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

OCTOBER 2002

Office of Maternal Child Health

Jan FlemingMCH Director

Marquita WeirichAdministrative Assistant

Maria Nardella (Acting)Children with Special Health Care Needs

Deb Lochner DoyleGenetics Services

Riley M. PetersMCH Assessment

* Support for local health department core functions* MCH Needs Assessment and data analysis* Disability and Child Injury Prevention* PRAMS* Birth Defects Surveillance

* Q.A. for genetics, public health and preventive services* Regional Genetics Services* Disability and Child Injury Prevention* Newborn Hearing Screening

* Support local health department core functions* QA for children with special health care needs, public health and preventive services* Neurodevelopmental, Diagnostic and Treatment, and Maxillofacial Services* Support for Parent programs

Margaret HansenImmunization

Sherilynn CaseyMaternal Infant Health

Nancy ReidChild and Adolescent Health/CHILD Profile

* Support for local health department core functions* Perinatal Regionalization* Maternity Support Services* Q.A. for perinatal and infancy, public health and preventive services* MCH toll-free referral line

* Assessment & surveillance of immunization rates* Public & provider awareness & education core functions for immunization* Surveillance & disease outbreak control* Vaccine Adverse Event Reporting System* Vaccines for Children Program* Support for local health departments

* Support for local health department core functions* Adolescent pregnancy prevention programs* Q.A. for child & adolescent, public health services and preventive programs* Child abuse prevention* Oral Health* CHILD Profile* Child Death Review

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 ManagerMaria Nardella(360) 236-3573

Secretary AdministrativeChristy Davis

(360) 236-3571

Secretary Administrative -- WISEJane Berube

(360) 236-3546

Public HealthNurse

Consultant

Linda Barnhart(360) 236-3491

WISE GrantCoordinatorKarla Dudley

(360) 236-3585

NutritionConsultantYuchi Yang

(360) 236-3561

AssessmentConsultant

Stacey De Fries(360) 236-3559

FamilyConsultant

Leslie Carroll(360) 236-3504

Program IntegrationConsultant

Civillia Winslow Hill(360) 236-3518

Budget & ContractsCoordinator

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

WashingtonNon-

CSHCN86.3%

CSHCN13.7%

National

CSHCN12.8%

Non-CSHCN87.2%

95%CI: ± 0.52%95%CI: ± 0.11%

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

13.5%±0.7%

6.7%±0.5%

22.3%±0.8% 57.5%

±1.0%

1 hour or less 2 - 5 hours6 - 10 hours 11+ hours

12.6%±3.5

5.5%±2.0

20.5%±3.9 61.4%

±4.3%

WashingtonNational

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.

No84.3%

Don't Know1.0%

No17.3%

Yes 15.7%

Yes 81.7%

Did [you] need professionalcare coordination during thepast 12 months?

Did [you] receive all the professional care coor-dination you needed?

N = 756 CSHCN intervews in WA State

Care Coordination for WA CSHCN

13

with special health care needs

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

Medicaid and CSHCN: A Comparison

Children in the Medicaid Program

CSHCN regardless of income

CSHCN in the Medicaid Program

Children in the CSHCN Program

CSHCN in both Medicaid andCSHCN Programs

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.htm

for 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: 1.Prior authorization.

2.Medical/nutrition criteria for oral nutrition supplements.

3.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.

1. Determine the Need

2. 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