DCS Comprehensive Health Plan

CHP Resource Coordination Policy

Statement/Purpose

This policy outlines Arizona Department of Child Safety Comprehensive Health Plan (DCS CHP) procedures for providing initial care management and coordination to caregivers of children and youth in out-of-home care statewide upon enrollment with DCS CHP to ensure the provision of appropriate and timely coordination of care.

Definitions

Care Coordination: Actions taken to assist a member receives needed health care to prevent or reduce an adverse health outcome such as assistance in obtaining care from practitioners and providers in various organizations or across a period of time. Care Management associates establish specific goals that can be reached with minimal member outreach. Typical methods of communication are by mail, telephone, and email.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT): A comprehensive child health program of prevention, treatment, correction, and improvement of physical and behavioral health conditions for members under the age of 21, to ensure the availability and accessibility of health care resources as well as to assist Medicaid recipients in effectively utilizing these resources. EPSDT services provide comprehensive health care through primary prevention, early intervention, diagnosis, medically necessary treatment, and follow-up care of physical and behavioral health conditions for AHCCCS members less than 21 years of age. EPSDT services include screening services, vision services, dental services, hearing services and all other medically necessary mandatory and optional services as specified in Federal Law 42 U.S.C. 1396d(a) to correct or ameliorate defects and physical and behavioral health illnesses and conditions identified in an EPSDT screening whether or not the services are covered under the AHCCCS State Plan. Limitations and exclusions, other than the requirement for medical necessity and cost effectiveness, do not apply to EPSDT services.

Policy

Care Coordination Activities

DCS CHP provides member support through caregiver outreach and coordination to enhance a ‘whole child’ and family approach to healthcare service delivery for children in out of home care.

Procedure

Care Coordination Activities

DCS CHP Resource Coordination function area contributes to care coordination efforts through telephonic outreach to caregivers upon health plan enrollment to identify and escalate the need for immediate care coordination and/or interventions from DCS CHP Health Coordination and System of Care function areas to ensure that children and youth in out-of-home care are receiving needed services in a timely manner.

Outreach and Education

DCS CHP’s contracted MCO sends newly enrolled members a comprehensive compilation of written information within 12 days of enrollment to assist caregivers with accessing appropriate, cost-effective health care. Materials and methods of dissemination are based upon regulatory requirements and member needs. [See DCS CHP Policy OP-MS-01, Member Information Requirements].

The Resource Coordination function area delivers customized health plan information and resources directly to caregivers through telephonic and email contact.

Resource Liaisons contact caregivers to assist with:

• Instructing on how to access member handbook and how to use the Member ID Card for appointments and at pharmacies;

• Identifying a primary care physician and dental provider as well as pharmacies, as close to the member’s home as possible;

• Explaining member benefits including Early and Periodic Screening, Diagnostic and Treatment (EPSDT) requirements and well-child, dental, vision including replacement glasses and behavioral health services; how to acquire non-emergency medical transportation for healthcare appointments;

• Scheduling medical, dental and behavioral health appointments within the first 30 days of entry into out of home care;

• Identifying gaps in healthcare services including immunizations;

• Disseminating contact information for health plan staff and other appropriate professionals who can support the caregiver and member if advocacy challenges occur;

• Referring to community-based resources, including peer to peer/family support agencies;

• Strategically listening and based on discussion with caregivers reporting unmet/unresolved needs, liaises with DCS CHP Health Services and System of Care teams, Care Managers for fast tracking and Custodial Agency Representatives (DCS Specialists); and

• Augmenting care coordination efforts by establishing a collaborative process with the contracted MCO to escalate care coordination for children and youth with a chronic or acute condition.

Collaboration and Coordination

The Resource Coordination function escalates issues when needed to DCS CHP System of Care and Health Services function areas for additional support to caregivers. This may include:

• Aiding in understanding the clinical needs of the child;

• Advocating for the review of quality of care concerns;

• Troubleshooting barriers to care; and

• Emphasizing an integrated approach to health care.

DCS CHP Resource Coordination function area collaborates with its contracted MCO’s Integrated Care Management (ICM) program to augment care coordination efforts for children and youth whose caregivers report they may have an acute or chronic health condition. The acute or chronic health conditions is conveyed via a digital contact using the messaging function in FamilyCare Central to the assigned Care Manager, if one has been assigned. If a Care Manager is not yet visible in FamilyCare Central, a weekly report is initiated via email to the Mercy Care urgent mailbox, dcschpurgentcarecoordinationissues@aetna.com. A process job aid clarifies roles and responsibilities of health plan staff and communication strategies.

DCS CHP Resource Coordination function area collaborates with members’ custodial agency representatives who play a vital role in ensuring that the members receive optimum health care. Custodial agency representatives help to achieve member compliance with EPSDT, dental, behavioral health and other required visits.