Healthy Start Coalition
of Miami-Dade

Healthy Start Contracted Providers

TEAMWithin this section, as a Healthy Start Contracted Providers, you will have access to the following items:

  • Meeting Minutes for various Healthy Start Coalition of Miami-Dade Meetings
  • Contract Documents
  • Administrative Forms (i.e. Material Distribution Form)
  • Approved Educational Materials to be used with Participants
  • Perinatal Bereavement Resources as of 6.16.16
  • TRAIN Access Request Form

Access to the Learning Management System (LMS) can be found here:
Should you have any difficulties with downloading any of the documents, we encourage you to please contact and someone from our Team will respond to you within five (5) business days. Thank you.

Best Practices Sub-Committee. A subcommittee of the Quality Improvement and Review Committee (QIRC) created to identify best practices used in the scope of service delivery. Best practices are research-based or evidence-based programs, practices and principles that are shown to be reliable and can produce measurable and sustainable improvements in productivity, efficiency or effectiveness. Contracted providers may send organizational representatives to participate on this committee.

The sub-committee will:

  • Identify best practices used for service delivery relevant to home visitation, engagement and retention of clients; and
  • Share best practices that can be used by HSCMD staff and contracted providers.
  • The Director of Quality Assurance and Quality Improvement will convene this committee.

Best Practices & Data Committees Meeting(s)

2013-2014 Best Practice Meeting Summary

2014-2015 Best Practice Meeting Summary

Data Committee.  Data is crucial to understanding the direction of HSCMD’s programs and initiatives, formulating strategies to achieve HSCMD objectives and providing evidence of established indicators, which allow HSCMD to make informed decisions.  The Director of Quality Assurance and Quality Improvement in conjunction with Directors/Program Managers and Supervisors regularly review data and present it for discussion at the QIRC Committee. In addition, a data committee will be convened by appropriate staff for: 

  • Developing processes to collect and analyze statistical data including performance and outcome objectives for HSCMD’s core services,
    • Addressing data quality issues,
    • Identifying community and state-wide data sources and
    • Evaluating HSCMD’s activities.


Continuous Quality Improvement (CQI) Workgroup. This workgroup is formed to assess and improve the overall quality of HSCMD’s internal programs or service by identifying positive and negative programs processes and outcomes. The Workgroup includes the the Chief Executive Officer, Director of Quality Assurance and Quality Improvement, Quality Assurance and Improvement Specialist, other HSCMD staff and Program Directors, Managers and Supervisors from all the Healthy Start Contracted Providers. The CQI Workgroup meets on the 4th Tuesday of every other month. 

Please find below the meeting minutes associated to these meetings. Should you have any problems with downloading any of these documents, please contact us at and someone from our Team will be happy to assist you further.

 FY July 1, 2012 – June 30, 2013*  FY July 1, 2013 – June 30, 2014  FY July 1, 2014 – June 30, 2015 FY July 1, 2015- June 30, 2016 FY July 1, 2016 – June 30, 2017
Agenda and HMS Minutes 11.9.2012 Agenda and HMS Minutes 7.12.2013 Agenda and HMS Minutes 7.11.2014   Agenda and Minutes 8 25 2015 CQI Minutes 8 23 2016
Agenda and HMS Minutes 12.14.2012 Agenda and HMS Minutes 8.9.2013 Agenda and HMS Minutes 8.8.2014  CQI Minutes 10 27 2015 CQI Minutes 12 20 2016
Agenda and HMS Minutes 1.11.2013 Agenda and HMS Minutes 9.13.2013 Agenda and HMS Minutes 9.12.2014  CQI Agenda 2 23 2016  
Agenda and HMS Minutes 2.8.2013 Agenda and HMS Minutes 10.11.2013
Agenda and HMS Minutes 10.10.2014  CQI Minutes 5 5 2016 CQI Subcommittee Meeting Minutes 3-17-17
Agenda and HMS Minutes 3.8.2013 Agenda and HMS Minutes 11.8.2013 Agenda and HMS Minutes 11.14.2014
Agenda and HMS Minutes 4.12.2013 Agenda and HMS Minutes 12.13.2013 Agenda and HMS Minutes 12.12.2014
Agenda and HMS Minutes 5.10.2013 Agenda and HMS Minutes 1.10.2014 Agenda and HMS Minutes 1.9.2015
Agenda and HMS Minutes 6.14.2013 Agenda and HMS Minutes 2.14.2014  Agenda and CQI Minutes 2.23.2015
Agenda and HMS Minutes 3.14.2014  Agenda and CQI Minutes 4.28.2015
Agenda and HMS Minutes 4.11.2014  Agenda and CQI Minutes 6.23.2015
Agenda and HMS Minutes 5.9.2014
Agenda and HMS Minutes 6 13 2014

*Please note that for FY 2012-2013, Minutes only began from November 2012 forward.

