FLMH

"2.14  Enrollment... For children in the care and custody of the state, the appropriate HRS district representative will consult with the plan to identify the appropriate direct service mental health care provider who will be responsible for monitoring all aspects of the recipient's care."  Florida Mental Health RFP, page 37.

KY

"7.11.2   Pre-enrollment Education and Outreach...
The following groups in particular should be prioritized for outreach and education: ...
  •  Parents and foster parents of children with disabilities...
The Partnership shall submit a plan for pre-enrollment education and outreach."  Kentucky RFA, page 80.

"Special Enrollment Procedures
DCBS staff will apply for Medicaid eligibility on behalf of foster children and guardianship clients through an expedited application process agreed on by the Department for Medicaid Services and the Department for Social Insurance.

DCBS staff may select a new primary care provider for foster children or guardianship clients whenever a change in the member's placement occurs.

Foster parents are contracted agents of the Department for Community based Services and may provide information on placement changes and primary care provider selection.

Partnerships shall develop and implement an expedited grievance process for grievances relating to denial of service for a DCBS client by the Partnership that may result in expenditure of public funds to provide the service."  Kentucky RFA, Attachment XV, page 124.

MD

"10.09.63.02...
E.  Children...
(2)  The following children shall be automatically enrolled in the MCO of the adoptive parent unless the parent unless the parent notifies the Department otherwise:
 (a)  A child who has been legally adopted;
 (b)  A child who is the subject of a petition for adoption who has been placed in the enrollee's home with the expectation that the placement will be permanent, and for whom a temporary custody order has been issued by a court of competent jurisdiction pending finalization of the child's adoption by the enrollee; or
 (c)  A child who is the subject of a petition by a licensed adoption agency for the termination of parental rights, and who has been placed in the enrollee's home by the licensed adoption agency with the expectation that the placement will be permanent and that the child will be legally adopted by the enrollee."  Maryland COMAR 10.09.63.02.

MO

"2.14.8  Children in state custody or foster care placement will be allowed automatic and unlimited changes in health plan and provider choice as often as circumstances necessitate.  Foster parents will normally have the decision making responsibility for which health plan will serve the foster children resident with them; however; there will be situations where the Social Service worker or the courts will select the health plan for a child in state custody or foster care placement."  Missouri RFP, page 75.

NE

"9.5.2 Departmental Wards/Foster Care Clients: The EBS shall coordinate enrollment activities with the Department’s Protection and Safety (PS) worker responsible for the case management of the ward/foster child. The PS worker shall work with the client and the client’s family or legal representative, as appropriate, to complete the health assessment and explore the most appropriate choice of PCP/plan.

The PS Worker shall notify the EBS of the client’s choice at the time the health assessment is completed.

The EBS shall work with the PS Worker to outreach to the Department Ward/Foster Care client who are mandatory for NHC with letters and telephone contacts (as appropriate, depending upon the needs of the client), according to standard enrollment activities.  A Department Ward/Foster care client will be excluded from auto-assignment. After completing the full enrollment process, the EBS shall make one last outreach attempt by sending the client a 'pre-nomination' letter identifying a potential PCP/plan based on information known about the client on the eligibility and claims history file. The client shall have an additional fifteen (15) calendar days from the date of the pre-nomination letter to make a change in the proposed PCP/plan. If the client does not make a change, the EBS shall activate the enrollment.

In some cases, the EBS may delay the activation of the client’s enrollment for an additional thirty (30) day period to allow the EBS to coordinate necessary services with the prospective PCP/plan.

If the EBS determines that the client does not have any medical issues that need immediate attention by the PCP/plan, the enrollment may be 'activated' immediately following completion of the enrollment activities described above."  Nebraska Contract, page 35.

"9.8 Enrollment Rules
9.8.1 Completion of the Enrollment Process: The client or the client’s legal representative shall complete the enrollment process.  For purposes of completing the enrollment process, the following rules apply: ...
 (c) Child Welfare staff may act on a Department ward’s behalf. The child’s foster parents must be involved in the selection of the PCP/plan. Child Welfare staff shall consider whether it is appropriate for the biological parents to be involved in the enrollment activity/choice of PCP/plan."  Nebraska Contract, page 37.

"9.14.4  Auto-Assignment Priorities: The following priorities shall apply: ...
 (b) For a client in the Blind/Disabled and Department Ward/Foster Care categories, the EBS shall facilitate an assignment by 'pre-nominating' a PCP/plan by taking into consideration eligibility and claims history information known about the client."  Nebraska Contract, page 40.

NEBH

"9.4 Special Coverage Situations: The following special coverage situations apply to the PHP and the provision of the MH/SA Package:
9.4.1 Case Management/Coordination for Children Who Are In the Custody of the Department: The PHP shall be responsible for providing case management, and coordinating MH/SA services with the Department’s Protection and Safety (PS) worker, for a child who is placed in the custody of the Department, effective with the request date of application for the Nebraska Medical Assistance Program and prior to the effective date of the client’s enrollment into the MH/SA Package.  The PHP shall participate in joint training and workgroups to coordinate the implementation of this section.

