HCP Specialty Care Clinics

The Health Care Program for Children with Special Needs (HCP) at the Colorado Department of Public Health and Environment (CDPHE), in collaboration with local public health agencies throughout the state of Colorado, seeks to ensure statewide access to pediatric specialty care by supporting HCP Pediatric Specialty Clinics for Children and Youth with Special Health Care Needs (CYSHCN).

 
The clinics exist to provide access to pediatric specialty care for children and youth with special health care needs and their families living in rural and frontier counties in Colorado where pediatric medical specialists are least available.  The clinics are designed to offer specialized clinic services and specialized pediatric medical expertise to children, youth and their families and primary care providers.

 
HCP within the Colorado Department of Public Health and Environment, contracts with the Regents of the University of Colorado so pediatric specialists from the University of Colorado School of Medicine, in partnership with Children’s Hospital Colorado can travel to rural areas of the state to provide care.

 
These pediatric specialists:  

• provide specialty care for neurology, orthopaedics, and rehabilitation medicine
• collaborate with local primary care providers and model a medical home team approach
• provide access to specialty care in rural and frontier communities of Colorado

HCP Pediatric Specialty Clinics Fact Sheet

Definition of Children and Youth with Special Health Care Needs
The Maternal and Child Health Bureau defines Children and Youth with Special Health  Care Needs (CYSHCN) as “those who have, or are at increased risk for having, a chronic  physical, developmental, behavioral or emotional condition and who also require  health and related services of a type or amount beyond that required by children [and  youth] generally.” (McPherson, et al., 1998). 

 
How can a child or youth attend a HCP Specialty Clinic?
Contact the child’s primary care provider to receive a referral or contact a clinic coordinator or public health nurse to receive assistance with getting a clinic appointment.  

To contact a HCP Specialty Clinic Coordinator:

Health Care Program for Children with Special Health Care Needs Referral Form

What can a family expect when a child or youth attends a HCP Specialty Clinic?
 
Attending a HCP Specialty Clinic is an opportunity for a child or youth with special health care needs to see a pediatric specialist in a rural community without driving to a large urban area. It is an opportunity to ask questions about a child’s care, medication, day to day concerns and possible resources.
 
 
The HCP specialty clinic coordinator or a public health nurse will:

• assist family with clinic forms and paperwork
• contact the child’s primary care provider (PCP) to request medical records/test results
• take the child/youth’s height/weight measurements and vital signs during clinic
• obtain parent signatures for clinic consent and release of information forms
• collect insurance information and copies of insurance cards
• ask the family to self report household income to determine specialty clinic support fees based on Federal Poverty Levels
• send appointment letter to confirm clinic appointment, location of clinic, name of the specialty provider and clinic fees if needed
• provide family with an evaluation form to improve future clinic services
• refer family to the child’s primary care provider for clinic follow-up
• refer family to a public health nurse for community services and supports if needed
• sends the family and PCP the pediatric specialist’s dictated notes
• notify family of follow-up clinic appointments if needed

Does it cost to attend a HCP Specialty Clinic?
Clinic Support Fee for a HCP Specialty Clinic Visit
HCP charges clinic support fees to provide financial support and to cover expenses related to hosting the clinics, such as clinic supplies and equipment.

• Clinic support fees are in addition to co-pays collected by University Physicians, Inc., which are based on the family’s insurance policy.
• Clinic support fees are not charged to families whose child is enrolled in Medicaid.
• The clinic site charges families according to a sliding scale fee. Families self report estimate of household income before taxes and the number of people in the household to determine the sliding scale fee. If a family refuses to self report income, a $100.00 maximum fee for each clinic is charged. 
• A family, who has more than one child seen in clinic, is charged a clinic support fee for each child.
• Sliding scale fees are based on Federal Poverty Level (FPL) which are updated annually: http://aspe.hhs.gov/poverty
• Sliding scale fees:     
  • No charge for families at or below 100% FPL
  • 5 fee per visit for a rating of 101 - 133% FPL
  • 10 fee per visit for a rating of 134 to 185% FPL
  • 30 fee per visit for a rating of 186 to 211% FPL
  • 50 fee per visit for a rating of 212 to 399% FPL
  • 75 fee per visit for a rating of 400 to 450% FPL
  • 100 fee per visit for a rating of 450% FPL and greater

Insurance coverage for a HCP specialty clinic visit: 
University Physicians (UPI), Inc, may bill Medicaid, CHP+ and private insurance companies for the clinic visit.

• UPI must accept Medicaid/CHP+ payment as full reimbursement.
• Billing is the responsibility of UPI; therefore, payment is made directly to them.
• Patients unable or unwilling to obtain their own insurance (identified as “self pay”) will not be billed by UPI, Inc. unless the family and the provider agree before services are rendered on payment plans based on the family’s ability to pay.
• UPI may bill a family co-pays associated with private insurance.
• UPI may bill a family with private insurance if an insurance payment is denied because the deductible has not been met.
• UPI may choose not to bill families but will receive no further compensation.

HCP Specialty Clinic Policy and Guidelines