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Managed Care Overview
Managed Care Eligibility
Clinically Related
Group and Target Population Group Assessments
TennCare
Partners Monitoring and Evaluation Reports
Ombudsman
Managed
Care Standards for the Delivery of Behavioral Health Services Manual (June
2006)
Manual
for Mental Health Coverage to
Uninsured Tennesseans
(January 2006)
Crisis Response Training Manual
for Crisis Services Providers
For Answers to Post Test,
Contact Trish Wilson
at (615) 532-9156
or Email
Trish.Wilson@state.tn.us
Clinically Related
Group / Targeted Population (CRG/TPG) Group Assessments Manual

Departmental
Offices
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Office of Managed
Care
Centers of Excellence for Behavioral Health (COE)
Children in foster care or otherwise in state custody
are highly likely to
have special health care needs, including behavioral health and
developmental needs. The Tennessee COE system is designed to support
the Department of Children Services (DCS) in integrating placement,
family,
health and developmental needs into a comprehensive, coordinated
care plan
based on the child and family’s unique needs. The COEs serve
children both in
state custody and at risk of state custody.
The three regional COEs are located at the University of Tennessee
Health Science Center’s Boling Center for Developmental
Disabilities in Memphis, at the College of Medicine, Department
of Psychiatry, East Tennessee State University in Johnson City
and at the Department of Psychiatry, Vanderbilt University in
Nashville. Each COE is intended to serve the surrounding region.
Regional COE Contact are listed here.
Referrals are made primarily through the Health Units of DCS and
Community Services Agency (CSA). In addition to DCS Health Units,
referrals can be initiated though other sources, such as pediatricians,
family practitioners, mental health service providers, and juvenile
courts, who have concerns about a child in, or at risk of, state
custody. Referrals might be made
- When problems are complex and there are diagnostic and mental
health concerns.
- When there are conflicting diagnoses among health service
providers.
- When a comprehensive review of the child’s history
(behavior,
treatment, placement) would assist in determining child’s
current needs.
- When an evaluation or examination would add information
needed for placement and treatment recommendations.
- When there is concern about a developmental delay
- When there is concern about psychoactive medications
Once a case is completed, recommendations are communicated to the
Health Unit, as well as directly to the case manager, to assist
in coordination
of care. Follow up consultations are often arranged through the
Health Unit.
The COEs also work at providing a basis for medical necessity
in accessing
service from TennCare Partners Behavioral Health Organizations
(BHOs).
The COEs also provide extensive consultation to pediatricians,
psychiatrists and
other health care providers, as well as participate in case conferences
with health
care providers and others with an interest in a child’s
welfare. Finally, COEs provide training to DCS and CSA case managers
and to other community providers and agencies with the intent
of improving the knowledge and skills of those serving children
in, or at risk of, state custody and their families.
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