Glossary

(Appendix 1 of the MCH Block Grant - Application/Annual Report Guidance)

Forms 2 and 3 – Budget and Expenditures

Form 5 – Program Participation and Reach

Form 5 – Number of Individuals and Percentage of Populations Served by Title V

Form 6 – Deliveries and Infants Served by Title V and Eligible for Medicaid

Form 10 – Performance Measurement

 

APPENDIX 1 :     Reporting Definitions for the forms

Forms 2 and 3 – Budget and Expenditures

Administrative Title V Funds - The amount of funds the state uses for the management of the Title V allocation. This amount is limited by statute to 10 percent of the Federal Title V allotment.

 

Capacity – Program capacity includes delivery systems, workforce, policies, and support systems (e.g., training, research, technical assistance, and information systems) and other infrastructure needed to maintain service delivery and policy making activities. Program capacity results measure the strength of the human and material resources necessary to meet public health obligations. As program capacity sets the stage for other activities, program capacity results are closely related to the results for process, health outcome, and risk factors. Program capacity results should answer the question, “What does the state need to achieve the results we want?”

 

Budget Period – Period of time for which funds are available for use by the state. For the MCH Block Grant, the budget period is 24 months, beginning on October 1 of the federal fiscal year in which the funds are awarded and ending on September 30 of the following federal fiscal year.

 

Children – A child from age one (1) through 21 years.

 

Federal Allocation – The funding provided to the states under the Federal Title V Block Grant in any given fiscal year; applies specifically to the Application Face Sheet (SF-424) and Form 2.

 

Federal Fiscal Year : The federal government’s fiscal year begins on October 1 and ends on September 30 of the following year.

 

Infants – Children in their first year of life (<365 days).

 

Local – Funds derived from local health jurisdictions within the state, which are used for MCH program activities and reported on the Application Face Sheet (SF 424) and Form 2.

 

Maintenance of Effort – State will maintain the level of funds being provided solely by such state for maternal and child health programs at a level at least equal to the level provided in fiscal year 1989.

 

Others (Class of Individuals) – Women and men, over age 21.

 

Other Federal Funds – Federal funds other than the Title V Block Grant that are under the control of the person responsible for administration of the Title V program and reported on the Application Face Sheet (SF 424) and Form 2. These funds may include, but are not limited to: WIC, EMSC, Healthy Start, SPRANS, HIV/AIDs monies, CISS funds, MCH targeted funds from CDC, MCH Education funds and Medicaid Federal Medical Assistance Percentage (FMAP).

 

Other Funds – Funds available from other private sources such as foundations, which are used for MCH program activities and reported on the Application Face Sheet (SF 424) and on Form 2, line 5.

 

Pregnant Woman – A person from the time of conception to 60 days after birth, delivery, or expulsion of fetus.

 

Program Income – Funds collected by State MCH agencies from sources generated by the State’s MCH

program to include insurance payments, Medicaid reimbursements, HMO payments, etc., as reported on the Application Face Sheet [SF 424] and Form 2.

 

State Funds – Non-federal funds derived from the state, as reported on the Application Face Sheet [SF 424] and Form 2, which are used for program activities and to meet the legislatively mandated match requirements (including overmatch, if applicable) for expenditure of the federal Title V MCH Block Grant allocation and the 1989 Maintenance of Effort, in any given year.

 

Total Federal-State Title V MCH Block Grant Partnership Funding – The total of the Federal Title V MCH Block Grant funds plus the state match. Included in this sum total are: 1) the Federal Title V Block grant allocation; 2) the State’s dedicated funds towards meeting the required match for the federal Title V allocation (match and overmatch); 3) the Local funds, which are the total amount of MCH dedicated funds from local government within the state; 4) Other funds (funds available from other private sources such as foundations, which are used for MCH program activities and reported on the Application Face Sheet (SF 424) and on Form 2, line 5); and 5) Program Income (funds collected by State MCH agencies from insurance payments, Medicaid, HMO’s, etc.). This total is reported on Form 2, line 8.

 

Total MCH Funding – All of the MCH funds administered by a State MCH program. Included in this sum total are the total of the Federal Title V MCH Block Grant funds plus the state match (as reported on Form 2, line 8), and Other Federal funds (monies other than the Title V Block Grant that are under the control of the person responsible for administration of the Title V program and reported on Form 2, Lines 9 and 10). This total MCH funding is reported on Form 2, Line 11.


