Children with Special Health Care Needs (CSHCN. In order to ensure state compliance with the provisions of 42 CFR 438.208, the Bureau of Managed Health Care established Children with Special Health Care Needs (CSHCN) basic program requirements in Appendix G, Coverage and Services, and corresponding minimum performance standards as described below. The purpose of these measures is to provide appropriate and targeted case management services to CSHCN.
Children with Special Health Care Needs (CSHCN. The Contractor 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. All CSHCN children shall receive case management services.
(a) Identification of CSHCN. The Contractor must implement mechanisms to identify CSHCNs who are in need of a follow-up assessment including: PCP referrals; outreach; and contacting newly-enrolled children.
Children with Special Health Care Needs (CSHCN. The Contractor must establish a CSI-ICN 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. All CSHCN children shall receive case management services.
(a) Identification of CSHCN. The Contractor must implement mechanisms to identify CSHCNs who are in need of a follow-up assessment including: PCP referrals; outreach; and contacting newly-enrolled children.
Children with Special Health Care Needs (CSHCN. (DOH Account Coding 732xx) • Promote collaboration with DSHS-MAA to facilitate access and delivery of services for Medicaid eligible children with special health care needs.* • The CSHCN-Supplemental Security Income (SSI) coordinator will: continue to serve as a liaison with the Disabilities Determination Service Unit; be responsible for maintaining a systematic mechanism for identifying Title V recipients who are potential SSI applicants and refer those recipients to the Social Security Administration (SSA); and provide Local Health Departments information on children who may be eligible for SSI.* • For children enrolled in both the CSHCN program and any Medical Assistance Program, maintain policies and procedures for use by Local Health Departments or their subcontractors to review and certify requests for hearing aid purchases.** • For Medicaid-eligible children with complex maxillofacial problems, maintain procedures and guidelines for regional maxillofacial teams.* • Coordinate with DSHS to maintain guidelines on reimbursement of special formulas and nutrition supplements for Medicaid-eligible children with complex medical/nutritional needs.* • For Medicaid eligible children enrolled in the CSHCN program and not enrolled in a Medical Assistance managed care plan, maintain policies and procedures for use by Local Health Departments or their subcontractors to review and certify requests for occupational, physical and speech therapy services.* • Assist MAA in facilitating access to health care for eligible SSI children.* • Coordinate with MAA to provide consultation to CSHCN contractors and providers regarding service delivery requirements and quality assurance.*
Children with Special Health Care Needs (CSHCN. In order to ensure state compliance with federal requirements under the 1915(b) Medicaid managed care waiver program authority, as well as the provisions of 42 CFR 438.208, the Bureau of Managed Health Care established Children with Special Health Care Needs (CSHCN) basic program requirements in Appendix G, Coverage and Services, and corresponding minimum performance standards as described below. The purpose of these measures is to improve identification and screening, assure a thorough and comprehensive assessment, and provide appropriate and targeted case management services to CSHCN. For a comprehensive description of the CSHCN measures below, see ODJFS Methods for Children with Special Health
