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

Effective Date:

Approval Date: 38

Measure 4.1.1: By December 31, 1998, develop a plan to exceed the current participation rate (83.7%) of physicians providing services to Medicaid-eligible children.

Measure 4.1.2: By December 31, 1999 and by December 31, 2000, the numbers of physicians providing services to Medicaid eligible children will be increased from the previous year.

Measure 4.1.3: By December 31, 1999 and by December 31, 2000, the numbers of dentists providing services to Medicaid eligible children will be increased from the previous year.

Measure 4.2.1: By September 1, 1998, regulations authorizing HHS to offer 12-month continuous eligibility for children will be finalized.

Measure 4.2.2: By September 1, 1998, regulations authorizing HHS to offer presumptive eligibility to children will be finalized.

Measure 5.1.1: By September 30, 1999, children will have equal or more well- child care visits per 1000 eligibles compared to the previous 12 months for the same age group (Phase I children).

Measure 5.1.2: By September 30, 2000, children will have equal or more well- child care visits per 1000 eligibles compared to the previous 12 months for the same age group (Phase I and Phase II children).

Measure 5.2.1: A. By September 30, 1999, children will have equal or more preventive dental care visits per 1000 eligible children compared to the previous 12 months for the same age group (Phase I and Phase II children).

B. By September 30, 2000, children will have equal or more preventive dental care visits per 1000 eligible children compared to the previous 12 months for the same age group (Phase I and Phase II children).

Measure 5.2.2: A. By September 30, 1999, children will have equal or more treatment dental care visits per 1000 eligible children compared to the previous 12 months for the same age group (Phase I children).

B. By September 30, 2000, children will have equal or more treatment dental care visits per 1000 eligible children compared to the previous 12 months for the same age group (Phase I and Phase II children).