Page 41

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

Effective Date:

Approval Date: 41 Section 7. Quality and Appropriateness of Care

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 8.

7.1. Describe the methods (including external and internal monitoring) used to assure the quality and appropriateness of care, particularly with respect to well- baby care, well-child care, and immunizations provided under the plan. (2102(a)(7)(A)) (42CFR 457.495(a))

The Department will perform satisfaction surveys. A random sample of all participating families will be asked to complete a survey periodically. Questions on the survey will be determined by input received from families, providers, and experts/researchers in the field. Sample measures are:

• Proportion of parents that rate the care provided to the child is poor, appropriate, good, or excellent • Proportion of parents reporting that they are satisfied with their role in making decisions about their child's care • Proportion of parents reporting satisfaction with the availability and choice of primary and specialty providers. • Proportion of parents reporting satisfaction with the amount of time providers spend with the child • Proportion of parents who filed formal complaints or grievances. • Average waiting time for appointments for preventive; primary, or specialty care. • Travel time and distance to receive preventive, primary and specialty care.

The use of prevention services will be evaluated through the following measures.

Well-child screening rate, by age (AAP standards)

• ages 6-11 • ages 12-18

The rate of use of acute care services will be measured by the following measures:

• Number and rate of ambulatory visits per 1000 member months, by age