The following CSHCN Services Program forms have been combined into a revised form:

·         “Required Information for Enrollment as a CSHCN Services Program Cleft/Craniofacial Team Surgical Services Only”

·         “Required Information for Enrollment as an Affiliated Provider of a CSHCN Services Program Enrolled Comprehensive Cleft/Craniofacial Team”

Click here to view the revised form, “Required Information for Designation as a Team Member or Affiliated Provider of a CSHCN Services Program Comprehensive Cleft/Craniofacial Team.”

C/C teams must comply with the following requirements:

·         C/C teams must include at least the following participants:

o        Plastic surgeon or oral surgeon

o        Otolaryngologist

o        Primary care physician

o        Orthodontist or pediatric dentist

o        Master’s level licensed speech-language pathologist

o        Client educator

o        Designated C/C team care coordinator (who also may be one of the participants listed above)

·         Each client must have a C/C team care coordinator to assure that the focus of the service is client- and family-oriented, and that the client, family, and C/C team jointly develop a comprehensive treatment plan.

·         Each C/C team must identify an administrator who is responsible for coordinating and maintaining the C/C team records and assuring that the C/C team adheres to CSHCN Services Program rules and regulations.

·         C/C teams must complete the required information and attestation on the “Required Information for Designation as a Team Member or Affiliated Provider of a CSHCN Services Program Comprehensive Cleft/Craniofacial Team” form.

·         Contact information (including address, telephone number, and e-mail address) must be included for the C/C team administrator.

·         When changes occur to team membership, C/C teams must provide TMHP with updated information in a timely manner or at least every two years.

To facilitate statewide coverage, the CSHCN Services Program may also designate affiliated providers. Affiliated providers must be linked with a CSHCN Services Program designated comprehensive C/C team and must ensure coordination of client management as needed. At the time of application, affiliated providers must specify the comprehensive C/C team with which they are affiliated.

TMHP coordinates the enrollment process for the CSHCN Services Program. TMHP’s provider enrollment staff maintains the most current list of C/C team providers.

For more information, call the TMHP-CSHCN Services Program Provider Enrollment at 1-800-568-2413.