Page 61

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

Effective Date:

Approval Date: 61 has expanded the capacity of the OHP to meet the needs of 48,000 CHIP eligibles. DMAP’s data and operational systems are structured to accommodate CHIP criteria in the areas of eligibility determination, enrollment, client information, and utilization of health care services. DMAP staff and Department of Human Services (DHS) field personnel have and continue to receive CHIP-related training.

Performance Goals for Objective 2 Since January 1, 1999, DMAP has developed and implemented outreach efforts among current Medicaid OHP channels to identify, enroll, and meet the health care needs of the CHIP population.

Performance Goals for Objective 3 As of May 2009, 48,000 low income children are enrolled in Oregon’s CHIP. They have access to a usual source of health care coverage in the form of a stable health care plan and a primary care provider (PCP).

Performance Goals for Objective 4 DHS CHIP enrollees are assigned a unique code that will enable DMAP analysts to distinguish CHIP clients from the OHP Medicaid population. DMAP monitors CHIP utilization patterns to help assure access to health care and the delivery of medically appropriate care.

Performance Goals for Objective 5 Health status and health care system measures for Oregon’s DHS CHIP program enrollees are collected and analyzed to demonstrate acceptable utilization in the following areas: access to a primary care provider, childhood immunization status, and well-child and -adolescent visits.

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)) Oregon’s performance relative to its stated goals is objectively and independently verified through DMAP analysis of DHS CHIP population and utilization data. The ongoing analysis of data obtained through the Medicaid Management Information System (MMIS) is used to measure the state’s progress toward its goals and objectives.

As previously noted, health plan oversight occurs as clinical data review, desktop medical chart audits, and on-site inspection of PHPs.