Anything and Everything Care Coordination: Let’s Put It into Action!

Children are like…

They require lots of…to navigate their world

EPSDT/Centennial Care PCP/BH School Nurses SBHC Community Family

EPSDT Early Periodic Screening Diagnosis Treatment The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services. Early: Assessing and identifying problems early Periodic : Checking children's health at periodic, age-appropriate intervals Screening: Providing physical, mental, developmental, dental, hearing, vision, and other screening tests to detect potential problems Diagnostic: Performing diagnostic tests to follow up when a risk is identified, and Treatment: Control, correct or reduce health problems found. The majority of medicaid services come under the EPSDT benefits

Care Coordination Care Coordinators Are the single point of contact NMAC: http://164.64.110.239 Care Coordination Care Coordinators Are the single point of contact For members and providers. Care Coordinators assist members with their families with complex needs. Care is member centered, family focused and culturally competent. Care Coordinators assists in locating services to meet the health and social needs of the member. The Care Coordination team consists of an integrated BH and PH clinicians and Health Coordinators The Centennial Care contract tells us the things that have timelines tied to them. Like assessements and careplans, It also tells the CC who they should reach out like schools, doctors, therapists, communities, natural resources, CYFD, probation officers. It doesn’t give specific as the contract is built on the relationshipo between CC and member be memberccentric. The idea being the CC can help the member lead as independent life as possible. To regain or maintain health.

Pediatric Care Coordination EPSDT benefits: Well Child exams Dental Vision Personal Care Services Private Duty nursing Therapies Behavioral Health Centennial Care/EPSDT Centennial Care/EPSDT Pediatric Medicaid benefits: Care Coordination Environmental Modifications-conditional Home Health Aide-18 years and older Durable medical equipment Medical Care/Medication Respite-conditional Transportation/lodging Self-direction-conditional/limited

What does this actually look like? At each table together The student health plan is the integral plan that allows the student to stay in school as do the EPSDT services, the Centennial Care plan brings in the member what is important in his or her world to work on like going to camp or a new wheelchair or communication device. Part One: Use the provided scenarios and develop student health plan Use the provided tools to create the plan Once we are done then we’ll chat about it.

Any provider can make a referral for care coordination At each table together Part Two: Use the provided scenarios and tools and decide what kind Care Coordination the members need. Remember the majority of benefits and services come from EPSDT Don’t be timid! Be bold! Part three: Now bring them together. How do they work together? Are there gaps or overlaps Any provider can make a referral for care coordination This is where you use the tools provider, the parts from the NMAC, and the EPSDT guide and the school health plan

EPSDT/Centennial Care Resources EPSDT MANUAL: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-and-Periodic-Screening-Diagnostic-and-Treatment.html BRIEFER VERSION: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Downloads/EPSDT_Coverage_Guide.pdf MCO CONTACT INFORMATION: http://www.hsd.state.nm.us/LookingForInformation/managed-care-organizations.aspx EPSDT regulations: http://164.64.110.239/nmac/cgi-bin/hse/homepagesearchengine.exe?url=http://164.64.110.239/nmac/parts/title08/08.320.0002.htm;geturl;terms=epsdt MCO policy manual: http://www.hsd.state.nm.us/providers/managed-care-policy-manual.aspx MCO CONTRACTS:http://www.hsd.state.nm.us/LookingForInformation/medical-assistance-division.aspx NMAC: http://164.64.110.239 Care Coordination and Medicaid: https://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/epsdt-care-coordination-strategy-guide.pdf