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State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998

Revised: 1/26/98, 2/19/98, 3/3/98, 3/6/98 Phase 2 Effective Date: July 1, 1998

Revised: 8/20/98, 8/24/98, 10/1/99, 7/28/00, 1/31/01, 7/02/02, 7/22/02, 1/3/03, 2/13/04, 9/27/04, 11/15/04, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 110 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))

Check the applicable suggested performance measurements listed below that the state plans to use: (Section 2107(a)(4)) 9.3.1.  The increase in the percentage of Medicaid-eligible children enrolled in Medicaid. 9.3.2.  The reduction in the percentage of uninsured children. 9.3.3.  The increase in the percentage of children with a usual source of care. 9.3.4.  The extent to which outcome measures show progress on one or more of the health problems identified by the state. 9.3.5.  HEDIS Measurement Set relevant to children and adolescents younger than 19. 9.3.6.  Other child appropriate measurement set. List or describe the set used.

MediKids The Agency for Health Care Administration requires Medicaid managed care organizations to report a subset of HEDIS effectiveness of care measures. The MediPass program also uses these measures for MediPass providers. The child-related requirements will be applied to the MediKids program. Examples include: • Childhood and adolescent immunization status; • Frequency of selected procedures (e.g., myringotomy, tonsillectomy); • Appropriate ambulatory treatment for diabetes and asthma to prevent unnecessary hospitalizations and emergency room care; and The Medicaid program also analyzes utilization of children’s dental health services. Medicaid is represented on a statewide dental coordinating council that will review utilization of diagnostic and preventive services compared to all other dental procedures for children (e.g., restorative, endodontics, and oral surgery). This council will use