Services for Children with Special Health Care Needs. Children with Special Health Care Needs (CSHCN) are defined as “those who have or are at increased risk for a chronic physical, behavioral, developmental, or emotional conditions and who also require health or related services of a type or amount beyond that required by children generally”. Contractor shall implement and maintain a program for CSHCN which includes, but is not limited to, the following:
A. Standardized procedures for the identification of CSHCN, at enrollment and on a periodic basis thereafter;
B. Methods for ensuring and monitoring timely access to pediatric specialists, sub-specialists, ancillary therapists, and specialized equipment and supplies; these may include assignment to a specialist as PCP, standing referrals, or other methods as defined by Contractor;
C. Methods for ensuring that each CSHCN receives a comprehensive assessment of health and related needs, and that all Medically Necessary follow-up services are documented in the medical record, including needed referrals;
D. A program for case management or care coordination for CSHCN, including coordination with other agencies which provide services for children with special health care needs (e.g. mental health, substance use disorder, Regional Center, CCS, local education agency, child welfare agency); and
E. Methods for monitoring and improving the quality and appropriateness of care for children with special health care needs.
