Frequently Asked Questions about CHA-CHIPs, and CSPs

During webinars in Winter 2013, participants asked questions about the Community Health Assessments (CHAs), Community Health Improvement Plans (CHIPs),reports that have to be submitted by local health departments, and about the Community Service Plans (CSPs), reports that have to be submitted by hospitals. The Frequently Asked Questions are organized by categories that relate to process, priority, deadlines, collaboration, format and disparities. Click on the question to navigate to the answer.

Community Health Assessment (CHA)-Community Health Improvement Plan (CHIP) and Community Service Plan (CSP) Process

CHA-CHP/CSP Process

1. Does the Affordable Care Act (ACA) require us to pick three priorities?
2. If a priority is selected, do the hospitals and local health departments (LHDs) need to work on the same goal?
3. Is there a requirement for the number of goals and objectives for each priority selected?
4. When you say "at least 2 community priorities" do you mean two of the five priority areas, or 2 focus areas from the many, or 2 goals? How many activities are you looking for at the state level?
5. Are the states goals suggestions or a list to pick from? Can we pick our own goals if they fall in line with the focus area and priority?
6. Must the hospitals choose a priority that is identified by a local health department?
7. How many measurable goals should we have for an identified priority?
8. Confirm that the two community priorities selected by Public Health and those of the hospital do not have to be the same?
9. If a hospital could pick two priorities, and because of their physical location in a rural area, could all of their proposed work address an 'access' disparity?
10. Do the actual dates of hospital needs assessment and collaborative planning meetings need to be documented?
11. Is the County Community Health Assessment and Health Improvement Plan a 4-year plan as in the past? The CSP is a 3-year plan?
12. What are the criteria for the CHA? How many people must be interviewed, etc?
13. Are publicly-owned hospitals required to complete a CSP?
14. Can you address whether the comprehensive CSP to be submitted by each hospital in November should include data from 2012 (as the last one-year update reported on activities in 2011)?
15. Will the Community Health Improvement Plan (CHIP) be replacing the MPHSP?
16. If a hospital has reviewed local community data and has identified priorities such as breast feeding rates and pediatric asthma can we move forward with plans for these two items or do we still have to go out to the community to validate the priorities we choose.

Specific Prevention Agenda Priority Questions

1. How much latitude do we have within each category? I work for a specialty hospital that focuses on orthopedics and rheumatology. The chronic diseases we would be addressing are lupus, rheumatoid arthritis, and arthritis which are not listed in the information provided in the chronic disease category.
2. You mentioned that violence prevention is included in the healthy and safe environment priority. Is it also included in promote mental health and substance abuse and if so, with equal emphasis?
3. Is Emergency Preparedness a priority in the new Prevention Agenda? If so, which of the five priorities address emergency preparedness?

Submission deadlines

1. When is the Community Health Improvement Plan (CHIP) due for Local Health Departments?
2. Please confirm that the Community Service Plan (CSP) due date has changed to Nov. 15.
3. Is the three year action plan for work beginning 2014 - 2016 or 2013 - 2015? Is the plan covering work in 2013 or starting in 2014?
4. Please describe the relationship between the IRS requirements and the CSP. My question has to do with the relationship between the State's CSP requirements and the requirements for a Community Health Needs Assessment (CHNA) and implementation plan under the ACA. The ACA requires that the CHNA and plan be completed, approved, and posted on the hospital's website by the end of the hospital's taxable year. For my Medical Center, that would be August 31, 2013. But the State requires that the CSP be completed, submitted, and disseminated by November 15, 2014. How do we reconcile these two timelines?

Collaboration

1. Can multiple counties and hospitals from a region pull together to do a regional assessment and community service plan?
2. How can hospitals in NYC work with local NYC health dept. when there are so many hospitals? Who can we contact specifically?
3. Is the local health department going to coordinate the collaborate effort with the hospitals in health assessment development or is up to the individual hospital to work with local DOH?
4. If you don't have a hospital in your county, how do you suggest collaboration and addressing priorities?
5. What organizations beside local public health and government do you recommend to collaborate with?
6. Does the information on slide #7 mean that the local Health Department has to do the Community Health Needs Assessment and not the hospital? Is the hospital not responsible for the Community Health Assessment?

Report Format

1. Will DOH provide a preferred format, such as a table, for hospitals to use to develop the three year plan of action?
2. Is the NYSDOH going to require the completion of a Health Grid for LHDs for the year 2013?
3. Will we receive feedback from SDOH on our plans after submission of Comprehensive CSP
4. Is your view that the CSP submission would be able to be submitted to the IRS, and meet their requirements (final requirements are still pending).
5. Will the CSP be submitted in "Survey Monkey" form again this year or will it be, as in the past submitted via email in doc form?
6. We are 60% complete with the CHNA requirements laid out by the Accountable Care Act, and this was a complete collaborative effort with county public health and community stakeholders. If these priorities align with the Prevention Agenda, will this work be acceptable as both a CHNA and CSP submission?
7. Has the state considered allowing hospitals to use alternate formats for CSP reporting? For example, choosing between a template and/or the narrative report with headings similar to what we've been using for the past few years. From others participating in the Web conference, the consensus of opinion is that a standardized template might clarify what the state is looking for and be a more straightforward tool for reporting. At the very least, it might serve as a reference guide for others choosing to use the more "traditional" reporting format. Follow-up question (SEW)

Disparities

1. How can we as hospitals assure that our new plan continually addresses disparities in the communities we serve?
2. One priority must address a 'disparity' - is there any further guidance from DOH on what will be considered a disparity for this purpose? Please give an example of a disparity related priority.
3. Can we consider military veterans to be a disparate group with regards to mental health/suicide?

Responses to Frequently Asked Questions

CHA-CHP/CSP Process

1. Does the Affordable Care Act (ACA) require us to pick three priorities?

The ACA requires hospitals to conduct a community health needs assessment at least every three years. It does not require that three priorities be selected.

2. If a priority is selected, do the hospitals and local health departments (LHD) need to work on the same goal?

The hospital and local health department need to work with community partners to select the same two priorities or focus areas or goals, but the interventions can be complementary. For example, if one of the priorities selected is Prevent Chronic Disease and the focus area selected is to reduce illness, disability and death related to tobacco use and second hand smoke, the hospital may work on increasing referrals to the NYS Smokers Quitline or using electronic medical records to prompt providers to complete 5 A's (Ask, Assess, Advise, Assist, and Arrange). The local health department may be working with its county policy makers to adopt tobacco free outdoor parks policies. See the Prevent Chronic Disease action plan (pdf, 1.17MB, 42 pp.) for more information. Interventions for each priority and focus area are available on the website and are sorted by sector so that it will be easy for different participants within local coalitions to identify what their role could be in addressing the selected priorities.

3. Is there a requirement for the number of goals and objectives for each priority selected?

No.

4. When you say "at least 2 community priorities" do you mean 2 of the 5 priority areas, or 2 focus areas from the many areas under each priority or 2 goals from the many focus areas in each priority? How many activities are you looking for at the state level?

To clarify the terminology, the Prevention Agenda 2013-2018 has five statewide priorities; within each priority are multiple focus areas; within each focus area are multiple goals. The guidance is asking that each local health department and hospital select at a minimum two common focus areas, or goals within the focus area. There is no limit to the number of activities that any organization undertakes to address those focus areas or goals.

5. Are the states goals suggestions or a list to pick from? Can we pick our own goals if they fall in line with the focus area and priority?

The Prevention Agenda goals were identified by a statewide community workgroup from several options. Within each priority area there are many focus areas and goals. We are asking local health departments and hospitals in collaboration with community partners to select from the Prevention Agenda 2013-2018 list.

6. Must the hospitals choose a priority that is identified by a local health department?

The hospital and local health department are asked to collaborate with community partners on identifying two common priorities or focus areas.

7. How many measurable objectives should we have for an identified priority?

The decision about the number of measurable objectives is left up to collaboration partners. It is helpful to have process and outcome measures.

8. Confirm that the two community priorities selected by Public Health and those of the hospital do NOT have to be the same?

At least two community priorities or focus areas selected by local health departments and hospitals in collaboration with community partners are expected to be the same. What can be different are the goals, measures and interventions.

9. If a hospital could pick 2 priorities, and because of their physical location in a rural area, could all of their proposed work address an 'access' disparity?

Geography may be identified as a disparity within the context of the priority. While Access to Care is not one of the priorities identified in the Prevention Agenda 2013-2018, some of the Priority Areas address specific aspects of health service delivery. See esp. Prevent Chronic Diseases and the focus area of increasing access to high quality chronic disease preventive care, and Promoting Women, Infants and Children.

10. Do the actual dates of hospital needs assessment and collaborative planning meetings need to be documented?

Approximate dates or months will suffice; DOH is looking for evidence that community collaboration took place. For local health departments that are going to use the CHA for accreditation, meeting, participation and communication of the process must be documented. See PHAB Standards and Measures, Standard 1.1.1 - Required Documentation.

