Page 49

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

Effective Date:

Approval Date: September 19, 2002 49 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.

See 9.3.7/ 9.3.7.

If not utilizing the entire HEDIS Measurement Set, specify which measures will be collected, such as: 9.3.7.1. Immunizations 9.3.7.2. Well child care 9.3.7.3. Adolescent well visits 9.3.7.4. Satisfaction with care 9.3.7.5. Mental health 9.3.7.6. Dental care 9.3.7.7. Other, please list:

Infant mortality

Childhood lead poisoning

School absenteeism

Hospitalization of enrolled children for ambulatory sensitive conditions of gastroenteritis/dehydration and asthma

Very low birthweight babies born to adolescents

9.3.8.

Performance measures for special targeted populations.