Annual: Agency: Certification: County: Region: MCH Nurse Visit Date: Consultant: Data Summary: 0-5 and Pregnant Youth in Care Data from # Active Cases 0-5 randomly selected Performance # of Charts # of Charts in Percent in HW Qtrly HW # Active Pregnant Youth in Care randomly Standard Reviewed Compliance Compliance Report Period Qtrly Report 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 Youth in Care Birth through age five (5) years, Pregnant DCFS Youth in Care, and children of parenting DCFS Youth in Care The Provider will provide medical case management services to all DCFS Youth in Care, birth through age five (5) years, pregnant DCFS Youth in Care, and children of parenting DCFS Youth in Care residing in the Provider’s service area. FY18 FCM Contract 1a. DCFS Youth in Care are linked to a Contract Performance HWIL 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 Youth in Care receive a medical P/P manual card under the Medicaid program.
Agency: Annual: Certification: County: Region: MCH Nurse Consultant: Visit Date: Data Summary: 0-5 and Pregnant Youth in Care # Active Cases 0-5 randomly selected Performance # of Charts # of Charts in Percent in HW Qtrly Data from HW # Active Pregnant Youth in Care randomly 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 Youth in Care Birth through age five (5) years, Pregnant DCFS Youth in Care, and children of parenting DCFS Youth in Care The Provider will provide medical case management services to all DCFS Youth in Care, birth through age five (5) years, pregnant DCFS Youth in Care, and children of parenting DCFS Youth in Care residing in the Provider’s service area. 1a. DCFS Youth in Care are linked to a HWIL Primary Care Physician. FY18 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 Youth in Care receive a medical card under the Medicaid program.
FY18HWILClinicalReviewReportFinal5-23-2017.docx