Health systems that serve Yes Title V 0 None CYSHCN solicit feedback 1 Weak (IF YES) How effective are those State Medicaid from the family and children policies and procedures? CHIP 2 Moderate on the experience of care 1 Not effective Health Plan/Insurer 3 Strong that they receive. 2 Somewhat effective Provider (please specify) 3 Very effective Family/Consumer Other (please specify) OPTIONAL: Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score: Health systems that serve Yes Title V 0 None CYSHCN have a family (IF YES) How effective are those State Medicaid 1 Weak advisory board or policies and procedures? CHIP 2 Moderate committee, inclusive of 1 Not effective Health Plan/Insurer 3 Strong families of CYSHCN that 2 Somewhat effective Provider (please specify) guides their policies, 3 Very effective Family/Consumer programs and quality Other (please specify) improvement activities and offers family members OPTIONAL: training, mentoring, and Why? reimbursement for their No for score, above ) (Select “0” participation as active Not applicable to my organization members of these boards and committees. Enter Score: Enter Score:
Health systems that serve CYSHCN solicit feedback from the family and children on the experience of care that they receive. 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: Health systems that serve CYSHCN have a family advisory board or committee, inclusive of families of CYSHCN that guides their policies, programs and quality improvement activities and offers family members training, mentoring, and reimbursement for their participation as active members of these boards and committees. 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:
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