Priority Health Medicaid members under the age of 26 may be eligible for coverage through the Michigan Children’s Special Health Care Services (CSHCS) program. To support eligibility determinations, the Michigan Department of Health and Human Services (MDHHS) requires timely documentation of the member’s diagnosis and treatment plan.
If Priority Health requests this documentation from you on behalf of a Medicaid member, please be sure it is signed by a licensed physician (MD or DO) when you submit it.
What is the CSHCS program?
CSHCS helps children and young adults under 26 with special health care needs to have improved health outcomes and an enhanced quality of life. It aids these individuals and their families with access to medical care, health education and other supports.
There are over 2,700 qualifying physical conditions. See MDHHS’s site for more information.
The Priority Health Care Management team identifies Medicaid members who may be eligible and initiates the application process with MDHHS.
What can providers do to help?
When we reach out to request medical records and treatment plans, be sure to have a licensed physician sign these documents so there’s no delay in securing CSHCS coverage for our members.
In the event the treatment plan is not signed, one of our Care Managers will request a signature via fax (see this example). Providers who receive these requests should respond promptly to ensure their patients receive the resources available to them.
What are the signature requirements?
Documentation of physician (MD/DO) participation is necessary for CSHCS eligibility. This includes either a physician signature, a physician addendum to a note or a statement that the plan was discussed with the physician.
Electronic signatures are allowed, as long as they are from a licensed physician.