Children with Special Health Care Needs. The Contractor shall have plans for provision of care for the special needs populations and for provision of medically necessary, specialty care through direct access to specialists. The Hoosier Healthwise managed care program uses the definition and reference for children with special health care needs as adopted by the Maternal and Child Health Bureau (MCHB) and published by the American Academy of Pediatrics (AAP): "Children with special health care needs are those who have or are at increased risk for 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 generally." The health screening tool will assign children to one of the Living with Illness Measures (LWIM) screener health domains based on the National Committee on Quality Assurance study design. The scoring for the LWIM screener identifies a child as potentially having a special health care need if the screening identifies needs in one or more of seven (7) different health domains: Functional limitations only Dependency on devices only Service use or need only Functional limitations and a dependency on devices Functional limitations and a service use or need Dependency on devices and a service use or need Functional limitations, a dependency on devices and a service use or need In accordance with 42 CFR 438.208(c)(2), which specifies allowable staff, the Contractor shall have a health care professional assess the member through a detailed health assessment if the health screening identifies the member as potentially having a special health care need. When the further assessment confirms the special health care need, the member must be placed in care management. The Contractor shall offer continued coordinated care services to any special health care needs members transferring into the Contractor’s membership from another MCE. For example, Contractor activities supporting special health care needs populations shall include, but are not limited to: Conducting the initial screening and more detailed health assessment to identify members who may have special needs; Scoring the initial screening and more detailed health assessment results; Distributing findings from the health assessment to the member’s PMP, OMPP and other appropriate parties in accordance with state and federal confidentiality regulations; Coordinating care through a Special Needs Unit or comparab...
Children with Special Health Care Needs. The coordination of care is of the utmost importance for Children with Special Health Care Needs. The Contractor will treat Children with Special Health Care Needs as a high-risk population. The Contractor is required to be in compliance with all DCYF policies regarding the care and treatment of youth in substitute care. The Contractor is required to meet with DCYF and EOHHS at a time interval specified by EOHHS and is required to provide timely ad-hoc reports when requested.
Children with Special Health Care Needs. Children with special health care needs means those children with complex health conditions who are enrolled in managed care.
Children with Special Health Care Needs. Children with special health care needs are those who have or are suspected of having a serious or 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 generally. The Contractor will be responsible for performing all of the same activities for this population as for adults. In addition, the Contractor will implement the following for these children:
a) Satisfactory methods for interacting with school districts, preschool services, child protective service agencies, early intervention officials, behavioral health, and developmental disabilities service organizations for the purpose of coordinating and assuring appropriate service delivery.
b) An adequate network of pediatric providers and sub-specialists, contractual relationships with tertiary institutions, to meet their medical needs.
Children with Special Health Care Needs. Children with special health care needs are those children who are in the custody of DCS. As provided in Section 2.4.4.4, TennCare enrollees who are in the custody of DCS will be enrolled in TennCare Select.
Children with Special Health Care Needs a) Children with special health care needs are those who have or are suspected of having a serious or 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 generally. The Contractor will be responsible for performing all of the same activities for this population as for adults. In addition, the Contractor will implement the following for these children:
i) Satisfactory methods for interacting with school districts, preschool services, child protective service agencies, early intervention officials, behavioral health, and developmental disabilities service organizations for the purpose of coordinating and assuring appropriate service delivery.
ii) An adequate network of pediatric providers and sub-specialists, and contractual relationships with tertiary institutions, to meet such children's medical needs.
iii) Satisfactory methods for assuring that children with serious, chronic, and rare disorders receive appropriate diagnostic work-ups on a timely basis.
iv) Satisfactory arrangements for assuring access to specialty centers in and out of New York State for diagnosis and treatment of rare disorders.