Form 5 – Title V Program Participation and Reach

 

Image lists the ten MCH Essential Services on the left side and the MCH Pyramid on the right side.
MCH Working Framework: MCH Pyramid of Services

 

Definitions are provided below for each level of service. In developing systems of care, states should assure that they are family- centered, community-based and culturally competent.

 

Direct Services – Direct services are preventive, primary, or specialty clinical services to pregnant women, infants and children, including children with special health care needs, where MCH Services Block Grant funds are used to reimburse or fund providers for these services through a formal process similar to paying a medical billing claim or managed care contracts. State reporting on direct services should not include the costs of clinical services which are delivered with Title V dollars but reimbursed by Medicaid, CHIP or other public or private payers. Examples include, but are not limited to, preventive, primary or specialty care visits, emergency department visits, inpatient services, outpatient and inpatient mental and behavioral health services, bereavement care, prescription drugs, occupational and physical therapy, speech therapy, durable medical equipment and medical supplies, medical foods, dental care, and vision care.

Enabling Services – Enabling services are non-clinical services (i.e., not included as direct or public health services) that enable individuals to access health care and improve health outcomes where MCH Services Block Grant funds are used to finance these services. Enabling services include, but are not limited to: case management, care coordination, referrals, translation/interpretation, transportation, eligibility assistance, health education for individuals or families, environmental health risk reduction, health literacy, and outreach. State reporting on enabling services should not include the costs for enabling services that are reimbursed by Medicaid, CHIP, or other public and private payers. This category may include salary and operational support to a clinic that enable individuals to access health care or improve health outcomes. Examples include the salary of a public health nurse who provides prenatal care in a local clinic or compensation provided to a specialist pediatrician who provides services for children with special health care needs. In both cases the direct services might still be billed to Medicaid or other insurance, but providing for the availability of the provider enables individuals to access the services.

 

Public Health Services and Systems – Public health services and systems are activities and infrastructure to carry out the core public health functions of assessment, assurance, and policy development, and the 10 essential public health services. Examples include the development of standards and guidelines, needs assessment, program planning, implementation, and evaluation, policy development, quality assurance and improvement, workforce development, and population-based disease prevention and health promotion campaigns for services such as newborn screening, immunization, injury prevention, safe-sleep education, and anti-smoking.

State reporting on public health services and systems should not include costs for direct clinical preventive services, such as immunization, newborn screening tests, or smoking cessation.

 

Form 5 – Number of Individuals and Percentage of Populations Served by Title V

Form 5a, Count of Individuals Served by Title V , enables the state to track and report on the number of who received an individually-delivered service funded in part or in full by the Title V program within the top two levels of the MCH Pyramid (direct and enabling services). This includes individuals receiving services funded by total Federal and State dollars reported on line 8 of Form 2 and should align with the combined totals on Form 3a and 3b for direct and enabling services. Data sources are typically reimbursement or individual client records.

 

Pregnant women may also receive non-pregnancy related services and be counted in other participant categories (i.e., children ages one (1) through 21 and others). All remaining categories are mutually exclusive with CSHCN reported as a subset of all infants and children ages zero (0) through 21. Within each reporting category, the count of individuals served should be unduplicated to the fullest extent possible. Examples of direct and enabling services by participant category that Title V may fund in part or in full are provided below.

Pregnant women (through 60 days postpartum) – payment for prenatal, delivery, or postpartum care, case management, insurance eligibility assistance, hotline calls.

Infants (less than age one) – payment for well child visits, immunization, case management.

Children ages one (1) through 21 – payment for well child visits, immunization, dental sealants, school- based health center services.

Children with special health care needs (ages 0 through 21) – specialty care services, care coordination.

Others (women and men over 21) – payment for well-woman visits, education or family- centered care provided to parents/guardians of children.

