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

Effective Date:

Approval Date: 40

Section 7. Quality and Appropriateness of Care

Check here if the state elects to use funds provided under Title XXI only to provide expanded eligibility under the state‟s Medicaid plan, and continue on to Section 8.

7.1. Describe the methods (including external and internal monitoring) used to assure the quality and appropriateness of care, particularly with respect to well-baby care, well-child care, and immunizations provided under the plan. (2102(a)(7)(A)) (42CFR 457.495(a))

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

The Department of Human Services (DHS) encourages all contracted managed health plans to pursue National Committee for Quality Assurance (NCQA) or Joint Commission on Accreditation of Healthcare Organizations (JCAHO) certification. 7.1.2.

Performance measurement

Refer to Section 9.1 The hawk-i Functional Health Assessment Survey The report presents the results of an ongoing evaluation of the impact of the Healthy and Well Kids in Iowa (hawk-i) Program on the access to and health status of enrolled children. The first evaluation, parents‟ responses to a survey given at the time they joined the program (the baseline survey) are compared with their responses to a survey given after their child has been enrolled for about a year (the follow-up survey) to determine if there are differences in the perceived ability to receive health services or in their child‟s health status. Also included in the follow-up survey and presented in the report are questions specific to hawk-i, such as ratings to the private health plans that contact with hawk-i and the impact of having health insurance.

7.1.3.

Information strategies All health plans participating in the hawk-i program are required to provide encounter data in accordance with the provisions outlined in their contract.

Additionally, all health plans are required to provide written information to enrollees which, at a minimum, includes the following: the phone number(s) that can be used for assistance to