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

Effective Date:

Approval Date: 42 • Number and rate of emergency room visits per 1000 member months • Number and rate of hospital stays per 1000 member months, by age • Average length of hospital stay

The adequacy of services for special needs children will be measured with advice from the NC Commission on Children with Special Health Care Needs. Attention will be focused on children with high cost and/or high incidence conditions such as:

• Asthma • Diabetes • Emotional Behavioral Conditions

Measures for these children may include:

• Proportion of children who have hospital stays, and length of stay • Percent of children requesting/receiving durable medical equipment • Types and number of mental health/behavioral health services received by age of child • Information from periodic surveys where questions target CSHCN • Use of emergency room by CSHCN

Notable gaps in service act as trigger points for consultation with the Commission for Special Health Care Needs to evaluate the service and develop a recommendation to improve care for the consideration by the Secretary of DHHS and the NC General Assembly.

Will the state utilize any of the following tools to assure quality? (Check all that apply and describe the activities for any categories utilized.) 7.1.1.

Quality standards 7.1.2.

Performance measurement -- HEDIS measures will be used 7.1.3.

Information strategies – parent surveys and claims data will be used

7.1.4.

Quality improvement strategies --

The Provider Task Force has agreed to include as part of its mission, acting as the Quality Assurance/Improvement group to review compliance with quality standards as revised. This team represents state agencies, provider groups, insurers and others associated with