Form 5b, Total Percentage of Populations Served by Title V , enables the state to track and report on the total percentage who received a Title V-supported service within all levels of the MCH Pyramid (direct services, enabling services, and public health services and systems). The purpose of this form is to better capture the breadth of the State’s Title V program and its reach in serving the MCH population. Included in this reporting are all individuals and populations served by the total Federal and State dollars, as reported on line 8 of Form 2, and the combined totals on Form 3a and 3b for all service levels. Non-Title V programs that provide direct and enabling services (e.g., WIC and Home Visiting) may be included if Title V funds or staff time are used to promote or enhance services. (Individual services that are Title V-funded may also be counted in Form 5a.) To avoid duplication, numerators for the percentage estimate should focus on the programs and services that have the largest reach for a given population, which generally involves the public health services and systems level of the MCH Pyramid. Approximate denominators for each population group will be provided to facilitate percentage estimation. Within public health services and systems, only those reached by activities directly connected to promoting the access or quality of specific population-based services and systems should be counted, thus public health services such as needs assessment, surveillance, mortality review, and other data collection would be excluded. Examples of these public health services and systems activities, as well as direct/enabling service partnerships, are provided below by participant category.

Pregnant women (through 60 days postpartum)

  • Develop and/or maintain a system of risk-appropriate perinatal care designations and transfer protocols (count 100%).
  • Fund local health departments to engage provider groups and promote screening for perinatal depression, smoking or substance use (count number or percent of births in funded counties).
  • Partner with Medicaid or other health plans to implement a policy/procedural change to reduce low- risk cesarean delivery or promote smoking cessation (count number or % served by Medicaid or other health plans).
  • Outreach to hospitals to institute a safe sleep or baby friendly policy, distribute educational materials, or participate in a QI collaborative (count number or % of births in participating hospitals).
  • Partner with WIC or home visiting programs to provide staff training or otherwise promote education, screening, or referrals on smoking cessation or preventive dental services (count number or % of pregnant/postpartum women served).
  • Engage in a health promotion campaign that addresses areas, such as stillbirth prevention or postpartum depression.

Infants (less than age one)

  • Administer, develop guidelines/standards/policies, or otherwise assure the newborn screening program (count 100%).
  • Develop and/or maintain a system of risk-appropriate perinatal care designations and transfer protocols (count 100%).
  • Outreach to hospitals to institute a safe sleep or baby friendly policy, distribute educational materials, or participate in a QI collaborative (count number or % of infants served).
  • Partner with WIC or home visiting programs to provide staff training or otherwise promote education/counseling on safe sleep practices (count number or % of pregnant/postpartum women served).
  • Implement a statewide campaign to promote safe sleep practices (count number of Web hits).

Children ages one (1) through 21

  • Develop and maintain a statewide registry for developmental screening and follow-up (count number of children age one (1) through 5).
  • Develop or promote school-based injury prevention, oral health, or physical activity programs (count number of children in participating schools).
  • Partner with Medicaid, health plans, pediatric practices, or schools to implement a policy/procedural change, QI collaborative, or other campaign to promote the adolescent well visit (count number of adolescents enrolled or served by plan/practice/school).
  • Fund local health departments to promote and advance the medical home model among all pediatric providers (count number of children in local counties).

 

Children with special health care needs ages 0 through 21

Population-based approaches for the broader child population with CSHCN as a subset:

  • See examples above and use the same percentage estimated for all children, assuming that CSHCN are served at the same rate since they are not excluded. CSHCN specific data can be used, if available, but it may underestimate reach if the definition does not match the MCHB definition of CSHCN used as a denominator.
  • Train non-licensed health professionals, including CSHCN parent consultants, to address the social determinants of health (count estimated annual case-loads of those trained or % of professionals trained as a proxy for % of children potentially reached).

 

Population-based approaches for CSHCN specifically:

  • Partner with state managed care organization to assess CSHCN quality of life measures for QI efforts (count number or % of CSHCN served by state managed care organization)
  • Implement a pediatric sub-specialty telemedicine program to ensure access for rural CSHCN (count rural or all CSHCN if system is designed for overall access)

 

Population-based approaches for a subset of CSHCN:

  • Partner with Medicaid to implement a Hispanic-focused care coordination program (count Hispanic CSHCN covered by Medicaid)
  • Implement a QI project to promote transition to adult health care for medically complex CSHCN (count medically complex youth with special health care needs)

Others (women and men over age 21)

