crvfhp orientation meeting - Massachusetts League of Community
Transcripción
crvfhp orientation meeting - Massachusetts League of Community
CRVFHP ORIENTATION MEETING 2009 VOUCHER COMPONENT SUMMARY (per Primary Care and Enabling/Outreach Services Contract) CRVFHP ♦ Remains payer of last resort ♦ Reimburses at Medicaid rate, fee schedule ♦ Pays within 60 days of receipt of documentation of delivery of covered services ♦ Covers migrant and seasonal farmworker (MSFW) and their dependents PROVIDER ♦ Makes best faith effort to screen MSFW for eligibility in other programs / health coverage ♦ Submits completed: CRVFHP Eligibility / Registration Form – once per year HCFA 1500 Form or ADA Form – for each billable visit CRVFHP Referral Voucher - for each UConn visit - for each external referral billable visit - for each non-billable visit Pharmaceutical Voucher – after receipt for onsite or referral pharmacy Documentation within 60 days from date of service or being denied by another payer, but: - no later than Aug. 15, 2009 for primary care services through June 30, 2009 and - no later than Jan. 15, 2010 for primary care services through Dec. 31, 2009 ♦ Does not seek payment for covered services from any MSFW beyond co-pay ♦ Manages costs against target amount (“Provider Voucher Allocation”) for all covered services provided to MSFWs COVERED PRIMARY CARE SERVICES – provided by and / or authorized by a Physician, MidLevel or Dental Provider: ♦ Primary Care including: diagnostic laboratory outpatient mental health services diagnostic radiology outpatient substance abuse services screenings including cancer, diabetes, primary vision care depression and STDs specialty care through CRVFHP ‘Referral Vouchers’ immunizations gynecological care ♦ Dental Care including: endodontic services diagnostic services preventative services periodontic services restorative services exodontic services ♦ Pharmacy (generic pharmaceuticals when available) services NON-COVERED SERVICES – includes the following: ♦ hospitalization / inpatient services ♦ deliveries (births) ♦ emergency room services ♦ ambulance services ♦ eye glasses and/or contact lenses ♦ prosthodontic, implant or orthodontic services 2008 CHC PATIENT CARE HOURS Brightwood Health Center 380 Plainfield St, Springfield, MA Outreach worker: Luz Peña-Till Office: 413-794-3295 Cell: 413-426-8863 Community Health Center of Enfield primary care hours M, F 8am - 5pm Tu, W, Th 8am - 8pm None weekends None M-F 8:30am - 5pm M-F 8:30am - 5pm None Turners Falls site: M, W-F 8am - 5pm Tu 8am - 9pm Orange site: M, W, F 8am - 5pm Tu, Th 8am - 9pm None M-Th 8am - 6pm F 12 - 5:30pm M-Th 8am - 6pm F 12 - 5:30pm Sa: 9am - 1pm East Hartford site: M, Tu, W, Th 7am - 7 pm F 7am - 5pm Manchester site (Suite 230): M-Th 8am - 5pm F 8am - 4:30pm None East Hartford site: M, Tu, W, Th 7am - 7pm F 8am - 4:30pm Manchester site (Suite 240): M, W 7am - 7pm T, Th 8am - 5pm F 8am - 4:30pm Vernon site (dental hygiene only): M, W, F 8am - 4:30pm M-Th 8:45am - 8:30pm F 9am - 5pm None Sa: 9am - 12pm (at the Haven Free Clinic) M, Th, F 8:30am - 5:30pm Tu, W 8:30am - 8pm M-F 8:30am - 5:30pm None dental hours 5 North Main St, Enfield, CT Outreach Worker: VACANT Office: 860-253-9024 Turners Falls site: M, W, F 7:50am - 5pm Tu, Th 7:50am - 9pm medical / dental site: 338 Montague City Rd, Orange site: Turners Falls, MA medical / dental site: 450 West River St, Orange, M-W, F 7:50am - 5pm Northfield site: MA medical site: 97 F. Sumner Turner Rd, Northfield, Tu 5 - 9pm W 7:50am - 12pm MA Buckland site: medical site: 26 Ashfield Rd, Buckland MA Th 1 - 5pm Outreach Worker: Byron Pareja Office: 413-772-3748 x146 Cell: 413-834-2174 Community Health Center of Franklin County Community Health Services & Hispanic Health Council CHS: 500 Albany Ave, Hartford, CT CHS Office: 860-249-9625 HHC: 175 Main Street, Hartford, CT HHC Outreach Worker: Luis Ayala 860-893-9157 East Hartford Community HealthCare medical / dental site: 94 Connecticut Blvd, East Hartford, CT medical / dental site: 150 North Main St, Suite 230 and Suite 240, Manchester, CT dental hygiene site: 3 Prospect St, Vernon, CT Office: 860-528-1359 Fair Haven Community Health Center 374 Grand Ave, New Haven, CT Outreach worker: Denise Dean Office: 203-777-7411 x5271 Generations Family Health Center 1315 Main St, Willimantic, CT Outreach Worker: VACANT Office: 860-450-7471 Holyoke Health Center 230 Maple St, Holyoke, MA 505 Front St, Chicopee, MA Outreach Worker: José Santana Office: 413-420-2134 Cell: 413-563-4379 2008hours.xls / hours Both sites: M-F 8am Both sites: M-F 8:30am 6pm 4:30pm Chicopee site only: M, Tu 5 - [closed Tu 12 - 2pm] 8pm 5/21/2008 3:12 PM None 1 of 2 University of Connecticut School of Medicine 2008hours.xls / hours primary care hours Tu, W, Th 6pm - sunset (June-August), W 6pm sunset (through midOctober) 5/21/2008 3:12 PM dental hours weekends Tu, W, Th 6pm - sunset None (June-August), W 6pm sunset (through midOctober) 2 of 2 2008 MONTHLY OUTREACH CONTACT SHEET Agency: _____________________________________ Report Month of Service: _____________ Completed By (Outreach Worker): _____________________________________ Submission Date: _____________ mated # of unduplicated contacts seen for the 1st time this month: __________ Enabling Service eligibility assistance eligibility assistance outreach patient health education translation / interpretation transportation case management case management case management case management Contact Type Location Type* <1 # of primary care encounters this month: __________ # of dental encounters this month: __________ 1-12 Male 13-19 20-44 45-64 65+ <1 1-12 Female 13-19 20-44 45-64 65+ TOTAL Registered MSFWs into CRVFHP (unduplicated Eligibility Apps) 0 Assistance in securing access to available health, social service, pharmacy and other assistance programs Case finding, education or other services to facilitate access / referral Personal assistance provided to promote health and healthy behaviors (to be detailed on p2 of Contact Sheet) Translation (number of times used as a translator) Transportation (each one way trip for each person) Health agency referral (health center, health dept, specialist, etc.) 0 Pregnancy related referral (family planning, pregnancy test, prenatal, post natal) Referrals received from health / social service organizations Follow-up / case management 0 0 0 0 0 0 0 0 Other (please specify): 0 TOTAL: 0 0 0 0 0 0 0 0 0 0 0 0 0 * location = CHC, Camp, Home, Field, Other (please specify). Do NOT list specific names; they should be included on p2. 2008OutreachContactSheet.xls / p1 5/22/2008 11:02 AM 1 of 4 2008 MONTHLY OUTREACH CONTACT SHEET Agency: _____________________________ Please list # of farms visited: # of trips to the farms (delivering meds, etc): ______ ______ Please list farm names, contacts and locations visited during this month. Please provide best estimates: Report Month of Service: _____________ Farm Location Comment ______ % migrant ______ % seasonal ______ % Users needing interpretation/bilingual services Please list MSFW countries of origin (and percentages). 