice need to become a medical home for CCS clients?

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