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7.2.3. Effective Date: November 1, 2009 November 1, 2009 November 1, 2009 these requirements. The State regulator of managed care organizations, the Department of Managed Health Care, enforces this law. In addition to State law, the State uses several methods to monitor access to services. The State collects information on the number of specific Healthy Families enrollee grievances each plan has received, and the number of enrollee complaints the State had directly received. The plan grievances and enrollee complaints are categorized and patterns of complaints among the plans are reviewed periodically. The State requires plans to submit annual performance measures, using HEDIS, which provides information on the delivery of well care and immunizations. The State is currently developing an infrastructure that collect encounter/claims data from participating health plans. Encounter/claims data collected from plans will enable the State to track utilization patterns among plans and compare these patterns against publicly available benchmarks. This infrastructure will be administered under the 2004 Administrative Vendor contract. The State also conducts an annual consumer satisfaction survey of families which address their experience with their health plan. The survey instrument used (CAHPS) requests information on access to care and the ability of members to get the care they needed quickly. Through the county contracts with the State, counties will be required to submit utilization data on preventive and emergency services and grievances from C-CHIP enrollees. Due to the limited number of C-CHIP enrollees in each county, counties will not be required to conduct consumer surveys. However, if a county opted to conduct a survey the county would be requested to submit the result to the State for information only. Results from any survey would not yield valid results. Appropriate and timely procedures to monitor and treat enrollees with chronic, complex, or serious medical conditions, including access to an adequate number of visits to specialists experienced in treating the specific medical condition and access to out-of-network providers when the network is not adequate for the enrollee’s medical condition. (Section 2102(a)(7)) (42CFR 457.495(c)) Approval Date: HFP Family Contribution Increase HFP Co-Payment Increase HFP Limited Dental Plan Choice for New Subscribers

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