2008OutreachContactSheet.xls / p2 Country of Origin 5/22/2008 11:02 AM 2 of 4 2008 MONTHLY OUTREACH CONTACT SHEET Agency: _____________________________ Materials: Report Month of Service: _____________ # of pamphlets distributed: # of condoms distributed: Health Topics: Please list health topics discussed (e.g diabetes, hypertension, oral health, condom use, hepatitis, HIV/AIDS, STDs, tuberculsis, etc.) NOTE: Please focus on the CRVFHP Health Care Plan Goals and Objectives. Topic: Topic: Topic: Topic: Topic: Topic: Topic: Topic: Topic: Topic: Group Education Sessions: Health Fairs: External Referrals: # of attendees: # of attendees: # of attendees: # of attendees: # of attendees: Topic: Topic: Topic: Topic: Topic: # of attendees: Topics: Participating Agencies: # of Dental: # of Eye Dr: # of Hospital: # of Lab: # of X-ray: # of Other: Please include brief narrative of monthly activities during this month and submit it to the CRVFHP Manager. (Attach in a separate Word file.) 2008OutreachContactSheet.xls / p3 5/22/2008 11:02 AM 3 of 4 Enabling Services Eligibility Assistance Outreach [Patient] Health Education Assistance in securing access to available health, social service, pharmacy and other assistance programs, including Medicaid, WIC, SSI, food stamps, TANF, and related assistance programs. Case finding, education or other services to identify potential clients and/or facilitate access/referral of clients to services. Personal assistance provided to promote knowledge regarding health and healthy behaviors, including knowledge concerning sexually transmitted diseases, family planning, prevention of fetal alcohol syndrome, smoking cessation, reduction in misuse of alcohol and drugs, improvement in physical fitness, control of stress, nutrition, and other topics. Included are services provided to the client's family and/or friends by non-licensed mental health staff which may include psychosocial, caregiver support, bereavement counseling, drop-in counseling, and other support groups activities. Interpretation/Translation Services Services to assist individuals with language/communication barriers in obtaining and understanding needed services. Transportation Case Management Transportation, including tokens and vouchers, provided by the grantee for users. Client-centered service that links clients with health care and psychosocial services to ensure timely, coordinated access to medically appropriate levels of health and support services and continuity of care. Key activities include: 1) assessment of the client's needs and personal support systems; 2) development of a comprehensive, individualized service plan; 3) coordination of services required to implement the plan; client monitoring to assess the efficacy of the plan; and 4) periodic re-evaluation and adaptation of the plan as necessary. Source: UDS 2007 2008OutreachContactSheet.xls / enabling services - definitions 5/22/2008 11:02 AM 4 of 2008 MONTHLY OUTREACH EXPENDITURE REPORT Contract Dates of Service: ______________________ Agency: ___________________________________________ Budget Line Item Budget Amount Monthly Report Dates of Service: ______________________ Expenditures This Period Cumulative Expenditures Total Expenditures Remaining Balance Comment Outreach Worker Outreach Coordinator Transportation Cell Phone Blood Pressure Cuffs TOTAL: Certification: I certify that the above data is correct and based on the accounting system of the Agency, and that the expenditures shown have been made for the purposes defined in the 2008 Contract between the Agency and the Massachusetts League of Community Health Centers. Program Contact Name: _________________________________ Title: _________________________________ Date: _________________ CRVFHP Paperwork Flow Chart MSFW Enrolls in CRVFHP Eligibility / Registration Form submitted to MLCHC & Enrollment Card Distributed (once per year) Yes Does MSFW Need Medical Care? No Consumer Surveys submitted to MLCHC (at least 10 per year) Appointment Made; MSFW Seen at CHC If applicable, Pharmaceutical Voucher submitted to MLCHC (once per Rx visit) Yes Is CRVFHP payer of last resort? No Non-Billable Visits: Referral Voucher/ Encounter Form submitted to MLCHC; ‘Other Payer’ listed (once per visit) Billable Visits: HCFA/ADA/Encounter Form submitted to MLCHC (once per visit) Does MSFW Need External Referral? Yes Billable Referral Visits: Referral Voucher and External Referral Provider Encounter Form submitted to MLCHC (once per visit) No CONNECTICUT RIVER VALLEY FARMWORKER HEALTH PROGRAM 2009 ELIGIBILITY / REGISTRATION FORM HOH / MSFW Dependent / Spouse Dependent / Child Dependent / Other, specify: _______________ _____________________________ ___________________________ ______________________ ______/______/______ Patient Name - Last First Middle Date of birth (month / day / year) Address _____________________________ Town _________________ State ____ Zip ________ Phone ______________________ If the patient is a dependent, give the name of the migrant / seasonal agricultural worker head of household (HOH). An Eligibility Application must already be completed for the HOH. HOH name _____________________________________________ Date of birth _____/_____/_____ SECTION I: TO BE COMPLETED ON HEAD OF HOUSEHOLD (HOH) FORM ONLY 1A. Within the last 24 months, has your main employment been agriculture? [ ] Yes [ ] No 1B. Have you stopped traveling for work in agriculture due to disability or old age more than 24 months ago? [ ] Yes [ ] No Within the last 24 months, have you moved here from outside the Valley to seek employment in agriculture? [ ] Yes [ ] No 2. If yes, where did you move from? 3. State or Village/Country _____________________________ Expected Farm Income: _____________ X _____________ + Expected Other Income: _____________ = __________________ wkly/mnthly paycheck X # of wks/mnths in Valley Source of income(s): __________________ = annualized family income Type of other employment: _________________________________ list source of income verification Co-payment? [ ] Yes 4. # of Dependents: in the Valley: ________ + outside the Valley: ________ = Total: _______ 5. Employer: What is the name of the farm where you now work or where you last worked? ________________________________ Where is that farm located? [ ] No Town Are you working on that farm now? [ ] Yes If yes, co-payment amount: _______ ______________________________ State __________ [ ] No, when did you last work on a farm? month / year _______ All of farmworker dependents are eligible for medical care through the CRVFHP. Please complete a separate Eligibility / Registration Form for each and check the appropriate box at the top of the form. SECTION II: TO BE COMPLETED FOR ALL PATIENTS [Separate Eligibility / Registration Form must be completed for HOH.] 6. Veteran: [ ] Yes 7. Health Insurance: [ ] None 8. Race: [ ] No [ ] Other, specify: ______________________________ [ ] Black/African American [ ] White including Hispanic/Latino Descent [ ] Asian [ ] Jamaican 9. Hispanic/Latino: [ ] American Indian/Alaska Native including Hispanic/Latino Descent [ ] Native Hawaiian [ ] More than one race [ ] Yes, check below [ ] No [ ] Mexican [ ] Guatemalan [ ] Other, specify: ______________________________ 10. Gender [ ] Male 11. Translation: Best served in a language other than English? including Hispanic/Latino Descent [ ] Other Pacific Islander [ ] Unreported / Refused to report [ ] Puerto Rican [ ] Female [ ] Yes, specify: ______________________ [ ] No 12. When was the last time you were seen by a medical provider besides an H2A provider (employment screening)? ______________ ACKNOWLEDGEMENT: I understand that I may be asked to pay a co-payment for each encounter. However, I have been informed that services will not be denied because of inability to pay. AUTHORIZATION: I hereby authorize disclosure of Protected Health Information (PHI) and the subsequent release of records to the Massachusetts League of Community Health Centers, CRVFHP, its funding source, and to the referred / referring Health Provider; the purpose of this authorization is to support and document medical care and / or process payments to migrant and seasonal farmworkers and their dependents which are supported directly and indirectly through CRVFHP Voucher and / or Outreach funds in 2009. “Notice of Privacy Practices” received? ____________________________________________________ Patient Signature [ ] Yes [ ] No ____________________________________________ Parent / Guardian (if patient is less than 18 years old) The CRVFHP reserves the right to verify the information provided above. Interviewer Signature: ____________________________________ Telephone: (________) ______________________ Agency / Provider: _______________________________________ Date of Application: ________/________/________ White Copy – CRVFHP (mail) Yellow Copy – Agency / Provider Pink Copy – Outreach CONNECTICUT RIVER VALLEY FARMWORKER HEALTH PROGRAM 2009 ELIGIBILITY / REGISTRATION FORM Program Eligibility Requirements Migrant and seasonal farmworkers (MSFWs) and their dependents are eligible for services through the CRVFHP while present in the Connecticut River Valley. A migrant agricultural worker is an individual whose principal employment is in agriculture on a seasonal basis (as opposed to yearround employment) and who establishes a temporary home for the purposes of such employment. This includes anyone who has been employed as a migrant agricultural worker within the last twenty-four (24) months as their primary income. If a former migrant worker stopped working due to disability or old age more than 24 months ago, the migrant worker is still eligible for the CRVFHP. A seasonal agricultural worker is an individual whose principal employment is in agriculture on a seasonal basis (as opposed to yearround employment) and who does not establish a temporary home for the purposes of employment. This includes anyone who has been employed as a seasonal agricultural worker within the last twenty-four (24) months as their primary income. Only MSFWs employed in the direct farming of the land in all its branches, including cultivation, tillage, growing, harvesting, preparation and on-site processing for market or storage are eligible for CRVFHP benefits. The migrant / seasonal agricultural worker may be employed through a crew leader, by contract (H2A), or directly by the farm owner. Persons not eligible include: farm crew leaders who do not work in the fields for wages; individuals coming to the Connecticut River Valley for purposes other than agricultural work who have not done agricultural work in the last twenty four (24) months; and individuals employed in seafood or meat processing, or care of farm animals. Instructions for completing the Eligibility / Registration Form (reverse side) 1. This Eligibility / Registration Form must be completed once per calendar year for each patient. 2. Check appropriate box (HOH or dependent) at the top of form. 3. Print the patient's last, first, and middle name. Please record hyphenated or multiple Hispanic surnames as part of the last name. 4. Enter the patient's date of birth in MM / DD / YY (month / date / year) format. 5. Enter the patient's complete address in the Valley – address, town, state, zip. Also list the phone number in the Valley. 6. If the patient is a dependent of a MSFW, record the head of household (HOH) name and HOH date of birth. 7. Section I: Interview the HOH patient only to answer Questions 1A and 1B. ¾ 8. If HOH patient is eligible, interview the HOH patient only to answer the remaining questions in Section I (Questions 2-5). ¾ 9. To be eligible for CRVFHP services, applicants MUST respond "yes" to Question 1A or 1B. For Question 3, expected annual income MUST be calculated for the entire family in order to determine income as a percent of the current federal poverty level. Include expected income from non-agricultural sources under ‘Expected Other Income’. Also include expected income of other dependents. Section II: Interview all patients (HOH and dependents) to answer questions in Section II (Questions 6-12). Reminder: All of the eligible HOH’s dependents are eligible for medical care through the CRVFHP. ¾ For Question 6, veteran status is defined as an individual who completed service in the Uniformed Services of the United States. 10. Have the patient or parent / guardian sign the completed application. If the patient or parent / guardian is unavailable to sign and the interviewer has obtained the information necessary to answer all the Questions, the interviewer's signature and the information supplied will be sufficient to determine eligibility. 11. Interviewer must sign the application in the space indicated for Interviewer Signature and provide their telephone number, Agency / Provider name and record the date the application is completed (this date is the registration date). 12. Interviewer retains yellow copy for Agency / Provider and pink copy for Outreach. Please return completed Eligibility / Registration Form (white copy) to: Massachusetts League of Community Health Centers Attention: CRVFHP 40 Court Street, 10th Floor Boston, MA 02108 ¾ Please do not submit incomplete forms or complete forms that indicate a patient is not eligible for CRVFHP services. They will be returned unprocessed. 13. This application remains valid through December 31, 2009. White Copy – CRVFHP (mail) Yellow Copy – Agency / Provider Pink Copy – Outreach 2009 ELEGIBILIDAD / REGISTRACIÓN PARA EL PROGRAMA DE SALUD DE LOS TRABAJADORES AGRICOLAS DE LA REGIÓN DEL VALLE DEL RIO DE CONNECTICUT HOH / MSFW Dependiente / Esposo(a) Dependiente / Niño(a) Dependiente / Otro, específique: _________ _____________________________ ___________________________ ____________________ ______/______/______ Apellido(s) Primer Nombre Segundo Nombre Fecha de Nacimiento (mes, dia, año) Calle _________________________ Ciudad ________________ Estado ____ Código postal ________ Teléfono _______________ Si el paciente es un/una dependiente, ponga el nombre del trabajador agrícola migratorio o de estación que es jefe de familia (HOH). Un uso de la elegibilidad se debe terminar ya para el HOH. HOH Apellido(s) ________________________________________________ Fecha de Nacimiento _____/_____/_____ SECCIÓN I: SER RELLENADO SOLAMENTE PARA EL FORMULARIO HOH. 1A. ¿Durante los últimos 24 meses, ha trabajado usted principalmente en agricultura? [ ] sí [ ] no 1B. ¿Usted haterminado de viajar por trabajo en agricultura debido a inhabilidad o edad avanzada hace más de 24 meses? [ ] sí [ ] no ¿ Durante los últimos 24 meses, se ha trasladado de otro lugar fuera del Valle para buscar trabajo en agricultura? [ ] sí [ ] no 2. ¿Si contestó sí, desde dónde usted se modió? Estado o cuidad/país: ________________________________ 3. Salario: granja salario: __________ X __________________ + el orto salario: _________________ = ___________________ cheque de pago mensual/semanal X # de meses/semanas en el Valle Origen de salario: _________________ = salario anualizado de la familia Tipo del otro trabajo: ____________________________________ formulario de verificación ¿Co- pago? [ ] sí [ ] no Si la respuesta es si, total de co-pago: _________ 4. Total # de dependientes: 5. Empleador: ¿Cuál es el nombre de la granja donde usted trabaja ahora o trabajó recientemente?______________________ dentro del Valle: ________ + fuera del Valle: ________ = Total: ________ ¿Dónde está localizada esa finca? ciudad _____________________________ ¿Está usted trabajando actualmente en una finca? [ ] si estado __________ [ ] no, ¿cuándo fue la última vez que trabajó en una finca? mes, año _________ Todos los dependientes del agricultor son elegibles para la asistencia médica con el CRVFHP. Por favor, reuene un formulario de elegibilidad/registro distinto para cada uno y marque la caja correcta en la parte arriba del formulario. SECCIÓN II: SER RELLENADO PARA TODOS LOS PACIENTES [Para HOH, hay que completer un formulario de Elegibilidad/Registro Distinto.] 