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

Effective Date: August 24, 2001

Approval Date: 47

2.2 Ensure each new CHIP-NM enrollee receives covered services, cost sharing and EPSDT information at the time that their eligibility is approved.

2.3 Include CHIP-NM eligible children in the quality measurement mechanisms that are used for Medicaid and M-SCHIP including measures of immunization, well child care, adolescent well care, satisfaction and other measures of health care quality. Measures will come from the HCFA 416 report, the Department of Health Immunization tracking system, and the evaluation process used in South Dakota’s PRIME managed care program operated under 1915(b) waiver authority. This evaluation process also uses client and provider surveys independent evaluations and clinical studies to report cost effectiveness and quality to CMS for waiver renewal purposes, and annual SCHIP reporting requirements. South Dakota will request the managed care waiver be incorporated into its Medicaid and SCHIP state plans.

3. Develop better measurement capabilities of health insurance coverage, health care service availability and quality to children in South Dakota.

3.1 Modify the Medicaid Management Information System to make CHIP-NM tracking and reporting capabilities available to measure enrollment, service, utilization, and overall program effectiveness. This enhancement will make all MARS and CMS reports available for CHIP-NM.

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))

1. Achieve a measurable reduction in the number of uninsured children in South Dakota.

The success of this objective will be determined by the number of uninsured children in South Dakota who receive health insurance coverage as the result of the CHIP-NM State Plan amendment, M-SCHIP, or Medicaid coverage. Evidence of this reduction will come from South Dakota medical assistance enrollment figures, estimates provided by the United States Census Bureau and supported with survey data from the Behavioral Health Survey and other publications. (The South Dakota Behavioral Risk Factor Surveillance System (BRFSS) is designed to collect information on the health behaviors in the State.