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

Effective Date:

Approval Date: 54 been established to design outreach to their respective racial and ethnic groups.

A Providers Task Force also exists to seek advice and counsel of the entire provider community. Members include representatives of the NC Pediatric Society, the NC Hospital Association, the NC Dental Society, the NC Family Practitioners Association, the opticians, hearing specialists, academic medical centers, academic dental centers, etc. The Task Force is consulted on program changes, for assistance with outreach and other advice and counsel.

In 2002-2003, the NC General Assembly requested a status report on NC Health Choice. They requested that the NC Institute of Medicine (IOM) review the program and make recommendations for any changes in the program. Several months of study yielded a list of recommendations which were presented to the General Assembly in their 2003-2004 session. One recommendation that was adopted was to change pharmacy prescription rates to encourage the use of generic medications. Another recommendation from this report that was adopted was to move the 0-5 year olds to Medicaid in order to access EPSDT services and assure continual coverage from birth through age 5.

All changes to the NC Title XXI Plan are required by state law to go through the legislative process and to be subject to the public scrutiny of any law change except for those changes the Secretary of DHHS may make to special needs. Should such a change be planned for children with special health care needs, the change would first be brought before the Governor’s Commission for Special Health Care Needs for that body’s advice and consent. These meeting are public meetings. Before the change could be implemented letters would have to be mailed to family members 30 days in advance of the change and public notice would need to be published in at least one newspaper in the state.

When major change is considered in the program, the Secretary of NC DHHS, the Governor and the NC General Assembly have asked the NC Institute of Medicine (IOM) or other independent body to convene an appropriate mix of members of the legislative, provider groups and advocacy groups to assure that the best alternatives are recommended to the legislative body. All IOM meetings are public meetings.

9.9.1 Describe the process used by the state to ensure interaction with Indian Tribes and organizations in the state on the development and implementation of the procedures required in 42 CFR 457.125. (Section