Partners For ChildrenPartners For ChildrenA Medicaid Waiver-A Medicaid Waiver-

Developed in Collaboration withDeveloped in Collaboration with

California Children’s Services (CCS) California Children’s Services (CCS) Children's Hospice & Palliative Care CoalitionChildren's Hospice & Palliative Care Coalition

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 What is Partners for Children? 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 WaiverMedicaid WaiverSection 1915(c) Section 1915(c)

Home and Community-Based Services WaiverHome 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 An active approach to care which enhances quality of life & enhances quality of life & minimizes suffering through minimizes suffering through interdisciplinary servicesinterdisciplinary services

Why Do We Need Pediatric Palliative Care?Why Do We Need Pediatric Palliative Care?

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

• It allows for both curative and It allows for both curative and comfort treatments simultaneouslycomfort treatments simultaneously

Why Do We Need Pediatric Palliative Care? Why Do We Need Pediatric Palliative Care? (cont.)(cont.)

– Supports family decision-makingSupports family decision-making– Includes family members on the care teamIncludes family members on the care team– Improves continuity of careImproves continuity of care– Decreases # of medical crisesDecreases # of medical crises– Decreases hospital admissions & length of Decreases hospital admissions & length of

staysstays

How Can Children Get How Can Children Get Palliative Care Services?Palliative Care Services?

• Palliative care services available to Palliative care services available to all CCS-eligible childrenall CCS-eligible children

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

How Can Children Get Palliative Care How Can Children Get Palliative Care Services ? Services ? (cont.)(cont.)

– Additional services will be available Additional services will be available through the pediatric palliative care through the pediatric palliative care waiver, waiver, Partners for ChildrenPartners for Children• A federal Home and Community-Based A federal Home and Community-Based

Services (HCBS) waiverServices (HCBS) waiver• Pilot in 5 counties beginning in October Pilot in 5 counties beginning in October

2009, expanding to 13 counties by 20112009, expanding to 13 counties by 2011

What is What is Partners for ChildrenPartners for Children??

A Medi-Cal demonstration project that A Medi-Cal demonstration project that enables children with certain CCS eligible enables children with certain CCS eligible medical conditions to receive:medical conditions to receive:– curative treatments ANDcurative treatments AND– home and community-based palliative home and community-based palliative

care services similar to those provided by care services similar to those provided by hospice agencieshospice agencies

Who Might Qualify?Who Might Qualify?

Applicant must meet all of the following:Applicant must meet all of the following:1.1. Be under 21 yrs oldBe under 21 yrs old2.2. Have “full scope,” “no share of cost” Have “full scope,” “no share of cost”

Medi-CalMedi-Cal3.3. Reside in a participating countyReside in a participating county4.4. Have a waiver-eligible medical conditionHave a waiver-eligible medical condition5.5. Choose to participate (Applicant or Choose to participate (Applicant or

parent/legal guardian)parent/legal guardian)

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

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

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

• Children enrolled in the waiver will not Children enrolled in the waiver will not be enrolled for a hospice benefitbe 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 WaiverPartners for Children WaiverChild must live in a participating countyChild must live in a participating county

Year 1Year 1 (300)(300) Year 2Year 2 (801)(801) Year 3Year 3 (1802)(1802)AlamedaAlamedaMontereyMontereySan DiegoSan DiegoSanta ClaraSanta ClaraSanta CruzSanta Cruz

AlamedaAlamedaMontereyMontereySan DiegoSan DiegoSanta ClaraSanta ClaraSanta CruzSanta CruzHumboldtHumboldtMarinMarinOrangeOrangeSacramentoSacramentoSan FranciscoSan FranciscoSonomaSonoma

AlamedaAlamedaMontereyMontereySan DiegoSan DiegoSanta ClaraSanta ClaraSanta CruzSanta CruzHumboldtHumboldtMarinMarinOrangeOrangeSacramentoSacramentoSan FranciscoSan FranciscoSonomaSonomaFresnoFresnoLos AngelesLos Angeles

What Services Might Applicants What Services Might Applicants Receive?Receive?

Community-based Care CoordinationCommunity-based Care Coordination• Assessment of participant’s & family’s Assessment of participant’s & family’s

goals of caregoals of care• Creation of a Family-Centered Action Plan Creation of a Family-Centered Action Plan

(F-CAP) with input from family and (F-CAP) with input from family and interdisciplinary care teaminterdisciplinary care team

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

What Services Might the Participant What Services Might the Participant Receive? Receive? (cont.)(cont.)

