Attachment 1: Community Service Plan (CSP) - Comprehensive 3-Year Plan Format

Comprehensive 3-Year Plan Format

The format of the Community Service Plan (CSP) has changed as outlined below. While some elements remain the same, other sections have been added and/or revised. The Department expects that CSPs will be submitted electronically for the September 15, 2009 deadline. Information about how to submit will follow at a later date.

1. Mission Statement

   Reaffirm the hospital’s mission statement that identifies commitment to the community it serves. Indicate if there have been no changes to the mission statement in this section

2. Service area

   Define the area the hospital uses for community/local health planning for the purposes of the Community Service Plan (CSP). Please include the method used to determine the service area e.g. zip codes, census data, etc.

3. Public Participation

   in this process, hospitals must provide a brief summary statement that:

   • Identifies the participants involved in assessing community health needs, e.g. community-based organizations; other health care providers such as community health centers, family planning clinics, physician groups, and home care agencies; facility advisory boards and the public.
   • Includes the dates and a brief description of the outcomes of the public input process including any discussion of barriers or gaps in service.
   • Describes how public notification of these sessions was accomplished.
4. Assessment of Public Health Priorities
   • Hospitals are considered co-conveners of the community assessment process with the LHDs with which they work most closely. Hospitals, LHDs and other community partners (community-based organizations, health care providers, and consumers, etc.) should form a partnership to share and analyze data to identify the 2 to 3 Prevention Agenda priorities. This section must describe the criteria by which the priorities were selected, including how data were used to target a community or a segment of the community.
   • Describe whether the priorities selected represent new community initiatives or existing programs that will be supplemented by input and support from community partners.
   • For all hospital public health programs considered in the assessment process, including the 2 to 3 Prevention Agenda priorities, provide a description of their scope, objectives and accomplishments.
5. Three Year Plan of Action

   For the Public Health Priorities identified in Section 4, including the 2 to 3 Prevention Agenda priorities, describe the strategies proposed to address them:

   • whether they are new or existing priorities;
   • how they may be addressed by the hospital and community partners and by whom, e.g. , a service or program will be implemented within the hospital, a community health center or local health department clinic, an educational effort will be undertaken by local schools, businesses, or health department(s). Prevention Agenda priorities should be addressed jointly with other community partners performing services or activities within their scope or mission. In the case of hospital public health programs falling outside the Prevention Agenda priorities, the hospital does not need to implement a collaborative approach to address the issue.
   • the overall goals of the strategies, how the goals will be measured for effectiveness and how these current strategies may be modified to include on-going input and support from the hospital’s community partners.
6. Financial Aid Program

   Describe the hospital’s successes and challenges related to the provision of financial aid in accordance with Public Health Law 2807(k) (9-a). Do not include the summary of the hospital’s policy or financial data required by Exhibit 50 of the ICR; rather discuss general accomplishments, process improvements and/or best practices related to the hospital’s financial aid program.

7. Changes Impacting Community Health/Provision of Charity Care/Access to Services

   Describe any changes to the hospital’s operation or financial situation that impacts the care of the community, financial assistance and/or access to health care. This could include, but is not limited to, impending mergers, increasing financial constraints, and key personnel turn over.

8. Dissemination of the Report to the Public

   A key element of the Community Service Plan is the dissemination of pertinent information regarding a hospital’s public health programs and availability of financial assistance to the public. The Department recommends that hospitals disseminate a written summary of the CSP and encourages hospitals to post information to their websites so that it is readily accessible by the public. Hospitals must be sure to include pertinent financial data that demonstrates its current and future commitment to public health programs and financial assistance in the written summary developed for the public.

9. Financial statement

   The Department of Health will not require a separate financial statement to be submitted as part of the Community Service Plan. Financial data already reported to the Department through the Institutional Cost Report (ICR) will satisfy the statutory requirement.