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DHFS Oversight activities & tools • Certification and recertification audits • Quality of care audits (internal & external) • Data validity audits • Complaint & grievance monitoring, audits and follow-up • External quality review

Will the state utilize any of the following tools to assure quality? (Check all that apply and describe the activities for any categories utilized.)

7.1.1  Quality standards 7.1.2  Performance measurement 7.1.3  Information strategies 7.1.4  Quality improvement strategies

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

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

MEDDIC-MS includes a clinical performance measure for each of the following, which is monitored program-wide and on an HMO-specific basis annually: • EPSDT (well-child visits) for children two years of age and younger getting 5, 6 and 7 or more visits in the look-back period and visits for children age two to twenty years of age; • Non-EPSDT well-child visits; • Immunizations on a program-wide and HMO-specific basis in the look-back period; • Primary care visits for children. • Blood lead toxicity screening tests for children age one and two years;

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

MEDDIC-MS includes a clinical performance measure for each of the following, which is monitored program-wide and on an HMO-specific basis annually:

WISCONSIN

Effective Date:

Approval Date: 37