1. The Future of the California Children’s Services (CCS) Program: Overview of CCS Laurie A. Soman Children’s Regional Integrated Service System (CRISS) Lucile Packard Children’s Hospital March 14, 2016

2. What Is CCS?  Oldest Public Health Program in California  Created in 1927-- 8 Years Before Federal Maternal and Child Health Program  Originally Created to Address Polio Epidemic and Serve as Safety Net to Keep Families from Bankruptcy

3. What Is CCS?  CCS Now CA’s Official Maternal and Child Health Program for CSHCN  Covers 180,000 Children/Youth Aged Birth to Age 21 with Complex, Chronic, and/or Potentially Disabling Conditions, e.g. o Cancer o Sickle Cell Disease o Cerebral Palsy o Cystic Fibrosis o Congenital Heart Conditions o Hemophilia

4. What Is CCS?  Built on Managed Care Principles but Specifically for CSHCN  Statewide Pediatric Quality Standards that Drive State System of Health Care for All Children  Statewide Network of Approved Pediatric Providers, Hospitals and Special Care Centers  Prior Authorization of Health Services According to Treatment Plan  Medical Case Management with Goal of “Right Care at Right Place at Right Time”

5. What Has Worked Well in CCS?  Population-Based Health Care Delivery Program for CSHCN  Regionalized System of Pediatric Specialty Care with Providers/Hospitals/Centers Certified under Statewide Standards  Access to Medically Necessary Services Determined by Pediatric Experts and Driven By Child’s Medical Conditions and Needs  Access to Statewide CCS Provider Network and Beyond

6. What Has Worked Well in CCS?  Excellent Medical Outcomes Reported in Pediatric Literature  High Family and Provider Satisfaction, e.g. o State Title V Need Assessment Reported 89% of Families Very Satisfied/Satisfied with Case Management  Fiscally Efficient Program o 92% of CCS Costs Spent on Health-Related Care o 8% on Administration, including Case Management

7. What Needs Improvement?  Does Not Serve “Whole Child”– Responsibility for Care Split Based on Condition  Lack of Inclusion of Families and Youth at All Levels of Planning and Decision-Making  Inconsistent Coordination of CCS Care with PCPs/ Medical Homes and Across Other Systems-- Mental Health, Developmental Services, Special Education  Lack of Intensive Care Coordination for High- Need Children and Families  Inadequate Preparation for Transition from CCS

8. CCS At a Crossroad  Current CCS Carve-Out Sunsets 12/31/16  CCS Is Last of State’s Fee-for-Service Medi-Cal Programs for Special Populations  State CCS Redesign Process Underway  DHCS Proposed “Whole Child Model” to Transfer Many CCS Functions to Medi-Cal Managed Care Plans  Today’s Panel Will: o Explain State Proposal o Provide Family Perspectives o Discuss Principles for Redesign 