* Please note that for FY 2014-2015, the meeting schedule was changed from monthly to bi-monthly after February 2015. 



Non-CHD Contract Documents Additional CHD Documents (For CHD Use Only) Other Important Documents
Exhibit A – Travel and Training Request Form with Instructions   Exhibit B1 – Cost Reimbursement Invoice Exhibits Y – Programmatic Reporting CHD Instructions to Complete Exhibit B4 Healthy Start Budget Form
 Exhibit B2 and B3 – Budget Revision Amendment Form Narrative Exhibit B4 and B5 Healthy Start Budget Form and Narrative Exhibit Y17 – Case Transfer Log
HSCMD Budget Guidelines 14-15
Exhibit B6 – Healthy Start Inventory Report Form Exhibit B7 – Federal Subrecipient and Vendor Determination Checklist
Exhibit Y18 – Healthy Start Quota
Materials Request Form for HSCPs 3.9.17
Exhibit B8 – Affidavit for Level 2 Background Screenings Exhibit C – Assurances for Balanced Budget Act Exhibit Y19 – Prenatal and Postnatal Distribution Log (5 Tabs)  HSCMD Healthy Start Coding Presentation
Exhibit D1 – North Region Map  
Exhibit D2 – Central Region Map  Exhibit Y20 – Self Referral Case Assignment Log MASTER List of Approved Educational Materials_as of 8-25-2017
Exhibit D3 – South Region Map  Exhibit E1- Healthy Start Statewide Leveling System Exhibit Y21 – Encounter Form Log(s) by Provider Perinatal Bereavement Resources
Exhibit E2 – Risk Assessment Leveling Guidelines Exhibit F – Prenatal Risk Screen Form Exhibit Y22 – Missing Information Work Log TRAIN Access Request Form
Exhibit G – Infant Risk Screen Form Exhibit H1 – Healthy Start Self-Referral Form English 8 1 2015 Exhibit Y23 – Sharing of Information Data Analysis  Creating Events on HSCMD Website
Exhibit H2 – Healthy Start Self-Referral Form Spanish 8 1 15 Exhibit I1 – Initial Contact Form Exhibit Y24 – Cover Memo for Case Assignments
 How to Enter Medicaid into the Health Management System (HMS)
Exhibit I2 – Prenatal Woman Initial Assessment Form Exhibit I3 – Infant Child Initial Assessment Form Exhibit Y25 – Zip Codes Assignment by Region and Provider  Healthy Start Care Coordination IC Documentation
Exhibit J – Family Support Plan and Instructions Exhibit K1 – Procedures for Referring a Participant for Healthy Start Wraparound Services Exhibit Y26 – Traffic Report Sample  Healthy Start IC IA FSP Documentation Requirements
Exhibit K2 – DOH Referral Form Exhibit L1 -Instructions for Nutrition Referrals Exhibit Y27 – Prenatal Screening Results Report Sample Safety Considerations for the Home Visitor 
Exhibit L2 – Nutrition Referral Form Exhibit M – Client Information Search 9 26 2013 Exhibit Y28 – Infant Screening Results Report Sample  What is Healthy Start and the Program Goals
 Exhibit N – Healthy Start Encounter Form Exhibit O – Provider Follow-up Letter Exhibit Y29 – No to Sharing of Information Assignment Log  Healthy Start Program Managers and Secondary Contact List
Exhibit P – Participant’s Follow-up Letter Exhibit Q – Healthy Start Coalition of Miami-Dade Providers Correspondence Exhibit XX – Florida Department of Health in Miami-Dade Screening and Referral Process  
Exhibit R1 – Consent to Use and Disclosure of Health Information for Treatment, Payment or Health Care Operations Exhibit R2 – Notice of Privacy Practices Exhibit YY – Client Notification of Healthy Start Services 10 2 2013
 24_HSCMD Referral Resource Guide_Final_3.17
Exhibit R3 – Consent or Authorization for Release of Confidential Information to Another Organization Exhibit S1 – Birth Summary Report Postnatal Outcomes Exhibit ZZ – Prenatal and Infant Import CHD and External HMS Instructions
Exhibit S2 – Healthy Start Prenatal Outcomes Exhibit T – Household Data Sheet Exhibit AAA – Prenatal Performance Measures Report Sample
Exhibit U – Recommended Immunization Schedule for Persons Aged 0 – 18 Years United States 2014 Exhibit V1 – Procedures for Healthy Start Case Transfer among Healthy Start Providers in Miami-Dade County Exhibit BBB – Screen Assignments for Healthy Start Contracted Providers
Exhibit V2 – Procedures for Healthy Start Case Transfer to Another Healthy Start Coalition in Florida Exhibit W – Wraparound Services Class Guidelines
Exhibit X – Wraparound Services Class Cancellation Report Exhibits Y – Programmatic Reporting Non-CHD 2016-2017 Updated
Exhibit Y4 – Healthy Start Infant Record Review Updated 1516 Exhibit Y5 – Healthy Start Prenatal Record Review Updated 1516
Exhibit Y7 – HS Client Statisfaction Survey in English Exhibit Y8 – HS Client Satisfaction Survey in Spanish
Exhibit Y14 – Schedule of Healthy Start Wraparound Service Class Exhibit Y16 – Performance Improvement Plan and Corrective Action Plan Policies and Procedures
Exhibit Z – Official Healthy Start Logo Exhibit AA – Healthy Start Coalition of Miami-Dade and Contracted Providers’ Holidays Observed FY2014-2015
Exhibit BB – Healthy Start Complaints and Grievances Protocol Exhibit CC – Healthy Start Coalition of Miami-Dade Continuous Quality Improvement Plan 2009 (Updated July 1 2014)
Exhibit DD – Contact List for HS Staff Updated FY15-16 Exhibit EE – WIC Agreement for Disclosure of Information between DOH and HSCMD
Exhibit FF – Certification Regarding Lobbying Exhibit GG – Certification Regarding Debarment
Exhibit HH – Financial and Compliance Audit Exhibit II – Healthy Start Waiver Billing Plan
Exhibit JJ – Civil Rights Compliance Checklist Exhibit KK- Psychosocial Assessment
Exhibit LL- Florida Quit Line Referral Form Exhibit MM – Domestic Violence Flowsheet
Exhibit NN – Review of Contract Language with Staff Exhibit OO – Healthy Start System of Care Orientation
Exhibit PP – Review of Meeting Minutes with Staff Exhibit QQ – Healthy Start Home Visit or Face-to-Face Signature Log
Exhibit RR – Client Services by Program Component Report Exhibit SS – Client Services by Service Provider Report
Well Family System Request & Removal Form 12 14 17 Exhibit UU – Healthy Start System of Care Guidelines for IC, IA, Care Coordination
Exhibit VV – HMS Duplication Resolution Form and Instructions Exhibit WW – Business Associate Agreement



