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ForwardPCMH 2025 Pediatric Nursing Care (PNC) Sprint - Session #2 - JHF
Participants will hear from peer PCMHs and MCOs on the topics of medical necessity criteria for authorizing shift care services and available MCO supports and resource, effective workflows and strategies for engaging families in plans of care, and how to structure the multidisciplinary care team to support partner relationships and goals, with robust discussion around effective interventions and barriers and challenges.
Agenda:
- Introduction and Review of the PCMH-PNC Program Goals – Carol Frazer, MEd, LPC, Behavioral Health Specialist, PRHI
- Guidance to PCMH-PNCs about How to Write an LOMN for Shift Care Services – Lily Higgins, MD, MBA, MS, Corporate Chief Medical Officer, AmeriHealth Caritas Pennsylvania and Keystone First, & Amy Rassas, Team Lead, Medicaid Ancillary Services, Jefferson Health Plans
- Valley Health’s Experience with Initiating/Maintaining the Necessary and Authorized Services – Sarah Kupchick, RN Care Manager, Valley Health
- Facilitated Peer-to-Peer Learning Discussion with MCOs and PCMH-PNCs – Carol Frazer
- What has or hasn’t worked well in initiating and maintaining authorized services for this population?
- How are you configuring the roles of your PCMH-PNC Care Team to initiate/maintain the authorized and necessary services?
- How is your team then updating and using the Family-Centered Plan of Care to ensure that all team members are working from the current version and providing the services in a coordinated way?
- What has worked well to involve the child/family in this process?
- Wrap Up and Next Steps – Jennifer Condel, SCT (ASCP) MT, Manager, Lean Healthcare Strategy and Implementation, PRHI
Target Audience
Nurse
Physician
Social Worker
Learning Objectives
- Describe the Pediatric Shift Care medical necessity criteria for authorizing shift care services and the available MCO resources
- Discuss effective workflows and strategies for engaging families in plans of care
- Describe ways to structure the multidisciplinary care team to support partner relationships and goals
Additional Information
| Attachment | Size |
|---|---|
 Audience Disclosure slides (001).pptx | 459.28 KB |
 Agenda_PCMH Sprint - PNC - Session 2.docx | 52.56 KB |
 Slides PCMH 2025 PNC Sprint Session 2 - 05.01.2025.pdf | 596.75 KB |
Participants will hear from peer PCMHs and MCOs on the topics of medical necessity criteria for authorizing shift care services and available MCO supports and resource, effective workflows and strategies for engaging families in plans of care, and how to structure the multidisciplinary care team to support partner relationships and goals, with robust discussion around effective interventions and barriers and challenges.
Agenda:
- Introduction and Review of the PCMH-PNC Program Goals – Carol Frazer, MEd, LPC, Behavioral Health Specialist, PRHI
- Guidance to PCMH-PNCs about How to Write an LOMN for Shift Care Services – Lily Higgins, MD, MBA, MS, Corporate Chief Medical Officer, AmeriHealth Caritas Pennsylvania and Keystone First, & Amy Rassas, Team Lead, Medicaid Ancillary Services, Jefferson Health Plans
- Valley Health’s Experience with Initiating/Maintaining the Necessary and Authorized Services – Sarah Kupchick, RN Care Manager, Valley Health
- Facilitated Peer-to-Peer Learning Discussion with MCOs and PCMH-PNCs – Carol Frazer
- What has or hasn’t worked well in initiating and maintaining authorized services for this population?
- How are you configuring the roles of your PCMH-PNC Care Team to initiate/maintain the authorized and necessary services?
- How is your team then updating and using the Family-Centered Plan of Care to ensure that all team members are working from the current version and providing the services in a coordinated way?
- What has worked well to involve the child/family in this process?
- Wrap Up and Next Steps – Jennifer Condel, SCT (ASCP) MT, Manager, Lean Healthcare Strategy and Implementation, PRHI
Carol Frazer, MEd, LPC, Behavioral Health Specialist, PRHI
Lily Higgins, MD, MBA, MS, Corporate Chief Medical Officer, AmeriHealth Caritas Pennsylvania and Keystone First
Amy Rassas, Team Lead, Medicaid Ancillary Services, Jefferson Health Plans
Sarah Kupchick, RN Care Manager, Valley Health
Jennifer Condel, SCT (ASCP) MT, Manager, Lean Healthcare Strategy and Implementation, PRHI
In support of improving patient care, this activity has been planned and implemented by the University of Pittsburgh and The Jewish Healthcare Foundation. The University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
As a Jointly Accredited Organization, University of Pittsburgh is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. University of Pittsburgh maintains responsibility for this course. Social workers completing this course receive 1.0 continuing education credits.
Physician (CME)
The University of Pittsburgh designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nursing (CNE)
The maximum number of hours awarded for this Continuing Nursing Education activity is 1.0 contact hours.
Social Work (ASWB)
The maximum number of hours awarded for this Continuing Social Work Education activity is 1.0 contact hours.
Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
Available Credit
- 1.00 AMA PRA Category 1 Credit™The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
- 1.00 ANCCUPMC Provider Unit is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation
- 1.00 ASWB
- 1.00 Attendance