HUSKY - Guide

HUSKY is free or low-cost health insurance for Connecticut’s uninsured children and youth up to age 19. Depending on family income, a child may be eligible for HUSKY A or HUSKY B.

HUSKY FAMILY INCOME CHART

HUSKY PLUS does not apply to children in HUSKY A. However, there is an equivalent program called Children with Special Health Care Needs (Title V program) that can be accessed through the HUSKY PLUS Centers.

What is HUSKY PLUS and Who is Eligible?

HUSKY PLUS is supplemental benefits for Children with Special Health Care Needs enrolled in HUSKY B (Bands 1 and 2).

Children with special health care needs are children who:

Have, or are at elevated risk for chronic conditions they were born with or later acquired including

-- Physical

-- Developmental

-- Behavioral

-- Emotional

Require health and related services (not educational and recreational) of a type and amount not usually required by children of the same age.
Range in age from birth to their 19^th birthday

There are two HUSKY PLUS Programs

HUSKY PLUS Physical

HUSKY PLUS Behavioral

HUSKY PLUS Physical

HUSKY PLUS Physical is designed to offer an array of supplemental specialty care services to children and youth with special physical health care needs, supporting care and covering the cost of some services.

Care Support

Multidisciplinary teams including Pediatricians, Advanced Practice Nurses, Benefits Specialists, Family Resource Coordinators and Advocates work with families to identify their child’s care needs and the resources to meet those needs.

Advocacy and Parent to Parent Support

Connecticut Children’s Medical Center Family Center
Yale Family Connections

Linkage to financial and clinical resources
Child and family needs assessment

Expert Pediatric Consultation

Pediatric Specialty Clinics
Educational and technical assistance to schools and community agencies

Providers

Families do not have to change their child’s current health care providers. HUSKY PLUS Physical staff work closely with primary care providers throughout Connecticut.

Covered Services

The HUSKY PLUS Physical benefits include payment for certain types of services and equipment not covered by the HUSKY B Plan or any other community resource. HUSKY PLUS has no deductibles, no co-pays and no lifetime maximums. Pre-existing conditions are not excluded.

HUSKY PLUS Physical
COVERED SERVICES

All services below are provided following these specific guidelines

They relate to the condition(s) which qualify the child for the program

The program is the documented payer of last resort

A prescription is obtained from an appropriate provider when required

Parental satisfaction is necessary before vendor is paid

Coordination of benefits and Explanation of Benefits is required.

Any exception to covered services or limits requires review by and approval of Steering Committee

Prior authorization is required for all covered services except care coordination, advocacy and family support

SERVICE	DESCRIPTION/LIMITATIONS
Adaptive Seating, Specialized	One evaluation, fabrication and completion per year. Fees are inclusive of one adjustment every 2 weeks until family is satisfied
Audiometry	Includes BAER, OAE; two per year
Care Planning	Comprehensive multidisciplinary team consultation leading to a care plan. Reimbursement to professional participants at Center’s case management rate, limited to 4 hours per year per child.
Cast room	Cast room visits as necessary to maintain integrity of case or to implement treatment plan
Diagnostic imaging (i.e., MRI, CT)	As medically necessary
Durable Medical Equipment	Items that assist in activities of daily living, including ambulatory aids or equipment necessary for medical treatment and home management including respiratory therapy equipment
EEG/telemetry	Two per year
EKG/Halter	Two per year
Emergency care	Authorized within 72 hours after visit Directly related to condition which qualifies child for program Emergency Room fees, including medical/surgical supplies Professional fees considered separately
General Dental	Only for children who: (1) have malocclusive disorders directly resulting from their underlying qualifying condition, or (2) have received Dilantin treatment
Hearing Aids	One per year new or two times per year repaired.

