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6.3 Based on the 2017 Child Core Set for ADHD (ADD-CH), ensure that there is follow-up care for children prescribed ADHD medications to help address quality of care for children with significant health needs.

Proposed measures: DHCS tracks the number of children with special health care needs who participate in the program. DMHC will also monitor subscriber complaints and health plans’ compliance with referral requirements. These complaints and grievances can be submitted to DMHC, and provide an Independent Medical Review (IMR) if needed.

COUNTY CHILDREN’S HEALTH INITIATIVE PROGRAM (CCHIP)

The volume of children in CCHIP makes it infeasible to set up separate performance goals and measures. However, the CCHIP projects are modeled consistent with the Medi-Cal and CHIP programs and the health plans delivering the CCHIP services are the same health plans. Thus, the information produced for the Medi-Cal and CHIP programs plans will be reflective of the performance for CCHIP.

Guidance: The State should include data sources to be used to assess each performance goal. In addition, check all appropriate measures from 9.3.1 to 9.3.8 that the State will be utilizing to measure performance, even if doing so duplicates what the State has already discussed in Section 9.

It is acceptable for the State to include performance measures for population subgroups chosen by the State for special emphasis, such as racial or ethnic minorities, particular high-risk or hard to reach populations, children with special needs, etc.

HEDIS (Health Employer Data and Information Set) 2008 contains performance measures relevant to children and adolescents younger than 19. In addition, HEDIS 3.0 contains measures for the general population, for which breakouts by children’s age bands (e.g., ages < 1, 1-9, 10-19) are required. Full definitions, explanations of data sources, and other important guidance on the use of HEDIS measures can be found in the HEDIS 2008 manual published by the National Committee on Quality Assurance. So that State HEDIS results are consistent and comparable with national and regional data, states should check the HEDIS 2008 manual for detailed definitions of each measure, including definitions of the numerator and denominator to be used. For states that do not plan to offer managed care plans, HEDIS measures may also be able to be adapted to organizations of care other than managed care.

9.3. Describe how performance under the plan will be measured through objective, independently verifiable means and compared against performance goals in order to