Healthy Children and Youth (HCY) Administrative Case Management Program

SHCN

Description:

The HCY Administrative Case Management Program assists families in meeting their child's needs to function at an optimal level.  Assistance is provided for:

• Access to screening services
• Follow-up on referrals to additional medical providers
• Establishment of a medical home
• Service plan development
• Follow through on the treatment plan

Treatment is determined by the primary care provider.  As a part of the Administrative Case Management role, the SHCN staff assists in securing the following services:

• Home health services
• Private duty nursing
• Personal care service
• Advanced personal care services
• HCY Case Management through Local Public Health Agencies

Eligibility:

This program is available to all MO HealthNet (formerly Medicaid) eligible children (birth to age 21) residing in Missouri who are in need of medically necessary services from MO HealthNet providers.

Service Coordination:

• Assisting recipients/families in identifying and accessing medically necessary services
• Establishing a medical home
• Connecting families with appropriate community resources
• Meeting with the recipient and family on an ongoing basis to plan, promote, assist and assure the implementation of services

Service (Case) Planning:

Developing an interdisciplinary plan for coordination of the required medical services.

Service Identification:

Following assessment and service planning, the SHCN service coordinator will identify the type, amount, intensity, and duration of services required to meet the case plan goals. The SHCN Service Coordinator/HCY Facilitator will identify potential service providers from which the family may choose.

Prior Authorization:

The SHCN Service Coordinator authorizes the following services:

• Private duty nursing
• Advanced personal care aide
• Personal care aide
• Skilled nursing visits
• Administrative Case Management

Service Monitoring:

Service coordinators monitor services through regular home visits and assessments, medical records, and care plan review.