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

Effective Date: August 24, 2001

Approval Date: 41

7.2.1 Access to well-baby care, well-child care, well-adolescent care and childhood and adolescent immunizations. (Section 2102(a)(7)) (42CFR 457.495(a))

In addition to inclusion on the HCFA 416 report that measures utilization of EPSDT services, South Dakota, as part of its SCHIP general satisfaction survey of recipients routinely asks recipients access to care questions. The survey instrument specifically asks questions relating to well child care, immunizations, vision services, substance abuse and dental services. The surveys provide excellent feedback regarding recipients access to care.

Parents of SCHIP kids are routinely provided with educational materials relating to EPSDT services to inform them on the importance of preventive healthcare.

Access to quality primary and preventive health services will be measured by the number of new SCHIP children enrolled in medical assistance primary care case management system. Utilization based studies for immunization, dental, well child screenings, optometry, substance abuse and mental health services will be used to provide additional measurement of access to services. Further, additional measurements are collected in accordance with Section 9.3.7 of this state plan and are included in the SCHIP annual reports.

7.2.2 Access to covered services, including emergency services as defined in 42 CFR ∋457.10. (Section 2102(a)(7)) 42CFR 457.495(b))

SCHIP will use the same delivery system, provider network and covered services as the Medicaid program in South Dakota. One of the benefits of this arrangement is the excellent provider participation for all types of service providers in the State. Nearly all primary care and specialty physicians participate in the program, all inpatient and outpatient hospitals participate, nearly all pharmacies participate, and participation from allied health providers is also very good. Using the PCCM system for SCHIP facilitates access to primary care and the use of PCP’s to provide referrals for non- emergency specialty services enhances access to specialty services as referral arrangements with PCP’s are established and specialists are not accessed for primary care purposes.

The selected SCHIP program structure allows the maximum use of the available rural providers to enhance access to services in the rural areas of South Dakota. The Indian Health Service and Tribal services are key resources in the most under-served areas of the State. Each IHS service unit has participating PCP providers in the PCCM program. The SCHIP program is also structured so those eligible clients have maximum access to IHS programs without a referral from another PCP if the individuals have selected