Access to pediatric specialists Yes Title V 0 None (face-to-face or via telemedicine) 1 Weak (IF YES) How effective are those State Medicaid specified in a of care policies and procedures? CHIP 2 Moderate child’s plan is provided without prior 1 Not effective Health Plan/Insurer 3 Strong authorization from a 2 Somewhat effective Provider (please specify) child’s primary care provider or 3 Very effective Family/Consumer Contractor (e.g., health plan) Other (please specify) whether or not such specialists participate in a OPTIONAL: Contractor’s provider network. Why? No for score, above ) (Select “0” Not applicable to my organization Enter Score: Enter Score: Transportation assistance is Yes Title V 0 None provided to families with (IF YES) How effective are those State Medicaid 1 Weak difficulties accessing needed policies and procedures? CHIP 2 Moderate medical services. 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 for score, above) (Select “0” Not applicable to my organization Enter Score: Enter Score:
Access to pediatric specialists (face-to-face or via telemedicine) specified in a child’s plan of care is provided without prior authorization from a child’s primary care provider or Contractor (e.g., health plan) whether or not such specialists participate in a Contractor’s provider network. 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: Transportation assistance is provided to families with difficulties accessing needed medical services. 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:
3_Access%20to%20Care_In%20DepthFINAL.docx