1. Case Management Maintenance Galynn Thomas, RN, MSN Children’s Medical Services

2. Complex Case Management Low case loads Low case loads High complexity cases High complexity cases Regular CCS case management Regular CCS case management

3. CCSNL Ongoing Responsibilities Communication & Oversight Communication & Oversight Monitoring & Maintenance Monitoring & Maintenance F-CAP – Authorizations (SARS) F-CAP – Authorizations (SARS) Assurances Assurances

4. Communication & Oversight Communication Communication Collaboration Collaboration Coordination Coordination

5. Communication Collaboration Coordination Message Message Communiqué Communiqué Announcement Announcement Statement Statement Contact Contact –Letter –Email –Phone call Team work Team work Partnership Partnership Group effort Group effort Association Association Alliance Alliance Relationship Relationship Cooperation Cooperation Harmonization Harmonization Organization Organization Management Management Synchronization Synchronization Bringing Together Bringing Together Dexterity Dexterity

6. Communication Multidisciplinary Multidisciplinary SCC SCC Care Coordinator Care Coordinator Participant/ Family/ Circle of Support Participant/ Family/ Circle of Support Referring Physician Referring Physician Medical Home Medical Home CMS Branch CMS Branch Other County CCS staff Other County CCS staff

7. Communication Liaison Liaison Technical assistance Technical assistance Oversee communication between CC and referring CCS providers to improve PFC practices Oversee communication between CC and referring CCS providers to improve PFC practices Summarization communication in PFC Database Summarization communication in PFC Database

8. Monitoring & Maintenance Monthly - Contact Participant/Family Unit Monthly - Contact Participant/Family Unit Review F-CAP – Review F-CAP – –Services requested appropriate –Meet the needs and goals ID – F-CAP Services are provided Services are provided (accordance with F-CAP) (accordance with F-CAP) –Frequency & Duration

9. Monitoring & Maintenance Participant/ Family Unit Access to CCS Participant/ Family Unit Access to CCS –Resources –Case management Telephone Telephone Email Email Direct contact Direct contact

10. Monitoring & Maintenance Participate PFC Case Management Conference Participate PFC Case Management Conference –Telephone –Direct contact –Participant’s home –Agency –CCS –Other facilities

11. Monitoring & Maintenance Coordinate Medical Services Coordinate Medical Services –PFC Services –State Plan Services – regular Medi-Cal –EPSDT SS –Discharge –Transition –Hospitalizations

12. Monitoring & Maintenance Provide Information Provide Information –Range of Services –Support Groups –Community Services –Provider –Participant, Family & Circle of Support –Inquires

13. Monitoring & Maintenance Utilization Management Utilization Management –Evaluate need - services –Authorizations –Review claims paid Frequency & duration in accordance with F-CAP Frequency & duration in accordance with F-CAP Track claims data Track claims data –Review appropriateness of the provider selected.

14. Monitoring & Maintenance Health & Welfare - Federal Assurance (FA) Health & Welfare - Federal Assurance (FA) –Monitoring Health, Safety & Welfare of Participant Health, Safety & Welfare of Participant On-going risk assessments (FA) by CC On-going risk assessments (FA) by CC F-CAP F-CAP –Evaluate risk of abuse, neglect & exploitation –Review psychosocial risk factors

15. Monitoring & Maintenance Health & Welfare (cont.) Health & Welfare (cont.) –Document all reported or observed critical events/incidents (FA) –Notify State CMS & send copies –Follow-up – within 30 days –PFC Database

16. Review of F-CAP At least every 60 days At least every 60 days Interim – as needed Interim – as needed Services Services Goals Goals Risk Factors Risk Factors Approve, sign, date, and return Approve, sign, date, and return

17. Review of F-CAP Hospitalizations Hospitalizations Emergency Department Admissions Emergency Department Admissions Respite Respite Condition Changes – illness trajectory Condition Changes – illness trajectory –LOC re-determination Care Coordinator hours Care Coordinator hours Therapy hours Therapy hours Bereavement Bereavement

18. Authorizations - SARs Service limits Service limits Appropriate provider Appropriate provider Special Instructions Special Instructions PFC, State Plan, and EPSDT Supplemental Services PFC, State Plan, and EPSDT Supplemental Services PFC Database PFC Database

20. Role of the Care Coordinator Coordinate all care Coordinate all care –PFC services –State Plan services –Community resources Collaboration Collaboration –CCSNL –Participant & family –Providers

21. Role of the Care Coordinator Educate and train participants & famiy Educate and train participants & famiy Development of the F-CAP Development of the F-CAP –Implementation –Revisions –Goals & services Home visits Home visits –Health, welfare and safety

22. Role of the Care Coordinator Accompany to appointments Accompany to appointments Maintain records Maintain records –Correspondence Conduct monthly interdisciplinary team meetings Conduct monthly interdisciplinary team meetings Collaboration with CCS Program Collaboration with CCS Program

23. Assurances Level of Care (LOC) Level of Care (LOC) F-CAP revisions – (Service plan development & Delivery) F-CAP revisions – (Service plan development & Delivery) Service Delivery Service Delivery Freedom of Choice Freedom of Choice Health & Welfare Reporting Health & Welfare Reporting Remediation Remediation

24. Other Transition Plan Transition Plan Dis-enrollment Dis-enrollment

25. Dis-enrollment Change in health status Change in health status Moved Moved Decline Decline Hospitalization > 30 days Hospitalization > 30 days Loss full scope, no share of cost Loss full scope, no share of cost Health & Safety issues Health & Safety issues

26. Dis-enrollment continued Compliance with appointments Compliance with appointments Enrolled in another 1915c HCBS Waiver Enrolled in another 1915c HCBS Waiver Reached 21 st birthday Reached 21 st birthday Transitioned Transitioned Passed away Passed away

27. Questions Questions