Children with Special Health Care Needs
The Children with Special Health Care Needs (CSHCN) program exists for health plans to develop a comprehensive program that will enable the Plan to identify appropriate members through a variety of methods including State identified Title V children, and program referrals from our Primary Care sites. Current CSHCN mandates are for Title V children.
Those members who score “high” risk will be referred for Case Management at Community Health Plan and will follow established Case Management processes. Outreach may include case management activities such as assisting the family in coordination of care, completing necessary “open” referrals, allowing seamless access to necessary care, and connecting the family to community resources that are available to them. For those members who may already be benefiting from case management at the Primary Care Provider's office, Community Health Plan interventions may include regular follow up with the family to ensure that current care needs are being met, periodic assessment for any anticipated health care needs, and targeted member health education material mailings.
Community Health Plan must ensure that clients have choice in healthcare providers, including PCP, to prevent any limitation or restriction to specialist care, and to ensure that the PCP has an individualized care plan for each child that includes all relevant bio-psycho-social factors. The goals of the Community Health Plan CHSCN program are to:
- Help families through the maze of Managed Care,
- Provide quality Case Management for complex and chronic special needs children,
- Include, but not be limited to, providing support services to PCPs to assist with Coordination of Care and providing resource information of medical and community services,
- Improve health outcomes whenever possible, and
- Contain costs.