ATTACHMENT A
SOLANO COUNTY CCS
CASE MANAGEMENT LEVEL CRITERIA
The Case Management Assessment Scale is used to identify CCS and full scope
Medi-Cal eligible children with multiple medical and social issues in order to provide
comprehensive case management to this group of CCS clients.
The Case Management Assessment Scale will be used as follows:
1. New Referrals/Current Active CCS cases
a. The Case Management Assessment Scale form will be placed in the
pending chart under the application letter.
b. The Case Management Assessment Scale form will be completed on
all patients.
c. The case Managers will date and note all known risk factors at time of
referral and as new information becomes available from the families,
providers and agencies involved with the CCS client’s care.
d. The Case Management Assessment Scale will be completed at least
when the case is opened and annually.
2. Scoring
a. Each risk factor is assigned a score based on Guidelines for
Completing Case Management Assessment Scale.
3. Levels
a. Level 1: Child with a medical condition that is stable and requires
only an annual evaluation by a CCS paneled specialist. These
children require case management by the CCS nurse case
managers on a limited basis. These cases may be capitated to a
primary care provider and remain open to the CCS program for
case management purposes.
b. Level 2: Child with a medical condition that is less acute in nature
and has a stable medical or therapy course. These children require
a moderate level of case management by the CCS nurse case
managers.
c. Level 3: Child with an acute/chronic medical problem that
requires specialized or intensive medical care, treatment, and
nursing intervention. These children require a high level of case
management by the CCS nurse case managers.
d. Level 4: Child with extremely acute/chronic medical problem that
requires highly specialized or intensive medical care, treatment,
and nursing intervention. These children require intensive case
management by the CCS nurse case managers.
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ATTACHMENT A
GUIDELINES FOR COMPLETING CASE MANAGEMENT
ASSESSMENT SCALE
1. MEDICAL CONDITION
a. Life threatening condition (or potential life threatening conditions).
i. For example: cancer, traumatic injury, extreme prematurity,
complex cardiac conditions, cystic fibrosis, sickle cell anemia…)
b. Transplant
i.
Bone Marrow
ii.
Organ
iii.
Pre-transplant evaluations
iv.
One year post transplant
v.
Rejection
c. Multiple diagnoses
i.
Two or more CCS eligible conditions
d. Diagnosis requiring center-based care
i.
For example Craniofacial
e. Complicating factors
i.
Infection
ii.
Acuity upgrade
iii.
Pregnancy
2. HOSPITALIZATIONS
a. Two or more admits within 30 days
b. Length of stay greater than 14 days
c. Complex discharge planning
i.
Technologically dependent
ii.
Skilled/home nursing needs
iii.
DME/medical supplies
iv.
Home PT/OT/Speech
d. Frequent/inappropriate ER/provider use
3. TECHNOLOGIC INTERVENTIONS
a. Discharge from hospital with DME (within last quarter)
b. Interventions that require supplies and monitoring
i.
GT with pump feedings
ii.
Home monitoring
iii.
Oxygen
iv.
TPN/IV infusions
v.
Central lines
c. Life-sustaining interventions
i.
Ventilator
ii.
Tracheostomy
d. DME requiring maintenance and repair
4. MEDICAL THERAPY UNIT
5. SOCIAL ISSUES
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ATTACHMENT A
a. Language/cultural issues and/or barriers
i.
Non-English speaking
ii.
Inability to read and/or write
iii.
Speech/hearing deficit
iv.
Information not available in native language
b. Transportation barriers
i. Reliance on public transportation
ii. Need for medical transport
iii. Inappropriate use of ambulance services
c. Lack of family resources
i. Homeless/transient
ii. Inadequate finances/food
d. Parental risk factors
i. History of family violence/abuse/neglect
ii. History of mental illness in parent or patient
iii. Disabled parent
iv. Teen parent
v. History substance abuse in parent or patient
vi. Pre/post natal exposure to drugs/alcohol
vii. More than one child with CCS eligible condition
e. Poor compliance with medical plan
f. Frequent/lengthy communications with caregiver
6. COORDINATION OF CARE ISSUES
a. Coordination with other agencies
i. Regional Center
ii. Partnership HealthPlan
iii. IEP
iv. IHO
v. EPSDT
b. Lack of communication with provider
c. Multiple providers
d. Multiple vendors
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