High Risk Infant Follow Up 

Overview

Becoming a HRIF Provider

Medical Eligibility Criteria

Authorizations

Program Reporting Requirements and Forms

Letters

Special Care Center Directory

HRIF Request for Application

Contact Us

Overview

The California Children's Services (CCS) HRIF program was established to identify infants who might develop CCS-eligible conditions after discharge from a CCS-approved Neonatal Intensive Care Unit (NICU). CCS Program standards require that each CCS-approved NICU ensure the follow-up of discharged high risk infants and that each NICU shall either have an organized program or a written agreement for provision of these services by another CCS-approved NICU.

The CCS Program’s goal of identifying infants who may develop a CCS eligible medical condition with the CCS HRIF program provides for a number of diagnostic services for children up to three years of age. The following are reimbursable diagnostic services:

• Comprehensive history and physical examination with neurologic assessment;
• Developmental assessment (Bayley Scales of Infant Development [BSID] or an equivalent test);
• Family psychosocial assessment;
• Hearing assessment;
• Ophthalmologic assessment; and
• Coordinator services (including assisting families in accessing identified, needed interventions and facilitating linkages to other agencies and services).

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Becoming a HRIF Provider

All HRIF services are provided by a multidisciplinary team including but not limited to a Medical Director (Pediatrician or Neonatologist), Social Worker, Opthalmologist, Audiologist, Psychologist, an HRIF Coordinator, and an individual to perform the developmental assessment.

All members of the HRIF multidisciplinary team require CCS paneling except a Pediatric Nurse Practitioner (PNP), unless functioning as the HRIF Coordinator.  The HRIF Coordinator must be CCS paneled.

Panel Applications and Instructions:

• Allied Health Care Professionals - Individual Provider Paneling Application
• Physicians and Podiatrists - Individual Provider Paneling Application

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HRIF Medical Eligibility Criteria

Entry into the HRIF program is limited to those infants who meet the following medical eligibility requirements and who have met CCS medical eligibility criteria for NICU care or had a CCS eligible medical condition during their stay in a CCS-approved NICU, even if they were never CCS clients during their NICU stay. Also, the program is available to infants who have a CCS eligible medical condition on discharge.

• An infant shall be medically eligible for the HRIF program when the infant:
• Met CCS medical eligibility criteria for NICU care, in a CCS-approved NICU (regardless of length of stay) (as per Numbered Letter 05-0502, Medical Eligibility in a CCS-approved NICU), or
• Had a CCS eligible medical condition in a CCS-approved NICU (regardless of length of stay), (as per California Code of Regulations, Title 22, Section 41800 through 41872, CCS Medical Eligibility Regulations). And
• The birth weight was less than 1500 grams or the gestational age at birth was less than 32 weeks. Or
• The birth weight was 1500 grams or more and the gestational age at birth was 32 weeks or more and one of the following criteria was met during the NICU stay:
  1. Cardiorespiratory depression at birth (defined as pH less than 7.0 on an umbilical blood sample or a blood gas obtained within one hour of life) or an Apgar score of less than or equal to three at five minutes.
  2. A persistently and severely unstable infant manifested by prolonged hypoxia, acidemia, hypoglycemia and/or hypotension requiring pressor support.
  3. Persistent apnea which required medication (e.g. caffeine) for the treatment of apnea at discharge.
  4. Required oxygen for more than 28 days of hospital stay and had radiographic finding consistent with chronic lung disease (CLD).
  5. Infants placed on extracorporeal membrane oxygenation (ECMO).
  6. Infants who received inhaled nitric oxide greater than four hours for persistent pulmonary hypertension of the newborn (PPHN).
  7. History of documented seizure activity.
  8. Evidence of intracranial pathology, including but not limited to, intracranial hemorrhage (grade II or worse), periventricular leukomalacia (PVL), cerebral thrombosis, cerebral infarction, developmental central nervous system (CNS) abnormality or “other CNS problems associated with adverse neurologic outcome”.
  9. Other problems that could result in a neurologic abnormality (e.g., history of CNS infection, documented sepsis, bilirubin in excess of usual exchange transfusion level, cardiovascular instability, hypoxic ischemic encephalopathy, et cetera.)

Medical eligibility for the HRIF Program is determined by the County CCS Program or Regional Office staff. The CCS Program is also required to determine residential eligibility. As the HRIF Program is a diagnostic service, there is no financial eligibility determination performed at the time of referral to CCS. However, insurance information shall be obtained by CCS. An infant or child is eligible for the HRIF Program from birth up to three years of age.

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Authorizations

All Referrals and requests for HRIF Program services must be submitted using a Service Authorization Request (SAR) form.

When an infant or child is determined eligible for the CCS HRIF services, a SAR for Service Code Grouping (SCG) 06 is issued to the applicable HRIF program. HRIF programs are considered outpatient CCS Special Care Centers (SCC) and allowed to bill for a limited range of SCC diagnostic services.

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• Registration - Client Identification Face Sheet (Instructions)
• Health and Developmental Status Report (Instructions)

• HRIF Team Visit Report Form

Special Care Center Directory

The CCS HRIF Special Care Center (SCC) Directory Form is available for SCC directory changes.  HRIF Program Letter 02-0606 contains more information on the HRIF SCC Directory Form.

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Contact Us

Contact information for questions:

• California Department of Health Care Services
  Children's Medical Services Branch
  Provider Services Unit
  P.O. Box 997413, MS 8100
  Sacramento, CA 95899-7413
• (916) 322-8702

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