* January 2008 * Volume 2, Issue 1
Message from your CHDP Deputy Director
Happy New Year to All! We hope that everyone enjoyed the wonderful holiday season, and have embraced the New Year at hand! CHDP Staff looks forward to working hand-in-hand supporting you in the CHDP program. We hope that you will take advantage of CHDP program support that we offer throughout the year. We frequently contact providers, offering program support by way of trainings, notices, newsletters, and provide program materials. If you have had questions or difficulty this year in implementing the CHDP program, please contact your CHDP program support staff at 381-1125. Would you like to prevent CHDP problems? Becoming familiar with
CHDP program policies, provided to you in the program manuals, will greatly enhance your success in the program. CHDP manuals are available on-line and on CD through our local office. We would be pleased to assist you with CHDP on-line or provide you with your very own program manuals on CD. Be advised that CHDP program manuals on CD or on-line are not intended to replace your hard copy in your office. CHDP providers should be familiar with CHDP program guidelines and procedures. For instance, did you know that when CHDP providers undergo changes or new developments, "providers must submit changes of information to the local CHDP program within 30 days of
the change. These changes include: change of address, addition of sites of service, use of temporary location or mobile van unit, changes in Medi-Cal or Federal Tax Identification Number, addition or deletion of rendering providers, and providers whose status changes from an individual provider to a group, from a group to a clinic, or from a clinic to a Federally Qualified Health Center (FQHC), must notify CHDP after securing the new status". Please see your CHDP Provider Manual, Section: Provider Enrollment "Prov Enroll", Page 9.
-from Mary Jo Rafferty, PHN, MSN
Inside this issue
Job Openings, Page 2 RSV Season, Page 2 CCS, Page 3 Rickets & Vitamin D, Page 4
CHDP Reminders, Pages 2, 3 CLPPP, Page 3
Newsletter is available on-line at http://www.co.merced.ca.us/health/CMS/CMShome.html
Children’s Medical Services MTP & CCS JOB OPENINGS
The MTP has openings for a Physical Therapist and an Occupational Therapist. Therapists will perform their job under the medical direction of a Physician, to plan and perform therapy for physically handicapped children under the age of 21. The Physical Therapist position requires graduation from an approved college or university educational program for Physical Therapy, which meets the requirements for licensure as a Physical Therapist in the State of California. The Occupational Therapist position requires graduation from an approved college or university educational program for Occupational Therapy, which meets the requirements for licensure as an Occupational Therapist in the State of California. The CCS program is currently recruiting for 2 full-time Public Health or Community Health Nurses, who will be responsible for medical determination and comprehensive case management for those children with CCS medical eligible conditions. If you are interested in applying for a position, please contact: Management Services Division 2222 “M” Street, Merced, CA 95340, (209) 385-7682, AA/ EOE/Drug Free Employer California Relay Service (1-800-735-2929) Is available for the Hearing Impaired Or Visit the Merced County Web Site. Click on Employment to download application materials. http://www.co.merced.ca.us
CHDP REMINDER
We would like to thank our providers who are recording BMI percentiles on the PM 160! It is CHDP policy that providers record the BMI percentile on the PM 160 for clients age 2 and above. Remember to check the routine dental box when a routine dental referral is made, starting at age 1.
-from Allison Moore, RN, BSN, CHDP PHN
RSV SEASON
Respiratory Syncytial Virus (RSV) season is upon us, and the California Children Services (CCS) program is receiving provider requests for the Palivizumab vaccine (trade name Synagis). The vaccine is usually prescribed during the RSV season, which is November thru April. Palivizumab is a humanized monoclonal antibody produced by recombinant DNA technology, licensed by the Federal Drug Administration, and indicated for the prevention of serious lower respiratory tract diseases caused by RSV in pediatric patients who are at high-risk for disease. In December 2002, Medi-Cal expanded the Palivizumab policy of 1998, making Palivizumab a covered benefit as “prophylactic treatment” against RSV for infants and children with cyanotic or acyanotic congenital heart diseases, who are less than 24 months of age at the time therapy begins. For more information about Palivizumab (Synagis) please refer to CCS N.L. 111006, which can be accessed at http://www.dhs.ca.gov/pcfh/ cms
-from Marie Estacio-Kelly, PHN CCS PHN Supervisor
“RSV...vaccine is usually prescribed during the RSV season, which is November thru April.”
CHDP REMINDER
Remember to follow the Health Assessment Guidelines (HAG) for anemia screening. HAG’s require testing for anemia by performing or referring out for a hemoglobin or hematocrit measurement at the 7-9 mth exam, 13-15 mth exam, and at every exam from two years on.
-from Allison Moore, RN, BSN, CHDP PHN
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Volume 2, Issue 1 CALIFORNIA CHILDREN SERVICES
“CCS paneled physicians...are reimbursed at a 39% higher rate The Merced County California Children Services (CCS) program, which than the Medi-Cal rate.” serves children with special health care needs, invites physicians to join our
CCS provider network. CCS paneled physicians, including primary care physicians with authorization to treat CCS eligible medical conditions, are reimbursed at a 39% higher rate than the Medi-Cal rate. The CCS program staff provide case management for CCS medically eligible conditions, which includes; provision of authorizations, assistance in obtaining appointments, assistance in communication with the family, and coordination of multi-disciplinary services. When CCS children are authorized to a CCS approved Special Care Center (SCC), a subspecialist physician works in conjunction with the primary care physician (PCP) to manage the care of the CCS medically eligible condition. This collaboration provides ongoing and immediate support to the PCP. A client is seen annually by the entire CCS SCC multidisciplinary team, who provides support and collaboration to the physician in management of the CCS medically eligible condition. The team may include physicians, nursing specialists, nutritionists, therapists, respiratory care practitioners, and social workers. Hospital admission or transfer to the nearest tertiary care center is facilitated for CCS clients open to specialty care at that center. If hospitalization is at a local hospital, the CCS authorized specialist and staff are available for ongoing consultation to the PCP. For additional information or inquiry into joining the CCS provider network, please contact Marie Estacio-Kelly, PHN, CCS PHN Supervisor, at 209-381-1117.