The PHP may also be required to collaborate with other care managers, service coordinators, etc., who are serving the client and his/her biological and/or foster family.
    9.4.1 (A) PHP Payment:  The PHP shall not receive a capitation payment during this time period.  The cost of providing case management and coordination of services shall be included in the capitation payment effective with the first month of enrollment into the MH/SA Package.
    9.4.1 (B) Service Payment:  Payment for Medicaid-coverable MH/SA services provided during this period of time shall be paid by the Department on a fee-for-service basis.
    9.4.1 (C) PHP Requirement:  The PHP shall follow all regulations governing services provided under the Nebraska Medical Assistance Program during this special coverage period, and promote continuity of care by participating in the development of a treatment plan, coordination of providers, and authorization of services."  Nebraska Behavioral Health Contract, pages 35-36.

NM

"2.B.1.h.iv  Clients in Treatment Foster Care Placements.  If a child or adolescent is residing in a treatment foster care placement at the time managed care enrollment begins for their geographic region of residence, they will be exempt from enrolling in an MCO until they are discharged from treatment foster care."  New Mexico Contract, page 24.

NC

"4.11  Children With Special Needs...
The selected Plan must provide these children with case managers.  The case managers must develop a plan of care and treatment to assure coordination of services and continuity of care.  In the event that the recipient or responsible party does not select a Plan, the child will be auto-assigned by the HBM… The child will be assigned to a Plan in which their current provider(s) participate(s) if available.  If not, the child will be assigned to a Plan and provider(s) that are capable of meeting specific needs of the child."  North Carolina Contract, page 7.

"APPENDIX I
DEFINITION OF TERMS...
1.8  Children with Special Needs - Includes these five subsets: ...
3.  In foster care or other out-of-home placement…"  North Carolina Contract, Appendix I.

PA

"C.  HealthChoices Program...
12.  Children in Substitution Care Transition Issues

If a child in substitute care is determined eligible for MA outside of the five (5) county HealthChoices project area and is placed in substitute care inside the five (5) county HealthChoices project area, s/he will be covered under the FFS Program.

If a child in substitute care is determined eligible inside the five (5) county HealthChoices project area and is placed outside of the five (5) county HealthChoices project area, s/he will be covered under the FFS Program.  (Except for the provision of Juvenile Detention Centers outlined in Part II.H.3)

If a child in substitute care is determined eligible inside the five (5) county HealthChoices project area and is placed anywhere inside the five (5) county HealthChoices area, the HMO with which the child initially enrolled remains financially responsible for the health care needs of the child ...

The HMO will continue financial responsibility for the health care needs of the child in substitute care unless or until the legal custodian (e.g., parent or county) makes a decision to enroll the child in another HMO or the child is placed in a facility which requires the child to be disenrolled from the HMO…"  Pennsylvania RFP, pages 6-11.

"H.  Coordination with Out-of-Plan Services...
3.  Members Admitted to Juvenile Detention Centers (JDCs)

Any child receiving MA benefits will continue to receive those benefits during placement in a JDC.  Children enrolled in an HMO and placed in JDCs both in and outside the HealthChoices project area will continue to be covered by the HMO in effect on the date of placement for a maximum of thirty-five (35) consecutive days.

A child already residing in a JDC will not be permitted to newly enroll in an HMO until after release from the JDC...

EPSDT screening results or other health care needs detected during the period of the JDC placement should be provided to the covering HMO.  Should a covered  Service be identified that cannot be provided at the JDC, the JDC must contact the HMO in order to arrange for the covered service to be provided…"  Pennsylvania RFP, pages 51-53.

TN

"SECTION 2 - CONTRACTOR RESPONSIBILITIES
2-2.    CONTRACTOR Qualifications
  The CONTRACTOR shall comply with the following requirements at the inception of this Agreement and at all times during the life of this Agreement:
  c...Each enrollee must have an identified primary care provider with the exception of the dually eligible Medicare/Medicaid enrollees and children who are appropriately enrolled in TennCare and who are temporarily placed in a residence out-of-state by a state agency (e.g., children in foster care, children in the Children’s Plan)...  Because of the fact that children in the Children’s Plan may move frequently due to residential placement issues and it is important to assure appropriate care to these children, children in the Children’s Plan may be assigned to a case manager at the MCO level or to a pre-defined group of primary care providers in lieu of a specific primary care provider."  Tennessee Contract, pages 3-4.

WA

"2.8  Effective Date of Enrollment: ...
  c.  Adopted children shall be covered consistent with the provisions of Title 48 RCW…"  Washington Contract, page 7.