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

Effective Date:

Approval Date: 52 9.4.

The state assures it will collect all data, maintain records and furnish reports to the Secretary at the times and in the standardized format that the Secretary requires. (Section 2107(b)(1)) (42CFR 457.720)

9.5.

The state assures it will comply with the annual assessment and evaluation required under Section 10. Briefly describe the state’s plan for these annual assessments and reports. (Section 2107(b)(2)) (42CFR 457.750)

Upon receipt of the Annual Plan Template the NCHC Coordinator sends appropriate template sections to various agencies and requests that information be provided. Usually a meeting is held with all applicable parties to go through an overview of the questions in the report, to explain the importance of compliance with the requests and to set deadlines. In addition a list of quality measures is presented to the Information Technology sections of both the Division of Medical Assistance and Blue Cross Blue Shield to ask that claims analyses be run. Usually a separate meeting with the information technology workers is necessary to clarify exactly which HEDIS data is being requested. The Coordinator gathers all the information and using it, writes the report, sometimes simply cutting and pasting, in other cases substantially rewriting submissions. In many cases, the Coordinator knows some of the information from personal involvement or research and writes it up in total. Through the year, when it is deemed necessary to gather additional data, the Coordinator assesses whether or not the resources exist in state government to run analyses (in which case, requests are submitted to applicable agencies), or if other groups need to be involved. In every case, the Annual Report is submitted for review and edits to all parties and agencies involved in the provision of services for NC Health Choice. Once these edits have been made, and the Report approved by the Division Director, the report is submitted.

9.6.

The state assures it will provide the Secretary with access to any records or information relating to the plan for purposes of review of audit. (Section 2107(b)(3)) (42CFR 457.720)

9.7.

The state assures that, in developing performance measures, it will modify those measures to meet national requirements when such requirements are developed. (42CFR 457.710(e))