Medically Complex Children

1
Medically Complex Childrens Waiver
Maria Platanis, RN, BSN Waiver
Administrator Department of Health Human
Services Medically Complex Childrens
Waiver platanis_at_scdhhs.gov 803-898-2644
2
Medically Complex Childrens (MCC) Waiver

• There have been 3 Medically Fragile Childrens
  Programs (MFCPs) across the State Charleston,
  Columbia, and Easley.
• In 2006, CMS advised DHHS that the operating
  authority for these programs must be changed to a
  Federally acceptable program.
• The MUSC program ended current operations on
  3/31/09. The Columbia and Easley Programs will
  transition to the new MCC waiver by 6/30/09.

3
Medically Complex Childrens (MCC) Waiver,
continued

• CMS approved the Medically Complex Childrens
  (MCC) Waiver effective 1/1/09.
• MCC waiver will be available statewide to serve
  children from birth to age 18 who meet either
  nursing facility or ICF-MR level of care, and
  medical complexity criteria.
• The model of care coordination used in the MCC
  waiver is Medically driven.
• The Care Coordinator is the liaison between
  providers and caregivers coordinating the
  medical needs of the children.

4
Medically Complex Childrens (MCC) Waiver,
continued

• The MCC waiver will utilize a Medical Homes
  Network (MHN), to provide the care coordination
  linkage between the families and the MHN primary
  care providers (PCP), as well as other service
  providers.
• As the 3 MFCPs are transitioned in early summer,
  children who are receiving Medicaid Private Duty
  Nursing, along with children in the Wonder Center
  at GHS, will be evaluated.
• We currently have funding for 150 slots in the
  MCC waiver and are taking referrals. We have
  begun to place children on the Waiting List.

5
Medical Complexity Criteria

• Children with a serious illness or condition
  expected to last at least 12 months. This
  illness or condition generally makes the child
  dependent upon comprehensive, medical, nursing
  and health supervision or intervention as
  established by state medical criteria.

6
Medical Complexity Eligibility Criteria

• Medications
• Number
• Frequency
• Route
• Hospitalizations
• Frequency
• Nursing care
• Respiratory Monitoring
• Neurological Monitoring
• Functional Monitoring
• Skin care needs
• Other Nursing needs

• Specialists
• Number of specialists
• Number of visits
• Therapies
• Number of therapies
• Frequency of therapies per week

7
MCC Waiver Services

• Medical Homes Network
• Physician Directed Coordinated Medical Care
  (enhanced reimbursement)

• MCC Waiver Services
• Care Coordination
• Incontinence Supplies
• Medical Day Care
• Respite

8
Medically Complex Childrens Waiver

• State Plan Services
• Durable Medical Equipment
• Prescriptions
• Therapies
• Transportation
• Specialists
• Nutrition
• Other

• MCC Waiver Services
• Care Coordination
• Respite
• Medical Day Care
• Incontinence Supplies
• Age appropriate diapers
• Pads
• Wipes