Page 48

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

Effective Date:

Approval Date: 9-1 Section 9 Strategic Objectives and Performance Goals and Plan Administration (Section 2107)

9.1. Describe strategic objectives for increasing the extent of creditable health coverage among targeted low-income children and other low-income children. (Section 2107(a)(2)) (42CFR 457.710(b))

The strategic objective for the CHPlus Program is to provide access to inpatient, outpatient, primary and preventive health care services to low income children by removing financial barriers and providing a medical home through a managed care product. The program has been successful in increasing enrollment. The same strategies that have worked, advertising and facilitated enrollment, will continue to be employed.

9.2. Specify one or more performance goals for each strategic objective identified. (Section 2107(a)(3)) (42CFR 457.710(c))

The following performance goals and measures will be utilized to measure the effectiveness of the CHPlus Program to meet this objective:

● Performance Goal: Increase the number of insured children in the State; Performance Measure: Analysis of current population survey (CPS) data to ensure that the number of insured children in the State remains stable or increases through CHPlus and Medicaid enrollment, while both the number and percentage of uninsured children under age 19 below 250 percent of the poverty level continues to decrease.

● Performance Goal: Program is accessible to all qualified families with uninsured children having knowledge of program availability; Performance Measure: Outreach is being conducted in all areas of the State and parent and health plan satisfaction are high. County specific enrollment is studied to target outreach activities. Hotline calls are tracked to monitor success of outreach.

● Performance Goal: Children have better health care status; Performance Measure: Health care indicators are increasing and children are receiving required preventive health care services.

9.3. Describe how performance under the plan will be measured through objective, independently verifiable means and compared against performance goals in order to determine the state’s performance, taking into account suggested performance indicators as specified below or other indicators the State develops. (Section 2107(a)(4)(A),(B)) (42CFR 457.710(d))

Health plans are responsible for submitting information to the Department regarding their enrollment. Reports can be generated from this information which include: monthly enrollment reports (detailing new and ongoing enrollment and disenrollment, quarterly disenrollment reports, and quarterly reports on applicants’ prior health insurance status to assess the potential for crowd-out. In 1994 New York State implemented the Quality Assurance Reporting Requirements (QARR) as a tool to measure and manage the quality of care provided to New York residents. QARR is largely based on the measures published by the National Committee