What Health Advocacy Does
- Maintains and strengthens the Department of Children's Services relationship with TennCare and assures compliance with TennCare program requirements, especially Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services;
- Assures compliance with the Grier Federal Lawsuit Consent Decree, which requires that children and their families are notified of appeal rights when TennCare-funded services are reduced, delayed, suspended or terminated;
- Sponsors the Crisis Management Team;
- Coordinates the network of Centers of Excellence for Children In or At Risk of State Custody.
Common Issues Addressed In Health Advocacy
- Medical and Dental services for children must be accessible and provided timely. Health Advocacy provides information to DCS Regions to help them stay on track to do this and coordinates with Managed Care Companies and Dental Benefits Manager when there are problems.
- When services are delayed or reduced, Health Advocacy makes certain children and families are notified of the right to appeal the changes in services.
- Some services are not TennCare eligible. Health Advocacy helps Regions maintain to access those services from private providers.
- Some children and youth in custody have Intellectual Disabilities. Health Advocacy facilitates transition to adult services of the Department of Intellectual and Developmental Disabilities (DIDD) when youth approach age 18.
- When a child is at imminent risk of entering custody because of severe behavioral problems, the Crisis Management Team facilitates provision of services so that the child can remain in the custody of the parents.
Health Advocacy Partnerships
As an administrative unit, Health Advocacy collaborates with other professionals in the DCS system, other state agencies and organizations, among them:
- BlueCare and TennCare Select, arms of BlueCross/BlueShield Insurance Company
- TennCare Bureau
- Tennessee Department of Mental Health and Substance Abuse Services
- Tennessee Department of Intellectual and Developmental Disabilities
- Tennessee Department of Health
- DCS Wellbeing Units
- Juvenile Courts
Health Advocacy participates with:
- Council on Children’s Mental Health
- Tennessee’s Early Intervention System (TEIS) Advisory Council
- Tennessee Young Child Wellness Council
- Tennessee Infant Mental Health Initiative
- Tennessee Suicide Prevention Network
Crisis Management Team
The Crisis Management Team assists TennCare-eligible children who have been denied residential mental health treatment by their TennCare MCO and may be at risk of DCS custody due to the denial of the service. The Crisis Management Team:
- Receives referrals for children at imminent risk of entering custody for whom TennCare services are needed.
- Works with TennCare Managed Care Companies to access those services.
- Facilitates review process with DCS Regional Psychologist for medical necessity for treatment if services are denied by the MCC.
- Issues Letters of Authorization to residential providers to cover medically necessary services to prevent custody.
- Files a TennCare Appeal following authorizations for residential treatment so the denial of residential services can be reconsidered by the MCCs.
- Liaisons with DCS staff, families, attorneys for youth, Youth Services Officers, and Court officials regarding youth who are at imminent risk of entering custody.
- The Crisis Management Team is often able to direct families to potential service alternatives and offer technical assistance regarding insurance and accessing TennCare.
To contact the Crisis Management Team call 615-532-1530
Centers of Excellence for Children In or At Risk of State Custody
Centers of Excellence are tertiary care academic medical centers, provider agencies, and partners possessing expertise in children's physical and behavioral health. They are focused on improving comprehensive well-being of children in or at risk of state custody. Centers of Excellence assist in providing science-based guidance to improve children's health, behavioral outcomes, and improve systems serving children by providing clinical consultations, evaluations, and limited direct services to children with complex needs. Referrals to the COEs are made by DCS Regional Psychologists. The COEs provide leadership in training and education, and best practice learning collaboratives. There are five locations across the state to serve children in or at risk of state custody.
Information is available at the following sites about the Centers in these locations:
- Vanderbilt University Medical Center, Nashville
- UT Health Sciences, Boling Center, Memphis
- UT-Cherokee Health Systems, Knoxville
- East Tennessee State University, Johnson City
- Southeast Center of Excellence, Chattanooga