crvfhp orientation meeting - Massachusetts League of Community

Transcripción

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
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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).
Country of Origin
5/22/2008 11:02 AM
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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.)
5/22/2008 11:02 AM
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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
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
[ ] 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?
[ ] 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
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.
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
[ ] 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?
[ ] 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:
Attention: CRVFHP
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
3.
yes / no
4.
Treatment/Plan:
yes / no
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
Straightforward (10 min)
Low Complexity (20 min)
Moderate Complexity (30 min)
High Complexity (45 min)
Extreme Complexity (60 min)
rev. 4/23/08
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: ____________
Pink Copy – UConn
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:
Attention: CRVFHP
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
Pink Copy – UConn
2009 PHARMACEUTICAL VOUCHER
Participating Provider sends to: Massachusetts League of Community Health Centers
Attention: CRVFHP
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
Yellow Copy – Participating Provider
Pink Copy - Pharmacy
CRVFHP Health Agency: _____________________
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: _____________________
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'
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CRVFHP Monthly Meeting Handouts - 4/15/08
Advisory Board Meeting Handouts: Download meeting materials by right clicking and 'save target as'
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CRVFHP Advisory Board Quarterly Meeting Handouts - 4/15/08
Contract Materials: Download contract materials by right clicking and 'save target as'
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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
Page 2 of 3
Orientation Packet: Download both orientation files by right clicking and 'save target as'
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Orientation Presentation
Orientation Packet
Immigration Materials: Download immigration materials by right clicking and 'save target as'
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‘Know Your Patients’ & Your Rights’ – English
& Spanish
– prepared by National Immigration Law Center
‘Warning! Protect Yourself from Immigration Raids’ – English
& Spanish
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
Other useful website links include:
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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'
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'Where There is No Doctor' - English or Espanol
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'Where There is No Dentist' - English or Espanol
Health Education / Disease Prevention Resources Listing
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Marketing Materials: Download marketing materials by right clicking and 'save target as'
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CRVFHP Tri-Fold Brochure
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Connecticut River Valley Farmworker Health Program - Stories From the Field
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2-Page Outreach Flyer with Contact Numbers-English
2-Page Outreach Flyer with Contact Numbers-Espanol
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1-Page Farmworker / Outreach Flyer-English [PDF
1-Page Farmworker / Outreach Flyer-Espanol [PDF
and Word]
and Word]
4/23/2008
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Farm Owner Survey [PDF
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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
4/23/2008
Mapa del Valle del Río Connecticut
Puntos de Acceso de Cuidado Médico que Participan en la
Programa:
380 Plainfield Street, Springfield, Massachusetts 01107
Teléfono: 413-794-4458 (oficina) or 413-426-8863 (celulár)
Servicios: Medico, Farmacia, Alcance de la Comunidad,
Transportación
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?
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
Boston, Massachusetts 02108
Teléfono: 617-426-2225
Fax: 617-426-0097
E-mail: [email protected]
Internet: www.massleague.org
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.
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
1315 Main Street, Willimantic, Connecticut 06226
Teléfono: 860-450-7471
Servicios: Medico, Dental, Alcance de la Comunidad, Transportación
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
380 Plainfield Street
Springfield, Massachusetts 01107
Phone: 413-794-3295
Outreach worker: Luz Peña-Till
Cell: 413-426-8863
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
CHS: 500 Albany Avenue
Hartford, Connecticut 06120
Phone: 860-249-9625
HHC: 175 Main Street
860-527-0856
Outreach worker: Luis Ayala
94 Connecticut Blvd
East Hartford, Connecticut 06108
Phone: 860-528-1359
374 Grand Avenue
New Haven, Connecticut 06513
Phone: 203-777-7411 x5271
Outreach worker: Denise Dean
1315 Main Street
Willimantic, Connecticut 06226
Phone: 860-450-7471
Outreach worker: VACANT
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.
380 Plainfield Street
Springfield, Massachusetts 01107
Teléfono: 413-794-3295
Trabajador de alcance: Luz Peña-Till
Celulár: 413-426-8863
5 North Main Street
Enfield, Connecticut 06082
Teléfono: 860-253-9024
Trabajador de alcance: VACANTE
94 Connecticut Blvd
East Hartford, Connecticut 06108
Teléfono: 860-528-1359
374 Grand Avenue
New Haven, Connecticut 06513
Teléfono: 203-777-7411 x5271
Trabajador de alcance: Denise Dean
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
Trabajador de alcance: Byron Pareja
P.O. Box 6260
Celulár: 413-834-2174
Holyoke, Massachusetts 01040
Teléfono: 413-420-2134
Trabajador de alcance: José Santana
CHS: 500 Albany Avenue
Celulár: 413-563-4379
Teléfono: 860-249-9625
HHC: 175 Main Street
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

crvfhp orientation meeting - Massachusetts League of Community

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