Improving Nutritional Care for Children with Special Health Care Needs: The Work of the CSHCN Program Yuchi Yang, MS, RD, CD Nutrition Consultant CSHCN Program Washington State Department of Health May 9, 2005

MCH Core Public Health Services Direct Medical Services Enabling Services Population Based Services Infrastructure Building Services

Children with Special Health Care Needs Program February 2005 Program Manager Maria Nardella (360) Secretary Administrative Christy Davis (360) Secretary Administrative -- WISE Jane Berube (360) Public Health Nurse Consultant Linda Barnhart (360) WISE Grant Coordinator Karla Dudley (360) Nutrition Consultant Yuchi Yang (360) Assessment Consultant Stacey De Fries (360) Family Consultant Leslie Carroll (360) Program Integration Consultant Civillia Winslow Hill (360) Budget & Contracts Coordinator Patsy Shumway (360)

Children with Special Health Care Needs (CSHCN) Program Ensuring all children and youth with special health care needs achieve the healthiest life possible”

Prevalence of Children with Special Health Care Needs: Persons 95%CI: ± 0.52%95%CI: ± 0.11% Source: National (n=372,174) & WA (n=6629) Screener files. 7

Children with Special Health Care Needs “Children with special health care needs are those who have or are at increased risk for chronic physical, developmental, behavioral, or emotional conditions and who require health and related services of a type or amount beyond that required by children generally.” … Maternal & Child Health Bureau

Who Do We Serve? Children up to 18 years of age who have or at risk of having a special health care needs. Resident of Washington Income Eligibility for certain services: 200%FPL

What is Care Coordination? …defined as “a process that links children with special health care needs and their families to services and resources in a coordinated effort to maximize the potential of children and provide them with optimal health care.” American Academy of Pediatrics Committee on Children with Disabilities. Care coordination: Integrating health and related systems of care for children with special health care needs. Pediatrics 1999;104(4):

Time Spent Providing, Arranging, or Coordinating Care for CSHCN, per week Washington National 11

CSHCN Coordinator is the Gatekeeper. Call your local health department or the ASK Line (Answers for Special Kids Resource Line) through Healthy Mothers, Healthy Babies to help families access needed services for their child, such as medical care and other interventions.

Care Coordination for WA CSHCN 13

with special health care needs

Multidisciplinary Team Physician Nutritionist Nurse Social worker OT/PT Speech pathologist Behavioral psychologist

Medicaid Medical Nutrition Therapy Enteral Nutrition Program MAA home page

Medicaid and CSHCN: A Comparison

MAA Medical Nutrition Therapy Certified Dietitian PCP Referral/EPSDT Medical Provider Number Specific Fee Schedule

Medicaid Nutrition Rates $10.88 per unit Unit = 15 minutes of a face-to-face interaction Initial assessment up to 2 hours Reassessments up to 1 hour per day No annual limit on reassessments $4.53 per unit for Group Therapy

Implications for Dietitians Certified Dietitians MAA Provider Numbers

Certified Dietitian Go to: for an application form.

Medical Provider Number Go to and click on “sign up to be a WA State Medical Assistance Provider”. Call MAA Provider Enrollment Unit at for questions.

WIC Supplemental Nutrition Program for Women, Infants and Children

WIC Services Supplemental Foods Nutrition Assessments Nutrition Education Breastfeeding Promotion Community Referrals Access to Health Services

Formula Coverage WIC First Medicaid CSHCN Special Formula Fund through CSHCN Coordinators

MAA Enteral Nutrition Program Current rules: Clients receive formula from pharmacies with Dr’s prescription without prior authorization.

New MAA Enteral Nutrition Program New rules will take effect July 1, 2005 Key points: 1.Prior authorization. 2.Medical/nutrition criteria for oral nutrition supplements. 3.Not meeting new criteria, will be evaluated on a case-by-case base.

CSHCN Special Formula Fund Medically necessary Not covered by any other program or insurance

CHDD Nutrition Contract Purpose: to promote the availability of quality, community- based nutrition and feeding team services and improve nutrition outcomes for children with special health care needs

CSHCN Training Opportunities CSHCN Nutrition Network Feeding Teams Distance Learning Grant (Training Modules)

Nutrition Focus for Children with Special Health Care Needs A newsletter for health professionals University of Washington based /co_NutriFocus.html 6 issues per year

Publication Medicaid Reimbursement for Medical Nutrition Products and Nutrition Services for Children with Special Health Care Needs: A Washington State Case Studies Report. For a copy, visit s.htm

Guidelines for the Development and Training of Community-Based Feeding Teams in Washington State. 1.Determine the Need 2.Identify Key Agencies and Professionals. (Revised edition will be on-line soon. Please visit CSHCN home web page)

Nutrition Interventions for Children with Special Health Care Needs To provide a resource for those involved in the monitoring or delivery of nutrition care for children with special health care needs. For order information, please visit s.htm

Children With Special Health Care Needs: Nutrition Care Handbook This newly published resource provides a quick and practical reference. Can be purchased through ADA at

Materials Children with Special Health Care Needs Program Brochures. The National Survey of Children with Special Health Care Needs. Chart book

CSHCN Program Home Page: