Page 62

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

Effective Date:

Approval Date: 62 Health plans are notified when areas of deficiency are discovered and of corrective actions needed. PHPs are required to give DMAP medical and dental service utilization reports, provider capacity reports and access to service statistics and various semiannual and annual financial reports. In addition to administering client satisfaction surveys, DMAP produces monthly enrollment reports, quarterly disenrollment reports and reports profiling the demographic characteristics of enrollees.

DMAP staff directly responsible for the implementation and monitoring of CHIP, continuously monitor program administration and take necessary action to ensure the program meets strategic objectives.

The Office for Oregon Health Policy and Research will analyze and evaluate the implementation of the Healthy Kids, including FHIAP Healthy Kids ESI, CHIP OHP Plus and Healthy KidsConnect expansion. The office will report on information using a variety of data sources including a statewide health insurance survey, program administrative data and other quantitative and qualitative data sources. Unless otherwise noted, the program will be evaluated annually. • Biennial estimates of the number of children who are eligible for but not enrolled in the program; • The number of children enrolled in the program; • The number of children disenrolled from the program; • A description of any identified barriers to enrolling or maintaining enrollment of children in the program; • The quality of care received using nationally accepted HEDIS measures for children; • Biennial estimates of the number children voluntarily not enrolling in employer-sponsored health coverage and enroll in the program.

Check the applicable suggested performance measurements listed below that the state plans to use: (Section 2107(a)(4)) 9.3.1.

The increase in the percentage of Medicaid-eligible children enrolled in Medicaid. 9.3.2.

The reduction in the percentage of uninsured children. 9.3.3.

The increase in the percentage of children with a usual source of care. 9.3.4.

The extent to which outcome measures show progress on one or more of the health problems identified by the state. 9.3.5.

HEDIS Measurement Set relevant to children and adolescents younger than 19. 9.3.6.

Other child appropriate measurement set. List or describe the set used.