HUSKY PLUS Physical COVERED SERVICES

SERVICE	DESCRIPTION/LIMITATIONS
Home Health Aide	Total of 10 hours/week of home health aide support to assist the family to provide personal care to the child Review at least every 60 days Must be provided by licensed home health agency
Laboratory	Any diagnostic laboratory evaluation
Medical and Surgical supplies	Gastrostomy, jejunostomy, nasogastric tubes Ostomy supplies Dressing supplies Catheters: Suction catheters - 360/month (tracheotomy) 60/month/oral (nonsterile) Urinary catheters - 20/30 per month; re-use (of clean, nonsterile) for CIC is essential Gloves for at home procedures (non-latex, nonsterile; 120 pair/month) Diapers for any HUSKY PLUS eligible client over 3 years old, limited to 180 diapers/month Other medically necessary supplies as indicated in care plan
Medical Nutrition Services	Consultation and treatment by registered dietitian consistent with the care plan
Medical 23 Hour Day Medical and Day Surgery	Any medically necessary test/treatment or procedure requiring less than 24 hour stay Physician fees considered separately
Occupational Therapy Physical Therapy	Includes all modalities delivered by certified professional Physical Therapist (no more than 1.5 hours or 2 visits per week); or Occupational Therapist (no more than 45 minutes or 1 visit per week) One initial evaluation session per year; one session per week (each modality subject to review every 60 days)
Orthodontics	Orthodontic treatment for children who have malocclusive problems directly resulting from their underlying qualifying condition
Orthotic Devices	No more than one a year or one pair per year per prescribed type including all delivery fees, fittings and adjustments
Pharmacy	Prescribed medications related to condition which qualifies child for the program

HUSKY PLUS Physical COVERED SERVICES

SERVICE	DESCRIPTION/LIMITATIONS
Physician Fees for Inpatient Care	No more than 1 visit/day/specialty Visits must be requested as consultations by the admitting physician and be specifically related to the qualifying condition
Physician Fees for Outpatient Care (Specialty)	Covered as per care plan
Prosthetics/Prosthetic Devices	No more than one per year including all delivery fees, fittings and adjustments/repairs; excludes myoelectric devices
Pulmonary Function Testing (PFT)	One PFT evaluation (test and technician) per year
Radiology	Any diagnostic radiological procedure
Skilled Intermittent Nursing	One visit per day for evaluation, treatment, education Re-evaluation needed after 30 days Must be provided by licensed home health agency
Sleep Study/Polysomnography	One per year
Special Nutritional Formulas or Supplements/ PKU Foods	Nutritional habilitative and/or rehabilitative sustenance of a type or amount not usually required by children; prescribed by an authorized professional within acceptable standards of American Dietetic Association; coverage reviewed every six months
Speech Therapy	One visit per year for diagnostic evaluation and one session per week (reviewed every 60 days)
Transportation	2 Round trips per year to any health care appointment by ambulance, chairvans and other licensed medical transportation for above non-emergent visits are covered. HUSKY PLUS will authorize ambulance travel only if there is documentation that this is the safest and most appropriate means of transporting the child.
Wheelchairs	One new manual or motorized wheelchair no more than every 3 years Repairs and modifications to either manual or motorized wheelchair (other than seating) will be covered 2 times per year

HUSKY PLUS Physical

Satellite Specialty Clinics and Services

Pediatric Cardiology Clinics
Craniofacial Clinics
Cystic Fibrosis Clinics
Genetics Clinics
Juvenile Diabetes Services
Muscle Disease Programs
Orthopedics Clinics
Physical, Occupational and Speech Therapy Consultations
Sickle Cell Clinics

HUSKY PLUS Behavioral

HUSKY PLUS Behavioral is available to children and youth with intensive behavioral health needs who are enrolled in a HUSKY B health plan in Connecticut. HUSKY PLUS Behavioral is designed to offer an array of community-based mental health and substance abuse services to children and youth with intensive behavioral health needs. The Department of Social Services has contracted with the Yale Child Study Center to serve as the lead provider and manager for the HUSKY PLUS Behavioral health plan.

Basic Benefit

HUSKY PLUS Behavioral has a basic package of services provided in the home and community. Services in the basic benefit are only covered when they are provided by a HUSKY PLUS Behavioral Center. The package includes:

in-home child and adolescent psychiatric and substance abuse services

mobile crisis services

care coordination services.

