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Missouri Application for the State Children’s Health Insurance Program Effective Date: 05/01/2009 Approval Date: Bolded/Italics Added Information Prior Approval Date: 09/28/2007 Strikethrough Deleted Information - 11 - Section 3. Methods of Delivery and Utilization Controls (Section 2102)(a)(4)) □ Check here if the State elects to use funds provided under Title XXI only to provide expanded eligibility under the state’s Medicaid plan, and continue on to Section 4. 3.1 Describe the methods of delivery of the child health assistance using Title XXI funds to targeted low-income children. Include a description of the choice of financing and the methods for assuring delivery of the insurance products and delivery of health care services covered by such products to the enrollees, including any variations. (Section 2102)(a)(4) (42 CFR 457.490(a)) Response: The Missouri DSS, MO HealthNet Division has identified eight guiding principles for the MO HealthNet, SCHIP 1, and SCHIP 2. The following principles apply to the program whether financed through Title XIX or Title XXI. 1) All recipients must have a medical home. 2) Attention to wellness of the individual (i.e., education). 3) Chronic care management. 4) Care management (resources focused towards people receiving the services they need, not necessarily because the service is available). 5) Appropriate setting at the right cost. 6) Emphasis on the individual person. 7) Evidenced based guidelines for improved quality care and use of resources. 8) Encourage responsibility and investment on the part of the recipient to ensure wellness. The delivery systems described below apply to MO HealthNet, SCHIP 1, and SCHIP 2. MO HealthNet Fee-For-Service Delivery System Individuals eligible for the SCHIP 1 and SCHIP 2 receive their care through the MO HealthNet Fee-For-Service delivery system in regions of the State where MO HealthNet Managed Care is not operational. In areas of the State where MCOs are not operational, participants may freely choose which MO HealthNet approved providers they go to for care under the MO HealthNet Fee-For-Service delivery system. MO HealthNet Managed Care Program Recipients are enrolled in MCOs that are contracted with the State of Missouri. Enrollment in the MO HealthNet Managed Care Program is mandatory for individuals who reside in areas of the State where MO HealthNet Managed Care is operational. Please see Attachment 2. Each MCO contracts with Primary Care Providers (PCP), specialists, and other providers to deliver and coordinate health care services for recipients. The MCO receives a per