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Application for the State of Indiana Children’s Health Insurance Program Amendment #7

Effective Date:

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Approval Date: Assistance Group (TAG) may also recommend.  Through the Clinical Advisory Committee, providers provide the OMPP with input on Hoosier Healthwise policies affecting quality, accessibility, appropriateness and cost effectiveness of care.  The Hoosier Healthwise QIC oversees quality of care and appropriateness of care and integrates the quality improvement process. The QIC membership consists of MCO medical directors, MCO QI staff representatives, and the OMPP staff members

 Requests to disenroll are documented, tracked and monitored.

7.1.2.

Performance measurement

 MCOs must conduct annual member satisfaction surveys, and present this information to the OMPP, recipients and providers.  MCOs must provide HEDIS measures to OMPP on an annual basis.  The evaluation consultant will develop performance criteria to measure the quality of services provided under CHIP. These measurements will include health status indicators and EPSDT compliance.

7.1.3.

Information strategies

 Hoosier Healthwise applicants are provided with materials regarding managed care; PMPs; MCOs; preventive services; 1-800 telephone hotline; emergency room usage; grievance procedures; recipients’ rights and responsibilities; coverage, cost and claims; and a summary of program activities.  The State conducts provider training and benefit advocate training. Indiana has implemented an enhanced outreach campaign.

7.1.4.

Quality improvement strategies

 The State has a toll free telephone number for recipients and providers. Staff investigates inquires and complaints received through this phone line.  The Hoosier Healthwise MCOs monitor PMPs 24-hour accessibility by making random calls to PMPs during regular business hours and after hours.  The State monitors several key indicators to assure that access problems do not arise. These indicators include: waiting periods; access to care after hours; referrals to specialists; and access to emergency or family planning services.  MCOs must conduct focus studies on areas of clinical priority including preventive care, behavioral health, prenatal outcomes, and disease management (e.g. asthma and diabetes care).

7.2. Describe the methods used, including monitoring, to assure: (2102(a) (7) (B)) (42CFR 457.495)

7.2.1 Access to well-baby care, well-child care, well-adolescent care and childhood and adolescent immunizations. (Section 2102(a) (7)) (42CFR 457.495(a))