6. Veterano/a: [ ] sí 7. Seguro de salud: [ ] ninguno 8. Etnicidad: [ ] no [ ] Otro, específique: _________________________ [ ] Negro/Afro Americano [ ] Blanco incluyendo pendiente de Hispáno/Latino [ ] Asiático [ ] Jamaiquino 9. Hispáno/Latino: [ ] Indio Americano/ Nativo de Alaska incluyendo pendiente de Hispáno/Latino [ ] Nativo de Hawaii [ ] Más de una etnicidad [ ] sí, compruebe abajo [ ] no [ ] Mexicano [ ] Guatemalteco [ ] Otro, específique: _________________________ 10. Género: [ ] hombre 11. Traducción: ¿Ayudado lo mejor posible en un idioma aparte de inglés? incluyendo pendiente de Hispáno/Latino [ ] Islas Pacíficas [ ] No denunciado/rechazado divulgar [ ] Puertorriqueño [ ] mujer [ ] sí, específique: _______________ [ ] no 12. ¿Cuándo fue la última vez que usted visitó un proveedor de servicios de salud a excepción de un H2A proveedor? ____________ RECONOCIMIENTO: Yo entiendo que se me solicitará una aportación mínima por cada visita médica. Sin embargo, se me ha informado que no se me negarán servicios si yo no puedo pagar la aportación mínima. AUTORIZACIÓN: Autorizo por este medio el acceso a mi información de salud protegida (PHI) y del uso subsecuente de todos los expedientes de esta visita a la Liga de Centros de Salud Comunitarios de Massachusetts; CRVFHP; su fuente de financiamiento; y al referido proveedor de servicios de salud que refiere; el propósito de esta autorización es apoyar y documentar asistencia médica y/o procesar pagos a los agricultores migratorios y estacionales y a sus dependientes que se han apollado directamente e indirectamente a través del valle de CRVFHP y/o fondos de alcance en 2009. ¿Recibió el "Informe de Prácticas Privadas"? [ ] sí [ ] no ____________________________________________________ ____________________________________________ Patient Signature Padre/Madre/Guardián(a) (si paciente no tiene 18 anòs) El CRVFHP se reserva el derecho de verificar la información proporcionada arriba. La Firma de Entrevistador: ____________________________________ Teléfono: (________) ______________________ Agencia / Proveedor: _______________________________________ Fecha de Aplicación: ________/________/________ Copia Blanca – CRVFHP (correo) Copia Amarilla – Agencia / Proveedor Copia Rosada - Outreach 2009 ELEGIBILIDAD / REGISTRACIÓN PARA EL PROGRAMA DE SALUD DE LOS TRABAJADORES AGRICOLAS DE LA REGION DEL VALLE DEL RIO DE CONNECTICUT Requisitos de Elegibilidad Migrantes y trabajadores agrícolas temporales y sus dependientes son elegibles para recibir servicios a través de la CRVFHP mientras estén en el Valle del Río Connecticut. Un trabajador agrícola migrante es una persona cuyo principal empleo es en la agricultura, de manera estacional (a diferencia de empleo durante todo un año) y que establece un hogar temporal por el propósito de este tipo de empleo. Esto incluye cualquier persona que ha sido empleado como trabajador agrícola migrante en los últimos veinticuatro (24) meses como su salario primario. Si un trabajador emigrante a parado de trabajar debido a inhabilidad o por edad avanzada hace más de 24 meses, es elegible para el CRVFHP. Un trabajador agrícola estacional es un individuo cuyo principal empleo es en la agricultura, de manera estacional (a diferencia de empleo durante todo un año) y que no establece un hogar temporal por el propósito de este empleo. Esto incluye cualquier persona que ha sido empleado como trabajador agrícola estacional durante los últimos veinticuatro (24) meses como su salario primario. Sólo migrantes y / o trabajadores agrícolas estaciónales empleados en el cultivo directo de la tierra en todas sus ramas, incluyendo el cultivo, la siembra, labranza, cosecha, elaboración y procesamiento en el lugar de almacenamiento para el mercado, son elegibles para beneficios del CRVFHP. El migrante y los trabajadores agrícolas estaciónales pueden ser empleado a través de un líder de tripulación, por contrato (H2A), o directamente por el propietario de la granja. Las personas que no son elegibles incluyen: lideres de tripulación que no trabajan en el campo por salario; individuos en del Valle del Río Connecticut para fines distintos de los trabajos agrícolas, que no han hecho trabajo agrícola en los últimos veinticuatro (24) meses; y personas empleadas en el procesamiento de carne o marisco, o el cuidado de los animales de granja. Instrucciones para completar el Formulario de Elegibilidad / Registración (lado reverso) 1. Este Formulario de Elegibilidad / Registración debe ser completado una vez al año para cada paciente. 2. Marque la casilla correspondiente (HOH o dependientes) en la parte superior del formulario. 3. Imprimir el apellido y el primer y segundo nombre del paciente por favor registrar apellidos con guión o apellido maternal en la parte del apellido. 4. Imprimir la fecha de nacimiento del paciente en el formato DD / MM / AA (mes, dia, año). 5. Imprimir la dirección completa del paciente en el Valle - calle, ciudad, estado, zip. También lista el número de teléfono en el Valle. 6. Si el paciente es un dependiente de un trabajador agrícola, registra el nombre y fecha de nacimiento del jefe de familia (HOH). 7. Sección I: Entreviste al jefe de familia (HOH) solamente para contestar las preguntas del 1A al 1B. ¾ 8. Si el HOH es elegible, entreviste al paciente HOH solamente para contestar las preguntas numero 2 y 5. ¾ 9. Para ser elegible, los solicitantes deben responder ‘sí’ a la pregunta numero 1A y 1B. Para la pregunta numero tres (3), el ingreso anual esperado DEBE ser calculado para toda la familia, con el fin de determinar los ingresos como porcentaje del nivel de pobreza federal actual. Incluya los ingresos esperados procedentes de fuentes no agrícolas en el espacio indicado “otros ingresos”. También incluya salario prevista de otros dependientes. Sección II: Entreviste a todos los pacientes (HOH y dependientes) para contestar las preguntas numero 6 y 12. Recordatorio: Todos los dependientes elegibles de HOH son elegibles para asistencia médica a través de la CRVFHP. ¾ Veteranos estado se define como una persona que completó el servicio en los servicios uniformados de los Estados Unidos. 10. El paciente o padre / madre / tutor debe firmar la aplicación completada. Si el paciente o padre / madre / tutor no está disponible para firmar y el entrevistador ha obtenido la información necesaria para responder a todas las preguntas, la firma del entrevistador y la información proveída será suficiente para determinar la elegibilidad. 11. El entrevistador debe firme la aplicación en el espacio indicado para la Firma del Entrevistador y provee su número de teléfono, nombre registrado de la Agencia / Proveedor y la fecha en que la aplicación se ha completado (esta fecha es la fecha de registro). 12. Entrevistador conservara la copia amarilla para la Agencia / Proveedor y la copia rosada de Extensión. Por favor devuelva el Formulario de Elegibilidad / Registración (copia blanca) a: Massachusetts League of Community Health Centers Attention: CRVFHP 40 Court Street, 10th Floor Boston, MA 02108 ¾ Por favor, no entreguen formularios incompletos o formularios que indican que un paciente no es elegible para servicios de CRVFHP. Estos serán devueltos sin procesar. 