Families of CYSHCN may seek Yes Title V 0 None second opinions from qualified (IF YES) How effective are those Medicaid 1 Weak health care providers without policies and procedures? CHIP 2 Moderate restrictions to such opinions. 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 (Select for score, above) “0” Not applicable to my organization Enter Score: Enter Score: Performance or financial Yes Title V 0 None incentives are in place to (IF YES) How effective are those State Medicaid 1 Weak promote medical homes and policies and procedures? CHIP 2 Moderate care coordination and enhance 1 Not effective Health Plan/Insurer 3 Strong access to services and promote 2 Somewhat effective Provider (please specify) quality. 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No (Select for score, above ) “0” Not applicable to my organization Enter Score: Score:
Families of CYSHCN may seek second opinions from qualified health care providers without restrictions to such opinions. 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 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: Performance or financial incentives are in place to promote medical homes and care coordination and enhance access to services and promote quality. 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? Score:
10_Insurance%20and%20Financing_In%20DepthFINAL.docx