–from Mary Jo Rafferty, PHN, MSN, CHDP Deputy Director, CCS Administrator
CLPPP—LEAD ALERTS! CHDP REMINDER
Please remember to record referral information in the referral box on the PM 160. Detailed referral information saves your staff time. Without this information, CHDP will need to call your office to obtain the appropriate information to provide care coordination for clients.
-from Allison Moore, RN, BSN, CHDP PHN
For an inclusive list of recalled toys, jewelry, candy & other items that contain excessive amounts of lead, refer to the Merced County Childhood Lead Poisoning Prevention Program (CLPPP) “Lead Alerts” website: http://www.co.merced.ca.us/ health/CMS/CHDP/Programs/ Lead/LeadAlerts/ LeadAlertsHome.html You can also visit the US Consumer Product Safety Commission website, www.cpsc.gov, where Lead Alerts are generated as well as other products that may jeopardize a child’s health and safety. LEAD ALERT!!! Bell Racing Recalls Collectible Mini Racing Helmets Due to Vio-
lation of Lead Paint Standard.
Importer: Bell Racing Co., of Santa Cruz, Calif. Description: The recalled products are six-inch tall, collectible, miniature helmets, modeled after helmets worn by several race car drivers. Manufactured in: China Sold at: Bell Racing dealers and distributors nationwide from February 2007 through November 2007 for about $40.
–from Carol Simmers-Tilma, RN, CLPPP Nurse
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Children’s Medical Services RICKETS & VITAMIN D
Volume 2, Issue 1
Once relegated to textbook cases in the United States (U.S.), Rickets has emerged again in children. In 2006, the Oakland Tribune reported on a chart review of all patients seen at Children’s Hospital Oakland. The review revealed a large number of cases of rickets among children up to age two. Rickets is a bone disease that appears when the body is not able to make the structure for normal bones, resulting in malformed bones. It appears after a period of vitamin D deficiency; it is a late outcome of a deficiency state. To prevent the bone disease, rickets, a daily dose of vitamin D is recommended for infants and children. Vitamin D helps the body absorb calcium and phosphorous, and absorption of these minerals keep bones strong and muscles working. Vitamin D is in many of the foods we eat. Cow’s milk, in the U.S, is fortified with vitamin D as well as fish, cod liver oil, soymilk, most yogurts, and cheeses. When shopping, always be sure to check for vitamin D on the label of your products. You can also get vitamin D intake through vitamin supplements. Besides obtaining vitamin D through our diet, the skin also makes vitamin D when exposed to the sun. To get enough vitamin D from sunshine, an adult can expose their arms and legs to the sun for 5-30 minutes, between 10am and 3 pm, just twice a week. However, people with dark skin need more sun exposure because melanin interferes with vitamin D synthesis. Excess vitamin D is stored in body fat and released during the winter when sunshine is often limited. Remember to be safe when exposing children to the sun, a safe sun exposure time for children is unknown. Unfortunately, vitamin D deficiency is still common in the U.S. As measured by blood levels, researchers have consistently found many populations to be deficient. For example, 40-100% of the elderly, half of postmenopausal women, half of Hispanic and African American teens, half of Caucasian preadolescent girls, 42% of 15-49 year old African American women, and lastly, one third of healthy students/physicians/residents at a Boston hospital, despite adequate food and vitamin intake, all have vitamin D deficiency. The high prevalence of vitamin D deficiency has some researchers wondering whether the recommended levels of intake should be higher.¹ Aside from rickets, symptoms of vitamin D deficiency among children include; hypocalcemic seizures, limb pain, and fractures. Particularly at high risk for vitamin D deficiency; are people with dark skin color, long term exclusive breastfeeding without a vitamin D supplement, and restricted sun exposure-including sunscreen use and clothing. Prevention of vitamin D deficiency includes screening by providers of pregnant women and newborns and treatment if indicated. The Child Health and Disability Prevention (CHDP) program previously distributed Provider Information Notice (PIN) 07-10 to all CHDP providers. PIN 07-10 provides background information and resources on rickets, vitamin D, and frequently asked questions on vitamin D supplementation. CHDP providers may access PIN 07-10 online at http:// www.dhs.ca.gov/pcfh/cms/onlinearchive/chdppl.htm.
-from Stephanie Russell, RD, MPH CHDP Nutritionist
¹Holick, M. F., Vitamin D Deficiency, New England Journal of Medicine, 357; 3, pp266-281, July 19, 2007.
CMS NEWSLETTER Compiled & Created by Travis Mitchell Authors: Marie Estacio Kelly, Allison Moore, Mary Jo Rafferty, Stephanie Russell, & Carol Simmers-Tilma Editor: Mary Jo Rafferty Assistant Editor: Travis Mitchell Pictures used from Microsoft Office & MCDPH webpage
Dept of Public Health
260 E. 15th Street Merced, California 95340 CHDP OFFICE Phone: 209-381 -1125 Fax: 209-381 -1173 http://www.co.merced.ca.us/health/CMS/CMShome.html
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