These services are designed to enhance the standard HUSKY B benefits, which include a combination of inpatient, outpatient, intensive outpatient, partial hospital, and extended day treatment services. Most children will receive a combination of HUSKY PLUS Behavioral and HUSKY B services at the same time. HUSKY PLUS Behavioral benefits are available throughout the initial eligibility year and for subsequent years in which the child remains eligible.

Supplementary Coverage for HUSKY B services

HUSKY PLUS Behavioral also provides limited coverage for HUSKY B services when a child’s HUSKY B outpatient benefits are exhausted. If a child’s mental health benefits are exhausted, HUSKY PLUS coverage is available for outpatient, intensive outpatient, extended day treatment and partial hospitalization services. If a child’s substance abuse benefits are exhausted, HUSKY PLUS coverage is available for outpatient services. This additional coverage is only available while a child is enrolled in HUSKY PLUS Behavioral.

In order to ensure continuity of care, HUSKY PLUS Behavioral will allow a child’s current HUSKY B provider to continue providing any of the standard HUSKY B services when appropriate.

Eligibility

Husky PLUS Behavioral is designed for children and youth with a psychiatric or substance abuse disorder who are receiving psychiatric or substance abuse services through a HUSKY B plan. If the usual HUSKY B services do not seem to be helping, the parents should contact HUSKY PLUS Behavioral at (888) 311-7735 or call their HUSKY B plan and ask to be referred to HUSKY PLUS Behavioral.

Children who are referred undergo an Eligibility Assessment conducted by the local HPB Center for Children’s Behavioral Health Care. Once the Eligibility Assessment is complete, the HPB Eligibility Review Committee reviews it. A child will be determined eligible if he or she has significant psychiatric and/or substance abuse problems, problems in daily functioning, and intensive service needs that cannot be met fully within the HUSKY B Health Plan.

HUSKY PLUS Behavioral Provider Network

HPB providers were selected using a competitive process in which interested agencies submitted detailed proposals. The HPB Steering Committee reviewed the proposals and selected twelve of the strongest applicants to serve as Centers of care throughout the state.

There are ten HPB service regions covering the entire state. Each region has at least one Center responsible for providing HPB services to any eligible family within that region. There are Centers in the Northwest Region, Hartford Region, Northeast Region, Danbury Region, Waterbury Region, Stamford/Norwalk Region, Bridgeport/Fairfield Region, New Haven Region, Eastern Middlesex Region, and the New London Region.

HUSKY PLUS Behavioral Network:

Centers for Children’s Behavioral Health Care

Northwest Region

Northwest Center for Family Service and
Mental Health
P.O. Box 153
Lakeville, CT. 06039

Northeast Region

United Services, Inc.
Child and Family Services
P.O. Box 839
1007 N. Main St.
Dayville, CT. 06241-0839

Hartford Region

The Institute Of Living
400 Washington St.
Hartford, CT. 06106

Wheeler Clinic
91 Northwest Drive
Plainville, CT. 06062

Danbury Region

Family and Children’s Aid
75 West St.
Danbury, CT. 06810

Waterbury Region

Child Guidance Clinic Of Greater Waterbury, Inc.
70 Pine St.
Waterbury, CT. 06710-2190

Norwalk/Stamford Region

Mid-Fairfield Child Guidance
74 Newton Ave.
Norwalk, CT. 06851

Bridgeport/Fairfield Region

Child Guidance Center of Greater Bridgeport
1081 Iranistan Ave.
Bridgeport, CT. 06604

New Haven Region

Clifford W. Beers Guidance Clinic, Inc.
93 Edwards St.
New Haven, CT. 06511

Yale Child Study Center
Intensive In-home Child and Adolescent Psychiatry Service
PO Box 207900
New Haven, CT. 06520-7900

Middlesex Region

Family Advocacy Program
Middlesex Hospital
28 Crescent St.
Middletown, CT. 06457

New London Region

Child & Family Agency of Southeastern Connecticut, Inc.
255 Hempstead St.
New London, CT. 06320

