An Overview of Care Coordination ServicesCoordination Services

October 2012

Mission

Provide, promote and coordinate family-centered, community-based, culturally competent care for eligible

children with special health care needs (CSHCN) in Illinois

13 Regional Officesg

North Cook County

Rockford

Rock Island

North Cook CountyChicago North & SouthDuPageSouth Cook

Peoria

Champaign

South Cook

ChampaignSpringfield

St. Clair Olney

Marion

Regional OfficeCare Coordination TeamsCare Coordination Teams

• Nurses

• Social Workers

• AudiologistsWorking together to

Childg

• Speech-Language Pathologists

serve Children with Special Health Care Pathologists

• Program Coordinator A i t t

Needs

Assistants

Challenges for Families of CSHCNg

• Require multiple services from an array ofRequire multiple services from an array of providers

S i b di t d d• Services can be uncoordinated and fragmented

• Need a link to and between these services• Need services to meet more than justNeed services to meet more than just

the medical needs

Challenges for Families of CSHCNg

Programs operate nder different r les• Programs operate under different rules and eligibility requirements that can result in gaps and overlap in servicesin gaps and overlap in services

• System is confusing to both those needingSystem is confusing to both those needing services and those providing services

• Health care resources are limited and insufficient to meet all needs

CORE PROGRAM

• Assisted more than 1 million children since inception in 1937

• Serves approximately 16,000 CSHCN a year

Core: Eligibilityg y

• Age (birth to 21)General • Residency• Citizenship

General Eligibility

• Category-specific impairment

Medical Eligibility impairmentEligibility

• 285% federal poverty level (FPL)

Financial Eligibility

Core: Medically Eligible Conditionsy g

Must have a treatable chronic condition in the following categories:Must have a treatable, chronic condition in the following categories: Orthopedic (bone, joint, muscle)

Eye impairments (including cataracts, strabismus and certain retinal conditions and excluding refractive errors)Neurological conditionNeurological condition

(nerve, brain, spinal cord)

Heart defect Cystic fibrosis

External body impairment (such as cleft lip/palate and severe burn scars)

Hemophilia

Hearing loss Certain inborn metabolic problems (such as PKU galactosemia)(such as PKU, galactosemia)

Speech conditions requiringmedical/dental treatment

Urinary impairments (kidney, ureter, bladder)

Core: Care Coordination Services

• Uses a family-centered approach• Uses a family-centered approach

• Conducts an assessment of needs

W k ith f il t d l• Works with family to develop an Individualized Service Plan (ISP)

• Facilitates communication among specialists medical home andspecialists, medical home and community providers

Core: Care Coordination Services

Off i f ti b t di l diti• Offers information about medical conditions and local resources

• Provides benefits management

• Assists with access to services, including educational resources

• Transition planning to move to adult services

HOME CARE PROGRAM

• Care coordination services for over 500 technology dependent childrentechnology dependent children

O t d b UIC S i li d C f• Operated by UIC-Specialized Care for Children; administered by Illinois D t t f H lth d F ilDepartment of Healthcare and Family Services (HFS)

Home Care: Care Coordination

• Accepts referrals

W k ith f il t k t f• Works with family to prepare packet of information for HFS review

• Assesses needs identified by family and physicianphysician

• Assesses home environment

Home Care: Care Coordination

• Assists family inAssists family in selecting providers

• Implements plan and• Implements plan and monitors servicesM k i t• Makes appropriate contact, as determined b h hild’ d tby each child’s needs, to stay abreast of changes

Home Care: Care Coordination

P ti l it hild’• Proactively monitors child’s status, including:• Hospitalizations, ER visits• Family living situation and related stress

issuesissues• Ongoing need for nursing support• Change in insurance status or benefitsg

• Performs home visits, as needed, with appropriate members ofwith appropriate members of care coordination team

Home Care: Care Coordination

C di f l f f il h• Coordinates referrals for family to other community resources

• Assists family with educational services/issuesservices/issues

• Conducts periodic reviews of pappropriateness of in-home resources and care

SMART Act

• Save Medicaid Access and Resources• Save Medicaid Access and Resources Together Act passed by state legislators and signed by the Governor – Spring 2012and signed by the Governor Spring 2012

• $1 5 Billion reduction to Medicaid• $1.5 Billion reduction to Medicaid spending

• $1.3 Billion in new revenue (separate related legislation)(separate related legislation)

SMART Act

• Physician rates are unchangedy g• Affected reimbursement rates (decreased):

Audiologist 2.7Chiropractor 2.7Durable Medical Equipment & Supplies 2.7Home Health Agencies 2.7gMost hospitals billing fee-for-service 3.5Imaging Centers 2.7Independent Diagnostic Testing Facilities 2.7Independent Diagnostic Testing Facilities 2.7

Occupational & Physical Therapists 2.7Optometrists, Opticians, Optical Co. 2.7Podiatrists 2 7Podiatrists 2.7Speech Therapists 2.7Transportation Providers 2.7

Future Plans

• Risk model for individualized allocation of care coordination servicescare coordination services

• Dedicated Home Care Unit• Dedicated Home Care Unit

El t i di ti i f ti• Electronic care coordination information system to increase efficacy of services

Future Plans

• Developing a telemedicine p gprogram to bring specialty consultative services to underserved areas

• Enhancing website to provideEnhancing website to provide concise information to families and providers

• Exploring social media as a resource to disseminate information and connect with familiesdisseminate information and connect with families

Tools for Success

• Advisory Groups

• Collaborative Child Find Activities

• Family Survey

• Community Connections

Advisory Groupsy p

Medical Family Advisory

Board

yAdvisory Council

16 members approved by UI

Board of Trustees

13 members from families throughout

the stateBoard of Trustees

12 physicians

the state

chairperson familyp yincluding various

pediatric specialties and three other professionals

chairperson, family members and DSCC

family liaison specialist

Collaborative Child Find Activities

• Universal NewbornUniversal Newborn Hearing Screening ProgramProgram

• Adverse Pregnancy Outcome ReportingOutcome Reporting System referralsSSI Di bl d Child ’• SSI-Disabled Children’s Program referrals

Excerpts from Family Surveyp y y

“They were compassionate “…provided meThey were compassionate, knowledgeable, and helpful. I felt that they were friends.”

…provided me with information I needed to get various services.”

“…our care coordinator has made having special needs children a much easier task than doing it

“…they have educated me and gave me strength to handle my child’s issues …” easier task than doing it

on my own.”“Caring,

dedicated, committed carecommitted care coordinators…”

Community Connectionsy

Mary VenturaMary Ventura Special Education Teacher & Transition Coordinator

• Successfully referred student diagnosed with Cerebral Palsy, Scoliosis and Quadriplegia

• Student experienced continuous painStudent experienced continuous pain• Staff worked with Mary and the client’s family

to have her evaluated by approved providers and specialists

• Outcome: enhanced performance with daily living activities and mobility functions atliving activities and mobility functions at school

Sarah’s Story

As an infant Sarah was diagnosed with cerebral palsy Her parents and

y

As an infant, Sarah was diagnosed with cerebral palsy. Her parents and DRS counselor strongly encouraged and helped her plan to attend the University of Illinois. Sarah says her participation on the U of I women’s wheelchair basketball team taught her to be independent.wheelchair basketball team taught her to be independent.

Within six months, she transitioned from a motorized scooter to a manual wheelchair and eliminated the need for a personal attendant to complete her daily activities.

Sarah is now a social worker at UIC-SpecializedSarah is now a social worker at UIC Specialized Care for Children, sharing her vision for developing appropriate goals for independence and promoting the importance of being active. p g p g

Contact Specialized Care for ChildrenSpecialized Care for Children

217 558 2350217-558-2350800-322-3722FAX 217 558 0773FAX 217-558-0773TDD 217-785-4728

i d /dwww.uic.edu/dscc