Managing Your Child's Care

Children’s Medical Services Health Plan offers members care management services to help with special healthcare needs. We will match your child with a care manager. Your child's care manager is the go-to person and can help coordinate your child’s care.

This means that they are the person who will help you figure out what services your child needs and how to get them. Your child's care manager will work with providers to manage the healthcare services. They can help you understand major health problems.

If there is a problem with care or a life change occurs for your child, let their care manager know. They will help decide if services need to change to better support you and your child.

Care Coordination Support from CMS Health Plan Trained Staff

Our care managers are trained to understand the unique challenges that our specialty members face. They offer the highest quality-of-care.

Your child can also get support through our Care Coordination Outreach Program. At least once per quarter, we check on your child to see if they need help with services like:

• Behavioral, medical or pharmacy
• Social services like housing, food, etc.

Access to Dedicated Children’s Medical Services Health Plan at School Specialist

Your child has access to our “CMS Health Plan at School” specialist. This person knows how to work with the schools to help arrange services your child may need to improve school success.

Access to Children’s Medical Services Health Plan Early Steps Specialist

Your child has access to our “CMS Health Plan Early Steps” specialist. This individual will work with you and your child to make a smooth transition from Early Steps in-home services as your child is turning 3 years of age and will move to new providers.

Transition Aged Youth Program (TAY)

We can help your child get ready to become an adult. Our trained care managers are here to guide you and your child on things like:

• Provider choice
• Employment
• Housing
• Transportation

Our program includes screening, coaching and education. We can help you and your child figure out what services and skills are needed to create a plan to reach goals.

Access to Transitions Specialist

You and your child have access to our “CMS Health Plan Transitions” specialist. This specialist can help your child transition from a skilled nursing facility, assisted living facility or hospital-like setting to live with family or in a group home. This specialist works closely to evaluate options and to create a plan if a change is in your child's best interest.

Changing Care Managers

If you want to choose a different care manager for your child, call Member Services at 1-866-799-5321 (TTY 1-800-955-8770). There may be times when we will have to change a care manager. If we need to do this, we will send a letter to let you know.

Important Things to Tell Your Care Manager

If something changes in your child’s life or you don't like a service or provider, tell the care manager. Tell your child's care manager if:

• You don’t like a service
• You have concerns about a service provider
• Your child’s services aren’t right
• Your family gets new health insurance
• Your child goes to the hospital or emergency room
• A caregiver can’t help anymore
• A family’s living situation changes
• A name, telephone number, address or county changes

Request to Put Services on Hold

If something changes in your child’s life and service(s) need to stop for a while, please tell your child's care manager. The care manager will ask you to complete and sign a form to put the service(s) on hold. 

Private Duty Nursing (PDN) Real-Time Reporting Process

We want to ensure that your child is receiving the services required to keep them safe in your home. Please contact CMS Health Plan right away when a Private Duty Nursing shift is missed. Here are a couple ways to reach us:

1. Contact your child’s Care Manager
   If you don’t know who your child’s care manager is, call Member Services at 1-866-799-5321 (TTY 1-800-955-8770).
2. Contact your child’s Care Manager’s supervisor
   If you don’t know who your child’s care manager’s supervisor is, call Member Services at 1-866-799-5321 (TTY 1-800-955-8770).
3. Call the 24-hour CMS Health Plan Nurse Advice Line
   1-866-799-5321 (TTY 1-800-955-8770)
   • Press 1 for Member
   • Press 7 to reach Nurse Advice Line
4. Email CMS Health Plan
   CMS_PDN_Escalation@SunshineHealth.com
   • Include your child’s name, Medicaid ID number and home health provider, the date and time of the shift missed, and your contact information.

When we are notified of a missed shift, your child’s Care Manager will:

• Contact your child’s home health agency to identify the issue with coverage.
• Work with the home health agency to ensure services will occur as authorized.
• Help with finding another home health agency who can provide care to your child.  

Please contact your child’s Care Manager if you have any questions or concerns.