Title V Block Grant Incorporating the National Standards for - - PowerPoint PPT Presentation

Title V Block Grant

Incorporating the National Standards for Systems of Care for CYSHCN

Saylem DePasquale, CSHCN Epidemiologist February 10th, 2018, AMCHP 2018

Process

Needs Assessment

Priority need for CSHCN: Medical home

*46.9% of CSHCN report receiving care in a medical home – 2016 NSCH

Evidence base: National Standards for Systems of Care for CYSHCN

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Burdens Facing CSHCN in West Virginia

• Socioeconomic disparities
• Inadequate health insurance coverage
• Burdensome travel to medical appointments
• Rural landscape
• Little to no access to public transportation
• Access to in-state pediatric specialists
• Typically located around three tertiary care centers in state
• Children are having to see providers out of state

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Development of Performance Measures

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National Standards for Systems of Care for CYSHCN Medical Home Transition Access to Care

NPM 11: Medical Home

Increase the percentage of children, with and without special health care needs, that have a medical home from 49% and 65% respectively in 2011/2012 to 69% by 2022. WV's rates are higher than the national average, but significant improvement is needed for children with special health care needs. ▪ Strategies: ▪ Provide financial support to provide Project Delivery of Chronic Care curriculum to resident students at two medical schools. ▪ Partner with WV HealthCheck to provide training to providers regarding the National Standards for Systems of Care for CYSHCN. ▪ Develop a shared care planning resource to facilitate communication among members of the medical home. ▪ Develop and implement care planning standards for the state Title V agency and Medicaid Managed Care Organizations and provide quality assurance monitoring to ensure these standards are being upheld.

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SPM 1: Transition

Increase the percentage of adolescents with and without special health care needs who receive services necessary to make transitions to adult health care from 41.6% in 2011 to 53.1% by

• 2022. Although WV's rate exceeds the national average, there is

a significant opportunity for improvement. ▪ Strategies: ▪ Partner with WV HealthCheck to provide training to providers regarding the Got Transition standards. ▪ Incorporate Got Transition standards into all care planning standards and materials. ▪ Provide transition services to YSCHN.

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SPM 2: Adequate insurance

Increase the percentage of children ages 0-17 who are adequately insured from 78.2% in 2011/2012 to 83.2% by 2022. Although there are very few children not insured in WV, the insurance often does not cover nutritional needs or genetic services for children identified with special needs. ▪ Strategies: ▪ Work with insurance providers to promote the coverage of medically necessary services. ▪ Provide easily accessible, medically necessary nutrition services as a payer of last resort. ▪ Facilitate the coverage of medically necessary nutrition services by other payers (Medicaid, MCOs, private insurance, etc.).

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Successes

• Development of a shared care plan resource.
• Identification of the foster care population as CYSHCN and

providing health care coordination to support the foster care state agency.

• Coordination of benefits through the Medicaid’s Managed

Care Organizations and EPSDT benefit.

• Development of Project DOCC at a second medical school to

educate residents to empower families of CYSHCN.

• Collaborating with Medicaid Managed Care Organizations to

consistently identify CYSHCN and address their needs.

• Streamlining medical foods costs to continue to provide Title

V benefits as a payer of last resort.

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Contact

Saylem DePasquale CSHCN Epidemiologist saylem.m.depasquale@wv.gov Mekell Golden CSHCN Program Manager mekell.l.golden@wv.gov

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