Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 5. Department of Health
Chapter 191. State Plan for the Children with Special Health Care Needs Program

12VAC5-191-180. Scope and content of the Care Connection for Children network.

A. Mission. The Care Connection for Children network promotes the optimal health and development of children and youth living in the Commonwealth with special health care needs by working in partnership with families, service providers, and communities.

B. Scope of services. The Care Connection for Children network provides the following enabling services:

1. Assistance in accessing specialty medical services and a medical home.

2. Care coordination.

3. Medical insurance benefits evaluation and coordination that may include services that promote the access to and the understanding of the use of private health insurance and state and federal medical assistance programs.

4. Information and referral.

5. Collaboration with the Virginia Department of Education and its Education in Hospitals Program to provide consultation for families, educators and school administrators.

6. Transition from child to adult-oriented health care system.

7. Family-to-family support.

8. Training and technical assistance for community providers.

9. Promotion of a family-centered, community-based, and culturally-competent service delivery system through advisory councils.

Based on community need, the Care Connection for Children network may provide direct health care services.

C. Criteria to receive services from Care Connection for Children. Children and youth are eligible to receive services from Care Connection for Children if they are:

1. Residents of the Commonwealth.

2. Between the ages of birth and their twenty-first birthday.

3. Diagnosed with a disorder that:

a. Has a physical basis;

b. Has lasted, or is expected to last, at least 12 months; and

c. Produces one of more of the following sequelae:

(1) Need for health care and ancillary services over and above the usual for the child's age, or for special ongoing treatments, interventions, or accommodation at home or school;

(2) Limitation in function, activities, or social role in comparison with healthy age peers in the general areas of physical, cognitive, emotional, and social growth and development;

(3) Dependency on one of the following to compensate for, or minimize limitation of, function, activities, or social role: medications, special diet, medical technology, assistive devices or personal assistance.

No financial eligibility criteria are required for clients to receive the enabling services. However, clients who meet the above criteria must also meet the financial requirements for eligibility for access to a pool of funds for payment of their direct health care services.

D. Goals. The Title V national performance measures, as required by the federal Government Performance and Results Act (GPRA-Pub. L. 103-62), are used to establish the program goals. The following goals shall change as needed to be consistent with the Title V national performance measures:

1. Families of children with special health care needs will partner in decision making at all levels and will be satisfied with the services they receive.

2. All children with special health care needs will receive coordinated, ongoing, comprehensive care within a medical home.

3. All families of children with special health care needs will have adequate private or public insurance or both to pay for the services they need.

4. All children will be screened early and continuously for special health care needs.

5. Community-based service systems will be organized so families can use them easily.

6. All youth with special health care needs will receive the services necessary to make transitions to all aspects of adult life, including adult health care, work, and independence.

Statutory Authority

§§ 32.1-12 and 32.1-77 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 23, Issue 21, eff. July 25, 2007.

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