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

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 SSI members only): Written documentation of a plan of action developed by the HMO and the member that identifies strengths, needs, goals, and necessary interventions to be addressed within a specific timeframe. The Care Plan is a living document that reflects an ongoing cycle of activity as long as care is being provided. HealthCheck: HealthCheck is Wisconsin’s name for the federally mandated Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for children under age 21. The EPSDT benefit is defined in federal law at §1905(r) of the Social Security Act. The benefit provides comprehensive and preventive health care services for all children under 21 years old. Federal and state regulations establish certain requirements for comprehensive HealthCheck screenings. A comprehensive HealthCheck screen includes all of the following components: • A complete health and developmental history (including anticipatory guidance). • A comprehensive unclothed physical examination. • An age-appropriate vision screening exam. • An age-appropriate hearing screening exam. • An oral assessment plus referral to a dentist beginning at one year of age. • The appropriate immunizations (according to age and health history). • The appropriate laboratory tests (including blood lead level testing when appropriate for age).

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 Bill 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 SSI members only): Written documentation of a plan of action developed by the HMO and the member that identifies strengths, needs, goals, and necessary interventions to be addressed within a specific timeframe. The Care Plan is a living document that reflects an ongoing cycle of activity as long as care is being provided. HealthCheck: HealthCheck is Wisconsin’s name for the federally mandated Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for children under age 21. The EPSDT benefit is defined in federal law at §1905(r) of the Social Security Act. The benefit provides comprehensive and preventive health care services for all children under 21 years old. Federal and state regulations establish certain requirements for comprehensive HealthCheck screenings. A comprehensive HealthCheck screen includes all of the following components: • A complete health and developmental history (including anticipatory guidance). • A comprehensive unclothed physical examination. • An age-appropriate vision screening exam. • An age-appropriate hearing screening exam. • An oral assessment plus referral to a dentist beginning at one year of age. • The appropriate immunizations (according to age and health history). • The appropriate laboratory tests (including blood lead level testing when appropriate for age).

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. Chronic Illness & Disability Payment System (CDPS): A diagnostic classification system used to make health-based capitated payments for Medicaid beneficiaries. 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 Screening (HNA) for purposes of this document, termed “Screening: ”): A survey tool to collect information on members’ self-reported diagnosis history, patterns of health service utilization, and social determinants of healthsocioeconomic barriers, allowing HMOs to stratify its CLA population based on urgent care and service needs. HNA screenings Screenings are conducted by appropriately qualified staff either online, through face-to-face, telephone or mail contact with the member and/or legal guardian. 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 Assessment (for Medicaid SSI members only): Written documentation A detailed evaluation where an appropriately qualified health care professional identifies a member’s health care, cultural and socioeconomic needs. The assessment may entail conducting a review of the member’s past medical history, analyzing member records, using diagnostic tools and patient interviews to form the basis for the development of a multidisciplinary plan of action developed by care for the HMO and the member that identifies strengths, needs, goals, and necessary interventions to be addressed within a specific timeframemember. The Care Plan is a living document that reflects evaluation must include an ongoing cycle encounter of activity care with the member, either face-to-face or through telephonic contact. For the purposes of an assessment, qualified health care professionals may include non-physician providers such as long an advanced practice nurse, physician assistant, registered nurse or social worker, or other staff as care is being providedapproved in the certification application. Comprehensive HealthCheck: HealthCheck is Wisconsin’s name for the federally mandated Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for children under age 21. The EPSDT benefit is defined in federal law at §1905(r) of the Social Security Act. The benefit provides comprehensive and preventive health care services for all children under 21 years old. Federal and state regulations establish certain requirements for comprehensive HealthCheck screenings. A To be considered a comprehensive HealthCheck screen includes all of screen, the provider must assess and document the following components: •  A complete health and developmental history (including anticipatory guidance). •  A comprehensive unclothed physical examination. •  An age-appropriate vision screening exam. •  An age-appropriate hearing screening exam. •  An oral assessment plus referral to a dentist beginning at one year of age. •  The appropriate immunizations (according to age and health history). •  The appropriate laboratory tests (including blood lead level testing when appropriate for age).

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 complete 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 memberan enrollee’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 SSI members only): Written documentation Assessment: A detailed assessment of the nature and cause of a plan person’s specific conditions and needs as well as personal resources and abilities. This is generally performed by an individual or a team of action developed by specialists and may involve family, friends, peers or other significant people. In some instances, the HMO and the member that identifies strengths, needs, goals, and necessary interventions to assessment may be addressed within a specific timeframedone in conjunction with care planning. The Care Plan is a living document that reflects an ongoing cycle of activity as long as care is being provided. Comprehensive HealthCheck: HealthCheck is Wisconsin’s name for the federally mandated Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) benefit for children under age 21. The EPSDT benefit is defined in federal law at §1905(r) of the Social Security Act. The benefit provides comprehensive and preventive health care services for all children under 21 years old. Federal and state regulations establish certain requirements for comprehensive HealthCheck screenings. A To be considered a comprehensive HealthCheck screen includes all of screen, the provider must assess and document the following components: • A complete health and developmental history (including anticipatory guidance). • A comprehensive unclothed physical examination. • An age-appropriate vision screening exam. • An age-appropriate hearing screening exam. • An oral assessment plus referral to a dentist beginning at one year three years of age. • The appropriate immunizations (according to age and health history). • The appropriate laboratory tests (including blood lead level testing when appropriate for age).