HUSKY PLUS Complaints and Grievances

All HUSKY PLUS Physical and Behavioral member parents and providers are entitled to a timely and organized procedure for resolving complaints and concerns, also referred to as grievances. Parents and providers will be encouraged and supported in the expression of grievances without fear of compromised service. To the degree possible, HUSKY PLUS will make an effort to resolve such grievances informally when concerns arise. When this is unsuccessful, parents and providers can follow the three-step appeals process, which begins by notifying the HUSKY Center directly.

Accessing HUSKY PLUS

A child may be referred for HUSKY PLUS by

Parents

Providers

Caregivers

Health Plans

Anyone who is familiar with the child’s care needs.

Referrals may be made directly to one of the following Centers or through the Member Services Departments of the child’s HUSKY B Plan.

HUSKY PLUS Physical (HPP)

Connecticut Children’s Medical Center
Center for Children with Special Health Care Needs
282 Washington Street
Hartford, CT 06106
Phone: (860) 545-9293
Fax: (860) 545-9201
Toll-free: 1-877-743-5515

Yale Center for Children with Special Health Care Needs
430 Congress Street
PO Box 208064
New Haven, CT 06520-8064
Phone: (203) 737-5462
Toll free 1-888-842-1937
Fax: (203) 737-5718

HUSKY PLUS Behavioral (HPB)

Yale Child Study Center
PO Box 207900
230 South Frontage Road
New Haven, CT 06520-7900
Toll free: 1-888-311-7735
Fax: (203) 785-7400

HUSKY B Plans

Anthem Blue Cross/Blue Shield (800) 554-1707	Community Health Network of Connecticut (800) 859-9889
Health Choice of Connecticut/ Preferred One (800) 925-3606	Kaiser Permanente (800) 722-0725

TO APPLY FOR HUSKY B, CALL 1-877-CT-HUSKY

HUSKY PLUS Physical

Yale Center for Children with Special Health Care Needs

430 Congress Avenue, PO Box 208064
New Haven, Connecticut 06520-8064
203-737-5462
Toll free: 888-842-1937
Se habla Español

A Network of Resources
A Community of Professionals
A Partnership with Families

Additional Programs Include:

Title V - Children with Special Health Care Needs
The Danbury Center for Children with Special Needs
Greater Bridgeport Special Care Needs Consortium
Pediatric Disabilities Program at the Easter Seals Rehabilitation Center of Southeastern Connecticut, New London

HUSKY PLUS Physical

Center for Children with Special Health Care Needs
Connecticut Children’s Medical Center

282 Washington Street
Hartford, CT 06106
860-545-9230
Toll-free: 1-877-743-5515
Se habla Español

Dedicated to providing expert health evaluation and comprehensive support services that are collaborative, family centered, culturally sensitive, fiscally responsible, community-based, coordinated and outcome-oriented to children with special health care needs and their families.

Additional Programs Include:

Title V- Children with Special Health Care Needs Program

CCMC Family Center

Foster Care Clinic

Key Contacts

Director - JoAnn Aitken, RN, BSN, MPH

Interim Medical Director - John Pelegano, MD

Program Care Manager - Barbara Draheim, MSN, RN, CS, PNP

Program Operations Coordinator - Janet Jendrzejczyk, MEd

The Family Center - Molly Cole

HUSKY PLUS Behavioral

Yale Child Study Center

PO Box 207900, 230 South Frontage Street
New Haven, CT 06520-7900
Toll Free: 1-888-311-7735
Se habla Español

Integrated,
Child-Centered,
Family-Focused,
Community Based Care

Key Contacts

Managing Director - Mark Schaefer, Ph.D.

Medical Director - Joseph Woolston, MD

Clinical Director - Jean Adnopoz, MPH

Quality Improvement Coordinator - Julie Klunk

The HUSKY Plan and HUSKY PLUS are funded by the
Connecticut Department of Social Services