Migratory and Seasonal Agricultural Worker Identification, Registration and Reporting. September 22, 2016

Transcription

1 Migratory and Seasonal Agricultural Worker Identification, Registration and Reporting September 22, 2016

2 About NCFH A national non-profit organization dedicated to improve the health status of farmworker families through the provision of innovative training, technical assistance, and information services. Visit our website:

3 Learning Objectives Describe the relationship between MSAW identification, Uniform Data System reports, and health center funding Identify industries and tasks in agriculture that meet the definition for agricultural worker in the Migrant Health Program Distinguish between migratory and seasonal agricultural workers (MSAW) Utilize acquired knowledge to correctly determine the agricultural worker status of health center patients from case studies

4 The Agriculture Industry

5 Definition of Agriculture The term "agriculture" means farming in all its branches, including: (i) cultivation and tillage of the soil; (ii) the production, cultivation, growing, and harvesting of any commodity grown on, in, or as an adjunct to or part of a commodity grown in or on, the land; and (iii) any practice (including preparation and processing for market and delivery to storage or to market or to carriers for transportation to market) performed by a farmer or on a farm incident to or in conjunction with an activity described in clause (ii). Source:

6 Section 330g of the Public Health Service Act Migratory Agricultural Worker Principal employment is in agriculture Has been so employed within the last 24 months Establishes a temporary home for the purpose of such employment Seasonal Agricultural Worker Principal employment is in agriculture on a seasonal basis Has been so employed within the last 24 months Is not a migratory worker Aged & Disabled Agricultural Worker Individual who has previously been a migratory agricultural worker but who no longer meets the requirements because of age or disability

7 MSAW & Family Members in U.S. Total # of Migrant Health Users in 2015: 910,172** million* Migrant 291,628 Unserved FW's 3,589,828 MH Patients 910,172 M/S 90,000+ Seasonal 525,402 *NCFH and National League Aid and Defender Association respectively **UDS 2015

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9 Number of Crop Workers by State NCFH 2015

10 Number of Animal Production Workers by State National Center for Farmworker Health

11 ID & Registration of Special Populations Special Populations have been identified due to their limited access to healthcare services. Special Populations have unique challenges and barriers in accessing healthcare services. Health Centers receive special funding to provide healthcare services to Special Populations. Special Population designation may impact treatment planning.

12 Status Verification and Funding Funding Funding corresponds to the # Migratory & Seasonal Agricultural Workers the CHC proposes to be served Funding Obligations Compliance with 19 HRSA program requirements for PHS Section 330 (g) Provision of services to eligible population Submission of UDS reports Funding Continuation

13 What is the Uniform Data System(UDS)? Government required electronic reporting mechanism for health centers funded with PHS section 330 funds including: Community Health Migrant Health Health Care for the Homeless Residents of Public Housing

14 Why is the UDS Important? It helps your health center to demonstrate: The number of patients your health center serves The race/ethnicity, age, income levels, insurance sources, and health status of your patients The services your health center provides The types of staff who work in your health center The types of funding and payments your health center receives The most important reason: To be in COMPLIANCE with the requirements of the federal government

15 What Information is Required? Demographic Clinical Financial Patient information: Zip code Age Gender Race Ethnicity Language Special population status Income Insurance Number of patients with selected diagnoses (such as HIV, diabetes mellitus, depression, etc.) Clinical services provided Quality of care indicators Health outcomes & disparities, etc. Number of: Users & encounters Health care providers People with insurance Cost of services, changes, discounts, billing, and collection, etc.

16 Poll Question #1 Who is responsible for the process of identifying special population status at health centers? a) Board of Directors b) Management staff c) Support staff d) All of the above

17 Responsibilities Board of Directors Establish policies Oversee compliance with local, state and federal regulation Management Team Implement board policies by establishing procedures, training staff, and monitoring compliance Support Staff Follow established policies and procedures to accomplish assigned registration tasks Provide feedback to management related to patient difficulties around the registration process Offer suggestions for improvement

18 What is Your Role in Helping Your Health Center to Complete the UDS Report? Clinical Financial Demographic

19 In Order to Verify MSAW Status, You Need to Know The definition of agriculture What types of industries and tasks in agriculture are included and excluded under HRSA rules The classifications of agricultural workers

20 STEP 1: Establish Occupation Is Agriculture principal employment? Verification Question: Have you or anyone in your family worked in agriculture?

