Enrollees with Special Health Care Needs

The term “Enrollee with Special Health Care Needs (ESHCN)” means a person having chronic and disabling condition(s) as defined in WAC 388-538-050. These enrollees must meet all of the following conditions:

• Have a biologic, psychological or cognitive basis
• Have lasted or are virtually certain to last for at least one year
• Produce one or more of the following conditions stemming from a disease:
• Significant limitation in areas of physical, cognitive, or emotional function
• Dependency on medical or assistive devices to minimize limitations of function or activities
• For children, any of the following:
  1. Significant limitation in social growth or developmental function
  2. Need for psychological, educational, medical or related services over and above the usual for the child's age
  3. Special ongoing treatments, such as medication, special diet, interventions or accommodations at home or school (WAC 388-538-050)

• ESHCN Adult Health Risk Assessment
• ESHCN Collaborative Care Plan
• ESHCN Interdisciplinary Team Assessment

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