Childrens Special Services Program Jacqueline Johnson, MPA Director Children and Youth with Special Health Care Needs Objectives Increase provider awareness of the Childrens Special Services (CSS) Program Outline service provision and coverage provided by the CSS Program Foster collaboration between public health and private providers What is CSS? CSS is the State of Tennessees Title V
program for Children and Youth with Special Health Care Needs funded through the Title V Maternal and Child Health Block Grant. How Did We Get Here? 1919: Started in Tennessee with the first Crippled Childrens Hospital in Memphis 1929: Crippled Childrens Act authorized state to run diagnostic and operative clinics. 1931-1934: CSS ceased to function from due to the depression and a lack of funding 1935: Federal Funding appropriated in Social Security Act, funds became available in 1936
How Did We Get Here, continued 1951: First screening program started for speech and hearing defects 1953: Limited services added that included speech and hearing for indigent population (separate program) 1961: State Legislature revised and broadened the definition to include chronic medical conditions How Did We Get Here, continued 1988: Three pilot projects started in Care Coordination 1988: Pediatric Clinic became entry point for Crippled Childrens Services
1989: Speech and hearing combined with crippled children services to form current Childrens Special Services Program - Care Coordination state wide Who is Eligible for CSS Services? A "child with a physical disability Under twenty-one (21) years of age Who is deemed to have a physical disability by any reason, whether congenital or acquired, as a result of accident, or disease, Requires medical, surgical, or dental treatment and rehabilitation, Who is or may be totally or partially incapacitated for the receipt of a normal
education or for self-support. Source: TCA 68-12-102 Eligibility, continued This definition does not include those children whose sole diagnosis is blindness or deafness; nor does this definition include children who are diagnosed as psychotic. This definition does not prohibit children's special services from accepting for treatment children with acute conditions such as, but not necessarily limited to, fractures, burns and osteomyelitis. Source: TCA 68-12-102
Eligibility, continued Participants must be a resident of the State of Tennessee Income (annual adjusted gross) must be at or below 200% of the Federal Poverty Level Source: TCA 68-12-102 Financial Eligibility Financial eligibility is based on family size and income level. A family's income must be at or below 200% of the federal poverty level. Family Size
$19,790 $23,850 $27,910 $31,970 $40,090 For each additional person add: $23,340 $31,460 $39,580 $47,700 $55,820 $63,940 $36,030
$80,180 $4,060 $72,060 $8,120 Guidelines based on the HHS Federal Poverty Guidelines, Federal Register, 2014, Vol. 79,No. 14, January 22, 2014, pp. 3593-3594. Program Services Care Coordination Promotes the effective and efficient organization and utilization of resources to
assure access to necessary comprehensive services for children with special health care needs and their families. Medical Services Medical, surgical, and rehabilitative treatment for conditions related to an approved diagnostic condition. Care Coordination Case management services that provide
assistance to families with services such as third party payor billing, filing appeals when third party payors deny payment, and seeking prior authorization from third party payors for health care services. Provide and receive referrals from TEIS, participate in multi-disciplinary team meetings and individual family service plan meetings Care Coordination, continued Work closely with school systems especially special education Provide support services assisting families to access medical and non-medical services for participation in activities of daily living
Collaborate with MCOs, provider offices and other agencies Care Coordination, continued Knowledgeable of community resources and makes referrals Assist in developing transition plan for participants age 14 and older for transition to adulthood for both medical and non-medical needs Medical Services CSS may assist with payments for services related to the eligible diagnosis Covered Services Include:
Diagnostic screening, testing, evaluations and treatment OT, ST, PT Surgeries inpatient and outpatient Hospitalization Office Visits Primary Care/Specialty Visits Prescription Drugs Medical Services, continued Covered services, continued: Durable Medical Equipment Assistive technology - augmentative communication devices Supplies (ex. Diabetic, tube feedings, diapers, etc.)
Hearing aids, batteries, molds etc., Rehabilitative services Special Food and Formula Co-pays, co-insurance and deductibles Sample of Current Diagnoses of CSS Enrollees For Calendar Year 2013, the CSS program provided services for over 540 different diagnoses. The most common diagnoses were: Hearing Loss Cardiac Related Diagnoses Seizure Disorders
Asthma Cerebral Palsy Source: TDH, CSS Program Current Diagnoses, continued Diabetes Cystic Fibrosis Esophageal Reflux Obesity (greater than 95th percentile) Congenital Hydrocephalus Sickle Cell Source: TDH, CSS Program Tennessee Statistics
CSS Enrollment (3/21/2014) Pediatric Providers (3/21/2014) 2,983 children/youth 1,598 pediatric providers, full or parton CSS caseloads as time, with active of 3/21/2014 licenses as of Source: TDH, CSS 3/21/2014 Program Source: TDH Division of Health Licensure and Regulation
Regional CSS Contact Information East Tennessee Region 2101 Medical Center Way Knoxville, TN 37920 Gretta Logan 865-549-5244 Counties Served Anderson, Blount, Campbell, Claiborne, Cocke, Grainger, Hamblen, Jefferson, Loudon, Monroe, Morgan, Roane, Scott, Sevier, Union _______________________________ Mid-Cumberland Region 715 Hart Lane Nashville, TN 37243
Sharon Woodard - 615 650-7000 Counties Served Cheatham, Dickson, Houston, Humphreys, Montgomery, Robertson, Rutherford, Stewart, Sumner, Trousdale, Williamson, Wilson Northeast Region 185 Treasure Lane Johnson City, TN 37604 Katherine (Kathy) Snyder 423-979-3200 Counties Served Carter, Greene, Hancock, Hawkins, Johnson, Unicoi, Washington _________________________________ South Central Region 1216 Trotwood Avenue
Columbia, TN 38401 Sherri Griggs 931-380-2532 Counties Served Bedford, Coffee, Crockett, Giles, Hickman, Lawrence, Lewis, Lincoln, Marshall, Maury, Moore, Perry, Wayne Regional CSS Contact Information, continued Southeast Region 540 McCallie Avenue Suite 450 Chattanooga, TN 37402 Billie Ammons 423-634-6319 Counties Served Bledsoe, Bradley, Franklin, Grundy, Marion, McMinn,
Meigs, Polk, Rhea, Sequatchie ______________________________ Upper Cumberland Region 1100 England Drive Cookeville, TN 38501 Tina Davis 931-528-7531 Counties Served Cannon, Clay, Cumberland, Dekalb, Fentress, Jackson, Macon, Overton, Pickett, Putnam, Smith, Van Buren, Warren, White West Tennessee Region 295 Summar Avenue Jackson, TN 38301
Andala Gray 731-423-6600 Counties Served Benton, Carroll, Chester, Crockett, Decatur, Dyer, Fayette, Gibson, Hardeman, Hardin, Haywood, Henderson, Henry, Lake, Lauderdale, Madison, McNairy, Obion, Tipton, Weakley Metro CSS Contact Information Davidson County 311 23rd Avenue North Nashville, TN 37203 Mary Koob 615-340-5697 County Served Davidson Metro Nashville Area
_______________________________ Hamilton County 921 East Third Street Chattanooga, TN 37403 Diana Kreider 423-209-8080 County Served Hamilton Chattanooga Area Knox County 140 Dameron Avenue Knoxville, TN 37917 Miranda Malone 865-215-5190 County Served Knox Knoxville Area _________________________________
Shelby County 814 Jefferson Street Memphis, TN 38105 Carolyn Somerville 901-544-7600 County Served Shelby Memphis Area _________________________________ Sullivan County P.O. Box 630 Blountville, TN 37617 Becca Wright 423-279-2777 County Served Sullivan Bristol, Kingsport Area Opportunities for Collaboration T.E.A.M. Together
Everyone Achieves More Contact Information Website: http://health.tn.gov Jacqueline Johnson, MPA Email: [email protected] Phone: 615-741-7353
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