Children with Medical Complexity

In compliance with Budget Epilogue Section 141 of the State of Delaware’s Legislature, 149th Generally Assembly’s act making appropriations for the expense of the State Government for the fiscal year ending June 30, 2018; specifying certain procedures, conditions and limitations for the expenditure of such funds; and amending certain pertinent statutory requirements [House Substitute No. 1 (HS1) for House Bill No. 275 (HB275)], Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) has published a comprehensive plan for children with Medical Complexity.

• Delaware’s Plan for Managing the Health Care Needs of Children with Medical Complexity

Identifying Children with Medical Complexity –

A working definition

Children with medical complexity are a subset of children and youth with special health care needs because of their extensive health care utilization. For the purpose of this work, a child is considered medically complex if she/he falls into two or more of the following categories:

• Having one or more chronic health condition(s) associated with significant morbidity or mortality;
• High risk or vulnerable populations with functional limitations impacting their ability to perform Activities of Daily Living (ADLs);
• Having high health care needs or utilization patterns, including requiring multiple (3 or more) subspecialties, therapists, and/or surgeries;
• A continuous dependence on technology to overcome functional limitations and maintain a basic quality of life.

The Children with Medical Complexity Steering Committee developed this broad definition of children with medical complexity to aid in the development of a Delaware’s Plan for Managing the Health Care Needs of Children with Medical Complexity, as well as to assist in the work this group is continuing to embark on. This definition is not intended to serve as the basis for denying or authorizing care and/or payment for care for children served through the Delaware Medicaid Program.

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Children with Medical Complexity Advisory Committee (CMCAC)

During development of Delaware’s Plan for Managing the Health Care Needs of Children with Medical Complexity (the Plan), it became evident early in the planning process that there would not be enough time to perform an in-depth analysis of the full continuum of care for children with medical complexity.  The data needed to perform a quantitative analysis is very detailed and complex.  Therefore, the first recommendation made as a result of the Plan development, was for DMMA to continue working with stakeholders to address the needs of this vulnerable population.  As a result, the Children with Medical Complexity Advisory Committee (CMCAC) was developed.  This group meets quarterly to strengthen the system of care, increase collaboration across agencies, encourage community involvement, and ultimately ensure that every child with medical complexity has the opportunity to receive the adequate and appropriate health care services they need and deserve.  These meetings are open to the public; all meeting dates, times, and locations will be posted on the State’s public meeting calendar at https://publicmeetings.delaware.gov.

CMCAC Charter and Guiding Principles

• Children with Medical Complexity Advisory Committee Charter

• Children with Medical Complexity Advisory Committee Guiding Principles

• Children with Medical Complexity Advisory Committee Short Term Priorities

CMCAC Meeting Agendas and Minutes

October 4, 2018

• CMCAC Agenda 10-4-18

• CMCAC Notes 10-4-18

• CMCAC Review of Plan and Progress to Date

January 16, 2019

• CMCAC Agenda 1-16-19

• CMCAC Notes 1-16-19

April 17, 2019

• CMCAC Agenda 4-17-19

• CMCAC Notes 4-17-19

• CMC Advisory Committee and Work Group Updates

• CMC Data Work Group Initial Population Report

• Highmark Health Options Private Duty Nursing Authorization Process

• AmeriHealth Caritas Delaware Home Health Services for Children with Medical Complexity

July 17, 2019

• CMCAC Agenda 7-17-19
• CMCAC Notes 7-17-19
• CMC Work Group Updates
• Children with Medical Complexity Utilization Data
• Private Duty Nursing Gaps in Care Preliminary Findings

October 16, 2019

• CMCAC Agenda 10-16-19
• CMCAC Notes 10-16-19 (Forthcoming) 
• CMC Advisory Committee and Work Group Updates
• CMC Data Analysis Update
• CMC Private Duty Nursing Gaps in Care Analysis Update

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Strengthening Health Care Delivery Systems for Children with Special Health Care Needs and the Role of Quality Measurement

As more states serve Children and Youth with Special Health Care Needs (CYSHCN) in Medicaid managed care, it is important to understand the unique needs of CYSHCN and how program and policy changes impact their access to high quality care. Delaware participated in a National Academy for State Health Policy (NASHP) learning collaborative focused on improving Medicaid managed care for CYSHCN. The link below will lead you to a webinar with presenters from Delaware, Rhode Island, and Massachusetts, who recently participated in this learning collaborative.

https://nashp.org/strengthening-health-care-delivery-systems-for-children-with-special-health-care-needs-and-the-role-of-quality-measurement/

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Improving Care for Children with Complex Medical Needs

DMMA Director Stephen Groff participated in an Alliance for Health Policy public briefing with other panelists to discuss factors that influence the quality, affordability, and accessibility of care for children with complex medical needs.

http://www.allhealthpolicy.org/1052018-publicbriefing/