Medically Complex Children’s Waiver

1. Medically Complex Children’s Waiver Maria Platanis, RN, BSN Waiver Administrator Department of Health & Human Services Medically Complex Children’s Waiver platanis@scdhhs.gov 803-898-2577

2. Medically Complex Children’s Waiver “This waiver will serve children who meet the Nursing Facility Level of Care or ICF-MR level of care and have a chronic physical/health condition that is expected to last longer than 12 months and must meet medical criteria defined by the state which makes the child dependent upon comprehensive medical, nursing, and health supervision or intervention. The services offered in this waiver include Children's Medical Day Care, Respite, Care Coordination, and Incontinence Supplies.” South Carolina’s Medically Complex Children’s Home and Community Based Waiver

3. Medically Complex Children’s (MCC) Waiver, continued • CMS approved the Medically Complex Children’s (MCC) Waiver effective 1/1/09. • MCC waiver is available statewide to serve children from birth to age 18 who meet either Nursing Facility or ICF-MR level of care, and medical complexity criteria. • The model of care coordination used in the MCC waiver is Medically driven. • The Care Coordinator is the liaison between providers and caregivers coordinating the medical needs of the children. • To participate in medically driven Care Coordination, guided by the child’s Primary Care Provider, the child must be enrolled in the Medical Homes Network.

4. Medically Complex Children’s (MCC) Waiver, continued • The MCC waiver will utilize a Medical Homes Network (MHN), to provide the Care Coordination linkage between the families and the MHN Primary Care Providers (PCP), as well as other service providers. • We currently have funding for 150 slots in the MCC waiver and are taking referrals. There are still several slots open. We are enrolling on “first come first serve basis”.

5. Medical Complexity Criteria Children with a serious illness or condition expected to last at least 12 months. This illness or condition generally makes the child dependent upon comprehensive, medical, nursing and health supervision or intervention as established by state medical criteria.

6. Medical Complexity Eligibility Criteria • Medications • Number • Frequency • Route • Hospitalizations • Frequency • ER visits • Nursing care • Respiratory Monitoring • Neurological Monitoring • Functional Monitoring • Skin care needs • Other Nursing needs • Specialists • Number of specialists • Number of visits • Therapies • Number of therapies • Frequency of therapies per week

7. MCC Waiver Services Medical Homes Network • Physician Directed Coordinated Medical Care MCC Waiver Services • Care Coordination • Incontinence Supplies • Medical Day Care • Respite

8. Care Coordination Medically Driven Care Coordination - Enrolled in Medical Home Network Community Based Care Coordination – Waiver only • Coordination of chronic and preventive medical management. • Conduct health related assessments • Health risk assessment with child • Developmental assessment • Disease specific assessment • Ensure “best practice” guidelines are followed for acute illness, prevention and chronic care management. • Coordinate specialty care services with other providers. Review and interpret subspecialty recommendations. • Provide continuity of care for inpatient and outpatient problems 24 hours a day. • Create and maintain an Emergency Medical Plan to be used by EMS personnel and caregivers at home. • Coordinate medical services, allied health (OT, PT, Speech Therapy) and other EPSDT services. • Facilitate participation of health related team members in care planning. • Provide family training regarding medical care in the home. • Conduct family training to address disease management and when appropriate the child’s management of their medical condition. • Monthly physician evaluations to reassess the plan of care and ensure new needs are addressed through the care coordination process. • Coordinate overall Care Coordination Plan ensuring integration and coordination of waiver services. • Ensure participant/family-centered care. • Ensure freedom of choice when educating waiver participants to the choice of providers for service in the Care Coordination Plan. • Coordination with other providers (e.g., early intervention, Department of Social Services, etc.) • Evaluate and refer to appropriate community/state programs to meet care needs. • Facilitate transportation to Medicaid services. • Assure health, safety and welfare as required in the 1915c waiver • Ongoing assessment of home environment to address barriers for caring for the in the home. • Maintain liaison with Department of Social Services – Foster Care. • Assess satisfaction (complaints, grievances) with other providers. • Re-evaluate Care Coordination Plan on an on-going basis, provide recommendations for amendments to the plan. • Discharge planning for participants with recommendations for termination and transfer out of the MCC waiver as appropriate. • Discharge planning and transition to another waiver and/or PCP/MH upon aging out of MCC waiver.

9. Medically Complex Children’s Waiver State Plan Services MCC Waiver Services • Durable Medical Equipment • Prescriptions • Therapies • Transportation • Specialists • Nutrition • Nursing • Other • Care Coordination • Respite • Provided by an RN/LPN • 12-16 hours per month • Medical Day Care • Incontinence Supplies • Age appropriate diapers • Pads • Wipes