Understanding Changes to Local Health Department Clinical Service Provision

ASPE Generic Clearance for the Collection of Qualitative Research and Assessment

ASPE_IP_draft_final

Understanding Changes to Local Health Department Clinical Service Provision

OMB: 0990-0421

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0990-0421 can be found here:

2024-03-27 - No material or nonsubstantive change to a currently approved collection
2024-02-22 - No material or nonsubstantive change to a currently approved collection

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Local Health Departments/ Clinical Service Provision Interview Guide

Interviewee:
Interviewer:
Location:
Date:
Thank you for agreeing to speak with me today regarding the practices of your local
health department in the area of clinical services. This interview is part of a project
focusing on public health services and capacity and funded by the Office of the Assistant
Secretary for Planning and Evaluation in the U.S. Department of Health and Human
Services. Our interest is in your local health department’s activities as a clinical service
provider and how you are funded and reimbursed for those services.
This interview, along with other activities, will lead to helping identify and describe
changes in clinical service delivery and provide other local health departments evidence
to optimize their performance. The questions asked are divided into three sub-sections:
Service provision, Billing Authority and Practices, and Fees and Reimbursement.
The Co-Principal Investigator for this project is Dr. Tamar Klaiman (University of the
Sciences in Philadelphia). If you have any questions please contact me at
t.klaiman@usciences.edu or 215-596-7031.
I will treat everything you tell me as confidential in the sense that I will not share it with
anyone in a way that identifies you or the organization you represent to the extent
provided by law.
This interview will take approximately one hour. Your participation in this interview is
strictly voluntary, and you may end this interview at any time. May we proceed?

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0990-0421. The time required to complete this information
collection is estimated to average 60 minutes per response, including the time to review instructions,
search existing data resources, gather the data needed, and complete and review the information
collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for
improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA,
200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports
Clearance Officer

** Contextual information will be collected for each state and confirmed with each
interviewee including:
 Public health governance (centralized/decentralized)
 Medicaid Expansion/Non-expansion state
 Population
 Rate or number of uninsured
 Proportion of population covered by Medicaid
 Health Department Budget
 Full time employees (FTEs)
 Metro/Micro/Rural
Service Provision
Initially, we are going to ask you some questions in order to get a sense of your Local
Health Department and its role as a clinical service provider.
1. Please describe in general the kinds of services your LHD provides. (Primary
care services? Safety net provider? ie. Vaccination, MCH, dentistry, mental
health, etc.)

2. Is there sufficient access to care in your community excluding those provided
by your LHD? (ie. Are there services that people need but don’t have access
to? Populations that need services and can’t access them, etc.?) How do you
assess this?

3. Are the services you provide primarily provided in the community or at the
LHD?

4. Has there been any change in your client volume over the past 5 years? What
services? Why has it changed?

5. Has the implementation of the ACA or other policies (eg. Other health reform
efforts, economic downturn) impacted the types of services you have provided
during the past 5 years? How?

6. How do you determine which services you will provide? (state, Board of Health,
local health officer?)
7. How do you fund your services? Can you provide this information by source and
what proportion each funder provides (eg federal, state, local, grants, contracts,
foundation, non-profit, insurance by payer (public and private)?

Billing Authority and Practices
Now, we would like to discuss billing authority and practices in your LHD.
8. Who do you bill to get reimbursed for the services you provide? (Medicaid,
private insurance, Medicaid Managed Care, Self-Pay, unfunded services, etc.)
Can you provide this information by source and what proportion each funder
provides?

9. How do you ascertain insurance status for clients?
10. Where does your LHD’s authority to bill derive from? For example, is it power
granted from the state through statute or by regulation or rule-making? County
jurisdiction? Does this authority or document also dictate what services are
billable?
11. Who negotiates and manages the contracts your LHD has with payers?
(individual, state, external contractor, etc.) What kind of training do they have? (if
internal)

12. Are there any state mandates in place regarding reimbursement? (ie: Mandates
that Medicaid reimburse LHDs for services provided)?
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a
collection of information unless it displays a valid OMB control number. The valid OMB control
number for this information collection is 0990-0421. The time required to complete this information
collection is estimated to average 60 minutes per response, including the time to review instructions,
search existing data resources, gather the data needed, and complete and review the information
collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for
improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA,
200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports
Clearance Officer

13. Have there been changes in recent years to payers with whom you contract? (ie:
Shift to Medicaid Managed Care?)

14. Can you describe how you manage billing for services? Do you use a database or
a billing system for billing purposes?

15. Have there been any prominent challenges faced by your LHD in the area of
billing for services? (Hard to retain providers, politics in the provision of services
from state/county, lack of/ low reimbursement amount, negotiation, staff training,
cost of systems, etc).
16. Do your billing practices vary by service?
Fees and Reimbursement
Next we are going to ask you a few questions about fees and reimbursement for the
services you provide.
17. Where does the revenue generated from reimbursable services go? (Do they fund
any LHD programs, state general fund, mixed, etc.) Has this changed during the
past 5 years? How? Why?
18. How does your LHD keep up to date with billing practice information? (Is there a
specific person on staff responsible for contracts, best practices, state and local
opportunities, etc)
19. What, if any, challenges have you faced over the past 5 years in providing clinical
services and billing and reimbursement? How have you managed these
challenges? What recommendations would you offer similar LHDs that are facing
similar challenges in terms of billing and reimbursement for services?

File Type	application/pdf
File Modified	2015-12-09
File Created	2015-12-09