v) A satisfactory approach for assuring access to allied health professionals (Physical Therapists, Occupational Therapists, Speech Therapists, and Audiologists) experienced in dealing with children and families. SECTION 10 (BENEFIT PACKAGE REQUIREMENTS) October 1, 2005 10-13
Children with Special Health Care Needs. Children with or at increased risk for chronic physical, developmental, behavioral, or emotional conditions who also require health and related services of a type or amount beyond that required by children generally and who are enrolled in a Children with Special Health Care Needs program operated by a Local Health Department or a local Title V funded Maternal and Child Health Program. Claim: Xxxx for services, a line item of service, or all services for one member. Childless Adults (CLAs): BadgerCare Plus Childless Adults members who are under 100% FPL. As of April 1, 2014, childless adults are eligible for Standard Plan benefits. CLA Health Needs Assessment (HNA) Screening: A survey tool to collect information on members’ self-reported diagnosis history, patterns of health service utilization, and social determinants of health, allowing HMOs to stratify its CLA population based on urgent care and service needs. HNA screenings are conducted by appropriately qualified staff either online, through face-to-face, telephone or mail contact with the member and/or legal guardian. Clean Claim: A truthful, complete, timely and accurate claim that does not have to be returned for additional information. Clinical Decision Support Tools: Tools that support informed clinical decision-making by presenting information in an integrated, interactive manner. Cold Call Marketing: Any unsolicited personal contact by the HMO with a potential member for the purpose of marketing. Communication Materials: Member communication materials are materials designed to provide members with clear and concise information about the HMO’s program, the HMO’s network, and the BadgerCare Plus and/or Medicaid SSI program. Community Based Health Organizations: Non-profit agencies providing community based health services. These organizations provide important health care services such as HealthCheck screenings, nutritional support, and family planning, targeting such services to high-risk populations. Complaint: A general term used to describe a member’s oral expression of dissatisfaction with the HMO. It can include access problems such as difficulty getting an appointment or receiving appropriate care; quality of care issues such as long waiting times in the reception area of a provider’s office, rude providers or provider staff; or denial or reduction of a service. A complaint may become a grievance or appeal if it is subsequently submitted in writing. Comprehensive Care Plan (for Medicaid SS...
Children with Special Health Care Needs a) Children with special health care needs are those who have or are suspected of having a serious or 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 generally. The Contractor will be responsible for performing all of the same activities for this population as for adults as described in Section 10.19 a) ii) A-E) and Section 10.19 a) iii). In addition, the Contractor will implement the following for these children:
i) Satisfactory methods for interacting with school districts, preschool services, child protective service agencies, early intervention officials, behavioral health, and developmental disabilities service organizations for the purpose of coordinating and assuring appropriate service delivery.
ii) An adequate network of pediatric providers and sub-specialists, and contractual relationships with tertiary institutions, to meet such children’s medical needs.
iii) Satisfactory methods for assuring that children with serious, chronic, and rare disorders receive appropriate diagnostic work-ups on a timely basis.
iv) Satisfactory arrangements for assuring access to specialty centers in and out of New York State for diagnosis and treatment of rare disorders.
v) A satisfactory approach for assuring access to allied health professionals (Physical Therapists, Occupational Therapists, Speech Therapists, and Audiologists) experienced in dealing with children and families.
b) Medically fragile children are those individuals under 21 who have a chronic debilitating condition or conditions, who may or may not be hospitalized or institutionalized, and meet one or more of the following criteria: is technologically dependent for life or health sustaining functions; requires complex medication regimen or medical interventions to maintain or to improve their health status; or is in need of ongoing assessment or intervention to prevent serious deterioration of their health status or medical complications that place their life, health or development at risk. Chronic debilitating conditions include, but are not limited to: bronchopulmonary dysplasia, cerebral palsy, congenital heart disease, microcephaly, pulmonary hypertension, and muscular dystrophy.
i) In addition to meeting the requirements of this Section, Section 10.4, and Appendix S of this Agreement, for medically fragile children, the Contractor shall:
A) develop procedures for the arrangeme...
Children with Special Health Care Needs. Children with special health care needs (CSHCN) are a particularly vulnerable population which often have chronic and complex medical health care conditions. In order to ensure state compliance with the provisions of 42 CFR 438.208, ODJFS has implemented program requirements for the identification, assessment, and case management of CSHCN. Each MCP must establish a CSHCN program with the goal of conducting timely identification and screening, assuring a thorough and comprehensive assessment, and providing appropriate and targeted case management services for any CSHCN. Appendix G
i. Definition of CSHCN CSHCN are defined as children age 17 and under who are pregnant, and members under 21 years of age with one or more of the following: - Asthma - HIV/AIDS - A chronic physical, emotional, or mental condition for which they need or are receiving treatment or counseling - Supplemental security income (SSI) for a health-related condition - A current letter of approval from the Bureau of Children with Medical Handicaps (BCMH), Ohio Department of Health
ii. Identification of CSHCN All MCPs must implement mechanisms to identify CSHCN. MCPs are expected to use a variety of mechanisms to identify children that meet the definition of CSHCN and are in need of a follow-up assessment including: MCP administrative review; information as reported by the SSC during membership selection; PCP referrals; outreach; and contacting newly-enrolled children. The MCP must annually submit the process used to identify and assess CSHCN for review and approval by ODJFS as part of their CSHCN program.
Children with Special Health Care Needs. An Assessment of Alternative Medicaid Managed Care Models. Health Systems Research, July 1999.
