2 ObjectivesIncrease provider awareness of the Children’s Special Services (CSS) ProgramOutline service provision and coverage provided by the CSS ProgramFoster collaboration between public health and private providers

3 What is CSS?CSS is the State of Tennessee’s Title V program for Children and Youth with Special Health Care Needs funded through the Title V Maternal and Child Health Block Grant.

4 How Did We Get Here?1919: Started in Tennessee with the first Crippled Children’s Hospital in Memphis1929: Crippled Children’s Act authorized state to run diagnostic and operative clinics.: CSS ceased to function from due to the depression and a lack of funding1935: Federal Funding appropriated in Social Security Act, funds became available in 1936

5 How Did We Get Here, continued1951: First screening program started for speech and hearing defects1953: Limited services added that included speech and hearing for indigent population (separate program)1961: State Legislature revised and broadened the definition to include chronic medical conditions

6 How Did We Get Here, continued1988: Three pilot projects started in Care Coordination1988: Pediatric Clinic became entry point for Crippled Children’s Services1989: Speech and hearing combined with crippled children services to form current Children’s Special Services Program - Care Coordination state wide

7 Who is Eligible for CSS Services?A "child with a physical disability“Under twenty-one (21) years of ageWho is deemed to have a physical disability by any reason, whether congenital or acquired, as a result of accident, or disease,Requires medical, surgical, or dental treatment and rehabilitation,Who is or may be totally or partially incapacitated for the receipt of a normal education or for self-support.Source: TCA

8 Eligibility, continuedThis definition does not include those children whose sole diagnosis is blindness or deafness; nor does this definition include children who are diagnosed as psychotic.This definition does not prohibit children's special services from accepting for treatment children with acute conditions such as, but not necessarily limited to, fractures, burns and osteomyelitis.Source: TCA

9 Eligibility, continuedParticipants must be a resident of the State of TennesseeIncome (annual adjusted gross) must be at or below 200% of the Federal Poverty LevelSource: TCA

11 Program Services Care CoordinationPromotes the effective and efficient organization and utilization of resources to assure access to necessary comprehensive services for children with special health care needs and their families.Medical ServicesMedical, surgical, and rehabilitative treatment for conditions related to an approved diagnostic condition.

12 Care CoordinationCase management services that provide assistance to families with services such as third party payor billing, filing appeals when third party payors deny payment, and seeking prior authorization from third party payors for health care services.Provide and receive referrals from TEIS, participate in multi-disciplinary team meetings and individual family service plan meetings

13 Care Coordination, continuedWork closely with school systems especially special educationProvide support services – assisting families to access medical and non-medical services for participation in activities of daily livingCollaborate with MCO’s, provider offices and other agencies

14 Care Coordination, continuedKnowledgeable of community resources and makes referralsAssist in developing transition plan for participants age 14 and older for transition to adulthood for both medical and non-medical needs

17 Sample of Current Diagnoses of CSS EnrolleesFor Calendar Year 2013, the CSS program provided services for over 540 different diagnoses.The most common diagnoses were:Hearing LossCardiac Related DiagnosesSeizure DisordersAsthmaCerebral PalsySource: TDH, CSS Program