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46 Effective Date: July 1, 2009

Approval Date: 7.1.2.

Performance measurement

Health Plan Employer Data and Information Set (HEDIS) performance measures will be reported and preventive health services relevant to the program such as EPSDT and child immunizations will be evaluated with the same criteria as the current HO program and similar FFS review. See further performance criteria in Section 7.1.4.

7.1.3.

Information strategies

Encounter data, HEDIS measures, provider network adequacy standards, and health care experience data will be reported by health plans. The current complaint management system will be maintained at both the health plan level and the State level to assure timely resolution of client complaints and grievances. FFS information strategies will be consistent with all information requirements under the state’s Medicaid plan.

7.1.4.

Quality improvement strategies

The following strategies and activities have been implemented and are consistent with the HO and FFS programs: • Monitoring and analysis of quality standards and performance measures for well- baby care, well-child and adolescent care, and childhood immunizations required through encounter data, chart review, HEDIS reporting, and a variety of other contract monitoring activities listed below; • Client interviews; • Biennial client satisfaction/health status surveys for managed care clients; • Complaint management system; • Exemption/disenrollment/fair hearing database; • Standards for health plan internal quality improvement programs; • Network adequacy standards; and • On-site contract compliance monitoring and technical assistance.

7.2. Describe the methods used, including monitoring, to assure: (2102(a)(7)(B)) (42CFR 457.495)

7.2.1 Access to well-baby care, well-child care, well-adolescent care and