CISWH Project Resources

In April, May, and June of 2022, the Catalyst Center and the National Coordinating Center for the Regional Genetics Networks, two programs supported by the Health Resources and Services Administration (HRSA), hosted a three-part webinar series to help the genetics community and other interested parties better understand how to navigate medical necessity and the prior authorization process. The webinars utilize a therapeutic case study as well as family and provider perspectives. 

Part one of the series explores the definition of medical necessity and shows how evidence is used to help inform medical necessity criteria and policy.

Part two discusses EPSDT, the Title V and Medicaid relationship, and defines the first steps in the process of getting prior authorization for medically necessary services. 

Part three provides a practical application of medical necessity, including understanding the prior authorization process, requesting authorizations, and navigating denials and appeals.

If you are interested in Continuing Medical Education (CME) credits The Medical Necessity Webinar Series is also available through the Genetics Academy, until May 31, 2024. Credits offered include: 3 CME (AMA) Credits, 3 CME (Other) Credits, and 3 Certificate of Participation Credits. Please see the course page on the Genetics Academy website for more information. 

In April, May, and June of 2022, the Catalyst Center and the National Coordinating Center for the Regional Genetics Networks, two programs supported by the Health Resources and Services Administration (HRSA), hosted a three-part webinar series to help the genetics community and other interested parties better understand how to navigate medical necessity and the prior authorization process. The webinars utilize a therapeutic case study as well as family and provider perspectives. 

Part one of the series explores the definition of medical necessity and shows how evidence is used to help inform medical necessity criteria and policy.

Part two discusses EPSDT, the Title V and Medicaid relationship, and defines the first steps in the process of getting prior authorization for medically necessary services. 

Part three provides a practical application of medical necessity, including understanding the prior authorization process, requesting authorizations, and navigating denials and appeals.

If you are interested in Continuing Medical Education (CME) credits The Medical Necessity Webinar Series is also available through the Genetics Academy, until May 31, 2024. Credits offered include: 3 CME (AMA) Credits, 3 CME (Other) Credits, and 3 Certificate of Participation Credits. Please see the course page on the Genetics Academy website for more information. 

In April, May, and June of 2022, the Catalyst Center and the National Coordinating Center for the Regional Genetics Networks, two programs supported by the Health Resources and Services Administration (HRSA), hosted a three-part webinar series to help the genetics community and other interested parties better understand how to navigate medical necessity and the prior authorization process. The webinars utilize a therapeutic case study as well as family and provider perspectives. 

Part one of the series explores the definition of medical necessity and shows how evidence is used to help inform medical necessity criteria and policy.

Part two discusses EPSDT, the Title V and Medicaid relationship, and defines the first steps in the process of getting prior authorization for medically necessary services. 

Part three provides a practical application of medical necessity, including understanding the prior authorization process, requesting authorizations, and navigating denials and appeals.

If you are interested in Continuing Medical Education (CME) credits The Medical Necessity Webinar Series is also available through the Genetics Academy, until May 31, 2024. Credits offered include: 3 CME (AMA) Credits, 3 CME (Other) Credits, and 3 Certificate of Participation Credits. Please see the course page on the Genetics Academy website for more information. 

In April, May, and June of 2022, the Catalyst Center and the National Coordinating Center for the Regional Genetics Networks, two programs supported by the Health Resources and Services Administration (HRSA), hosted a three-part webinar series to help the genetics community and other interested parties better understand how to navigate medical necessity and the prior authorization process. The webinars utilize a therapeutic case study as well as family and provider perspectives. 

Part one of the series explores the definition of medical necessity and shows how evidence is used to help inform medical necessity criteria and policy.

Part two discusses EPSDT, the Title V and Medicaid relationship, and defines the first steps in the process of getting prior authorization for medically necessary services. 

Part three provides a practical application of medical necessity, including understanding the prior authorization process, requesting authorizations, and navigating denials and appeals.