21 What is Agriculture? Agriculture means farming in all its branches, including: Horticulture Aquaculture Animal husbandry Packing and delivery to a location for sale or processing

22 Important Change to UDS Manual 2012 Agriculture means farming in all its branches as defined by the Office of Management (OMB)-developed North American Industry Classification System (NAICS), and includes migratory and seasonal agricultural workers employed in the following codes and all sub-codes: 2012 NAICS 111 Crop Production 1111 Oilseed and Grain Farming 1112 Vegetable and Melon Farming 1113 Fruit and Tree Nut Farming 112 Animal Production and Aquaculture 1121 Cattle Ranching and Farming 1122 Hog and Pig Farming 1123 Poultry and Egg Production 1151 Support Activities for Crop Production 1152 Support Activities for Animal Production

23 What Agricultural Sectors are included in the Migrant Health Program?

24 Grains and Nuts 111 Crop Production

25 Fruits and Vegetables 111 Crop Production Alan Pogue Alan Pogue Alan Pogue

26 Nurseries 111 Crop Production

27 Other Commodities 111 Crop Production Tobacco Cotton Christmas Trees

28 Forestry (only includes the production and harvesting of Christmas trees and other trees that are harvested at least every 10 years) 111 Crop Production

29 Support Activities for Crop Production 1151 Support Activities for Crop Production Harvesting primarily by machine Post-harvest crop activities And Farm labor contractors and crew leaders Soil preparation and cultivation Cotton ginning

30 Dairy Farms 112 Animal Production & Aquaculture

31 Animal Farms Goats, sheep, pigs, cattle, horses, & animals raised for fur 112 Animal Production & Aquaculture

32 Poultry Farms & Hatcheries 112 Animal Production & Aquaculture

33 Aquaculture 112 Animal Production & Aquaculture Photo by David Heikes

34 Support Activities for Animal Production 1152 Support Activities for Animal Production & Aquaculture Boarding Branding Reproductive services (breeding, insemination, semen collection, etc.) Livestock spraying, cleaning, etc. For more, see: ww/naics/

35 Tasks Performed by Agricultural Workers Examples Preparation of the soil Seeding plants, flowers, grass, trees, vegetables, fruits, and other commodities Planting, thinning, growing, irrigating of vegetables & fruits Planting, caring, pruning, fertilizing, replacing trees Detasseling, collecting, harvesting (corn and other grains) Sorting, preparing, processing Canning, preserving, packing Transporting, storing, distributing Catching, preparing, processing aquaculture products Feeding, caring, milking cows and other farm animals

36 Excluded Tasks and Industries Examples Meat and Meat Product Merchant Wholesalers Industry Landscaping - Industry Landscaping Services Trucking timber - Industry Specialized Freight Spectator Sporting Industry

37 Step 2: Verify Time Frame Have you worked in agriculture anytime in the last 24 months? Verification Question: Have you or anyone in your family worked in agriculture in the last two years?

38 Classification of Agricultural Workers Migratory Seasonal Aged/Disabled Principal employment is agriculture Employed within the last twenty-four months Establish a temporary home for the purposes of working in agriculture Principal employment is agriculture on a seasonal basis Employed within the last twenty-four months Is not a migratory worker Has not established a temporary home in order to work in agriculture Former migratory agricultural workers unable to work in agriculture due to old age or disability. NOTE: Workers and their family members receive the same classification

39 POLL QUESTION #2 Which classification of agricultural worker do you think is most often not identified and documented during the registration process? a. Migratory Worker b. Seasonal Worker c. Aged or Disabled d. Dependents/ Family members

40 Step 3: Inquire about Migratory Status Migratory or Seasonal Verification Question: Have you or anyone in your family established a temporary home in order to work in agriculture? Migratory - Establish a temporary abode When a person and/or family leaves the area in which he/she lives to do agriculture work and must live somewhere other than in his/her home in order to do such work, that person is considered to have established a temporary home. Seasonal Does not establish a temporary home

41 Step 4: Verify Seasonality On a Seasonal Basis Verification Question: Have you or anyone in your family worked in agriculture on a seasonal basis without having to establish a temporary home? Seasonality is not defined in the legislation, and is often defined unnecessarily narrowly. Seasonal basis means that the worker s employment and income may fluctuate with changes in conditions and the kinds of agriculture that they are working in. Does your job, hours, or income change with the seasons?

42 Step 5: Identify Former MAW Verification Question: Have you or anyone in your family stopped migrating to work in agriculture because of a disability or age? Former Migratory Worker No longer MAW because of age or disability

43 Step 6: Don t Forget the Family Members Family: (A) migratory agricultural workers, seasonal agricultural workers, and members of the families of such migratory and seasonal agricultural workers who are within a designated catchment area; and (B) individuals who have previously been migratory agricultural workers but who no longer meet the requirements of subparagraph (A) of paragraph (3) because of age or disability and members of the families of such individuals who are within such catchment area.