11. Is the County Community Health Assessment and Health Improvement Plan a 4 year plan as in the past? The Community Service Plan is a 3 year plan.

As defined in New York State law the CHA/CHIP is a 4-year plan, and the CSP is a three-year plan

12. What are the criteria for the CHA? How many people must be interviewed, etc?

In New York State, the working definition of a Community Health Assessment is a process that describes the health of the community by collecting, analyzing and using data to educate and mobilize communities, develop priorities, and plan, implement and evaluate actions to improve public health. The ultimate goal is health improvement. There are no requirements for the number of people that need to be interviewed.

13. Are publicly-owned hospitals required to complete a CSP?

CSPs are not required for publicly-owned hospitals.

14. Can you address whether the comprehensive CSP to be submitted by each hospital in November should include data from 2012 (as the last one-year update reported on activities in 2011)?

Data from the most recent years available should be included. Please include information on activities in 2012, if possible.

15.Will the Community Health Improvement Plan (CHIP) be replacing the Municipal Public Health Services Plan (MPHSP)?

The 2013-24 budget proposes elimination of the MPHSP. The Community Health Improvement plan describes the collaborative and systematic effort to address health problems on the basis of the results of assessment activitie by identifying and tracking measures, identifying and tracking implementation of evidence-based strategies. All local health departments are required to complete a CHA that includes a CHIP.

16. If a hospital has reviewed local community data and has identified priorities such as breast feeding rates and pediatric asthma can we move forward with plans for these two items or do we still have to go out to the community to validate the priorities we choose.

If a hospital collaborated with community partners to identify priorities and work on them it would be acceptable to move forward with plans. However if community partners were not involved, the hospital is encouraged to connect with community partners such as a local health departments, other health care organizations, community-based organization to collaboratively work towards addressing priorities. The purpose is primarily to get community buy-in and optimal efforts to address the problems, and not only validation of the priority.

Specific Prevention Agenda Priority Question

1. How much latitude do we have within each category? I work for a specialty hospital that focuses on orthopedics and rheumatology. The chronic diseases we would be addressing are lupus, rheumatoid arthritis, and arthritis which are not listed in the information provided in the chronic disease category.

All hospitals are asked to work with their local health department and partners to participate in the community health priority setting process and then identify a role that makes sense given the priority and the hospital's specialty.

2. You mentioned that violence prevention is included in the healthy and safe environment priority. Is it also included in promote mental health and substance abuse and if so, with equal emphasis?

Violence prevention is discussed under the "Health and Safe Environment" priority. Complementary goals relating to mental health promotion, mental health disorder prevention and building infrastructure are discussed under "Promote mental health and prevent substance abuse" priority. The Prevention Agenda committees tried to be complementary, and not duplicative in identifying goals and measures.

3. Is Emergency Preparedness a priority in the new Prevention Agenda? If so, which of the five priorities address emergency preparedness?

Emergency Preparedness was identified as a cross-cutting issue, not one of the five priorities.

Submission deadlines

1. When is the Community Health Improvement Plan (CHIP) due for Local Health Departments?

The due date is November 15, 2013 for both the Community Health Assessment (CHA) and the Community Health Improvement Plan.

2. Please confirm that the Community Service Plan (CSP) due date has changed to Nov. 15.

Hospital CSPs are now due November 15. The community needs assessment should be done prior to that date.

3. Is the three year action plan for work beginning 2014 - 2016 or 2013 - 2015? Is the plan covering work in 2013 or starting in 2014?

The plan is prospective and would cover 2014-2016.

4. Please describe the relationship between the State's CSP requirements and the requirements for a Community Health Needs Assessment (CHNA) and implementation plan under the ACA. The ACA requires that the CHNA and plan be completed, approved, and posted on the hospital's website by the end of the hospital's taxable year. For my Medical Center, that would be August 31, 2013. But the State requires that the CSP be completed, submitted, and disseminated by November 15, 2013. How do we reconcile these two timelines?

Section 501(r) of the Internal Revenue Code requires hospitals to conduct a CHNA at least once every three years and adopt an implementation strategy to meet the community health needs identified. HANYS and the American Hospital Association have developed a resource tool to help hospitals identify their cycles for conducting the needs assessment. The state's requirements for a CSP will assist the hospital to complete reporting required for the CHNA. HANYS has shared a timeline chart that was presented at one of the webinars in 2012 to address this question.

Collaboration

1. Can multiple counties and hospitals from a region pull together to do a regional assessment and community service plan?

Yes, this is encouraged as a model. At the same time, unique needs of the county should be addressed.

2. How can hospitals in NYC work with the NYC Department of Health and Mental Hygiene (NYCDOHMH)? Who can we contact specifically?

NYC hospitals should select priorities and focus areas that are common to both the Prevention Agenda 2013-2018 and Take Care New York. The Proposed Take Care New York (TCNY) 2016 priorities, cross walked to the Prevention Agenda and indicators for tracking will be released by March 1. NYC DOHMH will be organizing "TCNY Listening Sessions" that can provide opportunity for NYC hospitals to get stakeholder feedback on local concerns, priorities and potential strategies. To contact the NYC Department of Health, use this email: takecarenewyork@health.nyc.gov

3. Are the local health departments going to coordinate the collaborative effort with the hospitals in health assessment development or is it up to the individual hospital to work with the local DOH?

Hospitals and local health departments need to meet to determine their respective roles in the assessment process.

4. If you don't have a hospital in your county, how do you suggest collaboration and addressing priorities?

Local health departments will need to collaborate with hospital(s) outside the county who serve county residents. We encourage hospitals to be aware that they serve people in nearby counties as well and to offer to participate in these coalitions. Please contact us if you have specific requests for support.

5. What organizations beside local public health and government do you recommend to collaborate with?

A wide range of organizations can be involved in the local effort. These include community based organizations, other organizations in the health care system including health plans, Federally Qualified Community Health Centers, primary care providers, private doctor offices, medical societies, schools and colleges, local businesses, other county agencies, local policymakers and elected officials. It may depend on your community needs and priorities. For example, If you anticipate the focus to be on obesity prevention for children and youth, you would involve schools, pediatrician offices, other organizations serving children and youth, in addition to businesses, faith based organizations, neighborhood leaders. A list of DOH-funded public health partners and the public health priorities they are focusing on will be posted on the Prevention Agenda website.

6. Does the information on slide #7 mean that the local Health Department has to do the Community Health Needs Assessment and not the hospital? Is the hospital not responsible for the Community Health Assessment?

Local county health department and hospitals need to collaborate on developing the community needs assessment.

Report format

1. Will DOH provide a preferred format, such as a table, for LHDs and hospitals to use to develop the assessment and plan of action?

The health department will provide possible templates to use.

2. Is the NYSDOH going to require the completion of a Health Grid for LHDs for the year 2013?

No.

3. Will we receive feedback from SDOH on our plans after submission of Comprehensive CSP?

Yes.

4. Is your view that the CSP submission would be able to be submitted to the IRS, and meet their requirements (final requirements are still pending).

The CSP components were developed with the IRS draft requirements in mind, so most of the components will be the same.

5. Will the CSP be submitted in "Survey Monkey" form again this year or will it be, as in the past submitted via email in doc form?

Additional information will be provided on how to submit the document.

6. We are 60% complete with the CHNA requirements laid out by the Accountable Care Act, and this was a complete collaborative effort with county public health and community stakeholders. If these priorities align with the Prevention Agenda, will this work be acceptable as both a CHNA and CSP submission?

Yes.

Disparities

1. How can we as hospitals assure that our new plan continually addresses disparities in the communities we serve?

By identifying a clear disparity focus, identifying and tracking measures that track progress towards objectives, and using an evidence-based approach towards achieving the goal

2. One priority must address a 'disparity' - is there any further guidance from DOH on what will be considered a disparity for this purpose? Please give an example of a disparity related priority.

Although the term "disparities" often is interpreted to mean racial or ethnic disparities, many dimensions of disparities exist in the United States, particularly in health. If a health outcome is seen in a greater or lesser extent between populations, there is disparity. Race or ethnicity, sex, sexual identity, age, disability, socioeconomic status, and geographic location all contribute to an individual's ability to achieve good health. It is important to recognize the impact that social determinants have on health outcomes of specific populations. (Source:HealthyPeople.gov on Disparities.) Please also see the most recent copy of the DOH Minority Health Report.

Two examples of disparity-related objectives from the Prevention Agenda (pdf, )are:

• Decrease the percentage of population with low?income and low access to a supermarket or large grocery store by 10% from 2.49% to 2.24%
• The percentage of adults with disabilities ages 18 years and older who are obese is reduced 10% from 34.9% (2011) to 31.4%

3. Can we consider military veterans to be a disparate group with regards to mental health/suicide?

Yes, military veterans can be considered to be a disparate group with regards to mental health/suicide if they are significant segment of the population and data is available to illustrate the disparity at the local level.