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Providing High-Quality Services to Children with Special Health Care Needs (CSHCN) Under Managed Care
Providing Selected Services Outside Managed Care
Julian R. Taplin, Ph.D., Director, Division of Child Mental Health Services,
Delaware Department of Services for Children, Youth and Their Families,
Delaware Youth and Family Center, Wilmington, DE.
Ron Caldarone, L.I.C.S.W., Chief, Office of Children with Special Health Care
Needs, Rhode Island Department of Health, Providence, RI.
In contrast to the managed care systems described in previous sessions, several States have
chosen to provide primary care services to CSHCN through mainstream managed care plans,
while providing some of the specialty services they need through outside systems.
Division of Child Mental Health Services (DCMHS) for the State of Delaware, explained how
the State provides medical services through contracted health plans, but provides mental health
through the DCMHS, because they felt that commercial health plans were not providing the
continuous, specialized, coordinated and family-centered mental health care that some children
In order to share risk with providers, the DCMHS has used a bundled rate payment
structure. To assure the quality of care, the State developed a care assurance model, which focuses on the integration of clinical services, youth support systems and treatment resources. In
order to assess performance, DCMHS constructed performance measures and goals to measure
effectiveness, efficiency, appropriateness, accessibility, and capacity.
Ron Calderone, Chief of the Office of Children with Special Health Care Needs for the State of
Rhode Island, discussed how and why his State decided to take some Part H Early Intervention
services out of the standard managed care plans' responsibilities. While the managed care plans
under contract with the State provide the first $3000 of early intervention services, any services
needed above that limit are financed by the State Department of Health and provided by
community-based early intervention providers under contract with the plans. The State developed
this arrangement due to concerns over the cultural gaps between the family-centered, consumer-oriented Part H program, and the cost-driven nature of managed care.
Although the State has
encountered some barriers, such as data and capacity issues, Mr. Calderone emphasized the value
of frequent communication among the State plans, and the providers, to address these and other
Taplin JR, Ray RS, Widdoes NS, Soles CW. The Care Assurance Model in Public Managed Behavioral Health Care for Children. Division of Child Mental Health Services. Department of Services for Children, Youth and
Their Families. State of Delaware.
"Monthly Numbers—Appendix A." Division of Child Mental Health Services. Department of Services for Children, Youth and Their Families. State of Delaware.
State of Rhode Island. Department of Health. Early Intervention Program. RIte
Care Family Survey 1997. Ann M. Bisson.
State of Rhode Island. Department of Health. Early Intervention Program. How
Do RIte Care Members Access and Use the Early Intervention Program?
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