Page 37

Model Application Template for the State Children’s Health Insurance Program

Effective Date:

Approval Date: 37 the outpatient mental health visits) require pre-certification from the Mental Health Case Manager (patient responsible for keeping track of the number of visits); psychological testing over and above that performed during the 26 visits will also require certification from the Mental Health Case Manager.

6.2.20.

Case management services (Section 2110(a)(20))

6.2.21.

Care coordination services (Section 2110(a)(21))

6.2.22.

Physical therapy, occupational therapy, and services for individuals with speech, hearing, and language disorders (Section 2110(a)(22))

6.2.23.

Hospice care (Section 2110(a)(23))

6.2.24.

Any other medical, diagnostic, screening, preventive, restorative, remedial, therapeutic, or rehabilitative services. (See instructions) (Section 2110(a)(24))

The Department will coordinate efforts with the State Health Plan to assure that "children with ‘special needs’" receive the same level of services that are available under Title XIX in North Carolina. Service requests for children with special needs are reviewed by one or more of the following: Division of Public Health specialty clinicians, contracted vendor for mental/behavioral health (including behavioral health group homes) and/or nurses/physicians at claims processing contractor. Funds and service utilization for CSHCN, above the core services are regularly tracked and analyzed to improve proactive program and budget planning. The State Title V program for Children with Special Health Care Needs has lead responsibility for coordinating services and benefits for children who are medically high cost and for children meeting the following definition:

“Children with Special Needs" are those who have been diagnosed as having one or more of the following conditions which in the opinion of the diagnosing physician (1) is likely to continue indefinitely, (2) interferes with daily routine, and (3) requires extensive medical intervention and extensive family management: