CSHCN definition
Examples of CSHCN in a sentence
The HMO is responsible for providing Service Management to develop a Service Plan and ensure MSHCN, including CSHCN, have access to treatment by a multidisciplinary team when the Member’s PCP determines the treatment is Medically Necessary, or to avoid separate and fragmented evaluations and service plans.
For services to CSHCN, the HMO must have Network PCPs and specialty care Providers that have demonstrated experience with CSHCN in pediatric specialty centers such as children’s hospitals, teaching hospitals, and tertiary care centers.
The principal objective of the state legislation was to provide primary and preventative health care to low-income, uninsured children of Texas, including Children with Special Health Care Needs (CSHCN) who were not served by or eligible for other state-assisted health insurance programs.
The purpose of these measures is to provide appropriate and targeted case management services to CSHCN.
Failure to do so jeopardizes the MCP’s ability to demonstrate compliance with CSHCN requirements.
Identification of CSHCN All MCPs must implement mechanisms to identify CSHCN.
However, if the MCO does not contract with CSHCN providers, the MCO must provide the same level and types of services as those currently available through the CSHCN program.
Children with Special Health Care Needs (CSHCN) are defined as “those who have or are at increased risk for a chronic physical, behavioral, developmental, or emotional conditions and who also require health or related services of a type or amount beyond that required by children generally”.
For all payers that prohibit percentage-based billing arrangements, such as Department of State Health Services’ (DSHS’) Children with Special Health Care Needs (CSHCN) Services Program, Client shall pay Emergicon a flat fee of $38 per trip, to be invoiced at the time of billing.
The MCO is encouraged, but not required, to contract with CSHCN providers.