44 UDS 2015 Changes UDS guidance on Family Members aligned with definition Addition of guidance for documenting Aged and Disabled Page 46 All health centers are required to report either on Line 16 or on lines 14 and 15 the number of patients seen during the reporting period who were either migratory or seasonal agricultural workers or their family members, or other individuals described in the statute at Section 330(g)(1)(B). Page 47 Aged and Disabled Former Agricultural Workers: As defined in Section 330 (g)(1)(b), aged and disabled former agricultural workers are individuals who have previously been migratory agricultural workers but who no longer work in agriculture because of age or disability. These individuals and family members of such individuals are included in Line 14.

45 Common Mistakes in the Verification Process Self Administered form with no quality assurance Not asking the right questions Understanding and recognizing all Ag industries Verifying work in the last 24 months for those not currently working in Ag Not including family members in count Not verifying aged/disabled Garbage in Results? Garbage out Low numbers of MSAWs to report in the UDS and to justify funding

46 Asking the Right Questions VERIFYING MIGRATORY AND SEASONAL AGRICULTURAL WORKER STATUS Suggested Questions The following are key questions to ask in determining whether an individual and his/her family seeking health care at a health center are agricultural workers, and if they are to be considered seasonal (stay in one area all year long) or migratory. The four questions below are in alignment with the Public Health Service definitions of "Migrant", "Seasonal", "Aged or Disabled" farmworkers and agricultural employment. CURRENT 1. In the past two years, have you or a member of your family worked in agriculture/farming as your/their principal employment including, but not limited to: Preparing, irrigating or spraying the fields, nurseries, orchards; Planting, picking, sorting, packing, or transporting fruits, vegetables, grains, nuts, plants, tobacco, hops, flowers, grass, alfalfa, hay, or other agricultural products; Planting trees; working with Christmas trees; picking pine needles or Spanish moss; Working on farms that produce chickens, ducks, turkeys, cows, goats, sheep, horses, fish, seafood, etc., FORMER 2. Have you or a member of your family stopped migrating to work in agriculture because of a disability or old age? YES - This person and his/her family are agricultural workers. CONTINUE to questions 3-4. NO - There is no current agricultural worker in the household. GO to question 2. YES - This person and his/her family can be classified as migratory workers. VERIFICANDO EL ESTATUS DE TRABAJADORES AGRICOLAS MIGRATORIOS Y TEMPORALES Preguntas Sugeridas Las siguientes son preguntas claves para determinar si un individuo y su familia en busca de cuidados de salud en un centro de salud son trabajadores agrícolas y si pueden ser considerados como trabajadores temporales (seasonal- viven en la misma área todo el año) o migratorios (migrant). Las siguientes cuatro preguntas están alineadas con las definiciones de la Ley Americana de Salud Pública (PHS Sección 330) para Migrante Temporal y Migrante Retirado o Deshabilitado y empleo agrícola. PRESENTE 1. Durante los últimos dos años, usted o algún miembro de su familia ha trabajado en la agricultura o en el campo como su empleo principal, haciendo cosas como: Preparando, regando, fumigando parcelas, viveros o huertas; Plantando, cosechando, sorteando, empacando, o transportando frutas, vegetales, granos, nueces de todos tipos, plantas, tabaco, lúpulo, flores, zacate, alfalfa, pastura, u otros productos agrícolas; Plantando árboles; trabajando con árboles de navidad; cosechando las agujas de pino o el heno español; Trabajando en granjas que producen pollos, patos, guajolotes, ganado, chivos, borregos, caballos, pescado, mariscos, etc. ANTERIORMENTE 2. Usted o un miembro de su familia dejó de migrar para trabajar en la agricultura debido a una discapacidad o a la vejez? SI La persona y su familia son trabajadores agrícolas. CONTINÚE con las preguntas 3-4. NO Ningún miembro de la familia es trabajador agrícola presente. CONTINÚE con pregunta 2. SI - La persona fue trabajador agrícola. La persona y su familia pueden ser clasificados como trabajadores agrícolas migratorios. MIGRATORY 3. In the past two years, have you or a member of your family established a temporary home in order to work in agriculture? SEASONAL 4. In the past two years, have you or a member of your family worked in agriculture on a seasonal basis without the need to establish a temporary home? NO - There is no current or former agricultural worker in the household. STOP YES - This person and his/her family are migratory workers. STOP NO CONTINUE to question 4. YES - This person and his/her family are seasonal workers. STOP MIGRANTE 3. En los últimos dos años, usted o algún miembro de su familia han cambiado de casa para trabajar temporalmente en la agricultura? TEMPORAL 4. En los últimos dos años, usted o algún miembro de su familia han trabajado en la agricultura por una temporada sin la necesidad de cambiarse de casa? NO Ningún miembro de la familia es trabajador agrícola presente o anteriormente. PARE SI - La persona y su familia son trabajadores agrícolas migratorios. PARE NO CONTINÚE con pregunta 4 SI La persona y su familia son trabajadores agrícolas temporales. PARE Developed Alan by NCFH Pogue (2010) Revised (2015) This project was supported by the Health Resources and Services Administration (HRSA) of the Alan U.S. Department Pogue of Health and Human Services (HHS) under U30CS0 9737, Technical Assistance to Community and Migrant Health Centers and Homeless, ($1,583,856). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. Page 1 Developed by NCFH (2010) Revised (2015) This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U30CS0 9737, Technical Assistance to Community and Migrant Health Centers and Homeless, ($1,583,856). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. Page 1