Maternal Infant and Child Health Provider Network Committee (MICH). The Healthy Start Coalition of Miami-Dade is one facet of the Healthy Start system which delivers its services to women and children in Miami-Dade through contracted providers.  The MICH Committee is comprised of internal HSCMD staff and organizational representatives from contracted providers offering services through Healthy Start and MomCare, and representatives from other programs that may have a vested interest in Maternal, Infant and Child Health..  The committee addresses concerns that arise within HSCMD’s programs and other maternal, infant and child health systems. 

  • The committee identifies gaps in maternal, infant and child health services as well as barriers in accessing services.
  • The committee invites maternal, infant and child health providers to address related issues collaboratively.
  • HSCMD’s contracted providers are given the opportunity to dialogue about issues and concerns that impede their ability to provide quality services and receive assistance in developing strategies for improvement.

The MICH Provider Meeting meets every 4th Tuesday of every other month. Please find below the meeting minutes associated to these meetings. Should you have any problems with downloading any of these documents, please contact us at and someone from our Team will be happy to assist you further.

FY July 1, 2012 – June 30, 2013 FY July 1, 2013 – June 30, 2014 FY July 1, 2014 – June 30, 2015 FY July 1, 2015- June 30, 2016 FY July 1, 2016 – June 30, 2017
MICH Minutes 7.24.12 MICH Minutes 7.23.13
MICH Minutes 7.22.14
MICH Minutes 7 29 15 MICH Minutes 8 2 2016
MICH Minutes 9.25.12 MICH Minutes 9.24.13 MICH Minutes 9.23.14  MICH Minutes 9 22 15  MICH Minutes 9 27 2016
MICH Minutes 11.27.12 MICH Minutes 11.26.13 MICH Minutes 11.25.14 MICH Minutes 11 24 15 MICH Minutes 11 15 2016
MICH Minutes 1.29.13 MICH Minutes 1.28.14  MICH Minutes 1.27.2015  MICH Minutes 02 02 2016 MICH Minutes 1.24.2017
MICH Minutes 3.19.13 MICH Minutes 4.1.14 MICH Minutes 3.31.2015 MICH Minutes 3 29 2016  MICH Minutes-3.28.2017
MICH Minutes 6.4.13 MICH Minutes 5.27.14  MICH Minutes 5.26.2015