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Partners For Children. A Medicaid Waiver- Developed in Collaboration with California Children’s Services (CCS) Children's Hospice & Palliative Care Coalition. Table of Contents. What is Partners For Children? Waiver services Who might qualify? What counties do they live in?
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Partners For Children A Medicaid Waiver- Developed in Collaboration with California Children’s Services (CCS) Children'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 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 Waiver Section 1915(c) Home 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? An active approach to care which enhances quality of life & minimizes suffering through interdisciplinary services
Why Do We Need Pediatric Palliative Care? Families & providers are often reluctant to give up on curative therapies for children in order to focus only on comfort. It allows for both curative and comfort treatments simultaneously
Why Do We Need Pediatric Palliative Care? (cont.) Supports family decision-making Includes family members on the care team Improves continuity of care Decreases # of medical crises Decreases hospital admissions & length of stays
How Can Children Get Palliative Care Services? • Palliative care services available to all CCS-eligible children • Existing palliative care benefits available statewide are described in CCS Numbered Letter (NL) 04-0207
How Can Children Get Palliative Care Services ? (cont.) Additional services will be available through the pediatric palliative care waiver, Partners for Children A federal Home and Community-Based Services (HCBS) waiver Pilot in 5 counties beginning in October 2009, expanding to 13 counties by 2011
What is Partners for Children? A Medi-Cal demonstration project that enables children with certain CCS eligible medical conditions to receive: • curative treatments AND • home and community-based palliative care services similar to those provided by hospice agencies
Who Might Qualify? Applicant must meet all of the following: • Be under 21 yrs old • Have “full scope,” “no share of cost” Medi-Cal • Reside in a participating county • Have a waiver-eligible medical condition • Choose to participate (Applicant or parent/legal guardian)
Who Might Qualify? (cont’d) • Because of HCBS waiver rules, the child must be on only one HCBS waiver • If the child is enrolled in a different waiver, she will need to disenroll from that one • Children enrolled in the waiver will not be 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 Waiver Child must live in a participating county Year 1(300)Year 2(801)Year 3(1802) Alameda Monterey San Diego Santa Clara Santa Cruz Alameda Monterey San Diego Santa Clara Santa Cruz Humboldt Marin Orange Sacramento San Francisco Sonoma Alameda Monterey San Diego Santa Clara Santa Cruz Humboldt Marin Orange Sacramento San Francisco Sonoma Fresno Los Angeles
What Services Might Applicants Receive? Community-based Care Coordination Assessment of participant’s & family’s goals of care Creation of a Family-Centered Action Plan (F-CAP) with input from family and interdisciplinary care team Communication of plan across all settings including family, CCS & entire health care team
What Services Might the Participant Receive? (cont.) Respite care In-home and out-of-home Expressive therapies art, music, play, massage Family training Bereavement support
To make a referral: Anyone can refer a patient To make a referral: Confirm that the child has a waiver eligible condition Confirm 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-Cal Download a referral form from the CCS website [a
What Happens Next ? The CCS Nurse Liaison (CCSNL) will: Determine if the child is eligible for waiver services Discuss with eligible child’s family, and enroll if appropriate Review available care coordination agencies with family Connect the child with a Care Coordinator at the selected agency
End of short version Partners for Children
Partners for Children Services Care Coordination Respite care Bereavement Counseling Expressive therapies Family training
Keystone to Success Coordination of Services Waiver Services Care CoordinationRespite Care Bereavement CounselingExpressive therapiesFamily Training Family + Care Coordinator + CCS Nurse Liaison STATE PLAN/EPSDT ServicesCCS NL 04-0207 “ Full Scope Medi-Cal” “CCS” Community Services
Keystone to Success Care Coordination Emphasizes Holistic care Communication and information sharing Shared decision making Partnership between family, CCS program and providers
Care Coordinator Employee of Home Health Agency or Hospice Agency Registered Nurse or Medical Social Worker Anticipated patient staffing ratio 1:20-30
Care 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 Coordinator Core 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) Employee of County Registered Nurse case manager Patient staffing ratio 1:50
CCS Nurse Liaison (CCSNL) Functions CCS program liaison with the Care Coordinator Administrative Case Management for CCS clients enrolled in the waiver Knowledge of the CCS program, other State and community resources and limitations
CCS Nurse Liaison (CCSNL) Functions, cont’d Ensures that federal waiver requirements are met Review waiver applications and make level of care determinations Timely enrollment of qualified applicants Meet the client/ family unit’s goals and objectives Shared decision making Quality assurance and quality improvement
CCS Nurse Liaison (CCSNL) Functions - Ensures that federal waiver requirements are met, cont’d Inform and educate applicants on waiver eligibility, services, choice of providers and services, benefits Approve and authorize service requests based on F-CAP Monitor the process to ensure health, safety, choice
Care Coordinator and CCSNL require knowledge and expertise in: Family-Centered Care Palliative care Effective communication Shared decision making Cultural competence Quality assurance and quality improvement Waiver, state and community resources
Pediatric Palliative Care Numbered Letter Palliative care services available Home Health Agency (HHA) Services Nursing visits In-home shift nursing services <90 days In-home shift nursing services >90 days go to In Home Operations Physical Therapy / Occupational Therapy visits Social Worker visits Speech Therapy visits Respiratory Therapy visits Registered Dietitian visits Psychology services – related to CCS-eligible condition Provider Types DME Pain Control/Symptom Management Maintenance and Transportation (N.L. 01-0104)
California’s Responsibilities to the Federal Government Quality Assurance – Monitoring of: Timeliness of F-CAP Medical necessity of the F-CAP Patient and family satisfaction Freedom of choice for families Level of care determination
California’s Responsibilities to the Federal Government (cont’d) Quality Improvement Incident and complaint reporting, follow-up Training and Education Compilation 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?
