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Partners For Children. A Medicaid Waiver- Developed in Collaboration with California Children’s Services (CCS) Children's Hospice & Palliative Care Coalition. Table of Contents. What is Partners For Children? Waiver services Who might qualify? What counties do they live in?

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Presentation Transcript

Partners For Children

A Medicaid Waiver-

Developed in Collaboration with

California Children’s Services (CCS)

Children's Hospice & Palliative Care Coalition


Table of contents
Table of Contents

  • What is Partners For Children?

  • Waiver services

  • Who might qualify?

  • What counties do they live in?

  • How are children referred?

  • What happens next?


What is partners for children
What is Partners for Children?

Partners for Children is a program for children with serious medical conditions that supports children and families as they navigate the healthcare system. The goal is to improve the quality of life for the child and family. This program provides additional services to Medi-Cal beneficiaries with certain CCS eligible medical conditions. The primary benefit of the program is that the family is connected with a care coordinator in their community.


Medicaid waiver
Medicaid Waiver

Section 1915(c)

Home and Community-Based Services Waiver

Supports services provided in home and community based settings

An alternative to institutional or long-term care facility placement

Cost neutrality

Enrollment caps required


What is palliative care
What is Palliative Care?

An active approach to care which enhances quality of life & minimizes suffering through interdisciplinary services


Why do we need pediatric palliative care
Why Do We Need Pediatric Palliative Care?

Families & providers are often reluctant to give up on curative therapies for children in order to focus only on comfort.

It allows for both curative and comfort treatments simultaneously


Why do we need pediatric palliative care cont
Why Do We Need Pediatric Palliative Care? (cont.)

Supports family decision-making

Includes family members on the care team

Improves continuity of care

Decreases # of medical crises

Decreases hospital admissions & length of stays


How can children get palliative care services
How Can Children Get Palliative Care Services?

  • Palliative care services available to all CCS-eligible children

    • Existing palliative care benefits available statewide are described in CCS Numbered Letter (NL) 04-0207


How can children get palliative care services cont
How Can Children Get Palliative Care Services ? (cont.)

Additional services will be available through the pediatric palliative care waiver, Partners for Children

A federal Home and Community-Based Services (HCBS) waiver

Pilot in 5 counties beginning in October 2009, expanding to 13 counties by 2011


What is partners for children1
What is Partners for Children?

A Medi-Cal demonstration project that enables children with certain CCS eligible medical conditions to receive:

  • curative treatments AND

  • home and community-based palliative care services similar to those provided by hospice agencies


Who might qualify
Who Might Qualify?

Applicant must meet all of the following:

  • Be under 21 yrs old

  • Have “full scope,” “no share of cost” Medi-Cal

  • Reside in a participating county

  • Have a waiver-eligible medical condition

  • Choose to participate (Applicant or parent/legal guardian)


Who might qualify cont d
Who Might Qualify? (cont’d)

  • Because of HCBS waiver rules, the child must be on only one HCBS waiver

    • If the child is enrolled in a different waiver, she will need to disenroll from that one

  • Children enrolled in the waiver will not be enrolled for a hospice benefit

    • Although the child isn’t enrolled for hospice benefits, hospices and home health agencies (HHAs) can provide palliative care waiver services


Partners for children waiver

Partners for Children Waiver

Child must live in a participating county

Year 1(300)Year 2(801)Year 3(1802)

Alameda

Monterey

San Diego

Santa Clara

Santa Cruz

Alameda

Monterey

San Diego

Santa Clara

Santa Cruz

Humboldt

Marin

Orange

Sacramento

San Francisco

Sonoma

Alameda

Monterey

San Diego

Santa Clara

Santa Cruz

Humboldt

Marin

Orange

Sacramento

San Francisco

Sonoma

Fresno

Los Angeles


What services might applicants receive
What Services Might Applicants Receive?

Community-based Care Coordination

Assessment of participant’s & family’s goals of care

Creation of a Family-Centered Action Plan (F-CAP) with input from family and interdisciplinary care team

Communication of plan across all settings including family, CCS & entire health care team


What services might the participant receive cont
What Services Might the Participant Receive? (cont.)

