Tennessee Children's Special Services (CSS) by ojp13483


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.yopp@state.tn.us

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)
State Accomplishments

                                                                                                               Useful Tennessee Web Sites & Links
                                                                                                                                                    • CSS Homepage: http://www2.state.
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.
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.
champions@championsforprogress.org           Early Intervention Research Institute at Utah State University.

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