Page 46

46 Effective Date: July 1, 2009

Approval Date: • Each age-specific document is a two-page, NCR form. The first sheet is for the child’s medical record. On the back of the first page includes information about different components of the exam. The second page is given to the family after the exam. The back of the second page provides the family with both parent education and some information about the child’s growth and development between the current visit and the next anticipated visit. The forms are available in hard copy and can be ordered through MAA. The forms can also be downloaded at the DSHS website: http://www1.dshs.wa.gov/msa/forms/eforms.html (beginning at form # 13- 683). • Pay for Performance incentives for 2 year old immunizations and well-child care have been part of the Healthy Options/CHIP contract since 2004. DSHS set aside $1,000,000 each to be paid for improved performance on 2 year old immunizations and well-child care. Calculations are based on a point system that rewards health plans for both their current year performance relative to other plans and for their improvement from previous year to current year relative to other plans. The four highest performing plans share in the reward.

• EPSDT Rate Increase for Foster Care Children as a result of several studies that suggested that children in foster care were not receiving adequate health care services. MPA increased the rate of reimbursement for well-child care (for this population only) in late fall, 2001.

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))

Please see response to Section 7.2.1 regarding access to covered services. The same criteria apply to all covered services.

For emergency services, the definition of emergency in the plan will be based on the current definition addressing need as defined by the “prudent layperson”. As noted above, standards assuring access and network adequacy must be written by MCOs