HFS – 2011 Annual Report Page 5
III. CHILDREN WITH COMPLEX MEDICAL NEEDS
As required in the Medicaid reform law [P.A. 96-1501], the Department established a stakeholder group for advocates, providers and funders of care to collectively explore program design and delivery systems for children with complex medical needs to lead to more efficient, economical and consumer directed services. The group focused on children with chronic conditions and medically complex children with high cost in-home services. Analyses of the program and recommendations on program changes care are summarized below. Overview of the waivers, amendments, services and expenditures may be found in Section IX. This Section of the Annual Report is the final report as required by law.
Seven stakeholder meetings were held between June 2011 and February 2012. Information on the stakeholder groups may be found at: http:///hfs.illinois.gov/ccmn/
Meeting discussions focused on what is and what is not working in the care delivery system for children with complex medical needs and what components a new system should include. Extensive discussions included topics on the universe of children to be served; acuity levels that may drive the service levels and payment system; how to incentivize care coordination entities; range of services that would be covered by care coordination entities; creation of an unique provider type to provide tasks normally provided by licensed nurses; and cost-sharing by parents to pay for services. The last meeting focused on performance outcomes unique to children with complex medical needs.
1. General Consensus of Participants
Participants agreed on several key design points as described below.
Care Coordination (CC)
There was general agreement among the participants that care coordination is a key component for managing care for children with complex medical needs (CCMN). Recognizing the difficulties in identifying children with chronic conditions and high costs, two care coordination options were recommended: 1) a program for children who are ventilator or technology dependent; and 2) one for all other children with multiple chronic conditions.
The first CC program would utilize the Division of Specialized Care for Children (DSCC) as a Single Point of Entry (SPOE) to provide care coordination for all children with complex medical needs seeking in-home services. This will include children currently served under the Medically Fragile, Technology Dependent (MFTD) waiver as well as other children receiving private duty nursing in the home through Nursing and Personal Care Services, which may include children served in other waivers and through the Department of Children and Family Services (DCFS). For the children receiving in-home services, there will be two levels of assessment, 1) eligibility, and if eligible; 2) a further review (comprehensive assessment) to determine risk, develop a plan of care and to determine care coordination intensity levels. It was recommended that the eligibility and resource allocation would be determined separately from care coordination.
The second CC program would provide care coordination for all other children with “multiple” chronic conditions through a Care Coordination Entity (CCE) or Managed Care Community Network (MCCN). As with the Care Coordination Innovations Project serving adults with complex conditions, a second solicitation will seek proposals for CCEs and MCCNs to serve children identified with multiple chronic
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