Promptly after enrollment in Yes Title V 0 None a health plan, all CYSHCN (IF YES) How effective are those Medicaid 1 Weak are provided a documented policies and procedures? CHIP 2 Moderate initial assessment that is 1 Not effective Health Plan/Insurer 3 Strong conducted in collaboration 2 Somewhat effective Provider (please specify) with the child’s family or 3 Very effective Family/Consumer caregiver. Other (please specify) OPTIONAL: Why? No (Enter for score, below.) “0” Not applicable to my organization Enter Score: Enter Score: State newborn screening Yes Title V 0 None information is delivered to (IF YES) How effective are those State Medicaid 1 Weak providers and parents in a policies and procedures? CHIP 2 Moderate timely fashion and 1 Not effective Health Plan/Insurer 3 Strong arrangements made for 2 Somewhat effective Provider (please specify) necessary follow-up services 3 Very effective Family/Consumer are documented. If indicated, (please specify) OPTIONAL: the need for repeat Why? screening and follow-up is communicated to the health No (Enter for score, below.) “0” plan and providers by the Not applicable to my organization hospital or state program. Enter Score: Enter Score:
Promptly after enrollment in a health plan, all CYSHCN are provided a documented initial assessment that is conducted in collaboration with the child’s family or caregiver. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Enter “0” for score, below.) Not applicable to my organization Enter Score: Title V 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: State newborn screening information is delivered to providers and parents in a timely fashion and arrangements made for necessary follow-up services are documented. If indicated, the need for repeat screening and follow-up is communicated to the health plan and providers by the hospital or state program. Yes (IF YES) How effective are those policies and procedures? 1 Not effective 2 Somewhat effective 3 Very effective No (Enter “0” for score, below.) Not applicable to my organization Enter Score: Title V State Medicaid CHIP Health Plan/Insurer Provider (please specify) Family/Consumer (please specify) 0 None 1 Weak 2 Moderate 3 Strong OPTIONAL: Why? Enter Score:
1_Screening%20Assess%20Referl_In%20DepthFINAL.docx