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

Effective Date:

7 Approval Date:

Specific health services initiatives include the following:

• grants to providers to promote health education in primary and secondary school through “school health coordinators” where the school health coordinators implement a coordinated school health program that incorporates the Center for Disease Control/Division of Adolescent and School Health (CDC/DASH) guidelines for tobacco use, physical activity, and healthy eating; • grants to schools to build or expand capacity at school based health centers where the school based health centers provide support for their public health functions: educating future adult health care consumers on healthy behaviors and on the use of health care; • grants to providers to conduct outreach campaigns to promote family planning among adolescents where the providers support family life education consultation programs for schools and communities as well as community based adolescent pregnancy prevention projects. Outreach educators provide comprehensive family life education that includes information about abstinence and information on preventing sexually transmitted diseases and birth control. Examples of activities include: interactive workshops for youth, educational displays at health fairs for teens, and office hours at teen centers; and • grants to a contractor to develop media campaigns to promote tobacco prevention among children and youth where the contractor develops a statewide marketing campaign for the Partnership for a Tobacco-Free Maine which has a targeted audience of children and youth.

The school health coordinator initiative will serve approximately 5,000 individuals and the adolescent family planning initiative will serve approximately 7,500 individuals.

3.2. Describe the utilization controls under the child health assistance provided under the plan for targeted low-income children. Describe the systems designed to ensure that enrollees receiving health care services under the state plan receive only appropriate and medically necessary health care consistent with the benefit package described in the approved state plan. (Section 2102)(a)(4) (42CFR 457.490(b))

The utilization controls are the same for all MaineCare members regardless of the source of funds. The following utilization controls are in use:

1. Primary Care Providers – Under the primary care case management initiative, each MaineCare member has a Primary Care Provider who is responsible for managing (treating or referring out for treatment) the member’s health care. MaineCare members must receive authorization