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Missouri Application for the State Children’s Health Insurance Program Effective Date: 05/01/2009 Approval Date:

Prior Approval Date: 09/28/2007 - 13A - Treatment is determined by the primary care provider. As a part of the Administrative Case Management role, the Special Healthcare Needs (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 eligible children 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