PURPOSE: This rule establishes the components of CCS. It also delineates central office and district and subdistrict office roles in the components of the program.

1. (1) Central Office Role.

   1. (A) The Department of Health shall see that Crippled Children’s Service (CCS) is administered strictly within the states’ fiscal guidelines.

      1. 1. The line of authority by which the

Department of Health administers CCS shall be through the Division of Personal Health Services.

1. 2. The program administrator shall be

held accountable to the division director, who in turn shall be held accountable to the director of the Department of Health.

1. 3. The program administrator shall work

with the CCS advisory committee, informing committee members of issues pertinent to the operation of the program and giving due consideration to the committee’s collective advice.

1. (B) Central office may administratively revise limitations on CCS programs. CCS, for budgetary reasons, may suspend one (1) or more of the categories of care in 19 CSR 40-1.030(1)–(5) or impose or revise funding ceilings for services throughout the state.
2. (C) Central office may develop and implement demonstration or special projects to provide services to groups in special need. The development of the projects shall include development of policies, standards and criteria applicable to provision of the services and to the selection of groups in special need. Special funds may be set aside for these projects and shall be limited to no more than ten percent (10%) of the general service budget.
3. (D) Central office shall attempt to formulate written agreements with any other governmental agencies and their respective departments in order to carry out the mandates stipulated in section 201.030, RSMo 1986.
4. (E) Central office shall consult with the district and subdistrict staff on complicated individual care plans and shall monitor the case management function of the staff.
5. (F) Central office shall maintain statistics of children in Missouri who have congenital anomalies, birth defects and physically-handicapping conditions.
6. (G) Central office shall review the qualifications of CCS-approved providers. Notification of any changes of status or revisions will be sent to the district and subdistrict offices.

1. (2) District and Subdistrict Office Role.

   1. (A) Case finding is a primary function of the CCS staff at the district and subdistrict level. The staff, in conjunction with providers of care and other public and private agencies and concerned individuals, shall actively seek out children and families who may be eligible for CCS services.

   2. (B) Services shall be initiated at the district and subdistrict level.

      1. 1. The staff shall monitor requests for

diagnostic services from all providers of care and other public and private agencies and concerned individuals who may refer a child or family for the services.

1. 2. The staff shall reject or bring up for

further review with the central CCS office any referrals and requests for services for children with conditions not included in 19 CSR 40-1.030(1)–(5).

1. 3. Referral from district and subdistrict

staff to an appropriate provider of care and other public and private agencies and concerned individuals shall be made for all children or families referred to CCS.

1. (C) Case management shall be a primary function at the district and subdistrict level. It includes all activities related to the monitoring of the client’s medical progress and the individual care plan (ICP) outlined for the client by the provider(s) of service, case manager, client’s parents and the client.

   1. 1. The staff shall provide feedback on

the client to service providers and shall work with providers and other community resources to create an appropriate ICP for CCS clients.

1. 2. The staff shall also work together as

an interdisciplinary team when necessary to review and implement complicated ICPs and, when necessary, to see that ICPs are periodically being reviewed by the providers of care.

1. 3. The staff shall provide feedback on

the client’s CCS status within twenty (20) working days after the client or client’s family reports any major changes in income, household composition, insurance, Medicaid coverage, medical condition or the client’s care plan; and work with the client and the client’s family to insure the client’s ICP is appropriate.

AUTHORITY: sections 192.005.2 and 201.060, RSMo 1986.* This rule was previously filed 13 CSR 50-160.060. Emergency rule filed Dec. 12, 1984, effective Dec. 22, 1984, expired April 20, 1985. Original rule filed Dec. 12, 1984, effective April 11, 1985. Amended: Filed June 2, 1987, effective Aug. 13, 1987.

*Original authority: 192.005, RSMo 1985 and 201.060, RSMo 1959.