The utilization review and Yes Title V 0 None 1 Weak appeals processes for CYSHCN (IF YES) How effective are those State Medicaid include members of a policies and procedures? CHIP 2 Moderate child’s integrated care team. 1 Not effective Health Plan/Insurer 3 Strong 2 Somewhat effective Provider (please specify) 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score: Effectiveness Indicator: Organizational Influence Indicator: SUMMARY: QUALITY ASSURANCE AND IMPROVEMENT Additional Notes: ENDNOTES:
The utilization review and appeals processes for CYSHCN include members of a child’s integrated care team. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Select “0” for score, above ) Not applicable to my organization Enter Score: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify) Family/Consumer Other (please specify) 0 None 1 Weak 2 Moderate 3 Strong OPTIONAL: Why? Enter Score: SUMMARY: QUALITY ASSURANCE AND IMPROVEMENT Effectiveness Indicator: Organizational Influence Indicator: Additional Notes: ENDNOTES: