Improving Care Coordination, Case Management, and Linkages to

32
re c o m m e n dAt i o n s to im p ro v e cA r e co o r d i nAt i o n A n d li n kAg e s A m o n g services t h At pr o m o t e he A lt h y
ch i l d development
To a great extent, state Medicaid, SCHIP, Title V, Part C, home visiting and other health-related program policies
define the context in which CC/CM take place. Perhaps the most important step any state can take is to review
existing policies of key programs to identify opportunities for improvement. In particular, it is critical to review
case management and care coordination rules and payments under the programs identified here (see box for
sample review qestions).
Top Ten Questions for States Reviewing Policies that Support Cross-system Linkages and
Care Coordination/Case Management
Does your state:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Provide Medicaid and CHIP financing to support the care coordination/case management activities
of children’s medical home providers?
Fund county or community-level care coordination staff (e.g., EPSDT county staff)?
Have Medicaid and Medicaid managed care policies that support care coordination and case management,
including provider guidance, billing codes and graduated/tiered fee schedules?
Have mechanisms to track referrals from EPSDT well-child screening visits? To track referrals to Part
C/Part B? To track results of referrals?
Use Title V funding to support linkages and care coordination/case management for children both
with and without special health care needs?
Identify children with special health care needs using a common and comprehensive definition
regardless of health program?
Define the role of the pediatric primary care provider in Part C and Part B referrals, assessment and
treatment?
Use blended funds to finance cross-system training, including Title V, Child Care and Development
Fund, Part C, TANF and Social Services Block Grant?
Finance or provide technical assistance to family support, parenting education or similar programs
that provide services to families at higher risk?
10.
Evaluate the availability and quality of care coordination services?
Perhaps most important are the policy barriers to financing CC/CM and other approaches that facilitate crosssystem
linkages. For example, financing from Medicaid, CHIP and private health plans for the care coordination
activities of a medical home provider is critical to the ability of providers to fully adopt and adapt to new ways of
practice. Likewise, making Title V funds available to provide CC/CM for a wide array of CSHCN and others who
face barriers to access, can help to fill gaps left by entitlement programs such as Medicaid or Part C. Notably,
only a few states have committed funding to local staff that has responsibility for CC/CM.
Improving Care Coordination, Case Management, and Linkages to Service for Young Children: Opportunities for States
National Academy for State Health Policy