  • Implement a statewide campaign to promote the well-woman visit (count number of web hits)
  • Partner with WIC or Home Visiting to improve screening/counseling for smoking cessation (count number of women with a child age one (1) or more to avoid duplication with pregnant women)
  • Partner to promote family engagement services (count number of parents over 21 served)

Form 6 – Deliveries and Infants Served by Title V and Eligible for Medicaid

  • Title V of the Social Security Act – The authorizing legislation for the Maternal and Child Health Services Block Grant to States Program.
  • Title V Reporting Form 6, Deliveries to Pregnant Women Served by Title V – Unduplicated number of deliveries to pregnant women who were provided prenatal, delivery, or post- partum services through the Title V program during the reporting period.
  • Title V Reporting Form 6, Infants Served by Title V – The unduplicated count of infants provided services by the State’s Title V program during the reporting period.
  • Title XIX of the Social Security Act – The authorizing legislation for the Medicaid program.
  • Title XIX Reporting on Form 6, Pregnant Women Eligible for Title XIX – The number of pregnant women who delivered during the reporting period and were eligible for the State’s Title XIX (Medicaid) program.
  • Title XIX Reporting on Form 6, Infants Eligible for Title XIX – The number of infants eligible for the State’s Title XIX (Medicaid) program.

 

Form 10 – Performance Measurement

Evidence-based or –Informed Strategy Measure (ESM) –Developed by the state, ESMs assess the outputs of State Title V strategies and activities contained in the State Action Plan. The development of ESMs is guided through an examination of evidenced-based or evidence- informed strategies, and determining what components are meaningful, measurable, and achievable. The main criteria for ESMs are in being meaningfully related to the NPM through scientific evidence or theory and being measurable by the state with improvement achievable in multiple years of the five-year reporting cycle.

Evidence-based or –Informed Strategy Measure (ESM) Objectives – The objectives for activities and interventions that drive the achievement of higher-level objectives by the State Title V program.

Objectives – The yardsticks by which an agency can measure its efforts to accomplish a goal. (See also Performance Objectives)

Outcome Measure – The ultimate focus and desired result of any set of public health program activities and interventions is an improved health and well-being outcome. Health and well- being outcomes are usually longer term and tied to the ultimate program goal. Morbidity and mortality statistics are indicators of achievement of health outcomes. For the Title V performance framework, other outcomes reflect commonly accepted indicators of a highly functioning system of care for children with special health care needs and their families, positive outcomes, outcomes which are legislatively mandated or are a legislative focus, and outcomes where the prevalence is increased.

Performance Indicator – The statistical or quantitative value that expresses the result of a performance objective.

Performance Measure – An intermediate outcome on the path toward a longer-term outcome measure of health and well-being that is used to more directly assess the impact of a program. Positive health behaviors and access to quality health care are common intermediate outcomes that may lead to health, reduced morbidity and mortality, or highly functioning systems of care. For example, to reduce infant mortality, State Title V programs may work to promote safe sleep practices or access to quality well- woman care. The performance measure is phrased as a quantitative indicator, such as a rate or percentage. For example, “Percentage of infants placed to sleep on their backs.”

Performance Measurement – The collection of data on, recording of, or tabulation of results or achievements, usually for comparison to a benchmark.

Performance Objectives – A statement of intention with which actual achievement and results can be measured and compared. Performance objective statements clearly describe what is to be achieved, when it is to be achieved, the extent of the achievement, and the target populations. For example: “Increase the percentage of infants placed to sleep on their backs in State X by 10% over the next 5 years.”

Risk Factors – Public health activities and programs that focus on reduction of scientifically established direct causes of, and contributors to, morbidity and mortality (i.e., risk factors) are essential steps toward achieving desired health outcomes. Changes in behavior or physiological conditions are the indicators of achievement of risk factor results. Results focused on risk factors tend to be intermediate term. Risk factor results should answer the question, “Why should the state address this risk factor (i.e., what health outcome will this result support)?”

Risk Factor Objectives – Objectives that describe an improvement in risk factors (usually behavioral or physiological) that are associated with morbidity and mortality.

Targets – An aspired outcome that is explicitly stated, e.g., “Attain 90% of timeliness in reporting” or “Achieve 100% completeness of reporting,” etc. In this Guidance, “Targets” is often used interchangeably with “Objectives.”

 


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