• Respite careRespite care– In-home and out-of-homeIn-home and out-of-home

• Expressive therapies Expressive therapies – art, music, play, massageart, music, play, massage

• Family training Family training

• Bereavement supportBereavement support

To make a referral:To make a referral:• Anyone can refer a patientAnyone can refer a patient• To make a referral:To make a referral:

– Confirm that the child has a waiver eligible conditionConfirm that the child has a waiver eligible condition– Confirm that the child resides in a pilot countyConfirm 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-CalContact 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 websiteDownload a referral form from the CCS website

[a [a

What Happens Next ?What Happens Next ?The CCS Nurse Liaison (CCSNL) will:The CCS Nurse Liaison (CCSNL) will:

• Determine if the child is eligible for waiver Determine if the child is eligible for waiver servicesservices

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

• Review available care coordination agencies Review available care coordination agencies with family with family

• Connect the child with a Care Coordinator at Connect the child with a Care Coordinator at the selected agencythe selected agency

End of short versionEnd of short version

Partners for Children Partners for Children

Partners for Children Partners for Children ServicesServices

• Care Coordination Care Coordination

• Respite careRespite care

• Bereavement CounselingBereavement Counseling

• Expressive therapiesExpressive therapies

• Family trainingFamily training

Keystone to Success

STATE PLAN/EPSDTSTATE PLAN/EPSDTServicesServices

CCS NL 04-0207CCS NL 04-0207“ Full Scope Medi-Cal”

“CCS”

Waiver ServicesWaiver ServicesCare CoordinationRespite CareBereavement CounselingExpressive therapiesFamily Training

Community ServicesCommunity Services

Family+

Care Coordinator+

CCS Nurse Liaison

Coordination of Services

Keystone to SuccessKeystone to Success

Care CoordinationEmphasizes – Holistic care– Communication and information sharing– Shared decision making– Partnership between family, CCS program

and providers

Care CoordinatorCare Coordinator

• Employee of Home Health Agency Employee of Home Health Agency or Hospice Agencyor Hospice Agency

• Registered Nurse or Medical Social Registered Nurse or Medical Social WorkerWorker

• Anticipated patient staffing ratio Anticipated patient staffing ratio 1:20-301:20-30

Care CoordinatorCare 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 CoordinatorCare CoordinatorCore 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 CountyEmployee of County

– Registered Nurse case managerRegistered Nurse case manager

– PatientPatient staffing ratio 1:50 staffing ratio 1:50

CCS Nurse Liaison (CCSNL)CCS Nurse Liaison (CCSNL)

FunctionsFunctions– CCS program liaison with the Care CCS program liaison with the Care

CoordinatorCoordinator– Administrative Case Management for CCS Administrative Case Management for CCS

clients enrolled in the waiverclients enrolled in the waiver• Knowledge of the CCS program, other State and Knowledge of the CCS program, other State and

community resources and limitationscommunity resources and limitations

CCS Nurse Liaison (CCSNL)CCS Nurse Liaison (CCSNL)

FunctionsFunctions, cont’d, cont’d

– Ensures that federal waiver requirements Ensures that federal waiver requirements are metare met

• Review waiver applications and make level of Review waiver applications and make level of care determinationscare determinations

• Timely enrollment of qualified applicantsTimely enrollment of qualified applicants

• Meet the client/ family unit’s goals and objectives Meet the client/ family unit’s goals and objectives

• Shared decision makingShared decision making

• Quality assurance and quality improvementQuality assurance and quality improvement

CCS Nurse Liaison (CCSNL)CCS Nurse Liaison (CCSNL)

Functions - Functions - Ensures that federal Ensures that federal waiver requirements are met, cont’dwaiver requirements are met, cont’d– Inform and educate applicants on waiver eligibility, Inform and educate applicants on waiver eligibility,

services, choice of providers and services, benefitsservices, choice of providers and services, benefits

– Approve and authorize service requests based on F-Approve and authorize service requests based on F-CAPCAP

– Monitor the process to ensure health, safety, choiceMonitor the process to ensure health, safety, choice

Care Coordinator Care Coordinator andand CCSNL require CCSNL require knowledge and expertise in:knowledge and expertise in:

– Family-Centered CareFamily-Centered Care– Palliative care Palliative care – Effective communication Effective communication – Shared decision making Shared decision making – Cultural competence Cultural competence – Quality assurance and quality improvement Quality assurance and quality improvement – Waiver, state and community resourcesWaiver, state and community resources

Pediatric Palliative Care Numbered LetterPalliative care services availablePalliative care services available

Home Health Agency (HHA) ServicesHome Health Agency (HHA) ServicesNursing visitsNursing visits

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

Physical Therapy / Occupational Therapy visitsPhysical Therapy / Occupational Therapy visitsSocial Worker visitsSocial Worker visitsSpeech Therapy visitsSpeech Therapy visitsRespiratory Therapy visitsRespiratory Therapy visitsRegistered Dietitian visitsRegistered Dietitian visitsPsychology services – related to CCS-eligible conditionPsychology services – related to CCS-eligible condition

Provider TypesProvider TypesDMEDMEPain Control/Symptom ManagementPain Control/Symptom ManagementMaintenance and Transportation (N.L. 01-0104)Maintenance and Transportation (N.L. 01-0104)

California’s Responsibilities to the Federal Government

Quality Assurance – Monitoring of:Quality Assurance – Monitoring of:• Timeliness of F-CAPTimeliness of F-CAP• Medical necessity of the F-CAPMedical necessity of the F-CAP• Patient and family satisfactionPatient and family satisfaction• Freedom of choice for familiesFreedom of choice for families• Level of care determinationLevel of care determination

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

• Quality ImprovementQuality Improvement• Incident and complaint reporting, follow-upIncident and complaint reporting, follow-up• Training and EducationTraining and Education• Compilation and analysis of dataCompilation 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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