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

Effective Date:

28 Approval Date: On an ongoing basis, members and providers are sent periodic educational newsletters. The “MaineCare Managed Care Newsletter” is sent out on a quarterly basis and contains program information/updates for managed care members. The “MaineCare Managed Care Update” is a newsletter sent to providers on a quarterly basis and contains program/clinical information. “Facts and Footnotes” is a newsletter mailed out to all MaineCare providers periodically and contains program/administrative information.

In addition to the postcard used by members, the Bureau has developed a postcard for use by providers. This postcard is used by primary care providers to identify and request needed assistance from the Bureau on behalf of members on their panel. When appropriate, follow-up with the member may be provided by Member Services and, if needed, by Public Health Nurses. For example, a member may be provided with assistance locating transportation to the doctor’s office for well-child checks or in obtaining follow-up treatment recommended by health care providers.

Another informational tool used by the Bureau to educate members is Helpline messages. Members calling Member Services who are placed on hold listen to pre-recorded messages containing information regarding MaineCare benefits and available resources.

The Bureau also provides member education on inappropriate use of the emergency room. On a quarterly basis, the Bureau examines the 5 most prevalent diagnoses for inappropriate emergency room use. These members are contacted to assist with any barriers to care that may exist to accessing care in an appropriate setting (such as transportation). For example, members may not be aware that their primary care provider is available 24 hours or the provider may not have been available and intervention is needed with the provider.

7.1.4

Quality improvement strategies

A primary quality improvement strategy used by the Bureau to ensure access to well-baby/child/adolescent care and immunizations is the required use of a Bright Futures form (BF19) by MaineCare providers. The BF19 form (actually 19 age specific forms) was developed with input from pediatricians and other primary care physicians in the State and based on Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents. Each primary care provider participating with MaineCare who has signed an EPSDT Rider to the provider/supplier agreement is required to use the forms when providing well-child visits and is paid an enhanced reimbursement for