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

Effective Date: August 24, 2001

Approval Date: 48 The survey was initiated in 1987 by the South Dakota Department of Health with the assistance of the Centers for Disease Control and Prevention, and has been on-going since 1987. For the SCHIP Program in South Dakota, the BRFSS surveys South Dakotans to assist in measurements as to why a child is without health insurance, whether coverage such as Medicaid and SCHIP have been considered for those who respond that the child is uninsured, crowd out issues, etc. to determine effectiveness of outreach promotions.)

2. Improve access to quality primary and preventive health care services under Medicaid for CHIP-NM eligible children.

Access to quality primary and preventive health services will be measured by the number of new CHIP-NM 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.

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

Adequate data is available for the completion of annual reports and evaluations for CHIP-NM as well as the original M-SCHIP program in compliance with Section 9.5 of this State Plan Amendment.

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

9.3.1. X The increase in the percentage of Medicaid-eligible children enrolled in Medicaid. 9.3.2. X The reduction in the percentage of uninsured children. 9.3.3. X The increase in the percentage of children with a usual source of care. 9.3.4. X 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. 9.3.7. X If not utilizing the entire HEDIS Measurement Set, specify which measures will be collected, such as: 9.3.7.1. X Immunizations – CPT range 90700 through 90749 9.3.7.2. X Well child care – SD EPSDT code W8630, CPT range 9981 through 99383 and 99391 through 99393