13. Esta aplicación es valida hasta el 31 de Diciembre de 2009. Copia Blanca – CRVFHP (correo) Copia Amarilla – Agencia / Proveedor Copia Rosada - Outreach 2008 Federal HHS Poverty Guidelines for the 48 Contiguous States & DC (1/23/08 Federal Register, vol. 73, no. 15, pp. 3971-2) Low Income Persons in Family Unit * Poverty 100% between 100% and 150% lower upper between 150% and 200% 133% lower upper between 200% and 300% 185% lower upper between 300% and 400% lower upper greater than 400% 1 10,400 10,401 15,600 $ 13,832 15,601 20,800 $ 19,240 20,801 31,200 31,201 41,600 41,601 2 14,000 14,001 21,000 $ 18,620 21,001 28,000 $ 25,900 28,001 42,000 42,001 56,000 56,001 3 17,600 17,601 26,400 $ 23,408 26,401 35,200 $ 32,560 35,201 52,800 52,801 70,400 70,401 4 21,200 21,201 31,800 $ 28,196 31,801 42,400 $ 39,220 42,401 63,600 63,601 84,800 84,801 5 24,800 24,801 37,200 $ 32,984 37,201 49,600 $ 45,880 49,601 74,400 74,401 99,200 99,201 6 28,400 28,401 42,600 $ 37,772 42,601 56,800 $ 52,540 56,801 85,200 85,201 113,600 113,601 7 32,000 32,001 48,000 $ 42,560 48,001 64,000 $ 59,200 64,001 96,000 96,001 128,000 128,001 8 35,600 35,601 53,400 $ 47,348 53,401 71,200 $ 65,860 71,201 106,800 106,801 142,400 142,401 * for family units with more than 8 persons, add $3,600 for each add'l person to the amount in the "Poverty" column NOTE: the effective date for most state programs, including MassHealth and Commonwealth Care, is April 1. Date: University of Connecticut School of Medicine Connecticut River Valley Farmworker Health Program Medical Services Encounter Form Place of Permanent Residence: Patient Name (Last, First): Birth Date: Arrival date: Expected Departure: Age: Gender: Ethnicity: Barracks # ____ Chief Complaint Today : Mailing Address & Bed Location : Phone Number: History of Present Illness: Type of Visit: □ Initial □ Follow up Recent Environmental/Pesticide Exposures : Drugs: Social History: Marijuana? Tobacco? Heroine? EtOH? Cocaine? Sex? Other? Allergies: Meds: Past Medical History: Diabetes? Family History: Diabetes? BP? BP? HIV? Cardiac? STDs? Cancer? TB? Other? General: Medications: Immunizations: Asthma? Other? Physical Exam: Vitals: T? P? RR? Diagnosis(es): [codes needed below] BP? Work-related? [circle one] If yes, likelihood of being work related? [circle one] 1. yes / no Low / Moderate / High 2. yes / no Low / Moderate / High 3. yes / no Low / Moderate / High 4. Treatment/Plan: yes / no Low / Moderate / High Follow Up/Referrals: [use CRVFHP Referral Vouchers] Student/Attending Signature : Date: CPT Code: [circle one] 99201: New Patient 99202: New Patient 99203: New Patient 99204: New Patient 99205: New Patient Straightforward (10 min) Low Complexity (20 min) Moderate Complexity (30 min) High Complexity (45 min) Extreme Complexity (60 min) 99211: Established Patient 99212: Established Patient 99213: Established Patient 99214: Established Patient 99215: Established Patient Straightforward (10 min) Low Complexity (20 min) Moderate Complexity (30 min) High Complexity (45 min) Extreme Complexity (60 min) rev. 4/23/08 CONNECTICUT RIVER VALLEY FARMWORKER HEALTH PROGRAM 2009 REFERRAL VOUCHER NUMBER: 1. TO BE COMPLETED FOR UCONN REFERRALS (I – II, V) or 2. TO BE COMPLETED FOR EXTERNAL REFERRALS (I – II, V) or 3. TO BE COMPLETED FOR NON-BILLABLE ENCOUNTERS (I – V) SECTION I – ____________________________ Patient Name - Last ________________________ First ________________________________________________ Address ___________________ Middle __________________________ Town ________/________/___________ Date of birth (month / day / year) ___________ State ______________ Zip SECTION II – CHC/Health Care Facility: _________________________________ Clinician Name: _________________________________ Reason(s) for Appt/Referral: ___________________________________________________________________________________ Appointment Date: ______________ Type of care: Primary care Dental Mental health Pharmacy Lab X-ray Specialty care, specify: ___________________________ SECTION III – CPT Code: ______________ ICD-9 Code(s): 1. ______________ 2. ______________ 3. ______________ 4. ______________ SECTION IV – TO BE COMPLETED FOR NON-BILLABLE ENCOUNTERS ONLY – Type of insurance: Medicaid Medicare Private, specify: __________________ Public, specify: __________________ Other, specify: __________________ SECTION V – AUTHORIZATION: I hereby authorize disclosure of Protected Health Information (PHI) and the subsequent release of records to the Massachusetts League of Community Health Centers, CRVFHP, its funding source, and to the referred / referring Health Provider; the purpose of this authorization is to support and document medical care and / or process payments to migrant and seasonal farmworkers and their dependents which are supported directly and indirectly through CRVFHP Voucher and / or Outreach funds in 2009. Patient (or Parent / Guardian) Signature: ___________________________________________________ Date: ____________ Interviewer Signature: ___________________________________________________ Date: ____________ Health Care Provider (sign): __________________________ (print): _____________________________ Date: ____________ White Copy – CRVFHP (mail) Yellow Copy – Agency / Provider Pink Copy – UConn CONNECTICUT RIVER VALLEY FARMWORKER HEALTH PROGRAM 2009 REFERRAL VOUCHER Referral Voucher Requirements 1. Covered Services The following services provided and authorized by a Physician, Mid-Level or Dental Provider are covered services: primary care including: - diagnostic laboratory and diagnostic radiology - screenings including cancer, diabetes, depression and STDs - immunizations - gynecological care - outpatient mental health or substance abuse services - primary vision care - specialty care through CRVFHP ‘Referral Vouchers’ dental care including diagnostic, preventative, restorative, endodontic, periodontic and exodontic services pharmacy (generic pharmaceutical when available) services 2. Non-Covered Services 3. Non-Covered Services include: hospitalization or other inpatient services; services provided in an emergency room; ambulance services; eyeglasses; and prosthodontic, implant or orthodontic services. These services are not covered by the CRVFHP. Claims for non-covered services will not be processed or paid. 4. Co-payments Except for a co-payment, the Participating Provider agrees not to bill the CRVFHP patient for Covered Services, and the Participating Provider shall use best efforts to inform the CRVFHP patient in advance of services that are non-covered services. 5. CRVFHP-Supported Services Providers should report on all CRVFHP-supported farmworker patients and encounters regardless of whether the CRVFHP is the payer source. To document CRVFHP supported patients and encounters for which the CRVFHP is not the payer source, please submit a CRVFHP Eligibility / Registration Form (once per calendar year) and a completed CRVFHP Referral Voucher (once per encounter) OR a completed HCFA 1500 Form or ADA Form marked “Paid = Other Source” and list the payer source. Instructions for completing the Referral Voucher (reverse side) 1. Agency making referral / appointment completes Sections I, II and V of the Referral Voucher, retaining yellow copy for Agency / Provider. Please note: If a patient needs a follow-up appointment or a referral outside the health center, Section II must be completed with the name of the referral agency listed. You will also review these referral claims for accuracy, completeness and appropriateness before applying to the CRVFHP for payment. You will clearly identify documentation related to reimbursement for referred services with the Date of Service and numbered CRVFHP Referral Voucher that substantiates the medical care encounter and referral. 2. After appointment (except for External Referrals), Section III is completed by health care provider. 