Page 64

Missouri Application for the State Children’s Health Insurance Program Effective Date: 05/01/2009 Approval Date:

Prior Approval Date: 09/28/2007 - 31 - 7.2.2 Access to covered services, including emergency services as defined in 42 CFR part 457.10. (Section 2102(a)(7)) 42 CFR 457.495(b)) Response: The comprehensive benefit package for SCHIP 1 and SCHIP 2 includes emergency medical/mental health services. The contract with the MCOs include service accessibility standards for 24-hour coverage, prior authorization, travel distance standards, appointment standards, and care management. The monitoring of the standards is further outlined in the QI Strategy. 7.2.3 Appropriate and timely procedures to monitor and treat enrollees with chronic, complex, or serious medical conditions, including access to an adequate number of visits to specialists experienced in treating the specific medical condition and access to out-of-network providers when the network is not adequate for the enrollee’s medical condition. (Section 2102(a)(7)) (42 CFR 457.495(c)) Response: The delivery systems described below apply to MO HealthNet, SCHIP 1, and SCHIP 2.

loading…

Page 64

Official source

Missouri Application for the State Children’s Health Insurance Program Effective Date: 05/01/2009 Approval Date:

Prior Approval Date: 09/28/2007 - 31 - 7.2.2 Access to covered services, including emergency services as defined in 42 CFR part 457.10. (Section 2102(a)(7)) 42 CFR 457.495(b)) Response: The comprehensive benefit package for SCHIP 1 and SCHIP 2 includes emergency medical/mental health services. The contract with the MCOs include service accessibility standards for 24-hour coverage, prior authorization, travel distance standards, appointment standards, and care management. The monitoring of the standards is further outlined in the QI Strategy. 7.2.3 Appropriate and timely procedures to monitor and treat enrollees with chronic, complex, or serious medical conditions, including access to an adequate number of visits to specialists experienced in treating the specific medical condition and access to out-of-network providers when the network is not adequate for the enrollee’s medical condition. (Section 2102(a)(7)) (42 CFR 457.495(c)) Response: The delivery systems described below apply to MO HealthNet, SCHIP 1, and SCHIP 2.