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• Some special reports may be developed to monitor service utilization and outcomes for BadgerCare enrollees who have been bought into health insurance plans offered through their employers. In these cases, detailed utilization data may not be available in a feasible and cost-effective manner, so proxy measures may have to be developed. • Medical Records Audits - The current auditing of the Medicaid managed care program, performed by Department staff and contractors, will be expanded to encompass the BadgerCare program.

Control Group

A number of hypotheses suggest an evaluation design that requires a control group or a pre-post design. A suitable control group for many of the hypotheses will be Medicaid recipients either selected randomly or matched by characteristics to better mirror the BadgerCare enrollees. On other occasions a pre-post analysis will dictate that baseline information be collected and then replicated at a later date.

Other control groups may be some subset of the general insured population that may have health insurance with a less generous benefit package than BadgerCare.

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

9.3.1 The increase in the percentage of Medicaid-eligible children enrolled in Medicaid. 9.3.2 The reduction in the percentage of uninsured children. 9.3.3 The increase in the percentage of children with a usual source of care. 9.3.4 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.

Please see attached "Addendum IV - Contract-Specified Reporting Requirements," from the January 1998 - December 1999 Contract for Medicaid services Between HMO and Wisconsin Department of Family Services."

The Wisconsin Medicaid Health Maintenance Organization (HMO) Reporting Documentation User Manual, January 1998, provides a correlation between the reports listed in Addendum IV and the strategic objectives and performance goals which we indicate that they address. A copy of the User Manual was included with our responses to HCFA's questions about Wisconsin's Phase 1 application.

WISCONSIN

Effective Date:

Approval Date: 64