TN Tennessee Children’s Special Focus on Progress Gregory Yopp, Director Children’s Special Services Maternal and Child Health Services (CSS) C425 5th Ave N, 5th Fl Cordell Hull Bldg Nashville, TN 37247-4701 Phone: (615) 741-0361 Fax: (615) 741-1063 Email: Gregory.firstname.lastname@example.org Snapshot of Tennessee’s Services Tennessee Children’s Medical Services (CSS) provides services to eligible children and youth with special health care needs (CYSHCN). CSS has three components: medical services, care coordination, and the Parents Encouraging Parents program. It offers a variety of supports for children and families, such as: • Medical Services and Reimbursement for medical care (surgery, physicians/clinic visits), medical supplies, pharmaceuticals and therapies for children to age 21 years who meet medical and ﬁnancial criteria. • Care Coordination coordinates primary and specialty care through the designated primary care physician and corresponding managed care organization network. CCS care coordinators assist the family in accessing a variety of services, such as educational, medical, social, transportation, support, and advocacy. • Parents Encouraging Parents is a program that links parents/families of CYSHCN with other parents/families whose child may have the same or similar disorder. CSS employs a team of a parent of special needs child and a nurse or social worker to provide the support, linking and training for parents to assist them in the role of a support parent for other families. Progress in Building a System of Care In Tennessee, 14.0% or 198,647* children ages 0-17 have special health needs. All states are striving to achieve a community-based system of services for all families of CYSHCN by the year 2010. The table below reﬂects Tennessee’s progress in achieving a system of care for CYSHCN and compares it to the nation at large. Snapshot of Tennessee’s Children & Youth with Special Health Needs* Access to Care Child Health Impact on Family Family- Insurance Centered Care 16.3% had one or more unmet 20.9% experienced 24.3% of families experienced needs for speciﬁc services (18% 38.3% did not have health conditions ﬁnancial problems due to their 31% of families US). adequate insurance that frequently child’s health needs (21% US). did not consistently coverage (34% US). affected their daily receive care that 18.7% had problems getting a 17.4% of families spent more than referral for specialty care (22% US). 8.2% did not have activities (23% US). was family-centered 10 hours a week providing or insurance at some coordinating health care for their (33% US). 7.8% did not have a usual source point in the past year child (14% US). of medical care or relied on (12% US). emergency rooms (9% US). *Child and Adolescent Health Measurement Initiative (2005). National Survey of Children with Special Health Care Needs 2001, Data Resource Center on Child and Adolescent Health Web site. Retrieved 8/19/05 from www.cshcndata.org. Tennessee Children’s Medical Services (CSS) 2 State Accomplishments Useful Tennessee Web Sites & Links • CSS Homepage: http://www2.state. tn.us/health/MCH/css.htm All 50 states and territories are in the process of achieving six national outcomes for CYSHCN, as part of the President’s New Freedom Initiative by 2010. • Early Intervention: http://www.state. tn.us/education/speced/TEIS/ Tennessee’s efforts to achieve each outcome are listed below. • Family Voices of Tennessee: http:// Outcome #1 Families as Decision-Makers and Satisﬁed: CSS employs www.tndisability.org/familyvoices parents of CYSHCN who serve as parent advocates, secretaries, nurses, as well • Parent’s STEP Program: http://www. as other staff members from all across the state. CSS has a board member who tnstep.org is a parent of a child with a disability and CSS plans on recruiting additional • State Data Proﬁle: http://cshcndata. parents as board members. CSS partners with Tennessee Voices for Children, org/DesktopDefault.aspx?topic=statepr Family Voices, and the Department of Education to ensure that all families of evalence&geo=Tennessee CYSHCN participate in decision-making in all levels of the program. Outcome #2 Medical Home: CSS continually updates and educates local physicians, school systems, families, and other providers about the need for a medical home in the local community. Medical reports and family service plans A Community are routinely shared with the appropriate persons and follow-up is coordinated by the CSS care coordinator for both medical and non-medical needs. Snapshot Outcome #3 Adequate Insurance: Approximately 92% of the 6,244 children currently enrolled with CSS receive TennCare, which covers Medicaid-eligible One Tennessee family children and families as well as TennCare Standard, which is designed for those whose child needed heart who cannot obtain or do not have access to health insurance. Approximately surgery had lost their insurance. The 4% of the 6,244 children presently enrolled with CSS have private insurance, family applied to CSS and was accepted. while another 4% have CSS only as a form of health insurance. All needed services were coordinated Outcome #4 Screening: CSS helps to ensure that all children receive early with physicians, hospital, therapies, diagnostic screenings for approximately 51 different diseases, syndromes, and and follow-up, all paid for by CSS. In genetic defects, and hearing loss, as well as any other developmental delays. the meantime , the family’s CSS care Through care coordination referrals are received from the state lab, physician coordinator helped the father ﬁnd a job ofﬁces, hospitals, health departments, parents, and other professionals. Once and a new place to live due to being referrals are received the family is contacted and an application is completed. evicted. The family was overcome with CSS will then pay for and assist the family in getting the necessary follow-up tears of gratitude for all that CSS helped testing for their child. If a speciﬁc program eligible diagnosis is found and the them with during their time of crisis. family meets the ﬁnancial eligibility criteria, CSS will continue to coordinate, follow-up, educate, assist in provider payments (after other insurance payments Another family had a child with cleft/ have been exhausted), for all diagnostic needs, as well as non-medical needs. lip and palate whose insurance refused Outcome #5 Integrated Community-Based Services: CSS coordinates to pay for the necessary surgery calling those available in the community by participating in M-team meetings (a multi- it cosmetic in nature. CSS stepped up disciplinary focus on the child’s needs), family service plan meetings, physician to the plate and paid for the necessary and hospital visits, as well as any other needed services for CYSHCN. A resource medical surgery while at the same time guide of services available in the community is kept by each care coordinator, ﬁling an appeal with the insurance and is updated regularly. company. After several months of back Outcome #6 Transition to Adulthood: CSS recently obtained a grant from and forth communications, the insurance Utah State University directed toward transition to adulthood. CSS is conducting company agreed to reimburse CSS for a series of statewide meetings that will include community leaders, professionals, the surgery and follow-up care. medical personnel, clergy, business owners, transportation person/s, families, and children and youth with special health care needs. All phases of transition A third family had a teenage son who to adult life will be addressed, including; medical, employment, housing, had been in a car accident and had no transportation, recreational, shopping, religion, and all other transitional needs. insurance. The father was a sub contractor A resource book will be developed which will recognize all local transition who was barely over income to qualify resources available that will assist in making transition to adult life a much for state insurance. After determining smoother process. program eligibility status, CSS agreed to pay for the surgery and follow-up. This The work reported in this document was supported through a cooperative agreement (#U42MC00241) from the Health Resources child is now walking on his own and no and Services Administration, Maternal & Child Health Bureau to the longer needs a wheelchair or crutches. email@example.com Early Intervention Research Institute at Utah State University.
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