Policy/Procedure Title: Health Education Program / ☒ External Policy
☐ Internal Policy /
Original Date: 09/25/1994 / Next Review Date: 03/14/2019
Last Review Date: 03/14/2018 /
Applies to: / ☒ Medi-Cal / ☐ Employees /
Policy/Procedure Number: MPHP8001 (previously MPCD2004, CD100204) / Lead Department: Health Services /
Policy/Procedure Title: Health Education Program / ☒External Policy
☐ Internal Policy /
Original Date: 09/25/1994 / Next Review Date: 03/14/2019
Last Review Date: 03/14/2018 /
Applies to: / ☒ Medi-Cal / ☐ Employees /
Reviewing Entities: / ☒ IQI / ☐ P & T / ☒ QUAC /
☐ OPerations / ☐ Executive / ☐ Compliance / ☐ Department /
Approving Entities: / ☐ BOARD / ☐ COMPLIANCE / ☐ FINANCE / ☒ PAC
☐ CEO / ☐ COO / ☐ Credentialing / ☐ DEPT. DIRECTOR/OFFICER
Approval Signature: Robert Moore, MD, MPH, MBA / Approval Date: 03/14/2018
I. RELATED POLICIES:
A. MCQP1021 - Initial Health Assessment and Behavioral Risk Assessment (IHEBA)
B. MPQD1001 - Quality and Performance Improvement Program Description
C. MCLP7002 - Cultural and Linguistic Services
II. IMPACTED DEPTS:
A. Health Services
B. Member Services
C. Provider Relations
D. Quality Improvement
III. DEFINITIONS:
A. IHEBA – Individual Health Education Behavioral Assessment is a series of age specific questions designed to evaluate a member’s risk factors for developing preventable illness, injury, disability and major diseases.
B. The “Staying Healthy” Assessment is the Department of Health Care Services (DHCS) approved tool.
IV. ATTACHMENTS:
A. Readability and Suitability of Written Health Education Materials MMCD All Plan Letter 11-018
B. Readability and Suitability Checklist
C. Definitions and Requirements for Review and Approval of Written Health Education and Written Member Informing Materials
D. MMCD Clarification Letter Regarding APL 11-018
E. MMCD Approved Companies for Written Health Education Materials
F. MMCD KRAMES Approved Health Education Materials List
V. PURPOSE:
The Partnership HealthPlan of California (PHC) Health Education Program is designed to develop, implement, and maintain a member health education system that provides organized programs, services, functions and resources to deliver health education, health promotion and patient education to assist members to improve their health and manage illness.
VI. POLICY / PROCEDURE:
A. Partnership HealthPlan of California (PHC) members have a right to health education services that meet PHC’s health education standards.
B. PHC promotes self-care and wellness among health plan members. The health education staff works closely with Member Services, Care Coordination, Provider Relations and Quality Improvement to assess member needs and to develop, implement, evaluate and improve new and established activities. In addition, the health education staff obtains information to assess member health care needs and barriers to care by consulting regularly with the Consumer Advisory Committee (CAC), community organizations, PHC’s Chief Medical Officer and analyzing PHC’s data. Quality approved interventions are intended to assist members to improve their health, properly manage illness, and avoid preventable illnesses.
1. PHC’s health education program information reflects evidence-based practices and clinical practice guidelines as appropriate.
2. PHC’s health education program includes programs that are appropriate to the member population and can affect behavioral change for improved health outcomes. These include, but are not limited to, the following:
a. Educational interventions are designed to assist members to effectively access the managed health care system, preventive and primary healthcare services, obstetrical care and health education services; and to appropriately use complementary and alternative care.
b. Education regarding health promotion to include risk reduction and healthy lifestyles.
c. Educational interventions are designed to assist members to learn and follow self-care regimens and treatment therapies for existing medical conditions, chronic disease or health conditions including, but not limited to: prenatal care; asthma, diabetes, and hypertension. Other required health education interventions includes, but not limited to:
1) Tobacco use and smoking cessation
2) Alcohol and drug use
3) Family Planning
4) Prevention of sexually transmitted diseases
5) Injury Prevention Immunizations
6) Nutrition
7) Parenting
8) Physical Activity
d. Promote the availability of local social services and health care programs.
3. Appropriate services may be provided through individual classes, group classes, workshops, support groups, peer education programs, patient-centered management programs, educational materials and member newsletters.
4. PHC Providers may refer members to programs within the health education network, or members may self-refer.
5. Health education materials and programs are designed to reflect cultural diversity. PHC ensures that all materials visually recognize and display this diversity. Cultural issues are important variables in understanding health beliefs and practices.
6. PHC members have equal access to all programs within the PHC Health Education Network.
a. Programs may not discriminate against PHC members for any reason.
b. Health Educators participate in PHC’s internal committees, addressing quality and compliance with PHC’s programs, and to ensure that all health education programs and materials are appropriate for members of varying demographics, including but not limited to: language, age, race, ethnicity, national origin, disability, sex and gender. [per Section 1557 of the Patient Protection and Affordable Care Act (ACA 1557)]
7. PHC’s Cultural & Linguistic Services policy (MCLP7002) covers the requirements for the translation of member materials.
8. PHC ensures provisions are made for members who have limited English proficiency and/or low health literacy by assessing health education materials for readability with special attention to cultural and linguistic appropriateness, concept, density, tone, key messages, as well as format, page design and graphics. Health education materials are available in PHC’s threshold languages and are made available in other languages upon the request of the member.
9. The Health Education & Cultural and Linguistic Group Needs Assessment (GNA) is conducted for Medi-Cal to assess the health education and cultural and linguistic needs of PHC members. The GNA is conducted every five years; the executive summary is submitted electronically to DHCS upon completion on or before October 15th. Findings from the GNA, as well as other internal and external data sources, are utilized to guide the development and implementation of health education interventions.
10. It is required annually to submit the Health Education & Cultural and Linguistic Work Plan electronically on or before December 31st except in the year when the full GNA report is due. Acopy is kept on file at the health plan for DHCS to review upon request.
11. PHC members are not charged enrollment/attendance fees, co-payment or materials fees for health education programs.
12. Primary Care Providers (PCPs) are responsible for the screening and identification of members with specific health educational needs and referral to the appropriate health education program.
13. If a health education need is identified by the PCP, he/she is responsible for providing the information or referring the member and/or the caregiver to PHC’s Health Education.
14. PCPs are responsible for following-up on referrals from the individual health education behavioral assessment, (IHEBA), Staying Healthy Assessment, and anticipatory guidance.
15. Provider education and training on health education services include the following:
a. Health Education and Cultural & Linguistic Group Needs Assessment (GNA) findings
b. Individual health education behavioral assessment (IHEBA) and Staying Healthy Assessment (SHA), and Seniors and Persons with Disabilities (SPD) Sensitivity Awareness
c. Techniques to enhance the effectiveness of provider/patient interaction
d. Educational tools, modules, materials and staff resources
e. Plan specific resources and referral information
f. Health Education requirements, standards, guidelines and monitoring
16. PHC ensures that administrative oversight, direction, management, and supervision of the health education program is maintained by a full-time qualified health educator. Health education staff serves as an information resource center to providers, provider staff, PHC staff and community. This includes providing resource information, educational materials, and other program resources to assist contracted medical providers in providing and accessing health education services for members. This is accomplished through provider newsletters, posting materials on PHC’s website and making materials available upon request.
17. PHC uses national standards to establish goals. Health education interventions are based on national preventive care guidelines, professional experts, peers, best practices and published research findings, HEDIS studies, findings from the GNA, and results of program evaluation measures.
18. Health Education materials are written at or below a 6th grade reading level. Health education materials are designed to assist members to modify personal health behaviors, achieve and maintain healthy lifestyles, and promote positive health outcomes, including updates on current health conditions, self-care, and management of health conditions. PHC will use a readability formula that is most appropriate and reliable for the type of materials and target audience.
19. All written health education materials developed, adapted, purchased, or obtained free-of-charge for use by members must comply with requirements set forth in the Medi-Cal Managed Care Division (MMCD) All Plan Letter (APL) 11-018. The all plan letter does not apply to informing materials. Health plans can approve written member health education materials as long as the following conditions are met:
a. Materials are assessed and approved using the Readability and Suitability Checklist, (Attachment B) and all required elements or items have been met.
b. The signed/approved Readability and Suitability Checklist, along with the approved health education material, must be kept (electronic file or hard copy) by the health plan and made available to DHCS for auditing/monitoring purpose upon request.
c. The assessment and approval process must be conducted by a qualified health educator/health education specialist with the equivalent training and background required by DHCS for their Health Education Consultants. For the purposes of the MMCD All Plan Letter 11-018, a qualified health educator is defined as a health educator with one of the following qualifications:
1) Master of Public Health (MPH) degree with a health education or health promotion emphasis
2) Master’s degree in community health with a specialization in health education or health promotion
3) Master Certified Health Education Specialist (MCHES) awarded by the National Commission for Health Education Credentialing, Inc.
20. Health plan staff assigned health education duties who do not meet the definition of a “qualified health educator” as listed above may not approve health education materials for the health plan. If a Plan does not have a qualified health educator (as defined above) on staff to assess and approve health education materials, the Plan will be required to submit health education materials to the Managed Care Quality and Monitoring Division (MCQMD) of DHCS for review and prior approval. A completed Readability and Suitability Checklist must accompany all materials submitted to MCQMD for review and approval. All required sections of the checklist must be completed except for section H (Health Education Certification and Signature). This section will be completed by a MCQMD health education consultant.
21. PHC’s Internal Quality Improvement Committee (IQI) will review the Health Education & Cultural & Linguistic Work plan annually for a description of required activities, a timeline with milestones and identification of responsible individuals. Final approval of the work plan will be by the Quality/Utilization Advisory Committee (QUAC).
VII. REFERENCES:
A. DHCS/MMCD All Plan Letter 17-002 Released 02/03/2017
B. DHCS/MMCD All Plan Letter 11-018
C. Section 1557 of the Patient Protection and Affordable Care Act (ACA 1557)
VIII. DISTRIBUTION:
A. PHC Department Directors
B. PHC Provider Manual
IX. POSITION RESPONSIBLE FOR IMPLEMENTING PROCEDURE: Senior Director, Health Services
X. REVISION DATES:
Medi-Cal
07/08/96; 10/10/97 (name change only); 06/21/00, 12/19/01, 01/15/03; 04/20/05; 02/20/08; 04/21/10; 04/20/11; 11/16/11; 03/20/13; 10/15/14; 02/18/15; 01/20/16; 02/15/17; *03/14/18
*Through 2017, Approval Date reflective of the Quality/Utilization Advisory Committee meeting date. Effective January 2018, Approval Date reflects that of the Physician Advisory Committee’s meeting date.
PREVIOUSLY APPLIED TO:
Healthy Kids (Healthy Kids program ended 12/01/2016)
KK CC403 – 04/21/10
MPHP8001 – 11/16/11; 03/20/13; 10/15/14; 02/18/15; 01/20/16 to 12/01/2016
PartnershipAdvantage
PA CC202 - 06/21/2006 to 02/20/2008
MPCD2004 – 02/20/2008 to 11/16/2011
MPHP8001 – 11/16/2011 to 01/01/2015
Healthy Families
MPHP8001 – 04/20/2011 to 03/01/2013
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