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

Effective Date:

27 Approval Date: Additionally, in 2001, the Bureau conducted a two-part survey, “Your Voice Counts”, to assess the quality of care for low-income children enrolled in MaineCare. Primary survey goals included: correlation of parents’ perceptions with provider documentation on encounter forms; assessment of members’ perception of needed services and education; and use of aggregate data to update Bright Futures forms. Surveys were sent to 4,200 case heads with MaineCare eligible children between the ages of 3-48 months. A separate survey was developed to ascertain providers’ perceptions of what transpired during well child visits. Survey results were analyzed and linked to Bright Futures assessment forms to determine if parent/guardian opinion on services differed from actual EPSDT information provided on the Bright Futures forms. Overall, it was determined that when Bright Futures forms were used, there was a greater degree of satisfaction with the visit.

The Bureau also routinely monitors complaints and grievances received from members, provider transfer rates, provider caseload size and 24 hour coverage by primary care providers. Complaints and grievances are monitored for trends and required interventions and/or follow-up. Provider transfer rates (members transferring out of a particular practice) and caseload sizes are also monitored on a regular basis to determine whether intervention is required. Each primary care provider is also monitored once a year to ensure that each practice is providing the requisite 24 hour coverage for MaineCare members.

7.1.3

Information strategies

Within 30 days of enrollment, each MaineCare member is sent a mailing containing the informing letter, as required by EPSDT, and information describing covered services, locating providers, available assistance for scheduling visits and transportation, etc. The mailing also contains a postcard (which may be returned postage free) to be completed by those members who require assistance from the Department. Follow-up is provided by Member Services’ staff. Member Services will provide the member with requested assistance and will also provide information on statewide resources available for non- covered services. A Resource Guide is maintained and updated regularly and contains resources available on health and social services in the State, broken down by county. Members are also sent a reminder mailing containing information on when well child visits are due, in accordance with the EPSDT periodic schedule. The reminder mailing also contains information previously sent out with the initial informing letter, i.e., information on locating providers, available assistance for scheduling visits and transportation, etc.