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Effective Date:

Approval Date:

Updated and amended effective August 24, 2001

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plans. This assessment is intended to evaluate the plans’ collection of accurate HEDIS data, to submit high quality encounter data, and to administer timely consumer surveys. HRS concluded that the contracted insurers are equipped to accurately collect the required performance data.

7.1.3.

Information strategies

All CHIP enrollees receive membership handbooks (see Appendix F (provided with the original State Plan submission), sample handbook which describes the benefits provided to enrollees under the Program). These materials also describe members’ rights and responsibilities and the specific steps to appeal any medical or service issue to the plan and to the Department of Health. All service denials or reduction in benefits must also contain information about how to appeal the decision through the member grievance process. Managed care plan providers have developed a multitude of member educational materials and informational items that encourage CHIP enrollees to obtain age-appropriate health services and preventive care. These are distributed widely by the plans.

CHIP collects information from the eight CHIP Contractors on a quarterly and annual basis. This reporting provides information on CHIP enrollment, demographic and ethnic characteristics, outreach efforts, use of medical and dental services, member grievance information, and data on financial expenditures. Information is used by Program managers to document performance and promote adequate Program accountability. The data elements are updated on specific needs as identified.

7.1.4.

Quality improvement strategies

Several key initiatives mentioned herein are the basis for individual and collective quality improvement activities.

• Based on the clinical standards adopted and the data obtained from external reviews, each of the eight contractors have been required to identify appropriate mechanisms for improving the provision of preventative and health maintenance services for children enrolled in CHIP.

• The Department and the contractors work together