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Model Application Template for the State Children’s Health Insurance Program

Effective Date:

October 1, 2009 39 Approval Date: November 19, 2010 collaboration with stakeholders. It is also anticipated that an evaluation of ALL Kids PLUS may become part of the UAB evaluation in the future.

Will the state utilize any of the following tools to assure quality? (Check all that apply and describe the activities for any categories utilized.) 7.1.1. ∼ Quality standards 7.1.2. X Performance measurement The State ensures quality through contracted performance measures. These measures have been adapted in conjunction with the standards recommended by the AAP. 7.1.3. X Information strategies Vendors are required to provide key health indicators information. 7.1.4. X Quality improvement strategies The performance guarantees and provider recoupment policy were included in the RFP and are included in the contract with the health plan. 7.2. Describe the methods used, including monitoring, to assure: (2102(a)(7)(B)) (42CFR 457.495)

7.2.1 Access to well-baby care, well-child care, well-adolescent care and childhood and adolescent immunizations. (Section 2102(a)(7)) (42CFR 457.495(a)) Access is monitored through a number of methods including the following:

Periodic review of the number and types of providers by county

Quarterly review of claims data

Quarterly review of new enrollee, continuous enrollee, and disenrollee survey data

Feedback from families via telephone, e-mail, and postal service mail

Feedback from providers

Further, the state uses claims data to monitor well-baby care as is described in 7.1.

7.2.2 Access to covered services, including emergency services as defined in 42 CFR 457.10. (Section 2102(a)(7)) 42CFR 457.495(b)) Access is monitored through a number of methods including the following:

Quarterly review of claims data

Quarterly review of new enrollee, continuous enrollee, and disenrollee survey data

Feedback from families via telephone, e-mail, and postal service mail

Feedback from providers

Feedback from the CHIP Social Work Consultant

Further, the state uses claims data to monitor emergency room use as is described in 7.1.

7.2.3 Appropriate and timely procedures to monitor and treat enrollees with chronic, complex, or serious medical conditions, including access to an adequate