Improving%20Nutritional%20Care%20for%20Children%20with%20Special%20Health%20Care%20Needs:%20The%20Work%20of%20the%20CSHCN%20Program

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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
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MCH Core Public Health Services
Direct Medical Services
Enabling Services
Population Based Services
Infrastructure Building Services
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Children with Special Health Care Needs
ProgramFebruary 2005
Program Manager Maria Nardella [phone]
Secretary Administrative Christy Davis (360)
236-3571
Secretary Administrative -- WISE Jane
Berube [phone]
Public Health Nurse Consultant Linda
Barnhart [phone]
WISE Grant Coordinator Karla Dudley [phone]
Nutrition Consultant Yuchi Yang [phone]
Assessment Consultant Stacey De Fries (360)
236-3559
Family Consultant Leslie Carroll [phone]
Program Integration Consultant Civillia Winslow
Hill [phone]
Budget Contracts Coordinator Patsy
Shumway [phone]
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Children with Special Health Care Needs (CSHCN)
Program

• Ensuring all children and youth with special
  health care needs achieve the healthiest life
  possible

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Prevalence of Children with Special Health Care
Needs Persons
95CI 0.52
95CI 0.11
Source National (n372,174) WA (n6629)
Screener files.
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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

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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 200FPL

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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 1999104(4) 978-981.

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Time Spent Providing, Arranging, or Coordinating
Care for CSHCN, per week
National
Washington
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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
  1-800-322-2588 to help families access needed
  services for their child, such as medical care
  and other interventions.

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Care Coordination for WA CSHCN
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with special health care needs
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Multidisciplinary Team

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

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Medicaid

• Medical Nutrition Therapy
• Enteral Nutrition Program 
•   MAA home page http//maa.dshs.wa.gov

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Medicaid and CSHCN A Comparison
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MAA Medical Nutrition Therapy

• Certified Dietitian
• PCP Referral/EPSDT
• Medical Provider Number
• Specific Fee Schedule

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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

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Implications for Dietitians

• Certified Dietitians
• MAA Provider Numbers

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Certified Dietitian

• Go to https//fortress.wa.gov/doh/hpqa1/hps3/Diet
  _Nutritionist/forms.htm for an application form.

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Medical Provider Number

• Go to http//fortress.wa.gov/dshs/maa/provrel/
  and click on sign up to be a WA State Medical
  Assistance Provider.
• Call MAA Provider Enrollment Unit at
  1-866-545-0544 for questions.

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WIC

• Supplemental Nutrition Program for Women, Infants
  and Children

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WIC Services

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

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Formula Coverage

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

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MAA Enteral Nutrition Program

• Current rules
• Clients receive formula from pharmacies with
  Drs prescription without prior authorization.

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New MAA Enteral Nutrition Program

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

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CSHCN Special Formula Fund

• Medically necessary
• Not covered by any other program or insurance

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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

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CSHCN Training Opportunities

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

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Nutrition Focus for Children with Special Health
Care Needs

• A newsletter for health professionals
• University of Washington based
• http//depts.washington.edu/chdd/ucedd/CO/co_Nutri
  Focus.html
• 6 issues per year

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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 http//www.doh.wa.gov/Publicat/p
  ublications.htm

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Guidelines for the Development and Training of
Community-Based Feeding Teams in Washington
State.

• Determine the Need
• Identify Key Agencies and Professionals.
• (Revised edition will be on-line soon. Please
  visit CSHCN home web page)

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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
  http//www.doh.wa.gov/Publicat/publications.htm

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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
• www.eatright.org/Public/ProductCatalog

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Materials

• Children with Special Health Care Needs Program
  Brochures.
• The National Survey of Children with Special
  Health Care Needs. Chart book 2001
• www.cdc.gov/nchs/slaits.htm

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CSHCN Program

• Home Page http//www.doh.wa.gov/cfh/mch/CSHCNhome
  2.htm

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