47 Poll Questions: Case Studies

48 PQ #3 Your patient: Ms. Hernandez, 43 years old has 2 children with Medicaid. The Hernandez family travels from their home in Greenfield to Florida to harvest tomatoes from April to June. They then travel to Georgia to pick peaches. They return home and work in the cranberry through September. Questions to ask yourself: Has anyone in this family worked in agriculture? Is agriculture the principle employment? Have they had to establish a temporary home to work in agriculture? Did their work, hours or income change for any part of the year? Did anyone in this family stop migrating to work in agriculture due to age or disability? How should this patient be classified? Migratory agricultural worker Seasonal agricultural worker Aged/Disabled agricultural worker Not an agricultural worker

49 PQ #4 Your patient: Mrs. Benavidez, 72 years old came with her son, 53 years old Mrs. Benavidez s son has traveled to work in the tobacco fields for most of his career. Due to his severe arthritis, three years ago, his employer gave him an office job ordering supplies for the farm. Ms. Benavidez lives with her son. Questions to ask yourself: Has anyone in this family worked in agriculture? Is agriculture the principle employment? Have they had to establish a temporary home to work in agriculture? Did their work, hours or income change for any part of the year? Did anyone in this family stop migrating to work in agriculture due to age or disability? How should this patient be classified? Migrant agricultural worker Seasonal agricultural worker Aged/Disabled agricultural worker Not an agricultural worker

50 PQ #5 Your patient: Ms. Rodriguez, 40 years old Ms. Rodriguez and her family have lived in your area for the past 6 years. Mr. Rodriguez works on a poultry farm and part of the year, works pruning and cutting grapes. Questions to ask yourself: Has anyone in this family worked in agriculture? Is agriculture the principle employment? Have they established a temporary home to work in agriculture? Did their work, hours or income change for any part of the year? Did anyone in this family stop migrating to work in agriculture due to age or disability? How should this patient be classified? Migrant agricultural worker Seasonal agricultural worker Aged/Disabled agricultural worker Not an agricultural worker

51 PQ #6 Your patient: Mr. Aguilar, 34 years old Mr. Aguilar came from Puerto Rico five years ago to work with his brother harvesting apples. After saving for two years, he opened a small food truck that he operates close to a small migrant camp. Questions to ask yourself: Has anyone in this family worked in agriculture? Is agriculture the principle employment? Have they had to establish a temporary home to work in agriculture? Did their work, hours or income change for any part of the year? Did anyone in this family stop migrating to work in agriculture due to age or disability? How should this patient be classified? Migrant agricultural worker Seasonal agricultural worker Aged/Disabled agricultural worker Not an agricultural worker

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53 Ask yourself: Are we counting all of the Ag workers served in our HCs? Are there Ag workers that are currently not receiving services? Have we considered other Ag industries?

54 What will it take? Million ,172

55 How Do We Achieve This Goal? Learn about the recent clarification of the definition of Agriculture in UDS guidance Learn how to identify and document all migratory and seasonal agricultural workers and their family members in the registration process. Learn appropriate strategies to elicit information from patients in a culturally and linguistically appropriate manner. Learn more about the Campaign at:

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57 Resources and Tools Sample tools and templates Policy Procedures Registration forms Registration questions Training resources

58 Question and Answer To Ask a Question 1. Locate the Questions box of your GTW Panel 2. Type your question and click Send

59 Follow NCFH Access other NCFH Products and Services at Join Our Mailing List Today! Follow National Center for Farmworker Health

60 Thank You! Sylvia Partida This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U30CS0 9737, Technical Assistance to Community and Migrant Health Centers and Homeless, ($1,583,856). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. All photographs in header are Copyrighted to Alan Pogue National Center for Farmworker Health