If you are interested in Continuing Medical Education (CME) credits The Medical Necessity Webinar Series is also available through the Genetics Academy, until May 31, 2024. Credits offered include: 3 CME (AMA) Credits, 3 CME (Other) Credits, and 3 Certificate of Participation Credits. Please see the course page on the Genetics Academy website for more information. 

Transportation is essential for children and youth with special health care needs (CYSHCN) to regularly access health care and support chronic health conditions that require ongoing treatment. However, CYSHCN are significantly more likely to delay care due to transportation barriers than children and youth without a special health care need. State Medicaid agencies are required to administer the non-emergency medical transportation (NEMT) benefit, which provides coverage for rides to and from medical appointments for all Medicaid beneficiaries. States determine when a ride is necessary (e.g., a beneficiary has a mental or physical disability). Knowledge of the NEMT benefit can assist state health officials, including state Title V program staff, in supporting access to care for CYSHCN enrolled in Medicaid.

Care coordination can help children and youth with special health care needs (CYSHCN) and their families navigate the health care system while avoiding unnecessary costs and duplicative services. States have longstanding efforts to finance care coordination services for CYSHCN and their families through Medicaid, the state Title V Maternal and Child Health Services Block Grant (Title V), and other federal and state programs.  Some states have leveraged these programs as part of unique health care delivery systems and financing structures, including Medicaid reimbursement of care coordination administered by Title V programs.

This brief, developed by the National Academy for State Health Policy (NASHP) in collaboration with the Catalyst Center, describes how State Title V and Medicaid programs in Arkansas, Illinois, and Iowa have partnered to finance and deliver care coordination for CYSHCN.

As the single largest source of health coverage for Children and Youth with Special Health Care Needs (CYSCHN), with robust benefits and cost-sharing limits, Medicaid provides critical coverage of health care services to CYSHCN. State Title V programs are uniquely positioned to collaborate with Medicaid to promote access to the system of services for CYSHCN.

The Catalyst Center hosted a webinar on June 14, 2022, that presented foundational knowledge about Medicaid for Title V staff and their allies. Catalyst Center staff explained the basics of Medicaid including the eligibility pathways to Medicaid coverage for kids and a benefit for children unique to Medicaid called EPSDT that is crucial for access to care for CYSHCN. 

Please click the links below to access the webinar recording, slide deck, and a document with follow-up resources and Q&A responses. 

As the single largest source of health coverage for Children and Youth with Special Health Care Needs (CYSCHN), with robust benefits and cost-sharing limits, Medicaid provides critical coverage of health care services to CYSHCN. State Title V programs are uniquely positioned to collaborate with Medicaid to promote access to the system of services for CYSHCN.

The Catalyst Center hosted a webinar on June 14, 2022, that presented foundational knowledge about Medicaid for Title V staff and their allies. Catalyst Center staff explained the basics of Medicaid including the eligibility pathways to Medicaid coverage for kids and a benefit for children unique to Medicaid called EPSDT that is crucial for access to care for CYSHCN. 

Please click the links below to access the webinar recording, slide deck, and a document with follow-up resources and Q&A responses. 

This slide deck, originally presented at the Association of Maternal and Child Health Programs’ 2021 virtual conference, outlines a number of policy opportunities for Title V programs to utilize in sustaining funding for pediatric complex care. The presentation breaks down these policy opportunities into broad, targeted, eligibility, and reimbursement based strategies. For more in-depth information on each, review “Strategies for Changing State Medicaid Policy to Improve Services to Children with Medical Complexity”.

This paper introduces a number of existing Medicaid policy instruments and explains how to use them more effectively for programs and providers dedicated to serving CMC. Because Medicaid programs are so variable across the nation, we also provide a diagnostic approach to understanding each state’s Medicaid policy and service delivery system environment. Finally, we offer strategies of different scale to demonstrate how to change policy incrementally from the targeted to transformative.