1. Partners For Children A Medicaid Waiver- Developed in Collaboration with California Children’s Services (CCS) Children's Hospice & Palliative Care Coalition

2. Table of Contents What is Partners For Children? Waiver services Who might qualify? What counties do they live in? How are children referred? What happens next?

3. What is Partners for Children? Partners for Children is a program for children with serious medical conditions that supports children and families as they navigate the healthcare system. The goal is to improve the quality of life for the child and family. This program provides additional services to Medi-Cal beneficiaries with certain CCS eligible medical conditions. The primary benefit of the program is that the family is connected with a care coordinator in their community.

4. Medicaid Waiver Section 1915(c) Home and Community-Based Services Waiver Supports services provided in home and community based settings An alternative to institutional or long-term care facility placement Cost neutrality Enrollment caps required

5. What is Palliative Care? An active approach to care which enhances quality of life & minimizes suffering through interdisciplinary services An active approach to care which enhances quality of life & minimizes suffering through interdisciplinary services

6. Why Do We Need Pediatric Palliative Care? Families & providers are often reluctant to give up on curative therapies for children in order to focus only on comfort.Families & providers are often reluctant to give up on curative therapies for children in order to focus only on comfort. It allows for both curative and comfort treatments simultaneouslyIt allows for both curative and comfort treatments simultaneously

7. Why Do We Need Pediatric Palliative Care? (cont.) –Supports family decision-making –Includes family members on the care team –Improves continuity of care –Decreases # of medical crises –Decreases hospital admissions & length of stays

8. How Can Children Get Palliative Care Services? Palliative care services available to all CCS-eligible childrenPalliative care services available to all CCS-eligible children –Existing palliative care benefits available statewide are described in CCS Numbered Letter (NL) 04-0207

9. How Can Children Get Palliative Care Services ? (cont.) –Additional services will be available through the pediatric palliative care waiver, Partners for Children A federal Home and Community-Based Services (HCBS) waiverA federal Home and Community-Based Services (HCBS) waiver Pilot in 5 counties beginning in October 2009, expanding to 13 counties by 2011Pilot in 5 counties beginning in October 2009, expanding to 13 counties by 2011

10. What is Partners for Children? A Medi-Cal demonstration project that enables children with certain CCS eligible medical conditions to receive: A Medi-Cal demonstration project that enables children with certain CCS eligible medical conditions to receive: –curative treatments AND –home and community-based palliative care services similar to those provided by hospice agencies

11. Who Might Qualify? Applicant must meet all of the following: 1.Be under 21 yrs old 2.Have “full scope,” “no share of cost” Medi-Cal 3.Reside in a participating county 4.Have a waiver-eligible medical condition 5.Choose to participate (Applicant or parent/legal guardian)

12. Who Might Qualify? (cont’d) Because of HCBS waiver rules, the child must be on only one HCBS waiverBecause of HCBS waiver rules, the child must be on only one HCBS waiver If the child is enrolled in a different waiver, she will need to disenroll from that oneIf the child is enrolled in a different waiver, she will need to disenroll from that one Children enrolled in the waiver will not be enrolled for a hospice benefitChildren enrolled in the waiver will not be enrolled for a hospice benefit Although the child isn’t enrolled for hospice benefits, hospices and home health agencies (HHAs) can provide palliative care waiver services

13. Partners for Children Waiver Child must live in a participating county Year 1 (300) Year 2 (801) Year 3 (1802) Year 1 (300) Year 2 (801) Year 3 (1802) AlamedaMonterey San Diego Santa Clara Santa Cruz AlamedaMonterey San Diego Santa Clara Santa Cruz HumboldtMarinOrangeSacramento San Francisco SonomaAlamedaMonterey San Diego Santa Clara Santa Cruz HumboldtMarinOrangeSacramento San Francisco SonomaFresno Los Angeles

14. What Services Might Applicants Receive? Community-based Care Coordination Assessment of participant’s & family’s goals of careAssessment of participant’s & family’s goals of care Creation of a Family-Centered Action Plan (F-CAP) with input from family and interdisciplinary care teamCreation of a Family-Centered Action Plan (F-CAP) with input from family and interdisciplinary care team Communication of plan across all settings including family, CCS & entire health care teamCommunication of plan across all settings including family, CCS & entire health care team

15. What Services Might the Participant Receive? (cont.) Respite careRespite care –In-home and out-of-home Expressive therapiesExpressive therapies –art, music, play, massage Family trainingFamily training Bereavement supportBereavement support

16. To make a referral: Anyone can refer a patientAnyone can refer a patient To make a referral:To make a referral: –Confirm that the child has a waiver eligible condition –Confirm that the child resides in a pilot county –Contact the CCS Nurse Liaison in the child’s county to confirm that they are full-scope Medi-Cal –Download a referral form from the CCS website [a

17. What Happens Next ? The CCS Nurse Liaison (CCSNL) will: Determine if the child is eligible for waiver servicesDetermine if the child is eligible for waiver services Discuss with eligible child’s family, and enroll if appropriateDiscuss with eligible child’s family, and enroll if appropriate Review available care coordination agencies with familyReview available care coordination agencies with family Connect the child with a Care Coordinator at the selected agencyConnect the child with a Care Coordinator at the selected agency

18. End of short version Partners for Children

19. Partners for Children Services Care CoordinationCare Coordination Respite careRespite care Bereavement CounselingBereavement Counseling Expressive therapiesExpressive therapies Family trainingFamily training

20. Keystone to Success STATE PLAN/EPSDT Services CCS NL 04-0207 “ Full Scope Medi-Cal” “CCS” Waiver Services Care Coordination Respite Care Bereavement Counseling Expressive therapies Family Training Community Services Family + Care Coordinator + CCS Nurse Liaison Coordination of Services

21. Keystone to Success Care Coordination Emphasizes –Holistic care –Communication and information sharing –Shared decision making –Partnership between family, CCS program and providers

22. Care Coordinator Employee of Home Health Agency or Hospice AgencyEmployee of Home Health Agency or Hospice Agency Registered Nurse or Medical Social WorkerRegistered Nurse or Medical Social Worker Anticipated patient staffing ratio 1:20-30Anticipated patient staffing ratio 1:20-30

23. Care Coordinator Core functions –Ensures a seamless system of care (integrate family needs and medical goals) –Facilitates, develops and implements the Family- Centered Action Plan (F-CAP)

24. Care Coordinator Core functions, cont’d –Updates through ongoing communication, goals and plan of care to all healthcare providers –Maintains communication between CCSNL, the medical care providers, the patient and family and the interdisciplinary team –May accompany patient and family to appointments

25. CCS Nurse Liaison (CCSNL) Employee of CountyEmployee of County –Registered Nurse case manager –Patient staffing ratio 1:50

26. CCS Nurse Liaison (CCSNL) Functions –CCS program liaison with the Care Coordinator –Administrative Case Management for CCS clients enrolled in the waiver Knowledge of the CCS program, other State and community resources and limitationsKnowledge of the CCS program, other State and community resources and limitations

27. CCS Nurse Liaison (CCSNL) Functions, cont’d –Ensures that federal waiver requirements are met Review waiver applications and make level of care determinationsReview waiver applications and make level of care determinations Timely enrollment of qualified applicantsTimely enrollment of qualified applicants Meet the client/ family unit’s goals and objectivesMeet the client/ family unit’s goals and objectives Shared decision makingShared decision making Quality assurance and quality improvementQuality assurance and quality improvement

28. CCS Nurse Liaison (CCSNL) Functions - Ensures that federal waiver requirements are met, cont’d –Inform and educate applicants on waiver eligibility, services, choice of providers and services, benefits –Approve and authorize service requests based on F-CAP –Monitor the process to ensure health, safety, choice

29. Care Coordinator and CCSNL require knowledge and expertise in: –Family-Centered Care –Palliative care –Effective communication –Shared decision making –Cultural competence –Quality assurance and quality improvement –Waiver, state and community resources

30. Pediatric Palliative Care Numbered Letter Palliative care services available Home Health Agency (HHA) Services Nursing visits In-home shift nursing services <90 days In-home shift nursing services >90 days go to In Home Operations Physical Therapy / Occupational Therapy visits Social Worker visits Speech Therapy visits Respiratory Therapy visits Registered Dietitian visits Psychology services – related to CCS-eligible condition Provider Types DME Pain Control/Symptom Management Maintenance and Transportation (N.L. 01-0104)

31. California’s Responsibilities to the Federal Government Quality Assurance – Monitoring of: Timeliness of F-CAPTimeliness of F-CAP Medical necessity of the F-CAPMedical necessity of the F-CAP Patient and family satisfactionPatient and family satisfaction Freedom of choice for familiesFreedom of choice for families Level of care determinationLevel of care determination

32. California’s Responsibilities to the Federal Government (cont’d) Quality ImprovementQuality Improvement Incident and complaint reporting, follow-upIncident and complaint reporting, follow-up Training and EducationTraining and Education Compilation and analysis of dataCompilation and analysis of data Will this waiver participation: enhance the quality of life for children/families? enhance family satisfaction with ongoing care? Is this waiver cost neutral?

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