Improving Nutritional Care for Children with Special Health Care Needs: The Work of the CSHCN Program Yuchi Yang, MS, RD, CD Nutrition Consultant CSHCN Program Washington State Department of Health May 9, 2005
MCH Core Public Health Services Direct Medical Services Enabling Services Population Based Services Infrastructure Building Services
Children with Special Health Care Needs ProgramFebruary 2005 Program Manager Maria Nardella (360) 236-3573 Secretary Administrative -- WISE Jane Berube (360) 236-3546 Secretary Administrative Christy Davis (360) 236-3571 Public Health Nurse Consultant Linda Barnhart (360) 236-3491 WISE Grant Coordinator Karla Dudley (360) 236-3585 Nutrition Consultant Yuchi Yang (360) 236-3561 Assessment Consultant Stacey De Fries (360) 236-3559 Family Consultant Leslie Carroll (360) 236-3504 Program Integration Consultant Civillia Winslow Hill (360) 236-3518 Budget & Contracts Coordinator Patsy Shumway (360) 236-3539
Children with Special Health Care Needs (CSHCN) Program • Ensuring all children and youth with special health care needs achieve the healthiest life possible”
Prevalence of Children with Special Health Care Needs: Persons 95%CI: ± 0.11% 95%CI: ± 0.52% Source: National (n=372,174) & WA (n=6629) Screener files. 7
Children with Special Health Care Needs “Children with special health care needs are those who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who require health and related services of a type or amount beyond that required by children generally.” …Maternal & Child Health Bureau
Who Do We Serve? • Children up to 18 years of age who have or at risk of having a special health care needs. • Resident of Washington • Income Eligibility for certain services: 200%FPL
What is Care Coordination? • …defined as “a process that links children with special health care needs and their families to services and resources in a coordinated effort to maximize the potential of children and provide them with optimal health care.” American Academy of Pediatrics Committee on Children with Disabilities. Care coordination: Integrating health and related systems of care for children with special health care needs. Pediatrics 1999;104(4): 978-981.
Time Spent Providing, Arranging, or Coordinating Care for CSHCN, per week National Washington 11
CSHCN Coordinator is the Gatekeeper. Call your local health department or the ASK Line (Answers for Special Kids Resource Line) through Healthy Mothers, Healthy Babies 1-800-322-2588 to help families access needed services for their child, such as medical care and other interventions.
Multidisciplinary Team • Physician • Nutritionist • Nurse • Social worker • OT/PT • Speech pathologist • Behavioral psychologist
Medicaid • Medical Nutrition Therapy • Enteral Nutrition Program MAA home page http://maa.dshs.wa.gov
MAA Medical Nutrition Therapy • Certified Dietitian • PCP Referral/EPSDT • Medical Provider Number • Specific Fee Schedule
Medicaid Nutrition Rates • $10.88 per unit • Unit = 15 minutes of a face-to-face interaction • Initial assessment up to 2 hours • Reassessments up to 1 hour per day • No annual limit on reassessments • $4.53 per unit for Group Therapy
Implications for Dietitians • Certified Dietitians • MAA Provider Numbers
Certified Dietitian • Go to: https://fortress.wa.gov/doh/hpqa1/hps3/Diet_Nutritionist/forms.htmfor an application form.
Medical Provider Number • Go to http://fortress.wa.gov/dshs/maa/provrel/ and click on “sign up to be a WA State Medical Assistance Provider”. • Call MAA Provider Enrollment Unit at 1-866-545-0544 for questions.
WIC • Supplemental Nutrition Program for Women, Infants and Children
WIC Services • Supplemental Foods • Nutrition Assessments • Nutrition Education • Breastfeeding Promotion • Community Referrals • Access to Health Services
Formula Coverage • WIC First • Medicaid • CSHCN Special Formula Fund through CSHCN Coordinators
MAA Enteral Nutrition Program • Current rules: Clients receive formula from pharmacies with Dr’s prescription without prior authorization.
New MAA Enteral Nutrition Program • New rules will take effect July 1, 2005 • Key points: • Prior authorization. • Medical/nutrition criteria for oral nutrition supplements. • Not meeting new criteria, will be evaluated on a case-by-case base.
CSHCN Special Formula Fund • Medically necessary • Not covered by any other program or insurance
CHDD Nutrition Contract • Purpose: to promote the availability of quality, community-based nutrition and feeding team services and improve nutrition outcomes for children with special health care needs
CSHCN Training Opportunities • CSHCN Nutrition Network • Feeding Teams • Distance Learning Grant (Training Modules)
Nutrition Focus for Children with Special Health Care Needs • A newsletter for health professionals • University of Washington based • http://depts.washington.edu/chdd/ucedd/CO/co_NutriFocus.html • 6 issues per year
Publication • Medicaid Reimbursement for Medical Nutrition Products and Nutrition Services for Children with Special Health Care Needs: A Washington State Case Studies Report. • For a copy, visit http://www.doh.wa.gov/Publicat/publications.htm
Guidelines for the Development and Training of Community-Based Feeding Teams in Washington State. • Determine the Need • Identify Key Agencies and Professionals. (Revised edition will be on-line soon. Please visit CSHCN home web page)
Nutrition Interventions for Children with Special Health Care Needs • To provide a resource for those involved in the monitoring or delivery of nutrition care for children with special health care needs. • For order information, please visit http://www.doh.wa.gov/Publicat/publications.htm
Children With Special Health Care Needs: Nutrition Care Handbook • This newly published resource provides a quick and practical reference. • Can be purchased through ADA at www.eatright.org/Public/ProductCatalog
Materials • Children with Special Health Care Needs Program Brochures. • The National Survey of Children with Special Health Care Needs. Chart book 2001 www.cdc.gov/nchs/slaits.htm
CSHCN Program • Home Page: http://www.doh.wa.gov/cfh/mch/CSHCNhome2.htm