Common use of Children with Special Health Care Needs Clause in Contracts

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 comparable program services in accordance with the member’s care plan;  Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  Participating in clinical studies of special health care needs as directed by the State.

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 comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.

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 EXHIBIT 1.E HOOSIER HEALTHWISE SCOPE OF WORK 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 comparable program services in accordance with the member’s care plan;  Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  Participating in clinical studies of special health care needs as directed by the State.. EXHIBIT 1.E HOOSIER HEALTHWISE SCOPE OF WORK

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 FSSA and other appropriate parties in accordance with state and federal confidentiality regulations;  ▪ Coordinating care through a Special Needs Unit or comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP FSSA the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.

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 comparable program services in accordance with the member’s care plan;  Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  Participating in clinical studies of special health care needs as directed by the State.care

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 Contractor shall address any special health care needs as adopted by the Maternal for HIP members ages 19 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." up to their 21st birthday. 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 shall 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 EXHIBIT 1.A SCOPE OF WORK 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 between 19 and 21 years of age 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 FSSA and other appropriate parties in accordance with state and federal confidentiality regulations;  ▪ Coordinating care through a Special Needs Unit or comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP FSSA the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.

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 Contractor shall address any special health care needs as adopted by the Maternal for HIP members ages 19 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." up to their 21st birthday. 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 shall 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 between 19 and 21 years of age 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 comparable program services in accordance with the member’s care plan;  Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  Participating in clinical studies of special health care needs as directed by the State.

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 Contractor shall address any special health care needs as adopted by the Maternal for HIP members ages 19 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." up to their 21st birthday. 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 EXHIBIT 2.I SCOPE OF WORK – HEALTHY INDIANA PLAN 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 shall 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 between 19 and 21 years of age 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 comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.

Children with Special Health Care Needs. The Contractor shall have plans for provision of care for A Report from the special needs populations and for provision of medically necessaryEgg Harbor Family Summit. September 1995. Xxxxxxx, specialty care through direct access to specialists. The Hoosier Healthwise managed care program uses the definition and reference X. Care coordination for children with special health care needs as adopted needs. Orthopaedic Nursing, March/April 1998 Supplement, 45-51. Appendix A: National Survey Title V Roles in Care Coordination for Children with Special Health Care Needs A Survey by The National Policy Center for Children with Special Health Care Needs October 1999 Who is conducting this survey and why? This survey is being conducted by the National Policy Center for Children with Special Health Care Needs (CSHCN), a partnership between the Xxxxx Xxxxxxx University, Health Systems Research, Inc., and Family Voices funded by the Maternal and Child Health Bureau Bureau, to explore the different and changing roles that Title V agencies play in coordinating services for CSHCN. What will be the outcome of this survey? The outcome of this survey, as well as follow-up telephone interviews to be conducted with selected states utilizing a range of care coordination strategies for CSHCN, will be a document that presents a menu of options—illustrated with examples identified by our research—that state Title V agencies have for improving the coordination of services for CSHCN. This document will be shared with all Title V agencies, members of the Association of Maternal and Child Health Programs’ recently-convened care coordination committee, and other key partners. What does this survey explore? Specifically, this survey addresses the “enabling services” category within the MCH Services Pyramid with respect to care coordination for CSHCN. The survey seeks to identify the range of activities included under a broad definition of “enabling services” that directly or indirectly affect the degree to which services for CSHCN are coordinated. These activities include the provision of care coordination services (MCHBalternatively known as case management or service coordination) directly to clients, as well as broader systems development activities such as developing tools to identify CSHCN and published link them to needed services; convening or participating on interagency committees that facilitate coordination among agencies serving CSHCN; and defining standards or outcomes for care coordination services. Please note that, while many Title V agencies have lead responsibility for Part C/ Early Intervention, this survey is NOT focused on Part Cresponsibilities. Who should complete this survey? This survey should be completed by a high-level CSHCN program official with a broad understanding of the American Academy of Pediatrics (AAP): "Children with special health care needs Title V agency’s roles and how its policies and programs are those who have or are at increased risk for a chronic physicaloperationalized. Please return survey by *NOVEMBER 15, developmental1999* to: Xxxx Xxxxxxxxx, behavioralHealth Systems Research, Inc., 0000 00xx Xx., XX, Xxxxx 000, Xxxxxxxxxx, XX 00000, or emotional condition and who also Fax (000) 000-0000 Any questions? Contact Xxxx at (000) 000-0000 or xxxxxxxxxx@xxxxxx.xxx. Thank you very much for your participation in this study! STATE Name Title Department Agency Address Phone Fax E-mail For all questions, check all responses that apply. Note that questions in italics require health and related services short written responses (use back of a type or amount beyond that required by children generallypage if necessary)." 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 comparable program services in accordance with the member’s care plan;  Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  Participating in clinical studies of special health care needs as directed by the State.

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 EXHIBIT 1.E HOOSIER HEALTHWISE SCOPE OF WORK 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 comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.. EXHIBIT 1.E HOOSIER HEALTHWISE SCOPE OF WORK

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 Contractor shall address any special health care needs as adopted by the Maternal for HIP members ages 19 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." up to their 21st birthday. 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 shall 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 EXHIBIT 1.A SCOPE OF EXHIBIT 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 between 19 and 21 years of age 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 FSSA and other appropriate parties in accordance with state and federal confidentiality regulations;  ▪ Coordinating care through a Special Needs Unit or comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP FSSA the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.

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 EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE 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 FSSA and other appropriate parties in accordance with state and federal confidentiality regulations;  ▪ Coordinating care through a Special Needs Unit or comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP FSSA the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.

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 comparable program services in accordance with the member’s care plan;  Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  Participating in clinical studies of special health care needs as directed by the State.

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:  EXHIBIT 1 SCOPE OF WORK – HOOSIER HEALTHWISE ▪ 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 FSSA and other appropriate parties in accordance with state and federal confidentiality regulations;  ▪ Coordinating care through a Special Needs Unit or comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP FSSA the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.

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 comparable program services in accordance with the member’s care plan;  Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  Participating in clinical studies of special health care needs as directed by the State.care

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 Contractor shall address any special health care needs as adopted by the Maternal for HIP members ages 19 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." up to their 21st birthday. 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 EXHIBIT 2.I SCOPE OF WORK – HEALHTY INDIANA PLAN 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 shall 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 between 19 and 21 years of age 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 comparable program services in accordance with the member’s care plan;  ▪ Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  ▪ Participating in clinical studies of special health care needs as directed by the State.

Children with Special Health Care Needs. The Contractor shall have plans for provision of care for A Report from the special needs populations and for provision of medically necessaryEgg Harbor Family Summit. September 1995. Xxxxxxx, specialty care through direct access to specialists. The Hoosier Healthwise managed care program uses the definition and reference X. Care coordination for children with special health care needs as adopted needs. Orthopaedic Nursing, March/April 1998 Supplement, 45-51. Appendix A: National Survey Title V Roles in Care Coordination A Survey by The National Policy Center for Children with Special Health Care Needs October 1999 Who is conducting this survey and why? This survey is being conducted by the National Policy Center for Children with Special Health Care Needs (CSHCN), a partnership between the Xxxxx Xxxxxxx University, Health Systems Research, Inc., and Family Voices funded by the Maternal and Child Health Bureau Bureau, to explore the different and changing roles that Title V agencies play in coordinating services for CSHCN. What will be the outcome of this survey? The outcome of this survey, as well as follow-up telephone interviews to be conducted with selected states utilizing a range of care coordination strategies for CSHCN, will be a document that presents a menu of options—illustrated with examples identified by our research—that state Title V agencies have for improving the coordination of services for CSHCN. This document will be shared with all Title V agencies, members of the Association of Maternal and Child Health Programs’ recently-convened care coordination committee, and other key partners. What does this survey explore? Specifically, this survey addresses the “enabling services” category within the MCH Services Pyramid with respect to care coordination for CSHCN. The survey seeks to identify the range of activities included under a broad definition of “enabling services” that directly or indirectly affect the degree to which services for CSHCN are coordinated. These activities include the provision of care coordination services (MCHBalternatively known as case management or service coordination) directly to clients, as well as broader systems development activities such as developing tools to identify CSHCN and published link them to needed services; convening or participating on interagency committees that facilitate coordination among agencies serving CSHCN; and defining standards or outcomes for care coordination services. Please note that, while many Title V agencies have lead responsibility for Part C/Early Intervention, this survey is NOT focused on Part C responsibilities. Who should complete this survey? This survey should be completed by a high-level CSHCN program official with a broad understanding of the American Academy of Pediatrics (AAP): "Children with special health care needs Title V agency’s roles and how its policies and programs are those who have or are at increased risk for a chronic physicaloperationalized. Please return survey by*NOVEMBER 15, developmental1999* to: Xxxx Xxxxxxxxx, behavioralHealth Systems Research, Inc., 0000 00xx Xx., XX, Xxxxx 000, Xxxxxxxxxx, XX 00000, or emotional condition and who also Fax (000) 000-0000 Any questions? Contact Xxxx at (000) 000-0000 or xxxxxxxxxx@xxxxxx.xxx. Thank you very much for your participation in this study! STATE Name Title Department Agency Address Phone Fax E-mail For all questions, check all responses that apply. Note that questions initalics require health and related services short written responses (use back of a type or amount beyond that required by children generallypage if necessary)." 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 comparable program services in accordance with the member’s care plan;  Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and  Participating in clinical studies of special health care needs as directed by the State.

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 In HIP the definition and reference for children with contractor shall address any special health care needs as adopted by the Maternal for members 19 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." up to their 21st birthday. 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 shall 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 between 19 and 21 years of age 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 comparable program services in accordance with the member’s care plan;   Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and   Participating in clinical studies of special health care needs as directed by the State.

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 comparable program services in accordance with the member’s care plan;   Analyzing, tracking and reporting to OMPP the issues related to children with special health care needs, including grievances and appeals data; and   Participating in clinical studies of special health care needs as directed by the State.