Coverage and payment levels Yes Title V 0 None are adequate to facilitate access (IF YES) How effective are those State Medicaid 1 Weak to pediatric primary care and policies and procedures? CHIP 2 Moderate comprehensive and coordinated 1 Not effective Health Plan/Insurer 3 Strong medical subspecialty and 2 Somewhat effective Provider (please specify) surgical specialty services; 3 Very effective Family/Consumer developmental, behavioral, and Other (please specify) mental health services; inpatient and emergency department OPTIONAL: care; home health care; dental Why? care; and other specialized No (Select for score, above ) “0” pediatric services within a Not applicable to my organization medical home model of care. Enter Score: Enter Score: All children, including CYSHCN, Yes Title V 0 None have access to medically (IF YES) How effective are those State Medicaid 1 Weak necessary services to promote policies and procedures? CHIP 2 Moderate optimal growth and 1 Not effective Health Plan/Insurer 3 Strong development, maintain and avert 2 Somewhat effective Provider (please specify) deterioration in functioning, and 3 Very effective Family/Consumer to prevent, detect, diagnose, Other (please specify) treat, ameliorate, or palliate the effects of physical, genetic, OPTIONAL: congenital, developmental, Why? No behavioral, or mental conditions, (Select for score, above ) “0” injuries, or disabilities. Not applicable to my organization Enter Score: Enter Score:
Coverage and payment levels are adequate to facilitate access to pediatric primary care and comprehensive and coordinated medical subspecialty and surgical specialty services; developmental, behavioral, and mental health services; inpatient and emergency department care; home health care; dental care; and other specialized pediatric services within a medical home model of care. 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: All children, including CYSHCN, have access to medically necessary services to promote optimal growth and development, maintain and avert deterioration in functioning, and to prevent, detect, diagnose, treat, ameliorate, or palliate the effects of physical, genetic, congenital, developmental, behavioral, or mental conditions, injuries, or disabilities. 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:
10_Insurance%20and%20Financing_In%20DepthFINAL.docx