Page 49

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

Effective Date:

October 1, 2009 49 Approval Date: November 19, 2010

5. Performance Goals for Objective 5 a. A higher percentage of families report that their ALL Kids enrolled child(ren) have had a well child check-up in the past year since enrollment in ALL Kids than before enrollment in ALL Kids. b. A higher percentage of families report that their ALL Kids enrolled child(ren) have had a dental visit in the past year since enrollment in ALL Kids than before enrollment in ALL Kids. c. A higher percentage of families report that their ALL Kids enrolled child(ren) have had a vision screening in the past year since enrollment in ALL Kids than before enrollment in ALL Kids.

6. Performance Goal for Objective 6: a. Contracts with state agencies which serve children with special health care needs will be maintained for the purpose of providing specialty services beyond the basic ALL Kids coverage package for these children. b. Exploration of the feasibility of establishing contracts with other state agencies that serve children with special health care needs. c. Continued monitoring of access to specialty care for children with special health care needs.

9.3. Describe how performance under the plan will be measured through objective, independently verifiable means and compared against performance goals in order to determine the state’s performance, taking into account suggested performance indicators as specified below or other indicators the state develops: (Section 2107(a)(4)(A),(B)) (42CFR 457.710(d))

Assurance of an Objective Means for Measuring Performance To ensure an objective evaluation which can be independently verified, the evaluation will be based upon data bases which contain quantifiable information. These databases will, to the extent possible, contain numeric data. The ADPH will develop and/or direct the development of needed databases which do not currently exist. Since evaluation of some performance measures does not lend itself to numeric summation, measurement of these aspects of the plan will be based on review of a completed work plan which requires conclusive documentation. All data and documentation will be auditable.

At periodic intervals, a formal comparison of program performance to the goals and measures set forth in this document or its subsequent amendments will be conducted. The CHIP staff directly responsible for the implementation of the program will conduct information comparisons of performance to these goals and measures on an ongoing basis. In this way, the program will be continuously monitored and activities may be adjusted so that the program may achieve its objectives.