Annual: Agency: Certification: County: Region: MCH Nurse Visit Date: Consultant: Data Summary: 0-5 and Pregnant Wards Data from # Active Cases 0-5 randomly selected Performance # of Charts # of Charts in Percent in HW Qtrly HW Standard Reviewed Compliance Compliance Report Period Qtrly Report # Active Pregnant Wards ramdomly selected EPSDT Visits Up to Date 95% Immunizations Current 95% HealthWorks Primary Care Provider 95% Prenatal 95% Prenatal Depression Screening SV01-825 Postpartum 95% Individualized Care Plan (ICP) Needed Services Provided 90% Appropriate Referrals Made 95% EI/CFC referral made if indicated by dev assessment 100% # Made: # Indicated: Contract / HWIL KEY: CO: Commendation EVALUATION Medical Case NOT EVALUATION ITEM COMMENTS R: Recommendations MET N/A Management MECHANISM MET RQ: Required (bold) Handbook HealthWorks Medical Case Management for DCFS Wards Birth through age five (5) years, Pregnant DCFS Wards, and children of parenting DCFS Wards The Provider will provide medical case management services to all DCFS Wards, birth through age five (5) years, pregnant DCFS Wards, and children of parenting DCFS Wards residing in the Provider’s service area. FY17 FCM Contract 1a. DCFS Wards are linked to a HWIL Contract Performance Primary Care Physician. Standard 95% PA03 Enrollment 1b. If the selected PCP is not enrolled in HW, PA05 Medicaid the MCMA will notify the Lead Agency. CM04 Case Notes SV02 Activity Entry 1c. DCFS wards receive a medical card P/P manual under the Medicaid program.
Agency: Annual: Certification: County: Region: MCH Nurse Consultant: Visit Date: Data Summary: 0-5 and Pregnant Wards # Active Cases 0-5 randomly selected Performance # of Charts # of Charts in Percent in HW Qtrly Data from HW # Active Pregnant Wards ramdomly selected Standard Reviewed Compliance Compliance Report Period Qtrly Report EPSDT Visits Up to Date 95% Immunizations Current 95% HealthWorks Primary Care Provider 95% Prenatal Depression Screening SV01-825 Prenatal 95% Postpartum 95% Individualized Care Plan (ICP) Needed Services Provided 90% Appropriate Referrals Made 95% EI/CFC referral made if indicated by dev assessment 100% # Indicated: # Made: EVALUATION ITEM Contract / HWIL Medical Case Management Handbook EVALUATION MECHANISM MET NOT MET N/A KEY: CO: Commendation COMMENTS R: Recommendations RQ: Required (bold) HealthWorks Medical Case Management for DCFS Wards Birth through age five (5) years, Pregnant DCFS Wards, and children of parenting DCFS Wards The Provider will provide medical case management services to all DCFS Wards, birth through age five (5) years, pregnant DCFS Wards, and children of parenting DCFS Wards residing in the Provider’s service area. 1a. DCFS Wards are linked to a HWIL Primary Care Physician. FY17 FCM Contract Contract Performance Standard 95% PA03 Enrollment PA05 Medicaid CM04 Case Notes SV02 Activity Entry P/P manual 1b. If the selected PCP is not enrolled in HW, the MCMA will notify the Lead Agency. 1c. DCFS wards receive a medical card under the Medicaid program.
FY17HWIL_Clinical_Review_Report_Final.docx