Reminder: CSHCS Provider Attestation Requirement
Dear Provider Partners,
To ensure compliance with Michigan Department of Health and Human Services (MDHHS) guidelines, providers must adhere to all requirements related to the Children’s Special Health Care Services (CSHCS) program when rendering services to eligible members.
Overview
CSHCS is a state of Michigan program that serves children, and some adults, with special healthcare needs. CSHCS covers more than 2,700 medical diagnoses. CSHCS is not separate insurance, but it can cover some services not covered by Meridian if the service is related to the condition for which you/your child are/is enrolled.
Attestation
Providers are required to attest to specific criteria to provide care to members enrolled in CSHCS.
- Attestation can be completed via our Annual Training Resources.
- By completing the attestation form, providers are confirming the following:
- Provider is willing to accept new members in CSHCS with potential complex health conditions
- Provider will regularly service children or youth with complex chronic health conditions
- Provider has a mechanism to identify children or youth with chronic health conditions
- Provider allows expanded appointments when children have complex needs and require more time
- Provider has experience coordinating care for children who see multiple professionals (pediatric subspecialists, physical therapists, mental health professionals, etc.)
- Provider services appropriate for Health Care Transition, including but not limited to; the use of transition readiness assessment and adoption of transition policy that is publicly posted and specifies:
- The transition time frame
- Transition approach
- Legal changes that take place in privacy and consent at age 18
- Attestations are saved to the provider record to ensure members that fall under CSHCS population are appropriately assigned to providers that can render care
CSHCS Member Eligibility:
- Must be a resident of Michigan
- Must be a US citizen, document non-citizen admitted for permanent residence, or non-citizen legal admitted migrant worker
- Must be under 21 years old, but those 21 and older with cystic fibrosis or certain blood coagulate disorders may also qualify
- Must be receiving treatment for one of the 2,700 medical diagnoses identified by the state of Michigan
Provider Responsibilities
Providers participating in the care of CSHCS members are expected to:
- Verify CSHCS Eligibility
- Confirm the member is actively enrolled in CSHCS and that the condition being treated is covered under the program
- Ensure Services Align with Approved Diagnosis
- Services billed under CSHCS must be directly related to the member’s approved qualifying condition
- Obtain Required Authorizations
- Prior Authorization may be required for certain services. Please follow plan-specific authorization requirements in addition to CSHCS guidelines.
- Coordinate with Primary and Specialty Care Providers
- Collaboration across care teams is required to support continuity of care and appropriate treatment planning.
- Submit Accurate Claims
- Claims must include all required identifiers and documentation to support that services are related to the approved CSHCS condition.
Billing and Documentation Requirements
- Include appropriate diagnosis codes that align with approved CSHCS condition
- Maintain documentation supporting medical necessity and linkage to the qualifying condition
- Follow all Medicaid and plan-specific billing guidelines
Important Reminders
- Services not related to approved CSHCS conditions are not covered under the program
- Failure to follow CSHCS requirements may result in claim denials or recoupment
- Providers are responsible for staying current with MDHHS policy updates
Additional Resources
For complete program details and eligibility criteria, please refer to MDHHS CSHCS program guidance.
For questions or assistance, provider should submit an inquiry through the Provider Relations Contact Form to ensure timely routing and response.