3. The white copy (and CRVFHP Eligibility/Registration Form once yearly) is forwarded to: Massachusetts League of Community Health Centers Attention: CRVFHP 40 Court Street, 10th Floor Boston, MA 02108 4. If UConn box is checked, the pink copy is forwarded to: Shannon Bacchi UConn Health Center 263 Farmington Avenue, MC 2928 Farmington, CT 06030-2928 White Copy – CRVFHP (mail) Yellow Copy – Agency / Provider Pink Copy – UConn CONNECTICUT RIVER VALLEY FARMWORKER HEALTH PROGRAM 2009 PHARMACEUTICAL VOUCHER Participating Provider sends to: Massachusetts League of Community Health Centers Attention: CRVFHP 40 Court Street, 10th Floor Boston, MA 02108 617-426-2225 Pharmacy Name: Address: City, State: Phone #: Patient Information date of INITIAL office visit * If refill, date of REFILL patient name (last, first) Drug Information date of birth physician national drug code & drug name strength Price Information qty co-pay amount amount Office Use Only total due Grand Total: Instructions / Process • Patient presents prescription to Participating Providers’ Pharmacist. • Pharmacist fills prescription and fills out applicable row(s) of Pharmaceutical Voucher. (Please use generic drugs unless contraindicated by physician.) • Drug code, strength and quantity must be included. • Pharmacist signs and submits white and yellow copies of completed Pharmaceutical Voucher to Participating Provider retaining pink copy. • Participating Provider signs and submits white copy of Pharmaceutical Voucher to CRVFHP retaining yellow copy. • The CRVFHP will reimburse the Participating Provider the lesser of the Average Wholesale Price (AWP) or actual charge of each prescription. • Participating Provider can also submit pharmaceutical voucher in other payment format with prior approval from CRVFHP Manager. • Staple receipts to back of Voucher. I certify that these pharmaceuticals have been dispensed to these patients and that the stated prices are true and accurate. Pharmacist Signature: __________________________________ Date: ___________ Participating Agency: ___________________________________________________ Agency Provider Signature: ______________________________ Date: __________ NOT VALID WITHOUT ORIGINAL SIGNATURE OF REGISTERED PHARMACIST OR PARTICIPATING PROVIDER * date of office visit = INITIAL medical office visit that first generated prescription White Copy – CRVFHP (mail) Yellow Copy – Participating Provider Pink Copy - Pharmacy CRVFHP Health Agency: _____________________ CONNECTICUT RIVER VALLEY FARMWORKER HEALTH PROGRAM 2009 PATIENT SATISFACTION SURVEY ☺ YOUR OPINION MATTERS ☺ 1) How do you feel you were treated by outreach staff who visited your camp or home during the past year? Check one below. Poorly Okay Very Well ☺ I was not visited during the past year Comments:_____________________________________________________________________ ______________________________________________________________________________ 2) Do you feel that the information that the outreach staff gave you in your camp or home was helpful and clear? Check one below. I have not received information If no, please explain: ____________________________________________________________ Yes No _____________________________________________________________________________ 3) How do you feel you were treated by staff at the clinic during the past year? Check one below. Poorly Okay Very Well ☺ I have not gone to the clinic in this last year Comments: ____________________________________________________________________ _____________________________________________________________________________ 4) What health services have you needed in the past year that you had problems getting? Check all that apply. General doctor services Specialty care Mental health Dental care Other (please specify):____________________ I haven’t had any problems getting services 5) What problems have you had in the past year getting health services? Check all that apply. Transportation Cost of services Getting permission to leave work Language Clinic schedule Child care Other (please specify): __________________________________ 6) How can we improve our services? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Thank you for taking a moment to complete this survey! CRVFHP Health Agency: _____________________ CONNECTICUT RIVER VALLEY FARMWORKER HEALTH PROGRAM 2009 SATISFACCIÓN PACIENTE EXAMEN ☺ SU OPINIÓN VALE MUCHO ☺ 1) ¿Cómo ha sido tratado por el personal de nuestro programa que visita el campo o su casa en el último año? Marque una de las siguientes respuestas. Excelente ☺ No he sido visitado en este último año Comentarios:___________________________________________________________________ Mal Bien _____________________________________________________________________________ 2) ¿Piensa que la información que le dieron en el campo o su casa fue útil y clara? Marque una de las siguientes respuestas. Sí No No me dieron ningún tipo de información Si respondió “no”, por favor explique porque: _________________________________________ _____________________________________________________________________________ 3) ¿Cómo le ha tratado el personal de la clínica en este último año? Marque una de las siguientes respuestas. Excelente ☺ No he ido a la clínica en este último año Comentarios: __________________________________________________________________ Mal Bien _____________________________________________________________________________ 4) ¿Qué servicios de salud ha necesitaba en el último año pero no los pudo obtener? Seleccione las que aplican. Servicios médicos (doctor) Servicios especializados (especialistas) Salud mental Cuidado dental Otros (por favor especifique):________________ No he tenido ningún problema en obtener servicios 5) ¿Qué problemas ha tenido en obtener servicios de salud en este último año? Seleccione las que aplican. Falta de transporte Costo del servicio No me dieron permiso para faltar el trabajo Idioma El horario de la clínica Falta de cuidado para niños Otros (por favor especifique):_____________________________________________ 6) ¿Cómo podemos mejorar nuestros servicios? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ ¡Gracias por llenar esta encuesta! League Services & Programs-CRVFHP Page 1 of 1 PROGRAMS & INITIATIVES Connecticut River Valley Farmworker Health Program CRVFHP Program Agencies - Click here for online materials Click to Enter (English) Chasque para Entrar (Español) Working to improve primary health care access for medically underserved populations, in 1998 the League helped develop and continues to manage the Connecticut River Valley Farmworker Health Program (CRVFHP). The CRVFHP is a unique two-state contracted services program that provides outreach and primary health services to migrant and seasonal farmworkers through a partnership of health centers and other community-based organizations in Massachusetts and Connecticut. Back to other Programs & Initiatives Page. Home | About the League | Programs/Initiatives | Commonwealth Care | Health Centers | Boards & Committees Publications | Calendar of Events | Clinical Corner | Links | League Affiliates | Want to be a Member? http://www.massleague.org/CRVFHP/index.htm 4/26/2007 Connecticut River Valley Farmworker Health Program - English Page 1 of 3 Materials For Program Agencies / Staff Program Meeting Handouts Advisory Board Contract Orientation Immigration Educational Marketing Handouts Materials Packet Materials Materials Materials Program Meeting Handouts: Download meeting materials by right clicking and 'save target as' z z z z z z z z z z z CRVFHP Monthly Meeting Handouts - 4/15/08 CRVFHP Monthly Meeting Handouts - 2/26/08 CRVFHP Monthly Meeting Handouts - 1/15/08 CRVFHP Monthly Meeting Handouts - 12/18/07 CRVFHP Monthly Meeting Handouts - 11/20/07 CRVFHP Monthly Meeting Handouts - 10/16/07 CRVFHP Monthly Meeting Handouts - 9/18/07 CRVFHP Monthly Meeting Handouts - 8/21/07 CRVFHP Monthly Meeting Handouts - 7/17/07 CRVFHP Monthly Meeting Handouts - 6/19/07 CRVFHP Monthly Meeting Handouts - 5/15/07 Advisory Board Meeting Handouts: Download meeting materials by right clicking and 'save target as' z z z z CRVFHP Advisory Board Quarterly Meeting Handouts - 4/15/08 CRVFHP Advisory Board Quarterly Meeting Handouts - 1/15/08 CRVFHP Advisory Board Quarterly Meeting Handouts - 10/16/07 CRVFHP Advisory Board Quarterly Meeting Handouts - 7/17/07 Contract Materials: Download contract materials by right clicking and 'save target as' z z z z z z z z 2008 Voucher Component Summary 2007 CHC Patient Care Hours - primary care & dental hours of CRVFHP health centers Patient Enrollment Cards - contact the League for cards 2008 CRVFHP Outreach Contact Sheet - Excel 2008 CRVFHP Expenditure Report - Excel Farm Database Listing - contact the League for updated listing 2008 CRVFHP Forms: { Eligibility / Registration Form - English or Espanol { Referral Voucher { Pharmaceutical Voucher { Consumer Survey 2008 Federal Poverty Guidelines