Respite care

In-home and out-of-home

Expressive therapies

art, music, play, massage

Family training

Bereavement support


To make a referral
To make a referral:

Anyone can refer a patient

To make a referral:

Confirm that the child has a waiver eligible condition

Confirm that the child resides in a pilot county

Contact the CCS Nurse Liaison in the child’s county to confirm that they are full-scope Medi-Cal

Download a referral form from the CCS website

[a


What happens next
What Happens Next ?

The CCS Nurse Liaison (CCSNL) will:

Determine if the child is eligible for waiver services

Discuss with eligible child’s family, and enroll if appropriate

Review available care coordination agencies with family

Connect the child with a Care Coordinator at the selected agency


End of short version

End of short version

Partners for Children


Partners for children services
Partners for Children Services

Care Coordination

Respite care

Bereavement Counseling

Expressive therapies

Family training


Keystone to success
Keystone to Success

Coordination of Services

Waiver Services

Care CoordinationRespite Care

Bereavement CounselingExpressive therapiesFamily Training

Family

+

Care Coordinator

+

CCS Nurse Liaison

STATE PLAN/EPSDT

ServicesCCS NL 04-0207

“ Full Scope Medi-Cal”

“CCS”

Community Services


Keystone to success1
Keystone to Success

Care Coordination

Emphasizes

Holistic care

Communication and information sharing

Shared decision making

Partnership between family, CCS program and providers


Care coordinator
Care Coordinator

Employee of Home Health Agency or Hospice Agency

Registered Nurse or Medical Social Worker

Anticipated patient staffing ratio 1:20-30


Care coordinator1
Care Coordinator

Core functions

Ensures a seamless system of care (integrate family needs and medical goals)

Facilitates, develops and implements the Family-Centered Action Plan (F-CAP)


Care coordinator2
Care Coordinator

Core functions, cont’d

Updates through ongoing communication, goals and plan of care to all healthcare providers

Maintains communication between CCSNL, the medical care providers, the patient and family and the interdisciplinary team

May accompany patient and family to appointments


Ccs nurse liaison ccsnl
CCS Nurse Liaison (CCSNL)

Employee of County

Registered Nurse case manager

Patient staffing ratio 1:50


Ccs nurse liaison ccsnl1
CCS Nurse Liaison (CCSNL)

Functions

CCS program liaison with the Care Coordinator

Administrative Case Management for CCS clients enrolled in the waiver

Knowledge of the CCS program, other State and community resources and limitations


Ccs nurse liaison ccsnl2
CCS Nurse Liaison (CCSNL)

Functions, cont’d

Ensures that federal waiver requirements are met

Review waiver applications and make level of care determinations

Timely enrollment of qualified applicants

Meet the client/ family unit’s goals and objectives

Shared decision making

Quality assurance and quality improvement


Ccs nurse liaison ccsnl3
CCS Nurse Liaison (CCSNL)

Functions - Ensures that federal waiver requirements are met, cont’d

Inform and educate applicants on waiver eligibility, services, choice of providers and services, benefits

Approve and authorize service requests based on F-CAP

Monitor the process to ensure health, safety, choice


Care coordinator and ccsnl require knowledge and expertise in
Care Coordinator and CCSNL require knowledge and expertise in:

Family-Centered Care

Palliative care

Effective communication

Shared decision making

Cultural competence

Quality assurance and quality improvement

Waiver, state and community resources


Pediatric palliative care numbered letter
Pediatric Palliative Care Numbered Letter

Palliative care services available

Home Health Agency (HHA) Services

Nursing visits

In-home shift nursing services <90 days

In-home shift nursing services >90 days go to In Home Operations

Physical Therapy / Occupational Therapy visits

Social Worker visits

Speech Therapy visits

Respiratory Therapy visits

Registered Dietitian visits

Psychology services – related to CCS-eligible condition

Provider Types

DME

Pain Control/Symptom Management

Maintenance and Transportation (N.L. 01-0104)


California s responsibilities to the federal government
California’s Responsibilities to the Federal Government

Quality Assurance – Monitoring of:

Timeliness of F-CAP

Medical necessity of the F-CAP

Patient and family satisfaction

Freedom of choice for families

Level of care determination


California s responsibilities to the federal government cont d
California’s Responsibilities to the Federal Government (cont’d)

Quality Improvement

Incident and complaint reporting, follow-up

Training and Education

Compilation and analysis of data

Will this waiver participation:

enhance the quality of life for children/families?

enhance family satisfaction with ongoing care?

Is this waiver cost neutral?








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