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65 POPULATION 1/ CCHIP The county LI and COHS will provide to its enrolled members a detailed description of covered benefits, exclusions, and grievance procedures in their Evidence of Coverage (EOC) booklet.

7.1.4.

Quality improvement strategies

All of the approaches described under quality standards, performance measurement, and information strategies are used by DHCS to encourage quality improvement by participating plans. This is done through five strategic approaches. These are:

• Keeping up to date on developments in quality improvement, including any indicators that may be developed regarding the high quality medical home; • Feeding back information to plans to help them understand their own performance over time and how they compare to other plans providing services to subscribers; • Enforcing of contractual provisions which link quality based measures to plan performance; • Increasing plan performance targets over time; and • Providing quality based information to families. This final approach empowers the consumer to punish or reward plans with enrollment based on the value each family places on the quality standards.

Guidance: Provide a brief description of methods to be used to assure access to covered services, including a description of how the State will assure the quality and appropriateness of the care provided. The State should consider whether there are sufficient providers of care for the newly enrolled populations and whether there is reasonable access to care. (Section 2102(a)(7)(B))

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

DHCS will also take a number of steps to monitor access to covered services. Some of these are:

• DHCS will monitor the ongoing status of health plans with their regulators to assure quality services are available to subscribers. • DHCS will use plan enrollment and disenrollment reports as an early warning signal of access problems with a health plan.

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