http://www.massleague.org/CRVFHP/ProgramAgencies.htm 4/23/2008 Connecticut River Valley Farmworker Health Program - English Page 2 of 3 Orientation Packet: Download both orientation files by right clicking and 'save target as' z z Orientation Presentation Orientation Packet Immigration Materials: Download immigration materials by right clicking and 'save target as' z z z z z z ‘Know Your Patients’ & Your Rights’ – English & Spanish – prepared by National Immigration Law Center ‘Warning! Protect Yourself from Immigration Raids’ – English & Spanish – prepared by National Immigration Law Center Connecticut flyer: ‘Know Your Rights if You are Contacted or Detained by Immigration’ – English & Spanish – prepared by American Civil Liberties Union of Connecticut Massachusetts flyer: ‘Know Your Rights! What to do if stopped and questioned about your immigration & Spanish status on the street, the subway or the bus’ – English – prepared by American Civil Liberties Union of Massachusetts ‘Know Your Rights! What to Do if Questioned by Police, FBI, Customs Agents or Immigration Officers – & Spanish English – prepared by American Civil Liberties Union Rights Card – fold in half – English & Spanish – prepared by National Immigration Law Center Other useful website links include: z z z z z National Lawyers Guild: www.nlg.org National Immigration Law Center: www.nilc.org National Immigration Project: www.nationalimmigrationproject.org National Justice Fund: www.fwjustice.org American Civil Liberties Union: www.aclu.org Educational Materials: Download educational materials by right clicking and 'save target as' z 'Where There is No Doctor' - English or Espanol z 'Where There is No Dentist' - English or Espanol Health Education / Disease Prevention Resources Listing z Marketing Materials: Download marketing materials by right clicking and 'save target as' z CRVFHP Tri-Fold Brochure z Connecticut River Valley Farmworker Health Program - Stories From the Field z 2-Page Outreach Flyer with Contact Numbers-English 2-Page Outreach Flyer with Contact Numbers-Espanol z z z 1-Page Farmworker / Outreach Flyer-English [PDF 1-Page Farmworker / Outreach Flyer-Espanol [PDF and Word] and Word] http://www.massleague.org/CRVFHP/ProgramAgencies.htm 4/23/2008 Connecticut River Valley Farmworker Health Program - English z Farm Owner Survey [PDF z Map of Program Sites Page 3 of 3 and Word] Home | About the League | Programs/Initiatives | Health Centers Publications | Calendar of Events | Clinical Corner | Links http://www.massleague.org/CRVFHP/ProgramAgencies.htm 4/23/2008 Mapa del Valle del Río Connecticut Puntos de Acceso de Cuidado Médico que Participan en la Programa: Brightwood Health Center 380 Plainfield Street, Springfield, Massachusetts 01107 Teléfono: 413-794-4458 (oficina) or 413-426-8863 (celulár) Servicios: Medico, Farmacia, Alcance de la Comunidad, Transportación Community Health Center of Enfield 5 North Main Street, Enfield, Connecticut 06082 Teléfono: 860-253-9024 Servicios: Medico, Dental, Alcance de la Comunidad, Transportación Community Health Center of Franklin County 338 Montague City Road, Turners Falls, Massachusetts 01376 Teléfono: 413-772-3748 ext. 146 (oficina) or 413-834-2174 (celulár) Servicios: Medico, Dental, Farmacia, Alcance de la Comunidad, Transportación Community Health Services 500 Albany Avenue, Hartford, Connecticut 06120 Teléfono: 860-249-9625 o 860-808-8700 Servicios: Medico, Dental, Farmacia, Transportación ¿Cómo Puedo Comunicarme con el Programa CRVFHP? East Hartford Community HealthCare 94 Connecticut Blvd, East Hartford, Connecticut 06108 Teléfono: 860-528-1359 ext. 137 Servicios: Medico, Dental, Farmacia Connecticut River Valley Farmworker Health Program c/o Massachusetts League of Community Health Centers 40 Court Street, 10th Floor Boston, Massachusetts 02108 Teléfono: 617-426-2225 Fax: 617-426-0097 E-mail: [email protected] Internet: www.massleague.org Fair Haven Community Health Center 374 Grand Avenue, New Haven, Connecticut 06513 Teléfono: 203-777-7411 Servicios: Medico, Alcance de la Comunidad La Oficina de Servicios Básicos de Salud brinda apoyo financiero a el Programa de Salud para Trabajadores Agrícolas del Valle del Río Connecticut. Hispanic Health Council 175 Main Street, Hartford, Connecticut 06106 Teléfono: 860-527-0856 Servicios: Alcance de la Comunidad, Transportación This information is also available in English. 4/08 Generations Family Health Center 1315 Main Street, Willimantic, Connecticut 06226 Teléfono: 860-450-7471 Servicios: Medico, Dental, Alcance de la Comunidad, Transportación Holyoke Health Center 230 Maple Street, Holyoke, Massachusetts 01040 Teléfono: 413-420-2134 Servicios: Medico, Dental, Farmacia, Alcance de la Comunidad, Transportación Ofrecido por la Liga de Centros de Salud Comunitarios de Massachusetts, el Programa de Salud para Trabajadores Agrícolas del Valle del Río Connecticut (CRVFHP, por sus siglas en inglés) es un proyecto único en el valle que paga por algunos servicios básicos de salud para los trabajadores agrícolas, de temporada y migratorios, que cualifiquen. El programa se ofrece a través de centros de salud participantes y otros proveedores de cuidado médico en Connecticut y Massachusetts. Servicios de Alcance de la Comunidad Este programa incluye un componente de alcance de la comunidad, adaptado al idioma y la cultura de los trabajadores, que proporciona educación de salud y servicios de prevención para mejorar la calidad de vida de los trabajadores agrícolas y sus familias. Cuando sea necesario, el equipo de alcance brinda transporte a citas médicas y hacen referencias a otros servicios sociales y de salud. ¿Quién Califica para el Pago de Servicios Médicos? Los trabajadores de temporada y migratorios y sus dependientes que no tienen cobertura de salud cualifican para los pagos médicos bajo el programa CRVFHP mientras estén presentes en el Valle del Río Connecticut. Esto incluye a los que han laborado como trabajadores agrícolas migratorios o de temporada en los últimos veinticuatro (24) meses. Trabajador agrícola migratorio significa que su empleo principal es el trabajo agrícola de temporada y traslades a viviendas temporales para obtener trabajo en el campo. Trabajador agrícola de temporada significa que su empleo está en la agricultura en una base estacional y no estableces un hogar temporáneo por los propósitos del empleo. es un factor de riesgo para muchas enfermedades. Algunas condiciones comunes incluyen problemas en los músculos y los huesos, dermatitis y salpullidos, dolores de cabeza y problemas en los ojos. ¿Qué Servicios Médicos Cubre* el Programa CRVFHP? ¿Qué es considerado parte de la Región del Valle del Río Connecticut? ♦ El área del Valle del Río Connecticut es la región agrícola más grande de Nueva Inglaterra; Corriendo norte a sur a lo largo del Río Connecticut, extiende desde la frontera de Massachusetts con Vermont hasta el estrecho de Long Island. Los trabajadores agrícolas de la región cosechan tabaco (para envolver puros), manzana y otras frutas y verduras. También trabajan en viveros y fincas de césped en ambos estados. Se estima que viven 12,000 trabajadores migratorios y trabajadores de temporada con sus familias en el valle. Únicamente los trabajadores agrícolas de temporada o los migratorios que trabajan en la agricultura directa de cosechas de temporada cualifican para el programa. El trabajo en el campo incluye el cultivo, la recolección y la preparación de cosechas de temporada para el comercio o almacenamiento. Necesidades Médicas Los trabajadores agrícolas del Valle del Río Connecticut sufren mucho de los mismos malestares de salud que sufren el resto de los trabajadores agrícolas del país. Nacionalmente, los trabajadores agrícolas pueden sufrir de altos índices de diabetes, hipertensión crónica y enfermedades dentales. La exposición laboral a insecticidas ♦ ♦ Servicios del cuidado primario incluye: ∗ Visitas médicas sin hospitalización ∗ Servicios de diagnóstico de laboratorio ∗ Servicios de diagnóstico de rayos x ∗ Exámenes de salud ∗ inmunizaciones ∗ Servicios de salud mental ∗ Servicios de abuso de substancias sin hospitalización ∗ Cuidado básico de los ojos Servicios de Cuidado dental Servicios de farmacia * En algunos casos se te solicitará una aportación mínima por cada visita médica. Sin embargo, no te denegarán servicios si no puedes pagar la aportación mínima. ¿Se Pueden Elegir los Proveedores de Cuidado Medico? Sí. Participen varios centros de salud y proveedores de cuidado médico en el programa que brindan servicios sociales y médicos de alta calidad en el Valle del Río Connecticut. What is the Connecticut River Valley Farmworker Health Program? FREE Health Care Services Preventive and sick visits to a doctor or nurse practitioner Pregnancy care Dental care Mental health counseling Medicine prescribed by your health care provider Eye checks and glasses Lab work, x-rays, ultrasound FREE Outreach to the Farms Health educators to talk with you about your health Health care workers to check your blood pressure or do physical exams Referral to community resources Help getting other health services that are not provided at health center Transportation to health care appointments off the farm Who can receive the services? Migrant and seasonal farmworkers and their families The farmworker must work in direct farming of seasonal crops Farm work must be cultivating, harvesting or preparing seasonal crops for market or storage Where can farmworkers and their families receive services? Health centers in Massachusetts (3) and in Connecticut (5) At farms Valley-wide in Massachusetts and Connecticut At a health care provider who participates in the Connecticut River Valley Farmworker Health Program How can I get in contact with the health care provider? You can contact the health center or health care provider You can ask the outreach worker to help with an appointment Brightwood Health Center 380 Plainfield Street Springfield, Massachusetts 01107 Phone: 413-794-3295 Outreach worker: Luz Peña-Till Cell: 413-426-8863 Community Health Center of Enfield 5 North Main Street Enfield, Connecticut 06082 Phone : 860-253-9024 Outreach worker: VACANT Community Health Center of Franklin County 338 Montague City Road Turners Falls, Massachusetts 01376 Phone: 413-772-3748 x146 Outreach worker: Byron Pareja Cell: 413-834-2174 Community Health Services & Hispanic Health Council CHS: 500 Albany Avenue Hartford, Connecticut 06120 Phone: 860-249-9625 HHC: 175 Main Street Hartford, Connecticut 06120 860-527-0856 Outreach worker: Luis Ayala East Hartford Community HealthCare 94 Connecticut Blvd East Hartford, Connecticut 06108 Phone: 860-528-1359 Fair Haven Community Health Center 374 Grand Avenue New Haven, Connecticut 06513 Phone: 203-777-7411 x5271 Outreach worker: Denise Dean Generations Family Health Center 1315 Main Street Willimantic, Connecticut 06226 Phone: 860-450-7471 Outreach worker: VACANT Holyoke Health Center P.O. Box 6260 230 Maple Street Holyoke, Massachusetts 01040 Phone: 413-420-2134 Outreach worker: José Santana Cell: 413-563-4379 CRVFHP, c/o Massachusetts League of Community Health Centers 40 Court Street, 10th Floor - Boston, Massachusetts 02108 Phone: 800-475-8455 - Fax: 617-426-0097 e-mail: [email protected] - website: www.massleague.org/CRVFHP Esta información también está disponible en español. (1-800-475 8455 o 1-617-426-2225) May 08 ¿Qué es el Programa de Salud para Agricultores del Valle del Río Connecticut? Servicios médicos GRATIS. - Visitas al doctor o enfermera cuando esté enfermo o para prevenir enfermedades - Cuido del embarazo - Cuido dental - Asesoramiento para la salud mental - Medicamentos prescritos por su médico - Exámen de la vista y lentes - Exámenes de laboratorio, radiografías y ultrasonido Servicios de alcance GRATUITOS a las granjas. - Educadores de la salud hablarán con usted sobre su salud - Trabajadores de cuidado médico le tomarán su presión arterial y le harán exámenes físicos - Referencias y acceso a otros servicios sociales y de salud - Ayuda para conseguir servicios médicos que no se proveen en los centros de salud - Transporte a las citas médicas ¿Quién puede recibir los servicios? Trabajadores agrícolas migratorios y de temporada y sus familias El trabajador debe laborar en el cultivo de cosechas de temporada El trabajo de la finca debe ser cultivando, recojiendo o preparando cosechas de temporada para el mercado o el almacenamiento ¿Dónde pueden los agricultores y sus familias recibir servicios? Centros de Salud en Massachusetts (3) y en Connecticut (5) En las granjas que estan ubicadas en el Valle de Massachusetts y Connecticut Donde haya un proveedor médico que participe en el Programa de Salud para Agricultores del Valle del Río Connecticut (CRVFHP) ¿Cómo puedo contactar al proveedor del cuidado médico? Usted puede llamar al centro de la salud o el proveedor del cuidado médico Usted puede pedir que el trabajador que visita las granjas le ayude con una cita. Brightwood Health Center 380 Plainfield Street Springfield, Massachusetts 01107 Teléfono: 413-794-3295 Trabajador de alcance: Luz Peña-Till Celulár: 413-426-8863 Community Health Center of Enfield 5 North Main Street Enfield, Connecticut 06082 Teléfono: 860-253-9024 Trabajador de alcance: VACANTE East Hartford Community HealthCare 94 Connecticut Blvd East Hartford, Connecticut 06108 Teléfono: 860-528-1359 Fair Haven Community Health Center 374 Grand Avenue New Haven, Connecticut 06513 Teléfono: 203-777-7411 x5271 Trabajador de alcance: Denise Dean Generations Family Health Center 1315 Main Street Community Health Center of Franklin County Willimantic, Connecticut 06226 Teléfono: 860-450-7471 x241 338 Montague City Road Trabajador de alcance: VACANTE Turners Falls, Massachusetts 01376 Teléfono: 413-772-3748 x146 Holyoke Health Center Trabajador de alcance: Byron Pareja P.O. Box 6260 Celulár: 413-834-2174 Holyoke, Massachusetts 01040 Teléfono: 413-420-2134 Community Health Services & Trabajador de alcance: José Santana Hispanic Health Council CHS: 500 Albany Avenue Celulár: 413-563-4379 Hartford, Connecticut 06120 Teléfono: 860-249-9625 HHC: 175 Main Street Hartford, Connecticut 06120 Teléfono: 860-527-0856 x293 Trabajador de alcance: Luis Ayala CRVFHP, c/o Massachusetts League of Community Health Centers 40 Court Street, 10th Floor - Boston, Massachusetts 02108 Teléfono: 800-475-8455 - Fax: 617-426-0097 e-mail: [email protected] - website: www.massleague.org/CRVFHP Esta información también está disponible en Inglés. (1-800-475 8455 o 1-617-426-2225) May-08 Tell Us If You Are A Farmworker If you are a Migrant or Seasonal Farmworker If you work directly planting, cultivating or packing crops If you have been a Farmworker within the last 24 months You and your Dependents may be Eligible for Free Health Care Free Well and Sick Visits to the Doctor or Nurse Practitioner Free Health Screens Blood pressure & Diabetes checks Free Dental Care Free Eye Checks Free Medicine To Get These FREE Services Contact: Díganos si Usted es un/a Trabajador/a en una Hacienda o Granja Si usted es un trabajador en una hacienda o granja Si su trabajo es plantar, cultivar o empacar cosechas Si ha trabajado en una hacienda o granja durante los últimos 24 meses Usted y sus Dependientes pueden ser elegibles para estos Servicios Médicos Gratuitos Visitas médicas gratuitas con el doctor o la enfermera Visitas gratuitas para monitoriar su diabetes o presion alta Visitas dentales gratuitas para limpiar sus dientes y restaurar caries Examenes de la vista Medicamentos gratuitos Para recibir estos servicios GRATIS, contacte a: MASSACHUSETTS LEAGUE OF COMMUNITY HEALTH CENTERS CONNECTICUT RIVER VALLEY FARMWORKER HEALTH PROGRAM Stories from the Field