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67 provided on DHCS website, including Managed Care – Quality Improvement & Performance Measurement Reports and the Managed Care Performance Dashboard.

Through the county contracts with the State, counties will be required to submit utilization data on preventive and emergency services and grievances from CCHIP enrollees.

7.2.3. Appropriate and timely procedures to monitor and treat enrollees with chronic,

complex, or serious medical conditions, including access to an adequate number of

visits to specialists experienced in treating the specific medical condition and access to out-of-network providers when the network is not adequate for the enrollee’s medical condition. (Section 2102(a)(7)) (42CFR 457.495(c))

To meet the special needs of children, CHIP ensures the provision of necessary specialized services beyond those offered through the comprehensive insurance package in a coordinated manner. The CCS program addresses the significant needs of the minority of children whose needs may not be fully met under an insurance benefit package. The CCS program provides case management and treatment for chronic, serious, and complex physically handicapping conditions. Coverage is and will be limited to coverage of the specific condition. The program establishes standards for the approval of inpatient hospital facilities and pediatric specialty and subspecialty providers delivering care to eligible children. The program also has an extensive system of special care centers located at tertiary medical center at which multispecialty, multidisciplinary teams deliver coordinated inpatient and outpatient care to children with chronic medical conditions. The centers include cardiac, chronic pulmonary disease, hematology and oncology, myelomeningocele, hemophilia, sickle cell, renal, infectious disease/immunology, hearing and speech metabolic disorders, inherited neurologic disease, limb defect, gastroenterology, craniofacial anomalies and endocrinology. The program also approves neonatal intensive care, pediatric intensive care, and pediatric rehabilitation units.

The program staff determines the appropriate source of health care for eligible children, assist families in accessing care, and identify other needs of the child and family that could impact the care of the eligible condition.

The services to treat the CCS eligible medical condition of a child enrolled in CHIP will not be the responsibility of the contracting health plan in which the child is enrolled. The CCS program will continue to authorize the medically necessary services to treat the conditions using the program’s regulations, policies, procedures, and guidelines in determining the appropriateness of providers, and the necessity for services. CCS will expand the systems of communication that have been instituted to work with Medi-Cal managed care plans that have CCS services “carved out” from their capitation rate. Local CCS programs carefully coordinate the authorization and delivery of specialty and